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IOIOWLEDGE AND SKILL AREAS ASSOCIATED WITH DISABILITY
MANAGEMENT PRACTICE FOR REHABILITATION COUNSELORS

By

Susan Maria Scully

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling, Educational Psychology and Special Education

1996

ABSTRACT

KNOWLEDGE AND SKILLS AREAS ASSOCIATED WITH DISABILITY
MANAGEMENT PRACTICE FOR REHABILITATION COUNSELORS

By

Susan Maria Scully

A national survey of disability management providers was conducted in order to
identify and delineate the knowledge and skills perceived by practitioners to be important
in disability management service provision. Furthermore, this study explored the reported
preparedness of disability management providers. Participants included 790 individuals
who were either associated with professional health and injury management associations
or were Certiﬁed Rehabilitation Counselors in Michigan, Ohio and California. Participants
were mailed the Disability Management Skills Inventory (DMSI) which was developed for
this investigation. A total of 3 11 individuals responded for an overall response rate of
39.4%. Sixty-seven individuals reported no involvement in disability management thus,
yielding 244 usable questionnaires. The ﬁnal sample of respondents consisted of 149
rehabilitation counselors, 18 business professionals, 9 social workers and psychologists, 30
nurses, 23 physical and occupational therapists, and 13 "other" professionals. Factor
analysis of the DMSI revealed 94 knowledge and skill items distributed across 3
competency areas: (a) Fundamentals of Disability Management; (b) Elements of
Vocational Rehabilitation; and (c) Elements of Facilitative Counseling and Advocacy.
Multivariate and univariate analyses of variance revealed signiﬁcant diﬂ‘erences in
perceived importance of various knowledge and skill areas according to respondents'
provider setting and professional classiﬁcation. In addition, signiﬁcant diﬁ‘erences in

reported preparedness on the various knowledge and skill areas according to professional

.5

classiﬁcation were found. Results were presented and discussed according to their

implications for rehabilitation counselor practice, education and future research

To my mother, Dorothy, and my son, Aleksander; my best friends.

iv

ACKNOWLEDGMENTS

This dissertation would not have been possible without the guidance and assistance
of faculty members, family and ﬁiends. I would like to offer sincere gratitude and thanks
to my committee, Dr. Michael Leahy, Dr. Rochelle Habeck, Dr. Nancy Crewe, and Dr.
Betsy Becker. A special thank you and appreciation is extended to my dissertation
director, Dr. Michael Leahy. Without his tireless support and guidance, the dream of
completing this dissertation would not have been realized. My deepest gratitude and
appreciation is extended to my advisor, Dr. Rochelle Habeck Dr. Habeck has provided
countless hours of support, understanding, and wisdom. Her commitment to excellence is
appreciated and admired.

It is important to acknowledge my family and ﬁiends who offered assistance and
understanding throughout the course of my doctoral program. My mother provided
unlimited support and encouragement, and it is truly acknowledged that without her this
degree would not have been accomplished. I would like to recognize and thank many of
my ﬁ-iends who contributed to the earning of this degree. My best ﬁ'iend, Sally Smith
oﬂ‘ered much support, encouragement and understanding throughout this process. She
was my biggest cheerleader, always offering encouraging words to keep me going. My
dear ﬁiend, Margaret Sebastian provided support and shared care taking responsibilities
for my son, Aleksander. She always offered to help even though her load was just as
heavy. Finally, I wish to extend a sincere thank you to my ﬁnd and fellow classmate,
Manuela Kress. She always managed to keep me going; she was a comfort and a big

motivator.

TABLE OF CONTENTS

LIST OF TABLES

CHAPTER I: INTRODUCTION
Statement and Signﬁcance of the Problem
Purpose of the Study
Deﬁnition of Terms
Assumptions and Limitations

CHAPTER II: REVIEW OF THE LITERATURE

The Concept of Disability Management
Disability Management and Rehabilitation
Deﬁnitions of Disability Management
Components of the Disability Management
Approach
Employer Support for Disability Management Strategies
The Practitioners Role in Disability Management
Current Issues Impacting Disability Management

The Evolution of Rehabilition in the Private Sector
History
Rehabilitation Counseling and Individuals with
Industrial Injuries

Specialization in Rehabilitation Counseling

Competency Studies in Rehabilitation Counseling
Research Efforts to Further Deﬁne Rehabilitation
in the Private Sector

DJNOODJv—I

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l6
16
20

23
27
31
38
39
39

44
45
51

58

CHAPTER III: METHODOLOGY
Subjects
Description of the Sample
Sampling Procedures
Instrumentation
Instrument Development
Procedures
Design
Data Collection
Data Analysis

CHAPTER IV: RESULTS
Characteristics of the Sample
Provider Settings and Professional Classiﬁcations of
theTotal Sample
Provider Settings and Professional Classiﬁcations of
the Final Sample
Characteristics of the Sampling Frame
Education
Certiﬁcation Status
Perceived Importance and Preparedness of DMSI Items
Factor Analysis
Factor One: Fundamentals of Disability Management
Factor Two: Elements of Vocational Rehabilitation
Factor Three: Elements of F acilitative Counseling
and Advocacy
Perceived Importance and Preparedness for Factors
Differences According to Provider Setting and Professional
Classiﬁcation

vii

66
66
66
70
71
7 l
80
80
80
82

85
85

86

88
90
94
97
97
l l l
126
126

130
135

135

CHAPTER V: DISCUSSION
Observations About Disability Management

Providers 144
Importance and Preparedness of Knowledge and Skill Areas
Associated with Disability Management Practice 147
Importance and Preparedness in Fundamentals
of Disability Management 148
Importance and Preparedness in Elements
of Vocational Rehabilitation 149
Importance and Preparedness in Elements
of Facilitative Counseling and Advocacy 152
Limitations 154
Conclusions 156
Implications for the Rehabilitation Profession 159
Implications for Further Research 161
APPENDICES
Appendix A: Disability Management Skills Inventory 163
Appendix B: Demographic Questionnaire 171
Appendix C: Original Pilot Study Instrument 174
Appendix D: Means and Standard Deviations of Provider Categories
for Survey Items 183
Appendix E: Rehabilitation Skills Inventory 185
Appendix F: Transmittal Letter for First Mailing 190
Appendix G: Transmittal Letter for Second Mailing 191
Appendix H: Transmittal Letter for Disability Management
Conference 192
Appendix H: Follow-up Postcard 193
Appendix 1: Means and Standard Deviations for Provider Settings on
DMSI Items 194
Appendix J: Means and Standard Deviations for Professional
Classiﬁcations on DMSI Items 204
LIST OF REFERENCES 225

Table
Table

Table

Table

Table

Table

Table

Table

Table

LIST OF TABLES

l-Rating Scales for the DMSI
2-Total Sample by Subsample Group and Professional
Classiﬁcation
3-Final Sample by Provider Setting and Professional
Classiﬁcation
4-Final Sample by Subsample Group and Professional
Classiﬁcation

5-Final Sample Highest Degree Obtained by Provider
Setting
6-Respondents' Highest Degree Obtained by Professional
Classiﬁcation
7-Means and Standard Deviations for the Final Sample
on Importance

8-Means and Standard Deviations for the Final Sample
on Preparedness
9-Items in Factor One: Fundamentals

of Disability Management

Table lO-Items in Factor Two: Elements

Table

Table
Table

Table

Table

Table

Table

of Vocational Rehabilitation

ll-Items in Factor Three: Elements of
Facilitative Counseling and Advocacy

12-Factor Analysis Results for the DMSI
13-Means and Standard Deviations on Factors for
Provider Settings

14-Means and Standard Deviations on Factors for
Professional Classiﬁcation

lS-Two-way Analysis of Variance for Importance
Factor One

l6-Two-way Analysis of Variance for Importance
Factor Two

l7-Two-way Analysis of Variance for Importance
Factor Three

78

89

91

92

95

96

99

112

127

131

133
136

137

138

140

140

141

Table l8-Two-way Analysis of Variance for Preparedness

Factor One 141
Table l9-Two-way Analysis of Variance for Preparedness

Factor Two 142
Table 20-Two-way Analysis of Variance for Preparedness

Factor Three

142

Chapter I

Introduction

The ﬁeld of vocational rehabilitation has experienced many changes over the years
including the shift from predominantly public sector to private sector and industry-based
service provision. Initially, rehabilitation counselors were employed primarily in the
state/federal system, however, today rehabilitation counselors are employed in a variety of
settings such as school systems, hospitals, employee assistance programs, private practice
and private industry (Desmond, 1985; Garvin, 1985; Lynch & Herbert, 1984). This
service sector and setting shift also represents a change in rehabilitation emphasis.
Previously the majority of rehabilitation services were provided to assist persons with
disabilities to obtain employment, whereas in contrast, the private sector or industry-based
rehabilitation services have focused on assisting persons with disabilities to maintain
employment. This change in rehabilitation service emphasis has been inﬂuenced by
economic, social and legislative factors that have subsequently impacted the way that
employers manage their workers with disabilities and has created the need for industry-
based disability intervention strategies. '

Speciﬁc factors which have contributed to the development of disability
management programs in the workplace include anti-discrimination laws and regulations,
cost containment in health care and workers' compensation, increased numbers of qualiﬁed
people with disabilities entering the labor market, and the expansion of social
consciousness about employing persons with disabilities (Pati, 1985; Galvin, 1991). As a
result of these factors and the shift to a more global economy, employers have begun to
realize the importance of hiring and retaining a skilled, dependable work force along with
controlling health and disability costs to remain proﬁtable and competitive. Tate, Habeck,
and Galvin (1986) indicated that these business trends have prompted employers to

become more aware of the need for and potential beneﬁts of managing disability through
disability management programs.

Over the past decade, disability management programs have gained credibility as a
natural alternative for employers in addressing premature disability or early retirement for
those employees who have experienced serious injuries or illnesses (Akabas, Gates, &
Galvin, 1992). Employers are recognizing that disability costs are signiﬁcant and that with
the help of disability management programs, these costs can be controlled (Habeck,
Leahy, Hunt, Chan, & Welch, 1991; Hunt, Habeck, VanTol, & Scully, 1993; Shrey,
1990). Disability management programs have not only been recognized as a valuable
alternative for employers, but for workers with injuries and disabilities as well (Habeck et
a1, 1991). Safety, health and stability of employment are major concerns for workers.
According to Akabas, Gates, and Galvin (1992), one in ﬁve males and one in seven
females between the ages of 20 and 60 will become disabled, therefore supporting the
need for programs that assist injured and disabled workers to maintain productivity and
ﬁnancial independence. Disability management programs, if implemented and
administered effectively, are intended to achieve a win-win situation for both employees
and employing organizations (Habeck, 1991).

The concept of disability management has been applied to rehabilitation service
provision From the perspective of a rehabilitation service provider, disability
management is an organizational strategy that combines clinical and case management
approaches typically characterized by vocational rehabilitation counseling with the multi-
disciplinary team approach of rehabilitation and the principles of organizational
development. These approaches are blended into a comprehensive framework of
strategies that are managed and coordinated within organizations (Tate, Habeck & Galvin,
1986)

 

Va

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Statement and Sigmlj' cance of the Problem

The costs of work-related injuries and illness have become major concerns for
employers. Chelius, Galvin, and Owens (1992) reported that disability costs total over 8%
of payroll and in 1986, disability cost the United States $87.3 billion dollars. This ﬁgure

 

represents actual dollars paid in lieu of wages to individuals who could not work due to a
physical or mental disability. Over the past 10 to 15 years, these costs have increased
between 300% and 400% and it is expected that these costs will continue to increase if
solutions to control these costs are not sought (Shrey, 1990; Victor, 1989). A safety
services study conducted by DuPont in 1990 cited that one lost work day case as a result
of a disabling injury can cost an employer about 13,000 dollars. Included in this ﬁgure
are direct costs such as wages and insurance costs, along with indirect costs like accident
investigation and the loss of productivity (MacDonald, 1990). In 1990, the incidence rate
of occupational injuries and illnesses was 8.8 per 100 ﬁrll-time employees, which yielded
an incidence total of 6.8 million workers with injuries or illnesses. This represents an
increase of 177,000 injuries or illnesses over the preceding year along with an increase in
the severity of injuries and illnesses (Hansen, 1992). Gilbride, Stensrud, and Johnson
(1994) estimated that 8.6% to 12.1% of people in the United States had erqierienced some
type of work disability in 1988. These ﬁgures indicate that work injuries and illnesses are
not isolated events that are occurring with low frequency. In actuality, workplace
disability is on the rise and is affecting large numbers of companies and their workers
(Shrey, 1990). As severity of work disability increases, it is evident that intervention
strategies are needed to prevent and control the impact of such occurrences.

Companies are concerned not only with the economic costs of disability in the
workplace but with the human costs as well Employers have become more aware of their
valuable human resources and the importance of retaining their skilled workforce. As

frequent turnover and employment of unskilled workers threaten the productivity and

proﬁtability of the company, employers have realized the value in maintaining their current
workforce (Tate, Habeck, & Galvin, 1986). Disability management is an approach that
allows companies to address both the human and economic costs of disability while at the
same time allowing for increased employer control over the rising costs of work-related
disability. As our economy has moved toward being more service and information-
oriented, a favorable climate has been created for eﬂ‘orts aimed at reducing workplace
accidents and returning injured workers to their jobs as their contributions to the company
are viewed as valuable (Backer, 1987). Furthermore, the results of two recent employer
studies (Habeck, Leahy, Hunt, Chan & Welch, 1991; Hunt, Habeck, VanTol & Scully,
1993) have supported the beneﬁt of employer based disability intervention strategies and
have demonstrated that there is a relationship between an employer's disability prevention
and management strategies and their overall experience with disability. Companies that
have rigorously implemented the strategies associated with disability prevention and
management have been eﬂ‘ective in reducing the incidence of disability in their workplace
(Habeck et al., 1991; Hunt et a1, 1993).

As will be demonstrated in the literature review section for this investigation, the
rehabilitation literature clearly supports the trend toward private sector employment
options for rehabilitation counselors. Because of employers increased awareness of
employees with disabilities and the economic implications associated with high disability
incidence, it is reasonable to assume that many rehabilitation counselors employed in the
private sector will provide services to business and industry during their careers. In 1986,
the Research and Training Institute at the Human Resources Center in Albertson, New
York conducted a nation-wide survey of 114 companies investigating their process for
handling employees who experience a disabling injury or illness. Sixty-two percent of the
companies responding had indicated that they had set up a disability management program
and sixty percent of the companies without a disability management program felt that they

could beneﬁt ﬁ'om one (Gottlieb, Vandergoot, & Lutsky, 1991). As companies continue
to experience the growing costs of workplace injury and disability and look for strategies
to mitigate these costs, knowledgeable, skilled practitioners will be needed to develop and
implement disability management programs.

In order for rehabilitation counselors to serve as disability management
practitioners, they need to possess the knowledge required to provide enrployers with
information about the value of disability management and to comnnmicate this knowledge
in a language that employers understand Rehabilitation counselors also need the skills to
set up and operate a disability management program within a company. These knowledge
and skill needs related to eﬂ‘ective disability management practice may pose a challenge for
rehabilitation counselor education programs. Kilbury, Benshoﬂ‘ and Riggar (1990)
recognized the considerable challenge facing rehabilitation educators as they continue to
prepare curriculums that are up to date and reﬂect the current trends facing the profession.
As the trend toward employer based rehabilitation strategies became evident, Habeck and
Ellien (1986) recognized that the rehabilitation counseling profession needs to become
educated about how to work both with companies and individuals. Rehabilitation
counseling curriculums also need to incorporate business concepts into their programs to
recognize that employers as well as individuals with disabilities are the clients of
rehabilitation services.

The Leadership Forum on Disability Management (Galvin, Habeck & Kirchner
1992), recognized that in order to develop a relevant curriculum to prepare graduate level
rehabilitation counselors for the disability management role, it is necessary to ﬁrst identify
the core disability management ﬁmctions and the skills required to perform these functions
eﬁ‘ectively. Education and training programs could then be developed to build these
necessary skills. Findings from this investigation could provide rehabilitation counselor

educators with empirical evidence to consider when looking to modify currently existing

curriculums and to develop training and continuing education programs that produce
qualiﬁed professionals for employer-based practice. This information can therefore assist
educators in the challenging endeavor of structuring education and training programs that
will enhance graduate employment options in business and industry.

Many research eﬂ‘orts to date have been conducted to identify the roles and
functions and competencies of rehabilitation counselors in a number of settings (e.g.,
Berven, 1979; Emener & Rubin, 1980; Jacques, 1959; Leahy, Wright, & Shapson, 1987;
Matkin, 1983). However, to date none have speciﬁcally dealt with the competencies of
rehabilitation counselors in disability management. This study marks the ﬁrst attempt at
investigating practitioners involved in providing disability management services and
documenting the perceived importance of the knowledge and skills utilized by these
practitioners.

The shift of rehabilitation counselors to the disability management arena makes it
critical that rehabilitation professionals have thorough knowledge and skills of the
concepts and interventions of the disability management approach. But ﬁrst, the speciﬁc
components and strategies of disability management service provision need to be identiﬁed
and examined to ﬁnd out more about what constitutes effective disability management
practice. Both rehabilitation counselors who are currently providing disability
management services and those who are interested in providing these services will need a
knowledge and skill base on which to draw from when considering and launching into this
area of practice. Szymanski, Linkowski, Leahy, Diamond, and Thoreson (1993)
recognized that the basic underpinnings of any profession or specialty area are the
identiﬁcation of speciﬁc knowledge and skills that are required for eﬁ‘ective service
provision. Research in the ﬁeld of rehabilitation counseling has continued to play an
important role in the process of professionalization for rehabilitation counselors and it is

under this premise that this investigation is based.

Rehabilitation professionals have been identiﬁed as a natural source to help
employers meet the challenges of rising disability costs and incidence (Gottlieb,
Vandergoot, & Lutsky, 1991). Havranek (1994) claimed that the unique knowledge and
skills required to provide disability management programs are those which the effective
rehabilitation professional already possesses. Matkin (1983) stated that rehabilitation
counseling applied to the industrially injured does not involve the development of new and
different counseling skills, methods or techniques. Although many agree that the ﬁeld of
rehabilitation and more speciﬁcally the rehabilitation counselor possesses many of the
required skills necessary to provide effective disability management services, to date these
assertions have not been empirically examined.

However, others disagree that rehabilitation counselors possess all of the skills and
techniques required for effective disability management. For example, Shrey (1992) took
a somewhat diﬂ‘erent perspective when he indicated that traditional vocational
rehabilitation strategies are not adequate for returning injured workers to their jobs. He
states that the vocational rehabilitation perspective tends to overemphasize the physical
and psychological characteristics of individuals with injuries or illnesses and fails to
recognize the importance of company and external environmental factors that impede
successful return to work In contrast, disability management as an approach to managing
disability and returning injured workers to their jobs recognizes disability as a complex
phenomenon that cannot be managed by clinical interventions alone but in combination
with organizational strategies (Habeck, 1993 ).

These assertions and claims about the appropriateness of rehabilitation counselors
as a qualiﬁed practitioner and the compatibility of the vocational rehabilitation process in
disability management need to be investigated ﬁirther. The skills and knowledge areas
that are common to rehabilitation cormseling practice and to the disability management

role need to be identiﬁed and documented. It is also essential to determine those

knowledge and skill areas that go beyond traditional rehabilitation practice and are
thought to belong exclusively to the disability management role. As disability management
services continue to develop as an approach to controlling and managing workplace
injuries and resulting disability in the workplace, it will be important to determine which

practitioners are qualiﬁed to provide eﬁ‘ective services.

Purpose of the Study
As public sector employment options continue to decline for rehabilitation

counselors and as private industry realizes the human and economic beneﬁts of preventing
and managing disability, private sector employment for rehabilitation cormselors in ~
disability management may become a viable alternative. Fienberg and McFarlane (1979)
noted that since 1973 the employment market for new professionals graduating ﬁ'om
rehabilitation education programs has shifted from the public sector to other less
traditional employment settings. Title V of the Rehabilitation Act of 197 3 and the more
recent Americans with Disabilities Act (1990) contributed to an awareness among business
and industry concerning the needs and rights of their disabled workers As a result of
these events, rehabilitation counseling professionals must be educated in how to work with
companies as well as individuals with disabilities when providing rehabilitation services
(Gottlieb, Vandergoot, & Lutsky, 1991). Gottlieb, Vandergoot, and Lutsky's (1991)
investigation was based on the recognition that it is critical to identify the important
knowledge and skill areas that deﬁne eﬂ‘ective disability management practice so that
practitioners operating in this arena are prepared to deliver quality services. It is also
recognized that rehabilitation counseling professionals will need to develop and acquire
some of the less traditional skills that are identiﬁed as being important to disability
management practice. For example, it has been noted in the literature that rehabilitation

counselors will need skills in marketing and publicizing disability management services to

employers and once within companies (Gottlieb, Vandergoot, & Lutsky, 1991). Further,
they must be sure to target their services to speciﬁc employers' needs and base these
services on a thorough assessment of the company's disability experience (Habeck, 1991).

The purpose of this investigation was to examine and further validate the perceived
importance of various knowledge and skill areas believed to be related to effective
disability management practice. Furthermore, this study attempted to explore the reported
preparedness of practitioners in these knowledge and skill areas. Comparisons were made
with regard to the perceived level of importance and preparedness across practitioner
dimensions (e.g., professional classiﬁcation and provider setting). Rehabilitation
counselors and other practitioners providing disability management services within three
provider settings were surveyed and their responses analyzed for this investigation.

Along with answering the following speciﬁc research questions, results ﬁ'om this
investigation provided descriptive information obtained ﬁ'om the demographic portion of
the survey questionnaire. Information such as respondents' age, gender, educational level,
and credentialling status were analyzed in relation to disability management provider’s
professional classiﬁcation (rehabilitation counselors, nurses, physical therapists, etc.) and
work setting (internal, extemal/private consultant, insurance based). This information was
analyzed in an attempt to further describe the population of rehabilitation counselors and
other practitioners providing disability management services. The speciﬁc research

questions addressed in this investigation were as follows:

1. What are the knowledge and skill areas perceived to be important by disability
management providers to achieve the outcomes of eﬂ‘ective disability management
practice?

2. Does the perceived importance of these knowledge and skill areas differ in relation to
the provider‘s professional background (rehabilitation counselors, nurses, physical
therapists, occupational therapists, etc.) and the provider's work setting (internal,
extemal\private consultant, insurance-based)?

 

40610

10

3. To what degree do disability management providers feel prepared in the knowledge
and skill areas?

4. Does the reported preparation diﬁ'er in relation to the provider’s professional
background (rehabilitation counselors, nurses, physical therapists, occupational therapists,
etc.) and the provider's work setting (internal, extemal\private consultant, insurance-
based)?

Qplications for rehabilitation counselor practice, education, and research.

Based on its recency, continued growth, and increasing sophistication,
rehabilitation counseling as a profession has been the focus of much research and
discussion. The most noteworthy form of rehabilitation counseling research is role and
ﬁmction studies (Janikowski, 1990). Role and function and competency studies have
traditionally served a useful purpose in rehabilitation counselor education and practice.
Their results have provided clear and concise descriptions of the tasks and duties
performed by rehabilitation counselors (J anikowski, 1990). Empirically derived
competencies and ﬁmctions have been used speciﬁcally for curriculum development and
accreditation standards, as well as serving as a basis for rehabilitation counselor
certiﬁcation (Szymanski, Linkowski, Leahy, Diamond, and Thoreson, 1993).
Additionally, Szymanski et a1 (1993) indicated that empirically derived competencies and
ﬁmctions have assisted the rehabilitation counseling ﬁeld to identify training needs among
practitioners and serve as a basis for developing a professional identity.

This investigation is unique in that it will attempt to ﬁrrther identify the speciﬁc
knowledge and skills required by rehabilitation counselors to provide disability
management services. The results from this investigation are considered to have valuable
implications for rehabilitation cormselor practice, education and research.

On the basis of the recency of disability management as an employer-based
disability strategy, rehabilitation counselors interested in pursuing this area of practice may

initially face some diﬁculty locating job descriptions or even a network of peers that can

 

15

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11

assist them in identifying the multidisciplinary competencies needed for practice.
Furthermore, those practitioners who are employed within companies as internal disability
management providers may be responsible for writing their own job descriptions and
deﬁning their own job tasks related to their company's disability related needs. Private
providers/consultants will also be responsible for marketing disability management services
and developing service proposals targeted to their potential employer customers.
Rehabilitation counselors need to have access to information that documents the nature of
disability management practice and delineates the speciﬁc knowledge and skills necessary
for eﬂ‘ective service provision Results ﬁ'om this investigation can provide rehabilitation
counselors with empirically derived competencies that will identify strategies and
interventions characteristic of the disability management approach. These competencies
can then serve as the basis on which rehabilitation counselors can develop job descriptions,
plan service proposals and perform personal knowledge and skill assessments. The results
can also help rehabilitation counselors to identify the speciﬁc knowledge and skill areas in
need of ﬁrrther development in order to provide effective disability management services.
It is hoped that this study will be a stimulus for rehabilitation counselor educators to
critically analyze the rehabilitation counselor‘s involvement in disability management and
to review their curriculums to determine if alterations are needed to prepare graduates for
eﬂ‘ective practice in disability management. Results can also be used to analyze and
develop training and continuing education programs that address disability management
competencies.

Finally, this study could be a stimulus for other research in this area of practice to
more fully validate and evaluate the competencies required for effective disability
management service provision. Additional research in disability management practice will
be needed to determine if this area warrants consideration of specialty status within the

profession of rehabilitation counseling.

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Deﬁnition of Terms

Disabm' ' Management: Disability management as deﬁned for the use of this investigation
is a proactive approach in the workplace to reduce economic and human costs associated
with disability by preventing disability incidence or remediating its effects and coordinating
retum-to-work strategies for retaining employees with disabilities in employment
(Carruthers, 1993; Habeck, Leahy, Hunt, Chan, & Welch, 1991; Schwartz, Watson,
Galvin and Lipoﬂ; 1989). '

Rehabilitation Counselor: Practitioner with a master's degree who assists persons with
physical, mental, developmental, cognitive and emotional disabilities to achieve their
personal, career, and independent living goals through the utilization of the counseling
process. Some of the speciﬁc techniques and modalities used by rehabilitation counselors
include: (a) assessment and appraisal, (b) diagnosis and treatment planning, (c)
career/vocational counseling, (d) case management, referral and service coordination,
(e) program evaluation, (i) intervention to remove barriers (environmental, employment,
and attitudinal), and (g) job analysis, job accommodation, and job placement services
(Scope of Practice for Rehabilitation Counseling, 1994).

Provider Setting: Individuals' primary employment setting when providing disability

 

management services. Internal providers are company employees who directly
provide/administer disability management services in-lrouse. External providers are
independent, private providers or employees of ﬁrms that are contracted to develop and/or
provide disability management consultation or services. Insurance-based providers are
employed by an insurance carrier or third party administrator that provides disability

management services.

par

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13

Professional Classiﬁcation: Individual's professional background and identity as self-
designated on the Disability Management Skills Inventory. The following professional
classiﬁcation groups were represented in the study: (a) rehabilitation counselors; (b)
psychologists and social workers; (c) business professionals; (d) nurses; (e) physical

and occupational therapists; and (l) other professionals.

Competencies: Term that refers to the speciﬁc knowledge (what individuals know) and
skill (what individuals do) areas required of practitioners to provide effective services
intended to meet the needs of employers and individuals with disabilities.

As_sumptions and Limitations
The ﬁrst assumption underlying this investigation is related to the instrument used.

It is assumed that the DMSI has accurately captured the competencies related to effective
disability management practice; however, outcome studies were not used to verify this.
The 101 knowledge and skill items on the Disability Management Skills Inventory (DMSI)
were inferred ﬁ'om the literature and have not been connected to actual disability
management outcomes.

The second assumption underlying this investigation relates to the validity of using
self-report methods to assess the perceived importance and preparedness of knowledge
and skill areas necessary for eﬁ‘ective disability management service provision. It is
possible to assume that survey respondents may not accurately report their responses to
survey items and thus threaten the validity of the investigation. However, a substantial
part of disability management providers' jobs requires that they assess the needs of
workers with disabilities and assess the needs of employers related to their disability
experience. More speciﬁcally, disability management providers assess and review medical

information, client capacities and job requirements to determine vocational implications

l4

(Scully & Habeck, 1993 ). Therefore, the perspective of disability management providers
when evaluating the importance and preparedness of the knowledge and skill areas is
considered to be based on "practice-based professional judgmen " (Leahy, 1986). q
Respondents are felt to have the skill, ability and professional judgment for accurately and
honestly assessing the professional skills related to disability management. Selfreport
based survey research has been a ﬁ'equently used approach for deﬁning competencies that
are not directly observable or that can be reﬂected in many forms of behavior (Boyatzis,
1980). It is however acknowledged that other methods such as direct observation could
have been incorporated into the study design to increase the study's validity and further
determine importance and preparedness in the knowledge and skill areas related to
disability management practice.

The third assumption related to this investigation deals with the generalizability of
the results from the study sample. A limitation is recognized in that the accessible
population and subsequent study sample include disability management practitioners who
may not be representative of the entire population of disability management practitioners.
Many associations and conferences have arisen to address the continuing education needs
of individuals working in the disability management arena. Three such conference samples
were used in this study and it is unknown how they compare with the larger population of
disability management practitioners. It is recognized that the sample selected for this
study could represent ideal practice versus current standard practice in that these
practitioners are motivated to increasing their level of knowledge and skill in disability
management through participation in disability management training events This
investigation represents one of the ﬁrst attempts to deﬁne a population of disability
management practitioners. It is recognized that generalizing from the sample of
practitioners surveyed in this investigation to the larger population of disability

management providers may pose some limitations in that the sample may not be

p’CICI

392,.

b“‘\

15

representative of the general population of disability management providers.

The ﬁfth assumption is related to the Disability Management Skills Inventory.
Sixty four items (63.4%) were developed ﬁ'om the Rehabilitation Skills Inventory, an
instrument considered to be a comprehensive, standardized questionnaire of knowledge
and skill competencies for rehabilitation counselors and rehabilitation counseling
specializations. The DMSI is therefore biased toward a rehabilitation counselor
perspective as the RSI items included have not been validated as being involved in
eﬂ‘ective disability management.

Finally, the selection of the fourth group, the Commission on Rehabilitation
Counselor Certiﬁcation (CRCC) sample, causes a bias toward rehabilitation counselors in
the study sample. This was done to ﬁrlﬁll the study's purpose which was to examine the
perceived importance of various knowledge and skill areas believed to be related to
eﬂ‘ective disability management practice and to explore provider’s preparedness in these
knowledge and skill areas. The ﬁndings would be discussed for their implications for
rehabilitation counselors. It is recognized that the results are biased toward the
rehabilitation counseling perspective and are more likely to be generalizable to the
rehabilitation counseling population in disability management rather than to all providers
of disability management.

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Chapter II

Review of the Literature

A review of literature was conducted to inform this research and to provide a
context for the investigation and to examine past research and events in the ﬁeld of
rehabilitation counseling that support the need for empirical research on the competencies
currently performed in eﬂ‘ective disability management practice. Competency studies in
rehabilitation counseling were reviewed for their methodological approaches and ﬁndings
to develop a formdation for this present study. Literature was reviewed in disability
management and private rehabilitation practice to identify and infer competencies
associated with disability management practice. Outcome studies in disability management
were also reviewed to infer practices and thus competencies associated with eﬂ‘ective

disability management.

The Conc t of Disab' ' Mana ement

Disa ﬂgy' ' management and rehabilitation.

It was not by chance that the concept of disability management emerged during the
1980s. During this decade, employers, insurers, policy makers, and service providers
became aware of the critical eﬂ'ects of health care costs, the aging of the workforce, and
the increase in the incidence of disability in the workplace. These trends negatively
impacted the business "bottom line" and paralleled foreign competition in businesses and
industries which were once dominated by American companies (Galvin, 1991). Employers
began to show an increased interest in disability management. Since the formal
introduction of this concept in the literature, disability management has stimulated the

development of publications and provider organizations facilitating the implementation of

16

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17

employer disability management programs in numerous work places (Habeck, Kress,
Scully & Kirchner, 1994).

Since the early days of rehabilitation, there has been a clear connection between
economics and the goals of rehabilitation As early as the 15005, rehabilitation was
provided for injured naval personnel and merchant seamen. In the late 1700s disability
beneﬁts were paid to soldiers during times of military conﬂict and in the 18005 workers'
compensation was paid to railroad workers. Even at that time it was recognized that
failure to meet the needs of workers with disabilities would create costs for society in a
number of ways. Workers with injuries and disabilities impact industry directly in terms of
wage loss beneﬁts, health care and the ﬁnancial costs of increased labor turnover in
addition to the costs of recruitment and training of new workers. Also, the resulting
decrease of workers in the labor force impacts social insurance and beneﬁt systems that
can only ﬁmction adequately when large numbers of people are employed (Galvin, 1983 ).
These early programs for injured workers clearly demonstrated that rehabilitation services
were needed to reduce the ﬁnancial costs of disability while at the same time
demonstrating the value of promoting independence and economic productivity. Industry
based rehabilitation he Mince these early days when intervw occurred ‘
336: an injury or disability was acquired and has becoap ”proactive '3 “*5 c
Wu professionals are M“ May} mm to
M!

Thus, the practice of disability management has important implications for both
workers with disabilities and their employers (Habeck, Shrey & Growick, 1991). The
opportunities that the disability management movement has created have been a source of
interest for rehabilitation counselors, but only recently has this interest gained momentum
(Habeck et a1, 1994). This is partially due to the Americans with Disabilities Act (ADA).
Enacted in 1990, the ADA legislatively addressed discrimination against people with

l8

disabilities in employment. Although unanticipated, there was a signiﬁcant relationship
between the legal requirements of the ADA and the goals and objectives of disability
management (Habeck et a1, 1994). This has further strengthened the potential for the
rehabilitation profession and private businesses to share resources and work
collaboratively to address public policy mandates as well as the human and economic costs
of disability in the workplace.

E81211-

Over the past 15 years, the concepts of disability management and industrial
rehabilitation have emerged as critical components of business management and
rehabilitation practice (Habeck, Shrey & Growick, 1991). Before this time, disability
management was a new concept and was not yet operationally deﬁned. The economic
climate, labor market changes, cost containment in health care, workers' compensation
costs, and legislative forces have contributed to the adoption of rehabilitation strategies
and disability management programs in the workplace (Pati, 1985; Habeck et a1, 1991;
Naisbitt & Aburdene, 1985). In an attempt to respond to and control these critical forces,
business and industry began to experiment with a variety of interventions such as
employee assistance programs, wellness programs, public and private rehabilitation
programs, and job modiﬁcation. However, these interventions were provided in a
somewhat "piece-meal" fashion which did not comprehensively address company and
employee needs and therefore, were only moderately successful (Tate, Habeck, & Galvin,
1986)

Rehabilitation practitioners in the United States were more formally introduced to
the concept of industry-based rehabilitation interventions in the 1980s. At this time, the
World Rehabilitation Fund sponsored several international exchanges in this area including
a tour by Aila Jarvikoski ﬁom the Rehabilitation Foundation of Helsinki, Finland to lecture
to rehabilitation professionals in the U. S. about his project with the City of Helsinki. The

19

City of Helsinki conducted a project in 1980 to develop and test the effectiveness of a
rehabilitation program for two major Helsinki employers. This program was speciﬁcally
implemented to develop an eﬂ‘ective method for screening employees needing early
rehabilitation services and to develop rehabilitation strategies to be implemented at the
actual work site (Galvin, 1983). This early program included a number of interventions
aimed at rehabilitating injured workers including worker assessment, counseling, job
reassignments, modiﬁcation of work tasks and ergonomic solutions. Preventative
strategies were also implemented such as exercise and relaxation sessions, and educational
sessions addressing back pain, stress and cardiac impairments.

During this time period, similar workplace rehabilitation programs were being
developed in other countries as well. In Sweden, ﬁrms established groups that were
responsible for adapting jobs to workers with disabilities, and the Swedish government
often paid up to ﬁfty percent of costs related to modifying jobs and providing special
assistive devices for employees. In Australia, many large employers rehabilitated injured
workers through in-house rehabilitation programs (Galvin, 1983).

Disability management eﬂ'orts in the United States also began to surface in the
early 1980s. One of the ﬁrst companies to develop a disability management program was
Burlington Industries in North Carolina with a pilot program aimed at managing
osteoarthritis and rheumatoid arthritis (Tate, Habeck, & Galvin, 1986). Burlington
implemented rehabilitation services to workers before they became permanently disabled
and could not continue to work This initial program included services such as medical
screening, training for company personnel, disability and career counseling, ﬁmctional
assessment, job analysis and job modiﬁcations (Tate, Habeck, & Galvin, 1986).

These early disability management programs have led the way for other companies
to follow and implement workplace rehabilitation strategies as it was increasingly

recognized that new solutions were needed that eﬂ‘ectively addressed the complex issue of

20

work disabilities. Furthermore, experiences with disability revealed that it is not simply a
medical problem which can be dealt with by using medical solutions alone. Employers and
rehabilitation professionals realized that preventing and managing industrial injuries had to
occur within the context of the employing organization in order to achieve maximum
results for both employers and employees (Habeck, 1991). Thus, the practice and
conceptual foundation of disability management as a strategy for addressing the human
and economic costs of disability emanated from both the domestic and international
erqreriences of business, rehabilitation practitioners, researchers, and government (Galvin,

1986)

Deﬁnitions of m' bility management.
One of the ﬁrst and most frequently cited deﬁnitions of disability management

came from two social workers in Finland. Jarvikoski and Lahelma (1980) discussed the
concept of early rehabilitation in the workplace in their lecture tour to the United States
sponsored by the World Rehabilitation Fund. J arvikoski and Lahelma (1980) described
disability management as a coordinated activity directed toward individuals with chronic
or permanent ﬁrnctional limitations or disabilities, or an activity directed toward
individuals with symptoms indicating that there is risk of such limitations or disabilities.
Disability management services according to Jarvikoski and Lahelma (1980) are intended
to restore an individuals work capacity. Disability management services include strategies
aimed at developing an individual's resources or removing barriers imposed by the work
environment.

Galvin (1983) also provided an early deﬁnition of disability management, stating
that it is an orientation within business and industry that emphasizes the early identiﬁcation
of disability-related problems. This orientation also includes the management of physical
symptoms of disability, the modiﬁcation of jobs within the company, and the development

3110-
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(19s

21

of policies that facilitate the retum-to-work of employees with injuries or disabilities.
Later, this deﬁnition was broadened by Schwartz, Watson, Galvin, and Lipoﬂ (1989) and
focused on the goal of disability management versus the speciﬁc services provided within
the context of disability management. Disability management was described to include the
services, people, resources and materials which are utilized to (a) minimize the costs and
impact of disability on the company and the employees; and (b) encourage rehabilitation
and return to work for disabled employees.

LeClair and Mitchell (1993) posed two separate deﬁnitions in an effort to describe
the management and prevention of injury and disability. They deﬁned disability
management as a proactive approach in which employer based strategies are developed to
reduce the employment impact of injury and disability. Disability prevention was
subsequently deﬁned as the employer’s proactive involvement in developing policies and
procedures for employee health care, rehabilitation and return to work in addition to
identifying health and safety practices and risks in order to minimize the impact of injury
and disability in the work environment.

Shrey (1990) begins his deﬁnition by ﬁrst clarifying what disability management is
not. He states that disability management is not claims management, it is not the
traditional vocational rehabilitation process and it is not an expensive approach to
controlling injury and disability costs. Furthermore, disability management is not a
"faddish" health promotion program nor is it a "canned" approach to managing injury and
disability. Shrey (1990) describes disability management as an active process which
minimizes the impact of injury or disability on the worker’s ability to perform his/her job.
The basic principles of Shreys deﬁnition include disability management as a process that
allows the employer to have control and to assume the responsibility for making proactive
decisions as well as planning and coordinating appropriate intervention services. Shrey

(1990) also includes the promotion of disability and injury prevention strategies,

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22

rehabilitation services, and return to work initiatives in his description of eﬂective
disability management programs.

Akabas, Gates and Galvin (1992) deﬁned disability management as "a workplace
prevention and remediation strategy that seeks to prevent disability from occurring or,
lacking that, to intervene early following the onset of disability, using coordinated, cost-
conscious, quality rehabilitation service that reﬂects an organizational commitment to
continued employment of those experiencing ﬁmctional work limitations" (p.2).
Carruthers (1993) described disability management as a proactive, preventive, positive
organizational program which promotes integration of individuals into the work force
versus isolation. The disability management program according to Carruthers provides
services from a central source and is accepted by all company employees. The goals of
this organizational program include providing a humanistic approach to managing
disability, developing a single contact point with accessible communication among all
parties, and reducing the costs of disability. Habeck, Leahy, Hunt, Chan and Welch
(1991) also offered a comprehensive deﬁnition of disability management. They described
disability management as a proactive, employer based program designed to (a) prevent the
occurrence of injury and disability, (b) intervene early to mitigate disability risks, and (c)
coordinate services for cost eﬂective restoration and return to work.

These deﬁnitions share many common elements and together provide a clear
understanding of the concept of disability management. Disability management is a
coordinated, comprehensive, employer-based approach to managing disability which
provides a win-win situation for both employers and employees. In order to be fully
eﬂecﬁve, disability management should be a proactive, positive and preventive approach
with the goals of reducing economic and human costs associated with disability, reducing
disability incidence and retaining the productivity of employees by coordinating return to

work.

23

Co onents of the disab' ' mana ement a roach

Based on the above deﬁnitions of disability management, proponents of disability
management identiﬁed components and elements characteristic of this approach. Galvin
(1986) pointed out that eﬂ‘ective disability management programs do not just happen, but
rather that there are critical conditions or factors which must be present for programs to
be successful. First, top management in the company must be fully committed to
managing injury and disability and returning employees to their jobs if injury or disability
does occur. Successﬁrl disability management programs within companies have practices
which encourage a comprehensive study and analysis of injury and disability occurrence
among their workforce and have implemented policies and procedures that encourage and
support their return to work commitment. Second, successful companies possess a caring,
trusting environment where the quality of life and well-being of the injured/disabled
worker is valued. Also, in order to successﬁrlly manage injury and disability, these
companies involve labor oﬁcials or representatives in the return to work eﬂ‘ort. Third, all
company personnel (supervisors and general employees) are educated about the beneﬁts
of managing workplace injury/disability and return to work in companies with successﬁrl
programs. Within this educational component Galvin also notes that it is important for
other service providers participating in the return to work process to be trained as they are
potentially valuable resources in the accommodation eﬂ‘ort. Fourth, successﬁrl programs
collaborate cooperatively with public agencies and private service providers. At times,
supplemental services are required to return an employee to work and partnerships with
outside agencies can aid in this process. Finally, Galvin recognizes that the rehabilitation
process has much to oﬂ‘er enrployers who are investing in the physical and mental well-
being of their employees. He indicates that rehabilitation services should be planned,
coordinated and monitored by a skilled provider. This provider may have a variety of

24

backgrormds such as, counseling, personnel or psychology and should have knowledge of
company services as well as community services (Galvin, 1986).
Ifthe previously mentioned conditions are present, then the following steps are

taken to implement a disability management program (Mitchell, 1982; Galvin, 1986):

1. Development of a corporate policy which demonstrates a commitment
to rehabilitation and that addresses the speciﬁc injury/illness/disability
characteristics present in the organization.

2. Development of an educational program for all company employees which deﬁnes the
disability management concept and outlines the duties of all parties involved in the
process.

3. Identiﬁcation of the critical decision points related to medical care,
disability beneﬁts, return to work outcomes, and disability retirement.

4. Establishment of comprehensive and systematic rehabilitation services.

5. Development of a systematic return-to-work plan which involves such
components as job analysis, job modiﬁcation, and other placement services in order to
return employees to work

6. Development of an evaluation system for program review and program improvement.

As these steps for implementation of a disability management program suggest, all
programs are unique and must be tailored to ﬁt the company's speciﬁc injury and disability
problems. However, successful disability management programs share many of the same
components. Schwartz et a1 (1989) identiﬁed key features that were present in effective
disability management programs based on their case study research. The following

components were presented as elements of successful programs:

1. A company-wide commitment to reducing disability costs and to providing the services
needed to encourage return-to-work.

2. A thorough analysis and modiﬁcation of appropriate beneﬁts and policies which
support disability management objectives.

25

3. A comprehensive assessment of the company's needs, experiences and
responses to incidents of illness and injury.

4. Organization and coordination of the disability management approach across all levels
and locations of the company, with clearly assigned responsibilities and accountability
among all of the key parties and operating units.

5. The creation of a manageable and eﬂ‘ective information system which documents,
analyzes, manages, and evaluates data regarding employees, costs, services, and the
overall impact of injury and disability.

6. Educational initiatives directed toward managers, supervisors, and production workers
to communicate the company attitude regarding disability management eﬂons.

7. Contact with injured/ill employees and the treating physician within 24 hours aﬂer the
incident occurs.

8. Facilitating and coordinating early return to work of disabled workers through
modiﬁcations in job assignments, work hours and/or work duties.

9. Preparing an individual service and return to work plan by the responsible case
manager along with the participating employee.

10. Coordinating the use of professionals with the expertise to design accommodations
that permit employees with disabilities to perform their work in a productive, satisfactory
manner. ~

11. Collaboration with public and private service agencies to provide mental health and
rehabilitation services when appropriate.

Habeck (1991) has also identiﬁed some main features which successful employer
disability management programs share. She states that the goals and aims of the disability
management approach are common sense notions to effective business managers and
rehabilitation professionals, however, the concepts associated with disability management
are often hard to achieve in a uniﬁed way in companies. Habeck also points out that there
is no speciﬁc formula or recipe for a disability management program that companies
should implement blindly. The disability management program should address the
particular and sometimes unique disability problems experienced by the company and its

26

workforce. A disability management program needs to evolve and adapt to the speciﬁc
environment present within the company. According to Habeck (1991), these key features
of successful disability management programs include the following:

1. Commitment of top management within the company.
2. Education and employee involvement at all levels within the company.
3. Involvement and participation ﬁom union/labor representatives.

4. A coordinated, team approach across company departments for effective case
management and return to work

5. Active use of safety and prevention initiatives to prevent occurrences.
6. Systematic procedures for eﬂective use of health and rehabilitation services.
7. Early intervention strategies and continuous monitoring for all types of disability.

8. An organized return-to-work program, with supportive policies and modiﬁed duty
work options.

9. The use of incentives and accountability measures to encourage participation of
managers, supervisors, and employees in the disability management process.

10. An integrated management information system to monitor incidence, beneﬁt usage,
services, costs and outcomes.

Dent (1990) describes the process of eﬂ‘ective disability management as neither a
passive nor an aggressive approach. He describes disability management as an approach
aimed at returning injured and disabled employees back to work and within this approach
consistent steps are taken from the beginning, to facilitate a disabled employee's return to
work Dent (1990) offers these ways that disability management programs facilitate return

to work:

1. Early identiﬁcation of potential or problem disability cases.

27

2. Early contact with injured and disabled workers and assessment of motivation and
resources for return to work

3. Action planning or the mutually understood blue print for successﬁrl re-entry into the
workplace.

4. Supervisors' support and cooperation with return to work eﬂ‘orts.

5. Open and frequent communication with the injured/disabled worker and
all parties involved in the return to work eﬂ‘ort.

6. Vocational rehabilitation including job analysis and modiﬁcation, modiﬁed duty
assignments and special devices and aids which allow the disabled worker to perform job
duties.

Disability management is a complex initiative that consists of many components
and involves many individuals from the company in addition to the involving resources
ﬁom the community. Disability management programs continue to develop and change
over time and need to do so in order to remain responsive to the evolving needs and
circumstances experienced within the company. Therefore, the components of a company
disability management program depend on the characteristics of the company, the type of
work performed, the nature of the workforce, and the available resources (Akabas, Gates,
and Galvin, 1992).

Employer support for disab_rl_rt_y' ' management strategies.
Research in the area of disability management is limited and still relatively recent,

however, empirical evidence does exist which supports the impact of internal ﬁrm
behavior and disability management strategies on an employers' overall disability
experience. Rousmaniere (1989) conducted a study of 24 hospitals in the northeastern
part of the United States and found that injury incidence and severity were similar across
all hospitals. However, he also revealed that there was tremendous variability in the costs
incurred by these similar incidents within the hospitals studied, as well as tremendous

28

variation in the frequency of lost time injuries, total lost work days and workers'
compensation losses that they experienced. In fact, workers' compensation losses at
hospitals with high disability rates were twice as high per employee as hospitals with low
disability rates. The study found that the most important factor impacting the variability of
disability rates was the hospital's internal system of risk management and post injury
response. In other words, the hospitals with systematically developed disability prevention
and management programs experienced much better disability rates and costs. This study
concluded that over 50% of workers' compensation costs can be directly attributed to the
organization's handling and management of injured workers and their claims. National
Rehabilitation Planners (1993) similarly asserted that companies can reduce their workers'
compensation costs by roughly 25-30% in the ﬁrst year after implementing a disability
management program.

Two recent studies (Habeck, Leahy, Hunt, Chan & Welch, 1991; Hunt, Habeck,
VanTol & Scully, 1994) of employer practices with regard to injury and disability
management have clearly illustrated the connection between disability management
policies and procedures and disability outcomes within the company. The ﬁrst study
consisted of two parts. The ﬁrst part was an analysis to determine incidence rates of
workers' compensation claims among Michigan employers (Hunt, 1988). It was found
that there was at least a 10 times diﬂ‘erence in workers' compensation claim rates between
the highest and lowest claims ﬁrms within each of the 30 industries studied and that this
variability was only partially explained by the ﬁrm's size, industry type and location. It
was found that the high claims ﬁrms which were studied had twice as many accidents and
four times as many workers' compensation claims as the low claims companies. The
second part of the study was a survey of 124 Michigan ﬁrms with the purpose of exploring
the empirical relationship between disability prevention and management strategies and the
ﬁrms' workers' compensation claims experience (Habeck, et a1. 1991). The study

29

attempted to determine how company practices along with the structural characteristics of
the company inﬂuenced their workers' compensation experience. A number of
conclusions were reached ﬁom this study. It was determined ﬁom the study that this
particular ﬁnding supported assertions indicating that there are two well-deﬁned
components to the disability management process; the ﬁrst component consisting of
strategies that prevent the occurrence of incidents, and the second component consisting
of the process to manage incidents after they occur. Most importantly, it was found that a
ﬁrm's management philosophies and their policies and practices related to disability
prevention and management were signiﬁcantly related to a positive claims experience.
That is, if the ﬁrm possessed an open managerial style, a human resource orientation,
rigorous implementation of safety and injury prevention strategies, and speciﬁc company
procedures aimed at preventing and managing disabilities then their claims experience was
positive (Habeck et al., 1991).

The second study was an outgrowth of this ﬁrst study and had as its purpose the
goal to provide more reﬁned statistical and behavioral evidence about the impact of
company policies and practices have on disability prevention and management (Hunt et a1,
1993). This investigation studied 220 Michigan ﬁrms in seven industrial classiﬁcations.
The results clearly showed that companies which frequently engaged in behaviors such as
safety diligence, safety training activities, and proactive return to work strategies,
experienced sigriﬁcantly lower rates of injuries which resulted in lost work days.
Furthermore, companies implementing these behaviors also experienced fewer lost work
days and fewer workers' compensation claims than those companies not engaging in these
behaviors. Again, this study strongly suggested a causal connection between a ﬁrm's
policies and procedures in disability prevention and management and their performance on

disability measures.

30

This study had a qualitative component to its design which included making site
visits to 32 of the companies which participated in the larger survey. Companies with the
highest and lowest disability performance representing each of the industry classiﬁcation
groups and size categories were chosen for site visits. This qualitative component was
undertaken in an attempt to better understand how disability prevention and management
policies and practices are implemented and carried out within a company. Also,
information on how these policies and practices actually contributed to preventing and
controlling disability was sought. A number of observations were made about the
characteristics of companies which successﬁrlly manage injuries and disabilities.

Successful companies make extensive use of data to identify their injury and
disability problems and they analyze these problems to identify the root causes of injury
and disability in their company. They use this data to measure their overall disability
performance and they develop and target interventions to mitigate the causes of injury and
disability. Successful companies have a top level of management which supports the
goals, policies and procedures of disability prevention and management and they have an
educated labor force which understands the importance of safety and disability strategies
in relation to the overall well-being of the company and to themselves. Companies with a
positive disability experience incorporate ergonomic strategies into their prevention eﬂ‘orts
and they have developed eﬂecﬁve, cooperative relationships with knowledgeable and
responsive health care providers. These companies are active in case management and
they implement systematic return to work strategies in such a way that the needs of
individual situations and problems are addressed (Hunt, Habeck, VanTol & Scully, 1994).

These research efforts have supported the eﬂecﬁveness of speciﬁc disability
prevention and management strategies on the outcomes that companies can achieve with
rigorous implementation. The results described in this section support the deﬁnitions and

components of disability management as outlined previously. Therefore the ﬁndings were

31

used to develop knowledge and skill statements that constitute the Disability Management
Skills Inventory developed for this investigation. Thus, data obtained from this
investigation can assist in further identifying the knowledge and skills that rehabilitation

counselors are performing when providing disability management services.

The practitioner’s role in disabilig management.
In his position paper entitled "The Role of the Rehabilitation Counselor in

Industry", Garvin (1985) indicates that the survival of rehabilitation depends on
communicating the worth of rehabilitation services not only to persons with disabilities but
to the employer community as well. He states that the rehabilitation counseling profession
must consider the employer as a client or as Shawhan (1983) points out, rehabilitation
counselors must acknowledge that employers are viable consumers of rehabilitation
services. Pati (1985) stated that the future success of rehabilitation is directly related to
the rehabilitation professional's ability to create eﬂ‘ective partnerships with business and
industry. These positions occurred at a time when disability management as an employer
based initiative was gaining recognition among rehabilitation professionals and the
employer community. These positions served to provide support to this concept of
employer based interventions and demonstrate to rehabilitation professionals the need to
acquire skills and knowledge in order to eﬂ‘ectively interface with business and industry.
Disability management has been described by Habeck and Munrowd (1987) as an
employer-based rehabilitation strategy. It is important to deﬁne what is meant by
employer-based initiatives. Habeck and Munrowd (1987) state that employer-based
rehabilitation describes strategies that are implemented by employers to prevent the
unnecessary exit of injured employees ﬁom their jobs and to promote the retention and
productivity of these employees. They indicate that it is important to distinguish

employer-based strategies from employer oriented strategies such as supported

32

employment and projects with industries; and ﬁom private rehabilitation where service is
retained by an external consultant. However, many employer-oriented rehabilitation
services and disability management programs are provided by contracted providers of
rehabilitation services. In addition, many of the original disability management programs
were developed by insurance companies to control costs incurred by organizations insured
by their company. This increased utilization of DM services provided by private providers
and insurance companies has developed many opportunities for private rehabilitation to
expand into this market (W elch, 1979).

At the time of Habeck and Munrowd's writing in 1987, they noted that the trend
toward employment of rehabilitation counselors within internal, employer based company
programs was a small one and was not a signiﬁcant market at that date. The Institute for
Disability Management and Rehabilitation (Schwartz, 1986) conducted a survey of 400
employers and found that only a small percentage of responding companies had a formal,
identiﬁable internal disability management program. Results from a pilot study entitled
"The Role of the Rehabilitation Counselor in Disability Management" (Scully & Habeck,
1993) revealed similar ﬁndings. Internal disability management providers were
outnumbered 4 to 1 by private and insurance based providers collectively. Nevertheless,
the opportunities that the workplace represents for impacting the lives of many employees
by implementing eﬂecﬁve disability management strategies (Habeck & Munrowd, 1987),
is signiﬁcant regardless of the source of intervention eﬂ‘orts.

Habeck (1991) developed a matrix to delineate two parameters that impact the
nature of the role and the services provided by disability management practitioners. The
two parameters are "focus of service" (i. e. the focus of service is directly on the individual
employee or is indirect on the organization) and "relation to the company" (i e. an internal
company employee or an extemal contracted provider). Habeck (1991) asserted, that
depending upon the combination of parameters, very diﬂ‘erent tasks are completed in

33

relation to disability management. She stated that rehabilitation counselors who focus on
direct services to the individual with a disability will most likely use the skills characteristic
of a professional rehabilitation counselor whereas practitioners who work with employees
within the company will most likely perform the tasks of case management, service
coordination, assessment and job placement within the context of the company. However,
rehabilitation professionals who are focusing services on the organization are more likely
to perform activities that are beyond the scope of traditional rehabilitation counselor
practice. These practitioners will need knowledge of the many factors which impact
health and disability in the worlqilace and also will require knowledge of business
management and comp any operations.

Shrey (1990) discussed the role and function of the disability manager as a
designated individual who (a) plans for eﬂ‘ective allocation of employer resources
including time, (b) coordinates rehabilitation services, develops and manages the return
to work plan, and (0) reviews the progress of injured workers who have returned to
work in order to determine the eﬂ‘ectiveness of services. Shrey (1990) states that case
management is an essential component of the disability management process and therefore
disability managers rmrst have the necessary skills, knowledge and resources to coordinate
case management services for injured and disabled employees. In addition to case
management skills, disability management practitioners must possess a working
knowledge base in medical management, legal management, psychosocial management,
labor relations, claims management, and other interdisciplinary skills that aﬂ'ect disability
outcomes Shrey (1990) asserted that the following topics nnrst be addressed in training
practitioners to ﬁrnction as disability managers: (a) the principles of the disability
management process, (b) cost-eﬂ‘ective disability management strategies, (c) company
disability analysis, (d) the barriers which impede return to work and work retention, (e) .
claims and medical management, (l) the psychosocial aspects of injury and disability, (g)

34

health promotion, risk reduction and disability prevention strategies, (h) the impact of
labor relations on disability claims, (i) occupational medicine resources and interventions,
(j) vocational rehabilitation services, (k) disability management program development,
and (l) disability management program evaluation.

Shrey (1990) also suggested a sample training program outline which provides ﬁve
training modules addressing the knowledge and skill competencies needed for disability
managers (pp. 104-105). The ﬁve modules consist of topics and objectives for disability
management issues, corporate health and disability analysis process, case management
strategies, selection and evaluation of medical and rehabilitation providers for treatment of
vocational services, and disability management program evaluation.

Habeck and Ellien (1986) indicated that rehabilitation services in the workplace are
a logical application and erqiansion of the knowledge and skills utilized for traditional
rehabilitation service. Based on this assertion, they conducted a review of the roles and
ﬁrnctions of rehabilitation counselors in the workplace. This review and additional ﬁeld
research served as the basis for Habeck and Munrowd's (1987) conceptualization of
disability management skill needs. They categorized the skills needed for disability
management service provision in three areas; clinical and direct service skills,
administrative sln'lls, and organizational skills.

Habeck and Munrowd (1987) characterize clinical and direct service skills as
counseling skills, vocational assessment, evaluation skills, and the ability to integrate
occupational, educational, and social information into a plan of action. This area also
includes knowledge of the medical, psychosocial and social impact of disability. Merrill
(1985) indicated that the basic skill needed in this category of clinical skills are vocational
assessment and planning, referral and coordination of services, and coordination of return

to work.

35

Administrative skills are necessary to manage and coordinate eﬂ‘ective
rehabilitation services. This area of skills includes program evaluation and cost data
analysis along with leadership abilities to develop and maintain disability management
programs. Leadership skills are also needed for resolving and mediating conﬂicts between
the diﬂerent parties involved in the disability management process. Disability management
practitioners require business skills and the capacity to perform management duties.
Speciﬁc knowledge is also needed to perform effectively in the disability management role.
Practitioners need to understand beneﬁt systems, ﬁnancial procedures, organizational
behavior and development, collective bargaining and the role of labor unions, and
technology available for worksite accommodations and modiﬁcations. Preventive
strategies are also included here as practitioners require knowledge of prevention
strategies such as ergonomics, health promotion and wellness strategies.

The disability management practitioner is a change agent according to Habeck and
Munrowd (1987) and requires organizational development skills. The practitioner must
evaluate the needs of the employer organization and thus perform an organizational
analysis. This requires an investigation of the employer's policies, procedures and
practices in addition to the impact that these policies and behaviors have on the proposed
interventions. Practitioners must have knowledge of the company culture, values and
dynamics which occur across the various departments and personnel. Habeck and
Munrowd (1987) concluded that employer-based rehabilitation practice requires
competence in vocational rehabilitation skills along with a number of other skills in the
areas of organizational development and administration.

When discussing disability management and its implications for rehabilitation
counselors, (Tate, Habeck and Galvin, 1986) described the practitioner's role in a similar
fashion. They argued that the disability management concept is basically applied at three

intervention levels; clinical (direct employee service), educational (training and assisting

W

36

service providers), and consultative (facilitating communication and coordination among
the diﬂ‘erent parties in the disability management process). Tate et al. (1986) assert that
practitioners entering the disability management arena need to adopt a systems perspective
to intervention. Practitioners must have knowledge of management concepts and
organization structures in addition to knowledge of company policies and beneﬁt
administration. Tate et a1. (1987) state that this systems approach requires skills in
negotiating cross-departmental cooperation and facilitating a team approach with all
parties involved.

Disability management practitioners, according to Tate et a1 (1987) also need to
possess clinical skills which will enable them to address the psychosocial impact of injury
and disability, to mediate the barriers to rehabilitation and return to work, and to
coordinate the participation of the parties involved in the disability management process.
Furthermore, practitioners must have the skills to develop and monitor information
systems for determining company costs and outcomes and must have knowledge of
strategies that emphasize job and worker assessment and matching job modiﬁcations.

Gottlieb, Vandergoot and Lutsky (1991) conducted a study of 114 companies to
determine programs and practices in place within these companies to minimize the impact
of disability on their employees. Results of this study suggested several ways that the
rehabilitation commrmity can become involved in disability management. Rehabilitation
counseling professionals can provide information about the overall value of disability
management; they can suggest ideas about interventions and services oﬂ'ered in disability
management programs; and they can conduct training on case management and
subsequently provide case management and evaluation services.

Based on their study, Gottlieb et a1. ( 1991) identiﬁed a number of implications for
rehabilitation counseling professionals. Disability management practitioners need to base

their intervention strategies on a thorough assessment and understanding of the company

37

and its workforce. Rehabilitation practitioners in this area of practice will need to be
educated in how to work eﬂectively with business and industry and need to view the
employer as a consumer of services as well as the individual with a disability. As state and
federal governments become increasingly concerned about the impact of disability on
employers, disability management practitioners should be prepared to assist employers in
framing corporate policies to address disability. Practitioners in disability management
should also be prepared to assist employers in developing and implementing management
information systems that monitor those individuals utilizing disability beneﬁts, the services
they receive and the costs associated with disabilities.

Habeck, Kress, Scully and Kirchner (1994) in their article entitled "Determining
the Signiﬁcance of the Disability Management Movement for Rehabilitation Counselor
Education", caution against quickly concluding that there is a close match betwear the
traditional skills and competencies of the rehabilitation counselor and the competencies
needed for provision of disability management services. Habeck et a1 (1994) argue that
the disability management approach includes nnrch more than the provision of
rehabilitation services to employees after the onset of disability. It is important to realize
that disability management is an organizational approach which is often a component of a
company's human resources or medical services department. Depending on the focus of
service and the relation to the company, the rehabilitation counselor’s educational needs
for the unique and often times advanced knowledge and skills will change.

This assertion is supported by other disability management proponents as well
(Dent, 1990; Shrey, 1994; Olsheski, 1993). Shrey (1994) argues that the traditional
vocational rehabilitation approach is not suﬁcient to accomplish the goal of return to
work He states that the vocational rehabilitation approach over emphasizes the
characteristics of the individual and does not address environmental inﬂuences which

impact return to work Olsheski (1993) asserts that the diﬂ‘erent context in which

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38

disability management services occur requires that rehabilitation counselors be skilled in
areas such as the fundamentals of organizational behavior, labor relations, ergonomics,
and human resource management. He states that rehabilitation counselors need skills
which are beyond client assessment and intervention; they need? competencies in
addressing the organizational and environmental factors that impact on return to work In
conclusion, it would appear that in order to provide eﬂ‘ective disability management,
services must be dual focused including both the individual (clinical) and on the work
environment (system) (Habeck et a1, 1994).

Current issues m acting disabm' ' management.
Habeck, Kress, Scully and Kirchner (1994) recently summarized the factors

currently facing the disability management movement. They indicate that current health
care reform eﬂ‘orts and the current negative economic climate are impacting disability
management eﬂ‘orts. They cite an issues paper prepared by the Washington Business
Group on Health (May 1994) which states that employers continue to face increasing
problems in managing both occupational and, non occupational disability and that costs
continue to rise faster for workplace disability than for health care in general. Due to
constant changes in health care delivery systems and ongoing corporate reorganization, it
is diﬁcult for employers to develop and implement effective programs and beneﬁts which
target their disability problems. Employers are speciﬁcally challenged by exploding
disability costs which question the value of programs they have implemented in an attempt
to control these costs. In addition, employers are in need of reliable empirical information
which can assist them in assessing their company‘s needs and in developing the most
eﬂ‘ective strategies/programs to meet their speciﬁc health and disability needs

Habeck et al., (1994) discuss the controversy about health care reform proposals
which focus on managed care. This has caused increased concern as it is felt that relying

di

39

on third parties for managed care will ultimately reduce incentives for disability prevention
and management in the workplace and subsequently the employer involvement. It is
feared that employer-based disability management programs will be replaced with
provider-based case management services. However, many proponents of the disabihty
management movement including employers feel that disability management as an
employer based strategy to prevent and control disability and related costs will be a lasting
initiative.

The current negative economic climate facing business and industry and
subsequent management trends was also cited by Habeck et a1. (1994) as an issue facing
disability management, particularly downsizing the workforce and re-engineering the work
environment in an attempt to meet cost and quality demands. An important component of
the disability management approach is maintaining the connection between employer and
employee when an injury or disability occurs. Retention is becoming harder to accomplish
as employers are challenged to expand job duties and worker tasks in an attempt to
produce more with fewer workers. Further, downsizing is occurring not only with
production workers but with human resource and beneﬁt personnel as well.

Consequently, personnel with little or no knowledge of disability are assuming the role of
the disability manager and thus potentially compromising the eﬂ‘ectiveness of disability
management strategies. Based on these economic concerns, Habeck et a1, (1994) argue
that it becomes increasingly necessary for employers to gain credible information about the

costs and beneﬁts of disability management programs.

The Evolution pf Rehabilitatign in Qe Private Sectpr

Histogy.
Disability management as it is applied by rehabilitation counselors, emanated from

the movement toward private sector rehabilitation practice. This movement toward

 

providing services in the private sector impacted the rehabilitation counseling profession
and changed rehabilitation counselor education to reﬂect the role and ﬁmction of
counselors in this setting. Rehabilitation cormseling is considered a unique profession as it
was originally created and supported by the federal government. In the late 19703 and
early 1980s, accountability, inﬂation, and budgetary limitations contributed to the decrease
in federal and state ﬁnding for rehabilitation services (Anderson & Parente, 1982). This
decrease in funding could have potentially slowed the growth of rehabilitation; however,
at the same time, developments in worker's compensation provided alternative labor
markets for rehabilitation cormselors. Thus, the rehabilitation counseling profession
expanded into the private sector and the federal and state government was no longer the
only employer of rehabilitation counselors.

Griswold and Scott (1979) argued that it wasn't until the latter part of the 1970's
that rehabilitation in the private sector had increased suﬁciently to be viewed as a
signiﬁcant competitor to public sector rehabilitation. This competitive advantage was
viewed as the result of limited available public funds to meet the needs of many persons
with disabilities, particularly those individuals who were industrially injured (Matkin,
1980). Further, Diamond and Petkas (1979) explained that the traditional service delivery
practices of public sector rehabilitation caused some concern among employers/insurance
carriers and the workers' compensation oﬂicials in regard to services provided for the
industrially injured. These concerns were mostly related to the diﬂ‘erences in philosophical
approaches and timeliness in the provision of rehabilitation services. The approach of the
traditional state/federal rehabilitation program is to maximize a client's potential whereas
the workers' compensation approach is to rehabilitate the worker with an injury back to
their level of functioning prior to the injury (Diamond & Petkas, 1979). Another
diﬂ‘erence according to Diamond and Petkas (1979) was the outcome expectations of the

two approaches. The state/federal vocational rehabilitation program seeks to ﬁnd a

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Pron'

41

speciﬁc job placement which could require lengthy and formal training. The employer or
insurance carrier of an injured worker seeks an early closure by job placement or a
monetary settlement. Lengthy training programs are too costly to the insurance carrier.
Finally, Diamond and Petkas (1979) argued that the state/Federal vocational rehabilitation
program has not aggressively attempted to change its rehabilitation approach in order to
better accommodate the needs of those who are injured on the job. Subsequently a new
approach emerged which emphasized the needs of employers, insurance carriers and those
individuals injured on the job and began to gain momentum in the late 19705 and early
1980s.

The movement toward providing more eﬂ‘ective vocational rehabilitation services
to injured workers was encouraged and supported by the federal government.
Conferences were held which provided information to states regarding rehabilitation and
workers' compensation. At the same time, several initiatives were developed to review
state workers' compensation laws and to determine the adequacy of vocational
rehabilitation services provided (Lewin, Ramseur, & Sink, 1979). Perhaps the most
critical factor contributing to the development of rehabilitation in the private sector was
the establishment in 1971 of the National Commission on State Workers' Compensation
Laws which developed guidelines to assist states in providing an adequate workers’
compensation system This Commission recommended changes that would serve to
improve the workers' compensation system. Included in the changes was one objective
which dealt with the provision of suﬁcient medical care and rehabilitation services
(National Commission on State Workmen's Compensation Laws, 1972). The Commission
felt that workers' compensation was not doing an eﬂ‘ective job of assisting injured workers
to recover lost abilities and return to work and suggested that rehabilitation services be
provided by the employer or a designated provider (Lewin, Ramseur, & Sink, 1979).

42

Based on the Commission's ﬁndings and subsequent recommendations for
rehabilitation services to be provided for workers' compensation recipients, the state
vocational rehabilitation program was considered to be the logical source to obtain these
services. Formal agreements were then made between worker's compensation and
vocational rehabilitation (Lewin, Ramseur, & Sink, 197 9). However, it was not long
before the state/federal vocational rehabilitation system came under close scrutiny and
criticism for their inability to deliver these services to workers' compensation recipients.

McMahon (197 9) looked speciﬁcally at the problems inherent in the public service
delivery system based on Whittington's (1975) proposal to privatize mental health
services. According to McMahon (1979) there are four main problems with public
rehabilitation service provision for private sector applications. First, the nature of public
ﬁnding is not conducive to providing prompt, direct services to clients. Second, there are
managerial restraints which are highly inﬂuenced by legislative changes. These legislative
changes can alter the course of rehabilitation at a given moment. In addition, the civil
service philosophies or regulations make it diﬁcult to reward superior performance or to
discipline ineﬂ‘ective employees. Third, consumers of the public rehabilitation program do
not control vocational rehabilitation dollars and therefore lack a free choice. Thus, they
cannot monitor or change their treatment or control the services they receive. Finally,
McMahon (1979) cites limited resources as a problem with public vocational rehabilitation
service provision. He states that the need for vocational rehabilitation services far exceeds
the capabilities of the public service delivery system. He speciﬁcally states that some
populations are neglected by the public system such as older workers and the industrially
injured These problems and the need for solutions prompted the development of a
network of private rehabilitation providers

Matkin (1980) stated that the scope of services provided and the client population

served in the private sector may explain the short term approach of the private

43

rehabilitation provider as compared to the long term approach within the public sector.
Private rehabilitation service providers have primarily worked with workers' compensation
recipients and do not encounter the wide diversity of disability types that public sector
service providers do. In addition, timeliness of rehabilitation services is emphasized in the
private sector and based on the public sector’s priority system, those individuals with
industrially injuries were generally considered to be less severely disabled and could not
receive services in a timely manner (Diamond & Petkas, 1979; Griswold & Scott, 1979;
Matkin, 1980). Diamond and Petkas (1979) reported that the main diﬂ‘erences between
these two service sector approaches are the timeliness of service and a more personalized
case management approach in the private sector. They indicated that there is little
diﬂerence in the range of services provided by either sector. Referrals for the private
sector of rehabilitation service generally come ﬁom insurance carriers, self-insured
employers, attorneys, physicians, and state workers' compensation agencies. McMahon
(1979) also indicates that services provided in this sector generally mirror those oﬂ‘ered in
the public sector but vocational evaluation and job placement services are more frequently
requested in the private sector while counseling and training are less frequently
emphasized.

\Matkin (1983) indicated that the principle element shaping the context in which
rehabilitation counselors operate in the private sector is the insurance industry. The
insurance industry thus inﬂuences the types of services provided and the skills and
knowledge required by private rehabilitation providers (Lynch & Martin, 1982; Matkin,
1982). Individuals referred for rehabilitation services within the private sector are most
often injured or disabled in the workplace and are covered by workers' compensation
insurance (Diamond & Petkas, 1979; Griswold & Scott, 1979; Lewin, Ramseur & Sink,
1979; McMahon, 1979; Organist, 1979; Sales, 1979; Shrey, 1979).

Rehabilitation counseling and individuals with industrial h11u_r_r° 'es.
The above mentioned factors contributed to a new sector of rehabilitation

counseling practice which focused on providing rehabilitation services to individuals with
industrial injuries. Shrey (1979) stated that this private sector was becoming more
responsible for the rehabilitation of workers' injured on the job as the consequences of
these industrial accidents became more onerous. He recognized that escalating beneﬁt
levels were becoming a challenge to employers and insurers and that it was necessary to
ﬁnd new approaches to "disability management". Rehabilitation was cited as an important
component of workers' compensation claims management and thus, vocational
rehabilitation was seen as an important vehicle for controlling the social and economic
factors associated with industrial injuries (Sawyer, 1976). In the mid to late 19705,
research in the area of vocational rehabilitation of the industrially injured was relatively
new; however, some evidence did support the fact that industries could ﬁnancially beneﬁt
by returning injured workers' to their jobs as soon as possible after an injury (Shrey,
1979). Industry did see this as a ﬁnancial incentive and as a way to reduce turnover rates
through the utilization of rehabilitation services.

Industries began to recognize the importance of rehabilitation eﬂ‘orts as they
realized that they lacked much of the necessary experience and skills required to redesign
jobs and accommodate injured workers. Sawyer (1976) stated that "insurance carriers and
employers have a strong inducement to provide vocational services for disabled workers
whose prospects indicate that they may return to work and give up their claims to weekly
beneﬁts" (p.23). Akabas (1976) ﬁrrther identiﬁed several areas in which employers lack
information and consequently need direct involvement with rehabilitation counselors to
address these areas. She states that industry does not have access or knowledge regarding
the variety of disabling conditions and their potential impact on job placemmt and
employee productivity. Employers have little information about the rehabilitation process

45

and the utilization of assistive devices or technology for workers with disabilities. Akabas
(1976) states that employers do not possess the skills or knowledge for job restructuring
or job accommodation and that employers lack information and resources to assist
workers with problems such as alcoholism, substance abuse, depression, and anxiety.

Rehabilitation counselors who provide rehabilitation services to industrially injured
clients work in a setting that combines a variety of complex, diverse, and sometimes
unrelated systems; each with its own set of rules, regulations, regulatory bodies, and legal
and philosophical foundations (Matkin, 1983 ). Matkin (1983) identiﬁed the many systems
that rehabilitation counselors needed be familiar with in order to eﬂectively enter in to the
private sector service arena. These systems included: (a) workers' compensation, (b)
insurance coverage for injuries sustained in unrelated work activities, (c) automobile no-
fault insurance coverage, (d) coverage provided under the Railroad Workers' Retirement
Act, and (e) beneﬁts covered under Social Security Disability Insurance. Empirically
derived competencies related to private sector and insurance rehabilitation practice will be
discussed later.

Specialization in Rehabilitation Counseling
As new knowledge, technology, medical advances, and legislation continue to

develop, specialty practice areas emerge in an effort to address new service needs
Rehabilitation counseling is not exempt from this emergence into specialty practice areas.
Patterson (1967) stated that anyone who is aware of new developments in science and the
professions, realizes that we live in the age of specialization and that this specialization is
inevitable. He discusses specialization as a "natural development in a situation where
there are large numbers of clients who form clearly deﬁnable subgroups, or where
complex professional functions can be easily or logically subdivided" (p. 147). Over the

46

years since its inception as a profession, rehabilitation counseling has been faced with
opposing viewpoints about the need for specialization.

Wright (1980) describes rehabilitation counseling as a profession which possesses
an extensive body of knowledge and technology but this great and expanding
accumulation of information and skill related to rehabilitation counseling has exceeded the
realm of the practicing generalist. Therefore, he argues that it is necessary for the
rehabilitation counseling profession to accommodate and utilize this expanding knowledge
through specialization.

Wright (1980) provides a comprehensive history of the changing role and ﬁmction
of the rehabilitation counselor since the early days of the profession. In the 19205 when
public rehabilitation was implemented, the rehabilitation counselor was a "jack of all
trades" or was all things to all clients. This is the generalist role where the rehabilitation
counselor is responsible for everything and everyone in a speciﬁed area. Generalists
basically provide a variety of services and serve a variety of clients throughout the entire
rehabilitation process regardless of the client's unique needs. In the mid 19505 when the
federal government began funding rehabilitation counselor education programs, the
"counseling" counselor role emerged (Wright, 1980). At this time there was a singular
training focus on the counseling process which perpetuated the notion that there was a
clear distinction between counseling and other rehabilitation related frmctions. In the mid
19605, counseling as a professional function was moved into proper focus according to
Wright (1980) as one of the facilitating activities in the vocational adjustment of persons
with disabilities. Rehabilitation counselor education programs gave increased emphasis to
traditional rehabilitation functions and began preparing graduates for employment in state
rehabilitation agencies as generalists in various capacities (Wright, 1980).

Another historical perspective on specialization was oﬂ‘ered by Patterson (1957)

who stated that rehabilitation functions other than counseling were "nonprofessional" and

47

argued against including these other ”coordinator" type firnctions into the rehabilitation
counselor curriculum. Patterson recommended that a subprofessional provide these
coordinator functions such as casework and job placement. Later, Patterson (1967) still
adhered to his counselor versus coordinator distinction but acknowledged the diﬁculty in
specializing in the various professional ﬁmctions associated with rehabilitation counseling.
He acknowledged that specializing in just the counseling ﬁmction would serve to break the
client into individual parts and thus fragment the total rehabilitation process. Patterson
(1967) felt that specialized training should occur above and beyond the two year master's
program in rehabilitation counseling and that rehabilitation counselor education should
concentrate on the counseling function during this two year program.

DiMichael (1967) proposed a two-way classiﬁcation system of rehabilitation
counselor specialization. He discussed horizontal specialists as those who work with a
particular disability type and vertical specialists as those who provide one function in the
rehabilitation process. DiMichael (1967) argued that being either a horizontal or vertical
specialist sacriﬁces the continuity of the rehabilitation process and felt that a role
encompassing both types of specialization was optirmrm. Empirical research served to
support his proposal (e. g. Sather, Wright, & Butler, 1968; Ayer, Wright, & Butler, 1968).

Wright (1980) proposed that it would be most desirable to combine DiMichael's
(1967) argument for case continuity with the expertise of a specialist to ensure the
effectiveness of rehabilitation services. Wright (1980) also felt that the role of specialist
should include education or preparation which is above and beyond the rehabilitation
counseling master’s degree. He stated that specialization was needed in rehabilitation

based on the following issues:

1. The challenge of an expanding base of knowledge and the diﬁculty that practitioners
have in keeping up to date with new knowledge and the new literature relevant to
rehabilitation.

48

2. The pressures of accountability which are upon the rehabilitation process, agency, and
profession.

3. The challenge to maintain a level of ﬂexibility and innovation to accommodate
expanding needs, services and client populations.

4. The need for recognition of new groups of rehabilitation specialists who perform client
services which are not of a cormseling nature.

Most specialists operate within an existing discipline, institution or profession.
Specialists are employed to perform tasks or frmctions which are unique to a discipline and
are consistent with the goals and philosophies of that discipline. Nadolsky (1975) stated
that specialization or the development of specialized ﬁelds within a discipline is
accomplished through the elevation of one or more functions related to the discipline to
the status of a role. An example in rehabilitation would be vocational evaluation as it has
become a specialized discipline by elevating to a role selected ﬁrnctions of the vocational
rehabilitation counselor (N adolsky, 1975.)

In his article discussing trends in rehabilitation counselor specialization, Thomas
(1982) uses the term specialization but indicates that the terms "subspecialization" or
"emphasis" would be more appropriate. In Thomas's (1980) opinion, rehabilitation
counseling is a specialization within the ﬁeld of counseling and thus ﬁuther specializations
would in fact be subspecializations. He indicates that ﬁrrther specialization or
subspecialization is virtually inevitable for rehabilitation counseling based on the following

[88801182

1. Rehabilitation counselors, educators, and students have diverse interests and abilities.

2. University training programs have diﬂ‘erent capacities to oﬂ‘er various types of
instruction.

3. There are a variety of extensive roles and functions expected of rehabilitation
counselors.

49

4. Clients served in the rehabilitation process possess a wide variety of disabilities.

5. Rehabilitation counselors are employed in a wide variety of settings which may have
diﬂ‘erent requirements for success.

6. The eﬂ‘ectiveness of the generalist will be limited by the additional knowledge gained
about various client groups and diﬂ‘erent aspects of the rehabilitation process.

7. The rehabilitation counseling ﬁeld is constantly being inundated with new priorities.

8. The federal government has agreed to provide separate funds for graduate programs
which do not conform to the traditional generic training model

Reagles (1981) proposes another perspective of rehabilitation counseling
specialization. He proposes a model of the disciplines related to rehabilitation which he
feels are more contemporary than Thomas's view. He indicates that rehabilitation
principles, knowledge and competencies form the core base of rehabilitation counseling.
Reagles (1981) views rehabilitation counseling and vocational evaluation as disciplines
related to rehabilitation. In other words, rehabilitation is the core profession in which
rehabilitation counseling shares knowledge and expertise.

Nevertheless, it would seem that based on these assertions, specialization or
subspecialization is inherent or inevitable within the ﬁeld of rehabilitation counseling. The
reasons and issues raised by Wright (1980) and Thomas (1982) provide a solid rationale
for the need to encourage specialization within rehabilitation counseling. Thomas (1982)
identiﬁed four broad categories of rehabilitation counselor specialization which currently
exist. He indicated that rehabilitation counselors can specialize to work (a) with speciﬁc
disability groups, (b) in particular settings, (c) providing counseling in speciﬁc life areas,
and (d) in applying particular treatment methods. Private sector and industrial
rehabilitation ﬁt within these categories for specializations as services are provided in

distinct settings and are often provided to speciﬁc disability groups.

50

Private sector rehabilitation was gaining momentum at about the same time that
the specialization debate was becoming more heated. This was evidenced by the
development of a separate professional organization to meet the needs of rehabilitation
counselors in the private sector. The National Association of Rehabilitation Professionals
in the Private Sector was founded in 1977 as this sector's need were not accommodated by
the already existing rehabilitation organizations (Reagles, 1981). Further debate continued
about the merger of professional organizations into a single, independent rehabilitation
counseling organization. Based on the attitudes conveyed by leaders of the professional
organizations a merger became highly unlikely (Parker & Thomas, 1981). Scher (1979)
discussed the survival of the rehabilitation counseling profession in the 19805 as being
dependent upon three factors: (a) practitioners are qualiﬁed to provide rehabilitation
services, (b) an accreditation process is available which develops and enforces standards,
and (c) organizations exist which speak for the needs of everyone. Despite this warning,
the current state of rehabilitation counselor education, accrediting bodies and professional
organizations seems to reﬂect the trend toward specialization in the ﬁeld of rehabilitation
counseling.

Specialization issues are also relevant to disability management as this area of
practice could potentially constitute a specialty area within rehabilitation counseling.
Disability management services occur in a nontraditional setting for rehabilitation
counselors. Services are often provided to speciﬁc disability types which occur frequently
in the workplace. However, prior to concluding that disability management warrants a
position as a specialty or subspecialty area, it is important to empirically deﬁne the speciﬁc

competencies that are needed for eﬂ‘ective service provision.

51

Competengl Studies in Rehabilitation Counseling
Fundamental to the debate regarding rehabilitation counselor specialization,

rehabilitation counseling research has been involved in the development of an extensive
body of knowledge identifying the job ﬁmctions and competencies important to
rehabilitation counseling practice (e.g., Berven, 1979; Emener & Rubin, 1980; Fraser &
Clowers, 1978; Harrison & Lee, 1979; Jacques, 1959; Leahy, Wright & Shapson, 1987;
Muthard & Salomone, 1969; Porter, Rubin, & Sink, 1979; Rubin, Matkin, Ashley,
Beardsley, May, Onstott, & Puckett, 1984; Wright & Fraser, 1975). These studies have
been undertaken in an attempt to ﬁrrther deﬁne and afﬁrm rehabilitation counseling as a
profession (Walker & Myers, 1988). Szymanski, Linkowski, Leahy, Diamond, and
Thoreson (1993) stated that the foundation of any profession or professional specialty area
is the identiﬁcation and delineation of speciﬁc knowledge and skills which are required for
eﬂ’ective service provision. Findings of competency studies can also establish an empirical
basis for unifying professional activities (Wright, Leahy, & Riedesel, 1987).

Professional competency, role and ﬁmction, knowledge validation, and job analysis
research are terms that describe the process of systematically studying practitioners in a
speciﬁc area of practice to identify important functions and tasks or knowledge and skills
that are associated with the area of practice (Leahy, 1994). Role and firnction research
provides an empirically derived description of the tasks and functions that are associated
with a practitioner’s role. The knowledge that is required to perform functions is indirectly
inferred from the description of the ﬁrnctions and tasks. In contrast, knowledge validation
and professional competency studies provide descriptions derived directly from
assessments of the knowledge and skills characterizing a particular role, but the actual
functions and tasks performed are indirectly inferred based on the knowledge and skills
needed by the individual for eﬂ‘ective practice (Leahy, 1994).

52

Competencies can be described as existing in three distinct domains: (a)
knowledge (what an individual knows), (b) skill (what an individual can do), and (c)
aﬂ'ective characteristics (personal attributes such as attitudes, values, beliefs, motives)
(Berven, 1987). Competencies descn'be the attributions or characteristics of individuals
performing jobs, whereas ﬁmctions refer to the actual job characteristics

Traditionally, two methods have been utilized most often to identify the
competencies of rehabilitation counselors (Leahy, 1986). One method oﬂen utilized is self
report, survey research which asks practitioners to identify tasks which are important for
eﬂ‘ective practice. Another method used to identify competencies is to directly assess the
tasks performed by rehabilitation counselors. Job task analysis has been used to identify
the requirements of a job and serve as criteria for inferring knowledge, skill and other
characteristics which cause certain behaviors to occur (Leahy, 1986).

In this section a chronological account of the major studies conducted to identify
the important rehabilitation counselor competencies will be presented. Those studies
which speciﬁcally investigated the competencies of rehabilitation counselors in the private
or insurance sector will be discussed later.

Jacques ( 1959) was one of the ﬁrst to conduct a study of rehabilitation counselor
competencies. This study employed a critical incidents approach to a nationwide sample
of 404 rehabilitation counselors and supervisors in various settings and agencies. This
investigation was conducted to: (a) identify the critical job elements of counseling in
rehabilitation settings, (b) identify the training needs of rehabilitation counselors, and (c)
explore the diﬂ‘erences that academic preparation imposes in terms of what counselors
perceive to be critical incidents in counseling situations. Results ﬁom this study identiﬁed
six sub-roles found within the counseling process: (a) creating a therapeutic climate, (b)
structuring-arranging, and structuring-deﬁning limits, (c) gathering information ((1)
evaluating, (e) giving information, (f) interacting. Another important ﬁnding was that

53

the type of behavior reported by trained counselors was diﬂerent ﬁom the behavior
reported by untrained counselors. From this Jacques (1959) concluded that counselors
who had graduate level training were more sensitive and aware of the importance of
critical job requirements.

Ten years later, Muthard and Salomone (1969) conducted what was to become a
landmark role and function study in the ﬁeld of rehabilitation counseling. This study was
sponsored by the American Rehabilitation Counseling Association and was undertaken to
provide information for the rehabilitation counseling profession regarding their work role.
A stratiﬁed random sample of 378 rehabilitation counselors employed by state vocational
rehabilitation agencies, state agencies for the blind, and private non-proﬁt agencies were
surveyed using the Rehabilitation Counselor Task Inventory. The task inventory identiﬁed
a range of duties performed by rehabilitation counselors through a task analysis. This
study posed a number of research questions including: (a) what functions are performed
by rehabilitation counselors in various settings, (b) to what extent are the work setting
and characteristics of counselors related to their actual functions, and (c) what are the
implications of the study for rehabilitation counselor preparation. The study's ﬁndings
identiﬁed eight major categories which described the rehabilitation counselor's role: (a)
aﬂective counseling, (b) eligibility and case ﬁnding, (c) group procedures, (d)
placement, (e) vocational counseling, (t) test administration, and (g) test interpretation.
The study also found that approximately one-third of rehabilitation counselor’s time was
spent on counseling and guidance activities while approximately 25% of time was spent on
other duties such as case reporting and recording and performing clerical-type tasks
Based on the study's ﬁndings Muthard and Salomone (1969) reported that a generic
curriculum for rehabilitation counselor preparation was appropriate. Since 1969, a
number of researchers have either replicated or extended this work by Muthard and

Salomone.

54

Using a smaller regional sample, Fraser and Clowers (1978) attenrpted to
determine how rehabilitation counselors were spending their time and also the level of
difﬁculty of their job functions. This investigation surveyed 78 vocational rehabilitation
counselors who were attending a conference on severe physical disabilities. A function
survey was developed based on reviews and categorization of rehabilitation counselor
tasks by rehabilitation educators and agency counselors. Fiﬂeen ﬁmctions were identiﬁed
and rehabilitation counselors were asked to provide an estimate of the amount of time
spent in each ﬁmction during an average work week and to provide a rating in regard to
the ﬁmctions complexity. Results of this investigation revealed that counseling and
planning, and case recording and reporting were judged by rehabilitation counselors to be
the most time consuming ﬁrnctions. Counseling and planning consumed 20% of
rehabilitation counselor's time and case recording and reporting consumed approximately
16% of their time in an average week Of these more time consuming ﬁrnctions, only
counseling and planning were rated as highly complex Fraser and Clowers (197 8)
concluded that the results revealed slightly less time spent in counselor-client functions
and reduced time spent in professional growth or public relations activities as compared to
earlier studies.

Role and ﬁmction studies have been widely used to determine training needs for
rehabilitation counselors and to develop rehabilitation counselor curriculums which
adequately prepare graduates for effective practice. Berven (1979) stated that in order for
rehabilitation counseling training programs to address the most critical training needs, they
nurst ﬁrst be identiﬁed. Berven (1979) subsequently conducted an investigation to deﬁne
the training needs of rehabilitation counselors employed in the state agency in Region II.
This study attempted to deﬁne the pre-professional training needs of rehabilitation
counselors by determining the importance of various areas of competence. The sample

utilized for this study included 680 rehabilitation counselors and supervisors from Region

55

H as well as a nationwide sample of 70 trainers. The Rehabilitation Training Needs
Questionnaire was constructed for use in this investigation and was developed on the basis
of a literature review to deﬁne the areas of knowledge and skill required of rehabilitation
counselors. The study revealed six areas of competence which received the highest
rankings and Berven ( 1979) designated the following areas as the highest priority of pre-
professional training needs: (a) psychological information, (b) case management, (c)
medical information, (d) resource utilization and job placement, (e) counseling, and (f)
special rehabilitation problems.

Emener and Rubin (1980) also conducted a study using a survey research design to
determine an accurate description of the role and function of the rehabilitation cormselor in
the late 19705. They asserted that Muthard and Salomone's (1969) study provided an
accurate picture of rehabilitation counseling in the mid 19605 but competency studies
conducted since that time using smaller samples were showing an indication that this role
was changing (e.g., Fraser & Clowers, 1978; Parham & Harris, 1978; Rubin & Emener,
1979; Zadny & James, 1977). Emener and Rubin's (1980) investigation sought to identify
a number of issues, speciﬁcally the following research questions were addressed in the
study: (a) to what extent are the items on the Abbreviated Task Inventory a part of the
rehabilitation counselors job, (b) do rehabilitation counselors desire changes in their roles
and functions, and (c) to what extent are the roles and functions of rehabilitation
counselors similar to those reported by rehabilitation counselors in the mid 19605. A
nationwide sample of 352 rehabilitation counselors, administrators and educators were
surveyed using the Abbreviated Task Inventory which was developed by Muthard and
Salomone (1969). This investigation yielded many ﬁndings but was signiﬁcant in that
although many of the job tasks were reported as being substantial parts of rehabilitation

counselors job regardless of work setting, speciﬁc differences were found. For example,

56

state agency counselors attributed higher importance to tasks such as test interpretation,
medical referral, and eligibility case ﬁnding.

In 1984, Rubin, Matkin, Ashley, Beardsley, May, Onstott and Puckett examined
the work duties of certiﬁed rehabilitation counselors employed in a variety of work
settings. The Job Task Inventory was administered to a nationwide sample of 6,400
certiﬁed rehabilitation counselors with a 17.6% response rate. This study attempted to
identify the roles and functions of certiﬁed rehabilitation counselors and to determine if the
roles and functions differed across employment settings A factor analysis of the
responses revealed ﬁve major work categories and 11 subcategories. Additionally, the
data analysis revealed signiﬁcant diﬂ‘erences in perceived importance of various work
tasks according to the rehabilitation counselors work setting.

Results from earlier studies which revealed diﬂ‘erences in work tasks across work
settings provided a stimulus for a group of researchers from Wisconsin to further
determine the signiﬁcance of this important ﬁnding. Leahy, Shapson, and Wright (1987)
conducted the ﬁrst empirically based eﬂ‘ort to investigate three specializations of
rehabilitation counseling (rehabilitation counseling, job placement and development, and
vocational evaluation) across three primary employment settings (public agencies, private
nonproﬁt facilities, and private for -proﬁt ﬁrms). The study attempted to address these
speciﬁc research questions: (a) what are the patterns of competency importance for the
three specializations of practitioners, and (b) do perceptions of competency importance
and attainment diﬂ‘er according to practitioner specialization and employment setting. The
Rehabilitation Skills Inventory (RSI) was developed for this investigation and was
considered to be a comprehensive, standardized questionnaire of knowledge and skill
competencies. The RSI was empirically veriﬁed through extensive ﬁeld tryouts and
rigorous pretesting. Sample frame construction was also a major task as no pre-existing

sampling ﬁame was available that adequately stratiﬁed practitioners by specialization and

57

sector. A sample of 3,614 participants was selected for this study and a response rate of
37.1% was obtained. A cluster analysis was performed on responses and yielded ten
chrsters of items: (a) vocational counseling, (b) assessment planning and interpretation,
(0) personal adjustment counseling, (d) case management, (e) job placement, (f)
group and behavioral techniques, (g) professional and community involvement, (h)
consultation, (i) job analysis, and (j) assessment administration. The results from this
study oﬂ’ered many interesting ﬁndings for the ﬁeld of rehabilitation counseling. The
ﬁndings revealed that the three specializations of rehabilitation counseling shared a
common core of competencies but there were signiﬁcant diﬂerences in the level of
importance attributed to the various competencies Diﬂerences in the perceptions of
competency importance were also revealed in relation to the employment settings of
practitioners. Thus, the results from this study provided support to previous research
which indicated that setting-based factors inﬂuence the importance of practitioner
competencies.

Most recently, the Council on Rehabilitation Education (CORE) and the
Commission on Rehabilitation Counselor Certiﬁcation (CRCC) initiated an on-going
research project co-sponsored by the American Rehabilitation Counseling Association
(ARCA) and the National Rehabilitation Counseling Association (NRCA). The purpose
of this on-going research project was to conduct research for continual validation and
updating of the CORE standards for rehabilitation counseling curriculums and the CRCC
examination content areas across settings and over time (Szymanski, Linkowski, Leahy,
Diamond, and Thoreson, 1993). The rationale for this longitudinal, knowledge validation
study was based on current trends in rehabilitation-related legislation, expanding
employment settings and client populations, and new technologies and service delivery
strategies (Jenkins, Patterson, & Szymanski, 1992). They recognimd that competency

58

areas which emanate ﬁ'om these trends must be examined and incorporated into
rehabilitation education programs in addition to accreditation and certiﬁcation standards.
The nationwide sample used for this investigation consisted of certiﬁed
rehabilitation counselors and individuals graduating ﬁom CORE accredited rehabilitation
cormselor education programs. The instrument developed for this study contained items
ﬁom the CRCC examination content areas or the CORE curricular standards The
purpose of this study was to examine and validate the importance of empirically derived
knowledge domains in rehabilitation counseling. The study found that grouping
respondents according to their employment settings and job titles accounted for the most
frequent diﬂerences in knowledge importance. The researchers concluded that the results
ﬁom this study provided a clear description of the professional identity of rehabilitation
cormselors by identifying the knowledge base upon which services are provided (Leahy,

Szymanski, & Linkowski, 1993).

Research efforts to further deﬁne rehabilitation in the private for proﬁt sector.

Based on previously cited research, it is evident that setting-speciﬁc factors
account for variability within rehabilitation cormselors' work roles and may also account
for diﬂ‘erences in counselors' perceptions of important competency or knowledge areas
needed for eﬂ‘ective service delivery. Fienberg and McFarland (1979) stated that among
the many factors which inﬂuence the rehabilitation counselor's role and ﬁmction, the work
setting in which the counselor is employed is considered to be an extremely potent variable
in determining the nature of professional practice. These assertions along with the
empirical evidence supporting the variability of role and functions across rehabilitation
counseling employment settings, provided a stirrmlus for researchers to take a closer look

at the role of the rehabilitation counselor in the private for proﬁt sector.

59

Lynch & Martin (1982) began research eﬂ‘orts in private sector rehabilitation
practice based on the rationale that employment opportunities for rehabilitation counselors
‘ in this sector had continued to increase and there was very little research which examined
whether educational preparation programs were adequately preparing graduates for this
sector of practice. The purpose of their study was to begin the process of determining the
various knowledge and skill areas which were considered to be important for effective
provision of rehabilitation in the private sector. The sample for this investigation consisted
of 147 members of the National Association of Rehabilitation Professionals in the Private
Sector (NARPPS). A survey instrument was developed based on a review of the literature
in the area of rehabilitation counseling in the private sector and consisted of 41 items.
Survey items were analyzed using descriptive statistics. The study found that a number of
knowledge and skill items which are typically associated with rehabilitation education
were also rated as important by private sector rehabilitation practitioners However,
Lynch & Martin (1982) indicated that based on their ﬁndings, some changes in traditional
course oﬂ‘erings may be warranted. Private sector rehabilitation practitioners in this study
rated of primary importance items such as assessment, job analysis and placement, and
communication and organization Of least importance were items related to generic
interpersonal counseling.

Matkin (1983) conducted a similar study to identify the functions of the
rehabilitation counselor working in the private sector. The rationale for his study
emphasized that research eﬂ‘orts prior to this time did not address the roles and functions
of rehabilitation specialists in the private sector. Subsequently, Matkin (1983) conducted
this national study directed toward rehabilitation specialists employed within insurance
companies, private rehabilitation companies, self-insured industrial settings, and private
practice. The sample consisted of 850 NARPPS members or individuals who were
employed by NARPPS members. The Rehabilitation Specialists Task Inventory was

60

developed for this study and consisted of 132 items gathered ﬁ'om past competency
studies and literature describing the tasks of the private rehabilitation specialist. A factor
analysis of responses revealed ﬁve major work role categories. These work role
categories were as follows: (a) planning and coordinating client services, (b) business
and omce management, (c) job development and placement, (d) diagnostic assessment,
and (e) other professional activities. Based on this study, Matkin (1983) provided
recommendations for rehabilitation education, credentialling in the private sector, and
cooperation between public and private sectors.

In 1984, Matkin and Riggar conducted two national studies which were basically
designed to gather demographic information about the rise of private sector rehabilitation
employment and its eﬂ‘ect on graduate level training programs. Although these
investigations are not competency studies, it is important to note their ﬁndings as they
supported the trend toward private sector employment for rehabilitation counselors and
validated the need to continue research eﬂ‘orts in the area of practice. Matkin and Riggar
(1984) found that based on their review of the literature increased attention was being
given to employment in the private for proﬁt sector. Additionally, they cited the sudden
increase in membership within the National Association of Rehabilitation Professionals in
the Private Sector during its ﬁrst nine years of existence (1977-1986) as evidence of
increasing private sector employment for rehabilitation counselors. Two concurrent
studies were conducted of NARPPS members and National Council on Rehabilitation
Education (N CRE) members Participants were surveyed and responses revealed that
there was in fact an increase in employment opportrmities within the private sector and
that these opportunities were inﬂuencing rehabilitation counselor education programs.
Speciﬁcally, additional courses were being developed which addressed private sector
issues and interactive strategies with private sector rehabilitation providers were being

employed that enhanced the preparation of graduates

6l

Matkin (1987) continued to move ahead with this line of research identifying the
role and function of private sector rehabilitation practitioners. He recognized that
rehabilitation services were rapidly erqranding into insured health care programs (e. g.
personal injury protection policies, workers' compensation, Social Security) and the skills
needed in these areas of practice were not reﬂected in the traditional coursework of
rehabilitation cormselor education programs. As a result, Matkin (1987 ) stated that
consumers of such services and practitioners began to look for information and resources
that could provide them with knowledge of various disability insurance systems. Based on
this need, Matkin reviewed results from a study conducted by the Board for Rehabilitation
Certiﬁcation (BRC) which identiﬁed work ﬁmctions and knowledge requirements in
"insurance rehabilitation". Results from this two year study revealed four knowledge
areas which reﬂected service provision in this area of practice. The four knowledge areas
derived were as follows: (a) rules, regulations, policies, and procedures of disability
compensation systems; (b) service applications within disability compensation systems;
(c) forensic rehabilitation; and (d) cost containment and resource acquisition. After
considering this study's ﬁndings, Matkin (1987) proceeded to recommend training sites
which would allow for knowledge acquisition in insurance rehabilitation

Gilbride, Connolly, and Stensrud (1990) surveyed and interviewed employers of
insurance rehabilitation specialists to determine which knowledge, case handling, and
personal skills outcomes they felt were most important to obtain ﬁom graduate
rehabilitation counselor education programs. A 28-item instrument was developed for this
investigation to obtain information from employers of insurance rehabilitation specialists
on the educational outcomes they desired ﬁ'om rehabilitation education programs. The
instrument was constructed ﬁom a review of insurance rehabilitation literature and
consisted of three sections: (a) knowledge, (b) case handling skills, and (c) personal
skills. The survey was distributed to all of the major insurance rehabilitation employers in

62

Iowa. Results indicated that insurance rehabilitation employers found job placement and
development techniques, job analysis/modiﬁcation/restructuring, transferable skills analysis
and case management as the most important knowledge areas desired. The most
important case handling skills were time management, decision making, and writing. The
most important personal skills desired were independent working ability and
organizational skills. The results from this investigation were used by Gilbride, Connolly,
and Stensrud (1987 ) to design a market driven model of private rehabilitation curriculum
development.

Finally, in the area of disability management, currently no competency studies have
been published However, in 1993 a pilot study entitled "The Role of the Rehabilitation
Counselor in Disability Management" was conducted (Scully & Habeck, 1993). The
purpose of this study was to identify the key functions performed by rehabilitation
counselors in disability management and to identify the important knowledge and skill
areas needed for eﬂ‘ective disability management service provision An instrument was
developed for this investigation based on a review of relevant literature from vocational
rehabilitation, business and health, and workers' compensation. Subjects consisted of a
nationwide sample of 70 rehabilitation counselors who attended a conference at Michigan
State University on the rehabilitation counselor's role in disability management. Survey
responses were categorized and analyzed according to three major work settings: (a)
internal providers, (b) insurance based providers, and (0) external providers.
Participants in the study were asked to list the key functions that they performed in
relation to disability management and were also asked to rate 35 items according to their
perceived importance when providing disability management services. Although there
were several areas of divergence among major work settings of disability management
practitioners, there was agreement that several core aspects of the rehabilitation

counselor's role were inherent in the role of the disability management provider.

63

Rehabilitation counselors in disability management reported that knowledge about
disability-related legislation and beneﬁt systems was needed in addition to a number of
other tasks related to developing and maintaining a systematic process aimed at returning
injured/disabled workers to productive employment. 'Speciﬁc tasks included development
of a positive working relationship with injured workers and assessing medical and
employment information in order to develop return to work strategies.

This study revealed that very few of the individuals were actually employed within
the employer organization as rehabilitation counselors but it was also felt that this minority
group of providers could oﬂ‘er a more direct view of the needs of employers in the area of
disability management practice. This group of respondents demonstrated the importance
of interventions which focused directly on the organization. External providers on the
other hand reported more involvement in tasks such as mitigating psychosocial barriers to
return to work, utilizing comrmmity resources, identifying transferable skills, and
monitoring the medical aspects of a case. This study revealed many interesting ﬁndings
and served as a pilot investigation for the proposed investigation involving disability
management practitioners.

As is characteristic of role and ﬁmction and competency study ﬁndings,
implications for rehabilitation counselor education have been identiﬁed. With the shift
from public sector employment for rehabilitation counselors to private-for-proﬁt
rehabilitation settings, rehabilitation counselor education programs have attempted to
incorporate competency study ﬁndings into their curriculums. The rehabilitation
counseling literature has reﬂected the attempts of rehabilitation counselor educators who
have provided recommendations and proposed curriculums aimed at addressing the needs
of practitioners in the private sector (e. g. Sales, 1979; McMahon & Matkin, 1983; Matkin,
1983; Crystal, 1987; Scoﬁeld, 1987; Gilbride, Connolly, & Stensrud, 1990; Kilbury,
Benshoﬂ‘, & Riggar, 1990; Rasch, 1992).

In conclusion, the literature review creates a context and rationale for the
proposed study which will attempt to delineate the competencies required of practitioners
providing services in disability management. The shiﬂ ﬁom public sector rehabilitation to
private sector rehabilitation and subsequently industry-based rehabilitation eﬂ‘orts have
been major factors inﬂuencing the emerging role of the rehabilitation counselor in
disability management. Factors both within the ﬁeld of rehabilitation counseling and
within the business community have contributed to the evolution of the disability
management approach. As the review of competency studies has demonstrated, the role
of rehabilitation counselors varies greatly across diﬂ‘erent settings. Thus, it is reasonable
to conclude that the emerging area of disability management as it relates to rehabilitation
counseling will experience some divergence from the traditional rehabilitation counseling
competencies as well. None of the earlier conrpetency studies conducted have speciﬁcally
addressed the knowledge and skills required for disability management practitioners.
Therefore, this investigation could provide practitioners and educators with nnrch needed
information regarding this area of practice. Based on the specialty literature in
rehabilitation counseling, disability management services are considered to occur in a
nontraditional service setting for rehabilitation counselors and could potentially represent a
specialty area for practitioners. However, before concluding that disability management is
a viable specialty within rehabilitation counseling, it is necessary to further examine the
speciﬁc knowledge and skill base on which services are provided.

Habeck, Kress, Scully, & Kirchner (1994) asserted that if the rehabilitation
counseling profession wishes to make a signiﬁcant contribution to disability management,
it will be important to identify and address the areas where its activities and competencies
do not match the goals and competencies required for effective disability management.
This proposed study will attempt to identify these speciﬁc areas where disability

management knowledge and skills match and do not match those associated with

65

traditional rehabilitation counseling practice and to offer implications for addressing

competency needs in this area of practice.

Chapter III

Methodology

The purpose of this study was to identify and delineate the knowledge and skills
perceived to be important by disability management service providers. In addition, this
study explored the reported preparedness of disability management practitioners in the
important knowledge and skill areas. The ﬁndings ﬂom this investigation can provide
empirically derived competencies that will identify the knowledge and skill areas important
to rehabilitation counselors in disability management. Furthermore, the ﬁndings can
provide an empirically-derived knowledge and skill base ﬂom which rehabilitation
counselor's in disability management practitioners can draw for effective service provision.
A survey research design was utilized with a nationwide pool of subjects involved in

disability management service provision.

Subjects

Descgp' tion of the sa_mple.
The sample used in this investigation consisted of subjects drawn ﬂom a

nationwide, accessible population of practitioners who were believed to be involved in
disability management service provision. No pre-existing sampling ﬂame existed for
individuals providing disability management services in the United States. Therefore, a
rmique sampling ﬂame was constructed for use in this investigation based on the names of
practitioners collected ﬂom four distinct sources. The four sources used in sample ﬂame
construction were as follows

The ﬁrst source included rehabilitation counselors who participated in a national
disability management conference held in ere 1995 at Michigan State University. This
conference, "Disability Managers' Training Conference: Reﬁning and Expanding Skills for

67

the Worlquace", was attended by approximately 180 rehabilitation counselors and other
professionals were either directly involved in providing disability management services or
who were interested in learning more about this area of practice. Many of these
participants responded to a pilot study speciﬁcally examining the role of the rehabilitation
counselor in disability management. The responses of these "pioneers" in the ﬁeld of
rehabilitation and disability management served as the basis for development and
validation of the Disability Management Skills Inventory, which was used for this current
investigation The participants ﬂom the conference were appropriate to involve in this
follow-up investigation based on their previous exposure to disability management
concepts and practices. In addition, these participants were presumed to be involved in
disability management based on their known work aﬂiliation or interest in disability
management. The Disability Management Skills Inventory, the Demographic
Questionnaire, and a detailed cover letter were distnhuted to 87% of conference attendees
for a total of 156 individuals. Those selected to receive the survey were those individuals
who did not appear on other lists comprising the sampling ﬂame and who were not
conference personnel.

The second source of practitioners used for sample ﬂame construction was the list
of individuals who attended the fall 1994 conference sponsored by the Washington
Business Group on Health (WBGH), a major national organization representing large
employers on issues related to health care. For the past nine years, the WBGH conducted
the National Disability Management Conference dealing with current issues facing
employers regarding disability management. The conference is attended by employers,
insurers/third party administrators/beneﬁts administrators, case managers, risk managers,
public employers, labor representatives, occupational health nurses, rehabilitation
professionals, employee assistance professionals, social workers and psychologists. A list

of the 1994 conference participants was obtained and used as the second major source of

68

subjects for sample ﬂame construction. The individuals attending the WBGH conference
on disability management are a cross-disciplinary group of program and policy
administrators and practitioners involved in disability and injury management. These
individuals are appropriate for this investigation based on their involvement in disability
management and their cross-disciplinary nature. These practitioners have had exposure to
disability management concepts and practices as demonstrated by their attendance at the
disability management conference. The list of participants for this conference consisted of
440 individuals. Thirty-ﬁve percent of these individuals were chosen for participation the
study. Systematic random sampling procedures were used and every third name was
chosen for inclusion in the study thus yielding a total of 150 individuals. These 150
individuals received the Disability Management Skills Inventory and the Demographic
Questionnaire and were asked to participate in the study.

Work Injury Management subscribers comprised the third source for sample ﬂame
construction. Work Injury Management (WIM) is a publication with 400 subscribers who
are currently involved or interested in disability and injury management. Most WIM
subscribers are physical therapists or occupational therapists. WIM holds an annual
conference related to these themes. For example, the 1995 Work Injury Management
conference was entitled "The Application of Principles of Quality Management to Reduce
Work Injury Costs." This conference is typically attended by approximately 550 physical
and occupational therapists, vocational rehabilitation specialists and employers who are
either interested in managing and controlling workplace injury and disability or those
currently providing these services. The WIM srrbscnher and conference participant lists
were combined to comprise this third source of sample ﬂame construction These lists
were then cross-referenced with the MSU and WBGH conference participant lists to
eliminate duplication of names. This combined list of WIM conference participants and

subscribers consisted of 1431 names. Systematic random sampling procedures were used

69

to select individuals ﬂom these lists. Twenty percent of these individuals were chosen for
participation in the study. Every seventh individual was selected ﬂom this list yielding a
total sample of 204. These individuals were mailed the Disability Management Skills
Inventory, the Demographic Questionnaire and were asked to participate in the study.

The ﬁnal source used for the sampling ﬂame were lists of rehabilitation counselors
currently certiﬁed through the Commission on Rehabilitation Counselor Certiﬁcation. A
list of certiﬁed rehabilitation counselors employed in the private sector was obtained for
Michigan, Ohio and California. These states were chosen based on their activity level and
involvement in disability management and their progressive strategies aimed at dealing
with workplace injury and disability. Those certiﬁed counselors currently employed in the
private sector including insurancebased rehabilitation practitioners were identiﬁed and
included in the accessible population of disability management providers for this study. A
total of 1170 individuals comprised this list. Twenty-ﬁve percent of this population was
chosen for inclusion in the study. Systematic random sampling procedures were employed
and every fourth individual was selected yielding a total of 290 individuals who received a
survey. When completing the actual survey, private-for-proﬁt or insurance based
rehabilitation counselors were asked to indicate whether they were currently involved in
providing disability management services because little information was available to
validate this groups' involvement in disability management. Those individuals who were
not currently involved in providing disability management services designated such on the
demographic questionnaire and were instructed not to complete the Disability
Management Skills Inventory.

Lists ﬂom the above mentioned sources: Participants ﬂom the Michigan State
University Disability Manager's Training Conference, the Washington Business Group on
Health annual disability management conference, Work Injury Management annual

conference, and the selected three-state private sector sample ﬂom the Commission on

70

Certiﬁcation for Rehabilitation Counselors were thoroughly reviewed to avoid duplication
of names. Names ﬂom these four lists of practitioners comprised the accessible

population of subjects ﬂom which the sample was drawn for use in this investigation.

Sampling procedures.
The four groups of subjects used for sample ﬂame construction remained separate

for sampling purposes. In order to maximize the amount of data collected, with
consideration given to the cost constraints imposed on this investigation and the precision
desired, proportional sampling was conducted within each of the four population sources
based on previous knowledge about the group memberships' involvement in providing
disability management services. Based on knowledge of these population sources the
variability within and across each group was erqiected to be low. Therefore, for those
individuals involved in disability management, no distinct diﬂ‘erences were expected to
occur with respect to subjects' motivation or commitment toward performing disability
management services. However, the group of rehabilitation cormselors ﬂom the CRCC
group were an unknown entity in that members may or may not have been providing
disability management services during the time that the study occurred. This information
was not known rmtil aﬂer subjects were selected and the questionnaire was returned It
was felt that the conference participant groups were known entities in regard to their
involvement in disability management and a higher number of subjects were selected ﬂom
these population sources in an attempt to obtain a higher rate of usable responses ﬂom
participants. It was also felt that conference participants would be more likely to respond
based on their commitment to obtain more information about disability management as
demonstrated by their attendance at disability management conferences

Systematic random sampling procedures were conducted within three of the four
sources that were used to construct the sampling ﬂame. Systematic sampling procedures

71

stipulate that every kth subject is chosen systematically for inclusion in the sample. To
guard against any human bias in using this method, the ﬁrst subject is chosen at random
using a table of random numbers. The subject with that number is then included in the
sample along with every kth subject (determined by the sampling ratio and sampling
interval) that follows (Babbie, 1983 ). A total number of 800 subjects were sampled ﬂom
the four groups comprising the accessible population of subjects. A response rate of 40%
was anticipated yielding a total number of usable surveys that would satisfy guidelines for
conducting factor analysis . Liberal guidelines for conducting a factor analysis indicate
that the sample contain at least 100 subjects and that there be between a 4:1 to 2:1 ratio of
observations to variables. A 40% response rate would satisfy these guidelines by
providing a 3:1 ratio of observations to variables. Furthermore, this response rate would
satisfy conditions for conducting multivariate analysis of variance (MAN OVA) which
indicate that all cells of the respondent groups must be greater than the number of
dependent variables used in the study (Hair, Anderson, Tatham, & Black, 1992).

Instrumentation

Instrument development.

The purpose of this study was to identify the knowledge and skills performed by
disability management practitioners that they perceived to be important in achieving the
desired outcomes of the disability management approach. These variables were assessed
across three provider settings and six professional classiﬁcation groups. In order to obtain
valid information that can be analyzed in relation to the purpose of this investigation, a
questionnaire with 101 knowledge and skill statements was developed This questionnaire
will be referred to as the Disability Management Skills Inventory (DMSI) (See Appendix
A). A ten item demographic questionnaire was also developed to obtain descriptive
information about the sample of disability management providers (See Appendix B).

72

The Disability Management Skills Inventory (DMSI) was a composite of the
Rehabilitation Skills Inventory (RSI) (Leahy, Shapson & Wright, 1987) and an original
inventory entitled "The Role of the Rehabilitation Counselor in Disability Management"
(Scully & Habeck, 1993) used in a 1993 pilot study identifying the knowledge and skills
needed by rehabilitation counselors to provide eﬂ‘ective disability management services.
The Rehabilitation Skills Inventory (RSI) developed by Leahy, Shap son and Wright
(1987 ) was used in a comprehensive research project investigating rehabilitation counselor
competencies across service settings, conducted under the administrative auspices of the
National Council on Rehabilitation Education

The development of the original pilot- study knowledge and skill inventory was
based on two strategies: (a) literature review and development of a pool of competency
items, and (b) consultation and review by an expert content panel The following
methodologies were employed for the development of the pilot study knowledge and skill
inventory. Literature ﬂom the ﬁelds of vocational rehabilitation, business and health and
workers' compensation was reviewed. Knowledge and skill statements representing the
critical competencies needed by disability management providers were identiﬁed. These
knowledge and skill items were then rewritten so that each statement began with a verb as
indicated by Fine and his associates (Fine, 1973; Fine, Holt, and Hutchinson, 1974; Fine &
Wiley, 1971). This original questionnaire entitled "The Role of the Rehabilitation
Counselor in Disability Management" (See Appendix C) was a combination of structured
and unstructured items that allowed respondents to identify the key functions of their jobs
related to disability management and to respond to the importance of 35 knowledge and
skill items.

Once initial revisions were performed on the pilot study instrument, a panel of
professionals prominent in disability management and knowledgeable in disability

management content, independently reviewed the instrument for clarity, representation of

73

disability management practice, consistency of word use, and elimination of redundant
statements.

The pilot study instrument was then arranged into four sections beginning with
respondents' self-categorization of the primary work setting in which they provide
disability management services and unstructured items asking respondents to list the key
tasks that they perform in their job related to disability management. Section two
consisted of 35 statements that represented disability management lmowledge and skill
areas ﬂom the literature. This section contained a ﬁve-point Likert-type scale (0—4) asking
respondents to rate the importance of these statements according to their signiﬁcance,
relevance, and amount of time spent on each in relation to their role in disability
management. Section three was composed of rmstructured items related to special issues
in disability management such as case management. Section four of the questionnaire
consisted of demographic information.

The pilot study instrument was ﬁrst used to investigate the role of rehabilitation
counselors in disability management (Scully & Habeck, 1993 ). Questionnaires were
distributed to 116 rehabilitation counselors at a national invitational conference entitled
"Rehabilitation Counselors in Disability Management" held at Michigan State University.
Seventy participants responded to the pilot survey, for a response rate of 60%. Structured
and unstructured survey responses were analyzed in an attempt to gain more information
about the tasks and key functions performed by rehabilitation counselors in disability
management. Descriptive statistics were used for analyzing structured survey items that
asked respondents to rate the importance of speciﬁc statements related to their jobs as
disability management providers. Means and standard deviations were calculated based on
the responses to these items. (See Appendix D) Qualitative data were reviewed and actual
responses were recorded and categorized. Individual responses to unstructured survey
items yielded important information about the key functions in addition to the knowledge

74

and skills needed by rehabilitation counselors to provide disability management services.
These responses were thoroughly reviewed to analyze the comprehensiveness of the list of
knowledge and skill statements represented in the original disability management inventory
and to provide validity to the instrument.

Development of the Rehabilitation Skills Inventory (RSI) occurred over a 13-
month time period (November l984-December 1985). Methodology for developing the
RSI included consultation with ermert judges and obtaining input ﬂom a national advisory
committee. Further development stages included empirical veriﬁcation of the instrument
through ﬁeld testing and rigorous pro-testing methods. Four main stages characterized the
development of the RSI: (a) systematic literature review and development of a
comprehensive pool of competency items, (b) review of the initial items by a national
panel of expert judges, (c) practitioner tryouts of the item quality and instrument format,
and (d) pilot testing with subsequent extensive data analysis (Leahy, Shapson & Wright,
1987)

The Rehabilitation Skills Inventory originally consisted of 114 competency items
(See Appendix E) which were rated on two, ﬁve point Likert-type scales; importance of
skills to respondents primary work role and attainment of skills in meeting client needs.
Reliability estimates of the RSI were obtained using Cronbach's alpha, which yielded
relatively high reliability coemcients for each of the ﬁve item categories that were
developed a priori (assessment—=95; counseling=. 92; placement=.96; case
management=.91; professional development=.93 ). Content validity of the RSI was based
partly on the types of items that were selected ﬂom previous research eﬂ'orts where the
content validity was based on ﬁrnctional job analysis procedures. Validity was also based
on the development methodology used to construct the instrument including ﬁeld trials
and pretesting procedures (Leahy, Shapson & Wright, 1987).

75

The 114 original RSI items were reviewed to determine their relevance and
appropriateness for this investigation. These original items were considered to be a
comprehensive list of skills that are characteristic of rehabilitation counseling practice in
both the public and private setting. On the basis of the documented goals and outcomes
of disability management practice, items were reviewed and a determination was made
about their relevance to disability management. First, items that obtained an overall mean
value of less than 2.00 when rated by rehabilitation counselors were omitted Next, items
that did not relate to disability management practice as determined by the investigator and
could not be modiﬁed to relate to disability management practice. A total of 64 items
ﬂom the RSI were used for the DMSI These items were modiﬁed to be consistent with
disability management terminology and descriptive of disability management practice.
Speciﬁcally, terminology was changed to describe the activities and participants in the
disability-management process.

Thus, the original pilot study instrument and the Rehabilitation Skills Inventory
were adapted and merged to serve as the basis for developing the Disability Management
Skills Inventory. All of the knowledge and skill statements on the original pilot study
instrument with the exception of four items have been included in the Disability
Management Skills Inventory. The four items that were omitted for the DMSI had
obtained an overall mean score of less than 2.0 on the pilot study or the items were
considered redundant when the RSI and the pilot study instruments were combined
Furthermore, four additional items were added based on responses given to the
unstructured item asking rehabilitation counselors to list other skills that they perform
which are critical to their role in disability management that were not mentioned in the
original item list. These four items were constructed based on ﬂequently cited responses
ﬂom the participants. The Disability Management Skills Inventory, that served as the

basis for the expert review panel, consisted of 99 items, 35 ﬂom the pilot study instrument

76

and data analysis and 64 ﬂom the RSI After the experts reviewed the DMSI, two
additional items were added to the instrument. The two additional items dealt with
developing mechanisms for labor and management cooperation and analyzing beneﬁt plans
to ensure support of disability management strategies These content areas had not been
dealt with suﬁciently elsewhere in the instrument. The ﬁnal DMSI was 101 items.

The original importance scale used in the pilot study questionnaire was revised for
use in the DMSI. Originally, respondents were asked to rate the importance of knowledge
' and skill statements based on factors such as signiﬁcance, relevance and amount of time
spent on each. A ﬁve point Likert-type scale (0-4) was used with (0) as not a part of
respondents' jobs and (4) as a most signiﬁcant part of respondents' jobs. The importance
scale was modiﬁed for this current investigation and respondents were asked to rate the
importance of knowledge and skill items in relation for achieving the outcomes of eﬂ‘ective
disability management service provision. This change attempted to help respondents link
the important knowledge and skills directly to outcomes of the disability management
approach.

The 101 knowledge and skill statements comprising the Disability Management
Skills Inventory represent a comprehensive list of knowledge and skill areas characteristic
of rehabilitation counseling and disability management service provision (See Appendix
A). The rationale behind combining the knowledge and skill areas in these two domains of
practice into one comprehensive inventory was to empirically determine the knowledge
and skills perceived to be important to provide eﬂ‘ective disability management services
ﬂom the rehabilitation counselor's perspective. Because rehabilitation counselors have
evolved into roles as a signiﬁcant source of providers in this area, the DMSI was designed
to determine the interaction between disability management activities and rehabilitation
counselor knowledge and skills that practitioners consider to be important when providing

disability management services. Therefore, the sample of subjects consisted of

77

rehabilitation counseling professionals as well as other practitioners involved in disability
management. Obtaining data ﬂom a variety of practitioners provided a cross-disciplinary
perspective of a cross-discipline service arena and allowed comparisons to be made about
the skills and knowledge areas important to disability management practice as viewed by
diﬂ‘erent practitioner groups and their reported levels of preparation in these areas.

All of the DMSI statements were rated on two, ﬁve point Likert-type scales (0-4)
for importance and preparedness (See Table 1). Respondents were asked to consider each
statement and determine to what extent the item was important in achieving the desired
outcomes of disability management in their employment setting. Respondents also
reviewed statements to determine the degree to which they felt prepared in the knowledge
or skill area as a result of their education and training.

The 101 items comprising the DMSI were randomly ordered rather than grouped
into rationally derived categories. The rationale for random assignment was to minimize
any biasing eﬂ‘ect that the groupings of similar task items may have on subsequent ratings
of task importance or preparedness by participants.

The development of the demographic questionnaire for this investigation consisted
of ﬁrst identifying the major information of interest for use in the data analysis of the
study. Information identiﬁed as critical to the study's purpose and research questions were
considered along with other factors believed to have an impact on participant's responses.
The demographic questionnaire used with the Rehabilitation Skills Inventory (1987) was

thoroughly reviewed in relation to the study results to identify factors

Table 1

78

Rating Scales for the Disabirty' ' Management Skills Inventoty

Scale 1.

Scale 2.

IMPORTANCE: To what extent are these knowledge and skill
statements important to achieving the outcomes of eﬂ‘ective disability
management in your employment setting; how critical are these knowledge
and skill statements in achieving the outcomes of eﬂ‘ective disability
management. Evaluate the "importance" as follows:

[0] None: Not important at all
[1] Little: Minor importance

[2] Moderate: Fairly important
[3] High: Substantial importance
[4] Maximal: Essential, crucial

PREPAREDNESS: To what degree do you feel prepared in the
knowledge and skill statements as a result of your education and training?
Consider each statement in relation to the degree in which you feel
prepared as a result of your education or training. Please consider your pre-
service, in-service and continuing education Evaluate your "preparedness"
as follows:

[0] No preparation

[1] Little preparation

[2] Moderately prepared
[3] Highly prepared

[4] Very highly prepared

79

inﬂuencing participants' responses This resulted in a ten-item demographic questionnaire
that obtains identifying information regarding respondents' employment, professional
identity, education, and credentials.

Major items within the demographic questionnaire included: (a) identifying
information, (b) employment, (c) education, (d) professional identity/credentialling.
Speciﬁcally, the demographic portion of the questionnaire asked subjects to self-
categorize into a priori provider categories. Four categories of disability management -
provider settings were established for identifying respondents based on the pilot study.
These categories were as follows: (a) Company employee who directly
provides/administers disability management services in-house (internal providers), (b)
Independent private providers or employees of consulting ﬁrms that are contracted to
provide disability management services (private providers), (c) Providers employed by
insurance carriers or third party administrators who provide disability management
services (insurance based providers), and (d) professionals not currently providing or
administering disability management services.

This investigation employed self-report procedures as a method to determine the
perceived importance and reported preparedness in knowledge and skill areas associated
with disability management. The use of self-report for this investigation was based on the
assumption that practitioners are able and will in fact respond accurately to this survey.
Self-report measures are commonly used to obtain information about respondents as is
evidenced by the wide use of instruments such as interest inventories and attitude surveys
(Bolton, 1985; Nunnally, 1970). Another important consideration when deciding to use a
self-report measure was that it provides information not readily available ﬂom other
sources (Primoﬂ‘, 1980). Many of the competency areas included in the ﬁnal instrument
were knowledge and skill areas that could not be easily observed by others, therefore the

80

practitioner is in the best possible position to evahtate importance and preparedness with

respect to the skill or knowledge area in question.

Precedures

m.

A descriptive design was employed for this study. The descriptive procedures
were a self-report survey of the perceived importance and reported preparedness in the
knowledge and skill areas characteristic of disability management practice. These
variables were analyzed and comparisons were made based on the self-reported responses
to the a priori demographic categories of provider setting and professional classiﬁcation of
respondents.

The dependent variables for this investigation were (a) perceived importance of
knowledge and skills related to the provision of disability management services, and (b)
reported preparedness in these knowledge and skill areas. The independent variables were
(a) provider setting, (b) educational emphasis, (c) level of education, and ((1)

professional classiﬁcation.

Data collection.
After sample selection, mailing labels were developed and tracking books

constructed Subjects were identiﬁed via pre-coding and assigning a single instrument
serial number (pre-printed on the instrument) to individual subjects. The identiﬁcation
number was recorded in the tracking book and on the demographic portion of the
questionnaire.

Following instrument pro-coding, a packet of materials was mailed to each subject
in the sample (N=644) with the exception of Michigan State University’s disability

management conference participants. Packets included the transmittal letter and

81

instructions (See Appendix F), a copy of the DMSI and the demographic questionnaire,
and a self-addressed return envelope. All mailings were sent via ﬁrst class mail in order to
obtain information regarding subjects with undeliverable addresses and to develop an
accurate record of subjects who received the materials. Subjects comprising the Certiﬁed
Rehabilitation Cormselor (p=290) group were mailed packets directly ﬂom the
Commission on Rehabilitation Counselor Certiﬁcation. An additional transmittal letter
was included in the packet explaining mail back procedures and subjects were given three
continuing education credits for completing the survey.

Returns of the questionnaire were monitored daily and reviewed for completeness.
Approximately 4-6 weeks aﬂer the response date indicated on the transmittal letter, a
second complete packet was mailed to non-responding subjects. The packet was basically
identical to the initial packet with the exception of a new transmittal letter (See Appendix
G) reminding participants of the survey and further stressing the importance of their
participation.

During daily monitoring of returns, questionnaires were reviewed for accuracy
especially with regard to self-categorization of employment settings. This information was
veriﬁed by comparing it with demographic information obtained. This process allowed for
daily quality control and accuracy prior to actual data entry. Data was then directly and
manually entered onto the computer for storage and easy retrieval.

Data collection for the sample group of conference attendees at Michigan State
University's Disability Manager’s Training Conference was completed on-site. Conference
attendees were provided with a packet of materials consisting of the Disability
Management Skills Inventory, the Demographic Questionnaire, a cover letter and a self-
addressed envelope. At the opening of the conference an announcement was made
regarding the nature of the study, the importance of participation, and directions for

completion Annormcements were made throughout the conference regarding the

82

importance of this research and conference attendee's participation. Attendees were asked
to complete the survey during the three day conference, however, an envelope was
provided for those who preferred to mail their survey after the conference. As numerous
personal announcements were made to this group regarding participation, a complete
second set of materials was not mailed to non-respondents in order to conserve ﬁnancial
resources. A follow-up postcard was mailed approximately 3 weeks after the conference

was over (See Appendix H) to remind conference attendees to mail in their survey.

Data Analysis
Descriptive statistics were computed on sample characteristics ﬂom the

demographic portion of the questionnaire. Speciﬁc continuous variables that deﬁned
selected characteristics of the sample included age and years of paid work experience. For
each of these variables, group means and standard deviations were computed and
displayed in tables for the entire sample, and for the individual sub-sample groups (e.g.,
provider setting, professional classiﬁcation).

In an attempt to further describe this population of rehabilitation counselors
providing disability providers, ﬂequencies and percentages were computed on the
following categorical variables: (a) disability management provider setting, (b)
education level, (0) professional classiﬁcation, (d) educational emphasis (i e., major),
(e) certiﬁcation/licensure status, and, (f) the desirability of such credentials or licenses.

In responding to the ﬁrst research question determining knowledge and skill areas
considered to be important by practitioners in achieving the outcomes of eﬂ‘ective
disability management, descriptive statistics were computed for each lmowledge and skill
item on the DMSI Descriptive statistics were computed based on subject responses to
the ﬁve point Likert-type importance scale. Group means and standard deviations were

calculated for each item by professional classiﬁcation (rehabilitation counselors, business

83

professionals, nurses, physical & occupational therapists, psychologists & social workers,
and others) and provider setting (internal, private consultant, insurance based) and
displayed in table format.

Next, the 101 items on the Disability Management Skills Inventory were factor
analyzed. The purpose of the factor analysis was to condense or summarize the
information contained in the original 101 dependent variables into a smaller set of new
composite dimensions while minimizing loss of information. The factor analysis is
intended to deﬁne the fundamental constructs or dimensions underlying the original
knowledge and skill statements (Hair, Anderson, Tatham, & Black, 1992). Common
factor analysis was used to obtain a factor solution. Common factor analysis is aimed at
explaining common variance or the variance that is shared by the actual items as opposed
to principle components analysis which extracts both variance that is unique to variables as
well as error variance (Pedhazur and Schmelkin, 1991). Common factor analysis does not
imply that the variables are error ﬂee and do not have speciﬁc variance. In order to
improve the interpretation of the factor analysis, an orthogonal rotational method was
used. The Varimax solution was chosen as it has proved to be successful as an analytic
approach to obtaining an orthogonal rotation of factors. Varimax provides a clear
separation of factors and yields a simple factor solution (Hair, Anderson, Tatham, &
Black, 1992). After reviewing descriptive data for the sample sub-groups and considering
the size of the ﬁnal sample all subjects were used to determine a factor solution.

After conducting the factor analysis, reliability coeﬂicients were calculated through
the computation of Cronbach‘s alpha to determine the internal consistency reliability of
DMSI items within each identiﬁed factor.

In order to respond to the second research question and determine if the ratings of
knowledge and skill items diﬂ‘ered in perceived importance according to provider setting
and professional classiﬁcation, a multivariate analysis of variance was conducted The two

84

independent variables used were: (a) professional classiﬁcation (rehabilitation counselors,
business professionals, nurses, etc. ), and (b) provider setting (internal, extemal, insurance
based). The dependent variables for this analysis were the mean scores on the individual
item factors The MANOVA was conducted to evaluate both main eﬂects (professional
classiﬁcation and provider setting) and interaction eﬂ‘ects (professional classiﬁcation x
provider setting) for each factor. All signiﬁcant F ratios were followed up by post-hoe
comparisons

In order to address the third research question and determine the degree to which
practitioners feel prepared in the knowledge and skill areas as a result of their education
and training, descriptive statistics were computed for each knowledge and skill item on the
DMSI. Descriptive statistics were computed based on subject responses to the ﬁve point
Likert-type preparedness scale. Group means and standard deviations were calculated for
each item by professional classiﬁcation and provider setting and displayed in table format.
For the purpose of analyzing responses on the preparedness variable, the same factor
solution utilized for importance was used for further data analysis on the preparedness
variable.

In responding to the fourth research question regarding whether ratings of
knowledge and skill items diﬂ‘er in reported preparedness according to provider setting
and professional classiﬁcation, a multivariate analysis of variance was conducted The two
independent variables were: (a) professional classiﬁcation (rehabilitation counselors,
business professionals, nurses, other practitioners, etc. ), and (b) type of provider setting
(internal, external, insurance based). The dependent variables for this analysis were the
mean scores on the individual item factors. The MANOVA was conducted to evaluate
both main eﬂ‘ects (professional classiﬁcation and provider setting) and interaction eﬂ‘ects
(professional classiﬁcation x provider setting) for each factor. All signiﬁcant F ratios were

followed up by post-hoe comparisons.

Chapter IV
knits

Characteristics of the Sample

Of the 800 DMSI's distributed to practitioners throughout the nation, nine were
returned as undeliverable and one was returned as inappropriate for the study as the
subject resided in Australia. Of the remaining DMSI's (p=790) distributed, 311 were
returned for an overall response rate of 39.4%. This group will be referred to as the total
sample. Four sources were used to compose the sampling ﬂame for this study. All four
sources consisted of practitioners who were thought to be involved in disability
management by virtue of their group membership. While the overall response rate was
39.4%, response rates among the four sample groups were as follows: Work Injury
Management, 31.6% (p=62); Disability Management Conference, 48.1% (r_r=75);
Washington Business Group on Health, 31.1% (p=46); and, the Commission on
Rehabilitation Counselor Certiﬁcation, 44.1% (r_1=128).

The overall response rate obtained in the study was approximately as expected.
The response rate for this study closely parallels typical response rates for survey research
as ﬁrst mailings typically yield 30% return rates and subsequent mailings add 10-20%
(Babbie, 1979). Heppner, Kivlinghan, and Wampold (1992) state that there is no agreed
upon, acceptable return rate for survey research and that survey research is oﬂen
published with response rates of less than 40%. Response rates for two of the subsample
groups, the Disability Management Conference and the Commission on Rehabilitation
Counselor Certiﬁcation were somewhat higher than the other two groups. The higher
response rates for these two groups might be erqilained by the larger number of
rehabilitation counselors comprising their membership and that the survey instrument was
develOped ﬂom rehabilitation counseling research Rehabilitation counseling groups

appeared to be more likely to respond as the study represented their concerns and

85

86

perspective on disability management. The groups with a lower response rate had more
diversity within their professional membership and may have been less likely to respond as
the study may not have addressed their perspective on disability management. Further,
diﬂ‘erent participant recruitment strategies were employed for the CRCC group and the
Disability Management Conference and this may have also contributed to a higher
response rate for these two groups. Subjects ﬂom the CRCC group were mailed a
questionnaire directly ﬂom the Commission on Rehabilitation Counselor Certiﬁcation and
were given three continuing education credits for completing the survey. This incentive
may explain the higher response rate for this group. Subjects recruited ﬂom the Disability
Management Conference were recruited for participation via numerous verbal elicitations.
Throughout the duration of the conference announcements were made stressing the need
for participation and the value of their responses. The Disability Management Conference
group had the highest response rate and may be explained by the ﬂequent verbal pleas and
endorsements of conference personnel. The sample is biased based on the higher response
rates for groups predominantly comprised of rehabilitation counselors; however, the
purpose of this study was to further elucidate the rehabilitation cormselor's involvement in
disability management.

Provider settings and professional classiﬁcap'ons of the total smele.
Respondents were asked to identify their current provider setting in disability

management ﬂom these options: internal providers, external providers, insurance-based
providers, and not currently providing. The distribution of provider setting responses of
the 311 individuals responding to the questionnaire were as follows: internal providers,
18.3% (p=57); extemal providers, 47.6% (p=l48); insurance based providers, 12.5%
(n_=39); and not currently providing, 21.5% (r_1=67).

87

There were some problems inherent in the major categorical variable, provider
setting. Nine respondents noted that one category alone could not adequately describe the
setting of their work and subsequently categorized themselves in two provider-setting
categories. Apparently some individuals consider their work as crossing setting lines and
ﬁnd it diﬁcult to identify themselves with only one provider setting, probably reﬂecting
the changing venues of disability management practice today. In order to utilize these
responses for the ﬁnal analysis, these respondent's were re-categorized on the basis of
their predominant employment setting. Predominant work setting was inferred ﬂom
demographic information such as the name of the employing organization, job title, and
professional identity. When respondents listed the proportion of time spent in each
provider setting, this information was considered as well

In regard to the professional background of individuals providing disability
management, respondents were asked to designate their professional identity by choosing
ﬂom a list of 12 oﬂ‘ered and an "other" category. These included: (a) rehabilitation
cormselor; (b) human resource manager; (c) social worker; (d) occupational therapist;
(e) physician; (f) risk manager; (g) nurse; (h) educator; (i) psychologist; (j) physical
therapist; (k) business manager; (1) beneﬁts administrator; and (m) other. For data
analysis purposes, these categories were collapsed into six major categories as follows:
rehabilitation counselors, business professionals, psychologists and social workers, nurses,
physical and occupational therapists, and others Rehabilitation cormselors and nurses
maintained individual categories in the sample. Psychologists and social workers were
combined for their similar clinical orientation and physical and occupational therapists
were combined based on their similar goals of service. Development of the business
professionals category was achieved by combining human resource managers, risk
managers, business managers, and beneﬁts administrators. Originally, 40 individuals
(12.8%) of ﬂom the total sample classiﬁed themselves as "other", including two physicians

and four educators. Nineteen of these individuals were reclassiﬁed into the six merged
categories by inferring professional identity ﬂom reviewing their demographic data. Upon
completion of the recategorization process, the professional classiﬁcation of the total
sample was as follows: rehabilitation counselors, 59.6% (p=177); business professionals,
7.4% (p=23); psychologists and social workers, 4.4% (p=13); nurses, 10.8% (r_r=32);
physical and occupational therapists, 11.1% (n=33); and "others" 6.4% (p=l9). Fourteen
respondents did not designate a professional identity.

An interesting ﬁnding was made while reviewing demographic data for
recategorization of "others" for professional classiﬁcation Eleven respondents with
master's degrees in rehabilitation counseling or vocational rehabilitation related ﬁelds, and
with the certiﬁed rehabilitation counselor credential, had designated themselves as "others"
for professional identity. It appeared that these respondents did not consider themselves
rehabilitation counselors but rather wrote in their professional identity as rehabilitation
consultants, disability managers, or vocational consultants. These individuals were
reclassiﬁed as rehabilitation counselors for data analysis purposes but this ﬁnding may be
important to consider when describing practitioners that provide disability management
services. They may describe their professional identity other than rehabilitation counseling
and prefer terminology such as consultant or disability. manager.

The ﬁnal sample of 244 individuals represented 78.5% of the total respondents and
was used for the major data analyses. A complete summary of the total sample by
subsanrple group and a summary by professional classiﬁcation is provided in Table 2.

Provider settin s an rofession cla ' ' of e 1e.
Respondents in the ﬁnal sample were classiﬁed in the three major provider settings
as follows: internal providers, 23.4% (p=57), external providers, 60.7% (r_1=148), and

insurance based providers, 16.0% (p=39). The ﬁnal sample was categorized in

89

 

 

 

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professional classiﬁcations as follows: rehabilitation counselors, 61.6% (p=149); business
professionals, 7.4% (r_1=18); psychologists and social workers, 3.7% (p=9); nurses,
12.4% (r_r=30); and, physical and occupational therapists, 9.5% (r_1=23); and "others",
5.4% (r_r=13). Two respondents did not designate a professional identity and therefore
constitute missing data on this variable. The distribution of the ﬁnal sample by provider
setting and professional classiﬁcation is provided in Table 3, and the distribution of the
ﬁnal sample by subsample group and professional classiﬁcation is provided in Table 4.

Characteristics of the sampling ﬂame.
The mean age for the ﬁnal sample was 43.3 and the mean ages for the four

subsample groups were as follows: Work Injury Management (WIM), 38.4; Washington
Business Group on Health (WBGH), 42.9; Commission on Rehabilitation Counselor
Certiﬁcation (CRCC), 45.2; and, Disability Management Conference (DMC), 43.8. The
ﬁnal sample contained 36.9% (p=90) males and 63.1% (p=154) females. Gender
composition of the four subsample groups was as follows: WIM, 38.6% males and 61.4%
females; WBGH, 42.9% males and 57.1% females; CRCC, 33.0% males and 67.0%
females; and, DMC, 39.0% males and 61.0% females. With regard to work experience,
the ﬁnal sample had a mean of 12.77 years of rehabilitation work experience. The mean
years of experience for the four subsample groups were as follows: WIM, 10.43;
WBGH, 10.28; CRCC, 14.56; and DMC, 12.59. Regarding certiﬁcation status, the ﬁnal
sample contained 9.1% (p=22) respondents who held no professional certiﬁcations The
proportion of respondents not certiﬁed in each of the four subsample groups were as
follows: WIM, 18.2%; WBGH, 17.1%; CRCC, 0.0%; and, DMC, 13.8%. With regard
to professional classiﬁcation, 57.4% of the ﬁnal sample were reported to be rehabilitation
counselors with the next highest percentage being nurses (12.4%). With the exception of
respondents ﬂom WIM, who reported higher proportions of physical therapists (36.4%),

91

Table 3

Final Smle bLProvitler Setting and Professional Classiﬁcation

 

 

 

 

 

Internal (n=5 7) External Insurance
(r_r=l48) Based (p=39)
Professional 11 % n % r_r %
Identity
Rehabilitation
Counselors 23 40.4% 101 69.2% 25 64.1%
Business
Professionals 8 14.0% 6 4.1% 4 10.3%
Psychologists
& Social 3 5.3% 5 3.4% 1 2.6%
Workers
Nurses 13 22.8% 10 6.8% 7 17.9%
Physical &
Occ. Therapists 8 14.0% 14 9.6% 1 2.6%
Other
Professionals 2 3.5% 10 6.8% l 2.6%
(Missing) (0) (2) (0)

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93

nurses (18.2%), and occupational therapists (11.4%),the highest two proportions in each
of the other three groups reported to be rehabilitation counselors and nurses, as compared
to any other professional groups. Speciﬁc proportions were as follows: WBGH, 40.0%
rehabilitation counselors and 31.4% nurses; CRCC, 83.8% rehabilitation counselors and
2.9% nurses; and, DMC, 56.9% rehabilitation counselors and 13.8% nurses. With regard
to education most respondents reported education at the masters level (65.4%), and the
lowest proportion reported education at the associates degree level (5.0%). All four
subsample groups reported the highest proportion of their group memberships with
education at the masters level Speciﬁc percentages were as follows: WIM, 39.5%;
WBGH, 51.4%; CRCC, 84.6%; and, DMC, 58.6%.

Despite some diﬂ‘erences in the characteristics of individual subgroups, the four
groups were merged for data analysis on the basis of their known involvement in disability
management service provision in order to collect responses ﬂom rehabilitation counselors
and other practitioners currently providing disability management services. The ﬁnal
sample obtained for this study poses some limitations regarding generalizing to the larger
population of disability management providers. The ﬁnal sample may be somewhat biased
toward rehabilitation counselors as all individuals comprising the larger population of
disability management providers did not have an equal chance of being selected for the
study. Rehabilitation counselors comprised more than 50% of the ﬁnal sample of
disability management providers and this may not be indicative of the general population
of disability management practitioners. Based on these issues and the overall purpose of
this study, ﬁndings will be primarily generalized to rehabilitation counselors providing

disability management services

Education.

The educational levels reported by the ﬁnal sample, were as follows: 21
respondents (8.8%) had doctorates; 157 (65.4%) had masters degrees; 48 (20.0%) had
bachelors degrees; 12 (5.0%) had associates degrees; and, 2 respondents (.8%) reported
having no degree. A complete summary of respondents' highest degree obtained
according to provider setting is provided in Table 5 and according to professional
classiﬁcation in Table 6.

Of the respondents listing their highest degree obtained as an associates degree
(r_1=12), 91.7% were in nursing and 8.3% were in other areas not speciﬁed on the
demographic questionnaire. Respondents listing their highest degree as a bachelors degree
(p=48) reported degrees in the following areas: 16.7% in nursing; 6.3% in psychology;
8.3% in occupational therapy, 14.6% in physical therapy; 2.1% in special education;
8.3% in sociology; 6.3% in education; 2.0% in business; and, 35.4% in other areas not
speciﬁed on the demographic questionnaire. Respondents listing their highest degree as a
masters degree (p=157) reported degrees in the following areas: 52.9% in rehabilitation
counseling; 7.0% in vocational rehabilitation related areas; 1.3% in social work; 1.3% in
nursing; 14.7% in guidance/counseling; 5.1% in psychology; 1.3% in occupational
therapy; 3.8% in physical therapy; .6% in special education; .6% in sociology; 3.2% in
education; .6% in business; .6% in human resources; and, 7.0% in other areas not
speciﬁed on the demographic questionnaire. Respondents listing their highest degree as a
doctorate (n=21) reported their degrees in the following areas: 23.8% in rehabilitation
counseling; 4.8% in guidance and cormseling; 33.3% in psychology; 4.8% in physical
therapy; 9.5% in education; 4.8% in human resources; and 19.0% in other areas not

speciﬁed on the demographic questionnaire.

95

Table 5

Final Sample Highest Degree Obtained by Provider Setting

 

 

 

 

 

Internal External Insurance Final Sample
(r_r=5 7) (r_r=148) Based (N_=244)*
(I_1=3 9)
Degree p % r_r % p % N %
Level
None 0 0.0% 1 .7% 1 2.6% 2 .8%
Reported
Associates 4 7.1% 4 2.7% 4 10.5% 12 5.0%
Bachelors 20 3 5.7% 23 15.8% 5 13.2% 48 20.0%
Masters 28 50.0% 102 69.9% 27 71.1% 157 65.4%
Doctorate 4 7.1% 16 11.0% 1 2.6% 21 8.8%

*missing data for 4 cases on this variable

96

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Certiﬁcation status.

Regarding certiﬁcation status of the ﬁnal sample, 22 individuals (9.1%) were not
certiﬁed and 220 individuals (90.9%) had one or more certiﬁcations. Of those
respondents who were certiﬁed, 151 individuals (61.8%) were Certiﬁed Rehabilitation
Counselors, 59 (24.1%) were Certiﬁed Insurance Rehabilitation Specialists, 8 (3.2%)
were Certiﬁed Vocational Evaluators, 32 (13.1%) were Registered Nurses, 9 (3.6%) were
National Certiﬁed Counselors, 54 (22.2%) were Certiﬁed Case Managers, 34 (13.9%)
were licensed Professional Counselors, 2 (.8%) were Certiﬁed Risk Managers, and 53
(21.7%) held other certiﬁcations besides those oralong with those listed on the
demographic questionnaire. Most ﬂequently listed "other" certiﬁcations reported were
Licensed Physical Therapist, Registered Physical Therapist, Registered Occupational
Therapist, Certiﬁed Occupational Health Nurse, licensed Psychologist, Certiﬁed
Rehabilitation Registered Nurse, and Registered Social Worker. Respondents were also
asked how desirable their credentials were in their present job; 80 individuals (33.3%) felt
that certiﬁcation was mandatory; 130 individuals (54.2%) reported that certiﬁcation was
advantageous for their present job; and 30 individuals (12.5%) felt that certiﬁcation was

not needed for their present job.

Perceived mortance and Preparedness of DMSI hm

In order to examine the perceived importance of knowledge and skill areas
associated with disability management practice, respondents were asked to rate the
importance of 101 knowledge and skill areas. Respondents rated the items using the
following ﬁve point Likert-type scale: (0) None: not important at all; (1) Little: minor
importance; (2) Moderate: fairly important; (3) High: substantial importance; and (4)
Maximal: essential or crucial A review of the means for the ﬁnal sample demonstrated

that 100 out of 101 items received a mean score of 2.0 or greater indicating that almost all

98

of the items were perceived to be of moderate or greater importance. The one item on the
DMSI with a mean score below 2.0 was "describe Social Security regulations and
procedures regarding disability determination and beneﬁts". Furthermore, 38 out of 101
items received a mean score of 3.0 or greater indicating that approximately 40% of the
items were perceived to be highly important. A complete summary of means and standard
deviations for the ﬁnal sample on importance items is provided in Table 7.

In order to determine the reported preparedness of respondents in knowledge and
skill areas associated with disability management practice, respondents were asked to rate
their preparedness on the 101 DMSI items. Respondents rated the degree to which they
felt prepared as a result of their education and training using the following ﬁve point
Likert-type scale: (0) No preparation; (1) Little preparation; (2) Moderately prepared;
(3) Highly prepared; (4) Very highly prepared. A review of the means for the ﬁnal
sample demonstrated that 85 of 101 items received a mean score of 2.0 or greater
indicating that respondents felt at least moderately prepared in approximately 85% of the
knowledge and skill areas associated with disability management.

Only 9 of 101 items received a total mean score of 3.0 or greater, indicating that
respondents felt highly prepared as a result of their education and training on a small
number (9%)of the knowledge and skills items associated with disability management
practice. Most of these items with an overall mean at or above the 3.0 level appeared to
be characteristic of a professional, ethical relationship with workers and other
professionals are listed below:

1. Abide by ethical and legal considerations of case communication and recording.
2. Write case notes, summaries and reports so that others can understand the case.
6. Assess medical information, job restrictions and job requirements to determine
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24. Develop a therapeutic relationship characterized by empathy and positive regard for
the disabled worker
25. Interview the disabled worker to verify the accuracy of case information.
42. Prepare rehabilitation plans with disabled workers that consist of mutually agreed
upon interventions and outcomes.
43. Identify and comply with ethical and legal implications of client relationships.
50. Consult with medical professionals regarding functional capacities, prognosis and
treatment plans for workers with injuries or illnesses.
82. Review medical information to determine the disabled worker‘s functional limitations
and their vocational implications.

A complete summary of means and standard deviations for the ﬁnal sample on
preparedness is listed in Table 8. For a complete summary of means and standard
deviations on importance and preparedness according to professional classiﬁcation and

provider setting see Appendices I and J respectively.

Factor Angysis

In order to allow for parsimonious analysis and interpretation of the data, the 101

items on the DMSI were subjected to factor analysis. All responses ﬁom the ﬁnal sample

_=244) on importance were used for the factor analysis. Respondent's ratings of
perceived importance on the 101 knowledge and skill items were used to derive the factor
structure which was then imposed on ratings of preparedness. The individual scores of the
importance items were ﬁrst intercorrelated using the product-moment method. The matrix
of intercorrelations were factored using common factor analysis. Common factor analysis
is aimed at explaining the variance shared by the items and the principal diagonal of the
correlation matrix consists of estimates of the variance accomted for by the common

factor (Pedhazur & Schmelkin, 1991). Common factor analysis yields more accurate

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estimates of communalin and techniques are strongly preferred for most research
applications that are attempting to understand a domain of phenomena in terms of a
smaller number of underlying, latent variables (Floyd & Widamen, 1995). Based on this
rationale, common factor analysis techniques were deemed appropriate and used for this
study.

Prior to factor analyzing the DMSI items, participants were randomly assigned into
two groups. The ﬁrst group was used as the derivation sample and the second group
served as the cross-validation sample. Factor analyses utilizing the maximum-likelihood
method were then computed on the derivation and the cross-validation sample. Initially,
an eigenvalue of greater than one was used as the cutoﬁ‘ for the determination of factors.
This method yielded 20 factors and most proved to be inconsistent across the cross-
validation and derivation samples. Further analyses and examination of the loadings
narrowed the number of desired factors to three. Other numbers of factors were
examined, but more than three factors gave inconsistent results across the derivation and
cross-validation samples. In addition, after a Varimax rotation, an analysis of the created
factors demonstrated three distinct knowledge and skill areas. A re-derivation of a three
factor system based on the whole ﬁnal sample accounted for 46.6% of the total variance.
Examination of the items loading highest on each of the three factors suggested that the
results were substantively justiﬁed. Items loading high on Factor One were characteristic
of fundamentals of disability management, items loading high on Factor Two were typical
vocational rehabilitation knowledge and skill areas, and items loading high on Factor
Three were characteristic of facilitative cormseling and advocacy. The stability of the
factor structure is not known based on the low respondent to item ratio utilized in the
factor analysis. Further, the factor structure may have been compromised by grouping all

respondents from various professional classiﬁcations into one group to derive the factor

125

structure. There were approximately two respondents to every DMSI item, the lowest
acceptable ratio for factor analysis techniques.

For subsequent data analysis, three subscales were created based on these
collections of items. Initially, a factor loading criterion of .40 or higher was used;
however, a secondary criterion for DMSI items with overall means of 2.5 or greater and
factor loadings of .30 or greater were included into the factor structure so that items rated
as highly important would not be omitted Five items were added using this secondary
criterion (Items #1 and 43 were added to Factor Three and Items # 6, 32, and 73 were
added to Factor One). Two of these items (#1 and #43) were characteristic of maintaining
professional ethical standards with individual clients and were rated as highly important by
all provider setting and professional classiﬁcation groups in the sample. Ifan item loaded
higher than .40 on two or more factors, it was included in the factor with the highest
loading. The following seven items did not meet any of these criteria and were deleted
from fmther analyses:

2. Write case notes, summaries and reports so that others can understand the case.

10. Describe Social Security regulations and procedures regarding disability
determination and beneﬁts

12. Prepare and present cases for mediation

33. Read professional literature.

68. Apply published research results to professional practice.

70. Apply principles of disability related legislation to daily practice.

78. Develop and use criteria for the selection and evaluation of external service providers.

Computation of Cronbach's alpha revealed high internal consistency reliability
coeﬂicients for the three identiﬁed factors. Reliability coeﬁcients were .97 for
Importance Factor One, .96 for Importance Factor Two, .94 for Importance Factor Three.

Chronbach's alpha was also computed on the three factors using preparedness data.

126

Reliability coefﬁcients were .98 for Preparedness Factor One, .97 for Preparedness Factor
Two, and .94 for Preparedness Factor Three.

Factor One: Fundamentals of Disaerty' ' Management.
Factor One was labeled Fundamentals of Disability Management. This factor

accounted for 30.5% of the total variance and consisted of 44 items. This factor identiﬁed
employer-based strategies aimed at minimizing work place injmy/disability and developing
mechanisms for returning injured/disabled workers to the workplace. Using DMSI items
loading highest on Factor One, speciﬁc competency areas were identiﬁed. Examples of
speciﬁc competency areas describing Fundamentals of Disability Management were as
follows: (a) developing, analyzing and using data to identify risks and promote injury and
disability prevention; (b) facilitating a team approach and coordinating all parties for
return to work; (c) understanding labor union issues regarding disability management and
facilitating labor and management cooperation; (d) training and educating supervisors,
managers and employees to prepare them for their roles in the disability management
process and to facilitate attitudes compatible with a return to work philosophy; (e)
developing and managing return-to-work programs and implementing retum-to-work
sohrtions; (f) modifying jobs and implementing ergonomic solutions for return to work;
(g) consulting regarding disability legal compliance; and (h) developing programs and
managing systems for program evaluation. The items and factor loadings for Factor One
are listed in Table 9.

ﬂctor Two: Elements of Vocational Rehabilitation.
Factor Two was labeled Elements of Vocational Rehabilitation. This factor
accounted for 11.9% of the variance and consisted of 28 items. This factor identiﬁed

many of the elements characteristic of career counseling, assessment, and job placement as

127

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130

they relate to persons with disabilities. Using DMSI items loading highest on Factor Two,
speciﬁc competency areas were identiﬁed Examples of speciﬁc competency areas
describing Elements of Vocational Rehabilitation were as follows: (a) identifying
transferable work skills and matching workers with jobs; (b) using local resources to
assist in job placement; (c) interpreting and counseling workers in consideration of
assessment results; ((1) conducting job analyses; (e) instructing workers in systematic
job search skills; (1) selecting and utilizing appropriate evaluation instruments; and (g)
using labor market information to assist with job placement. The items and factor

loadings for Factor Two are listed in Table 10.

Factor Three: Elements of Facilitative Counseling and Advocacy.
Factor Three was labeled Elements of Facilitative Counseling and Advocacy. This

factor accounted for 4.1% of the total variance and consisted of 22 items. This factor
identiﬁed adjustment counseling and advocacy functions that supported disability
management efforts. Using DMSI items loading highest on Factor Three, speciﬁc
competency areas were identiﬁed. Examples of speciﬁc competency areas describing
Elements of Facilitative Counseling and Advocacy were as follows: (a) facilitating
communication between workers and other parties involved in the return-to-work plan;
(b) monitoring the medical management of cases; (c) initiating and coordinating
comnnmication between medical providers, other specialists, workers with disabilities, and
conrpany personnel; (d) developing a therapeutic relationship; and (e) providing
counseling services to workers in order to facilitate timely and appropriate return to

employment. The items and factor loadings for Factor Three are listed in Table 11.

131

 

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Perceived inmortance and preparednessjn fa_ct_o§.

Mean scores for the three importance factors demonstrated that, on average,
respondent's perceived Fundamentals of Disability Management, Elements of Vocational
Rehabilitation, and Elements of Facilitative Counseling and Advocacy to be highly
important. Respondents, on average, viewed their level of preparedness in the three areas
to be in the moderate to high level Highest ratings of preparedness occurred in Elements
of Vocational Rehabilitation and Elements of Facilitative Counseling and Advocacy. The
lowest reported preparation occurred in Fundamentals of Disability Management. Table
12 shows the three factors for both importance and preparedness, their mean ratings, and
reliability. The means and standard deviations on each factor according to provider setting

and professional classiﬁcation are summarized in Tables 13 and 14 respectively.

Diﬁ‘erencegccordjiggto Provider Setting and Profesg’onal Clasﬂ cation
To examine the relationship between importance and preparedness on the

 

knowledge and skill areas associated with disability management practice and
practitioner's provider setting and professional classiﬁcation, a two-way multivariate
analysis of variance (MANOVA) was conducted Provider setting (three levels) and
professional classiﬁcation (six levels) were the independent variables and the importance
and preparedness scores for the three factors (importance 1-3, preparedness 1-3) were the
dependent variables. An alpha level of .05 was used. An initial run of the MANOVA
revealed eight standardized residual scores with an absolute value greater than three
across the six univariate analyses. A ﬁrll three of these were attributable to one
respondent. Upon further examination it was revealed that this respondent described
himself as a business consultant and not a disability management provider. Therefore, he
rated almost all of the items as not important. This respondent was deleted from the

MANOVA. The ﬁnal run yielded, with respect to provider setting, a signiﬁcant Wilks'

136

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Table 13

Means and Standard Deviations on Factor Scores by Provider Setting

Internal External Insurance-
Providers Providers Based
Providers

M 312 M $2 M 312
Imp. Factor 1 2.96 .69 2.76 .77 2.80 .83
Imp. Factor 2 2.63 .81 3.08 .66 2.84 .91
Imp. Factor 3 2.87 .71 2.96 .64 2.87 .71
Prep. Factor 1 2.32 .88 2.20 .84 2.31 .89
Prep. Factor 2 2.54 .88 2.87 .81 2.78 .90

Prep. Factor 3 2.64 .73 2.78 .67 2.80 .65

138

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139

Lambda (F(12, 448)=1.89, p<.03). With respect to professional classiﬁcation, a
signiﬁcant Wilks‘ Lambda (F(30, 898)=8.53, p<.001) was obtained. No interaction effects
were found.

As a follow-up procedure to the MANOVA, six 2-way AN OVA's were computed
in order to identify the dependent variables (factor scores) that diﬁ‘ered signiﬁcantly
according to provider setting and professional classiﬁcation (See Tables 15-20). An alpha
level of .05 was used in each signiﬁcance test. Post hoc comparisons were then made to
determine which groups were signiﬁcantly different from others. Tukey's Honestly
Signiﬁcant difference (HSD) method was used with an alpha level of .05. Simple pairwise
comparisons revealed a number of signiﬁcant diﬁ‘erences.

With respect to provider setting (internal, external, insurance-based) and the three
importance and three preparedness factors, only one signiﬁcant diﬁ‘erence was fmmd
Respondents' ratings on Importance Factor Two (Elements of Vocational Rehabilitation)
varied according to their provider setting. Post hoc comparisons revealed that external
providers rated knowledge and skill areas associated with Importance Factor Two as more
important than internal providers. No other signiﬁcant differences were found between
respondents' provider setting and perceived importance or preparedness on the three
factors.

With respect to professional classiﬁcation (rehabilitation counselors, business
professionals, psychologists and social workers, nurses, physical and occupational
therapists, others) on importance and preparedness for the three factors, a number of
signiﬁcant differences were found. Respondents' ratings on Importance Factor Two
(Elements of Vocational Rehabilitation) varied according to their professional
classiﬁcation. Post hoc comparisons revealed that rehabilitation counselors rated
Elements of Vocational Rehabilitation as more important than business professionals,

nurses, physical and occupational therapists, and "other" professionals providing disability

140

Table 15

Two-way Analysis of Variance for mortance Factor]

 

 

 

Source if Sum of Squares E Value
Professional 5 4.771 1.653
Classiﬁcation

Provider Setting 2 1.285 1.113
Error 229 132. 192

Table 16

Two-wagAna sis of Variance for ortance Factor 2

 

 

Source if Sum of Squares E Value
Professional 5 24.919 1 1.953
Classiﬁcation -

Provider Setting 2 3.059 3.668

Error 229 95.482

E Prob.

.147

.330

E Prob.

.00"'

.027"

Table 17

141

Two-way mug of Variance for Importance Factor 3

 

 

 

Source d_f Sum of Squares _E Vahre
Professional 5 5.785 2.936
Classiﬁcation

Provider Setting 2 .386 .490
Error 229 90.252

Table 18

Two-wa An sis of Variance for Pr aredness Factorl

 

 

Source d_f Sum of Squares E Value
Professional 5 1.554 .412
Classiﬁcation

Provider Setting 2 .477 .316
Error 229 172.774

*g<.05

E Prob.

.014“

.613

_E Prob.

.840

.729

Table 19

142

Two-w An ° of Variance for Pr aredness Factor 2

 

 

 

Source d_f Sum of Squares E Value
Professional 5 50.896 21.301
Classiﬁcation

Provider Setting 2 .067 .070
Error 229 109.434

*p<.os

Table 20

Two-way Analysis of Variance for Preparedness Factor 3

 

 

 

 

Source if Sum of Squares E Value
Professional 5 6.663 3.206
Classiﬁcation
Provider Setting 2 .313 .376

‘ Error 229 95.176

‘p<.05

_E Prob.

.00*

.933

E Prob.

.008"

.687

143

management services. Furthermore, psychologists and social workers rated Elements of
Vocational Rehabilitation as more important than business professionals. Respondents'
ratings of preparedness on knowledge and 51611 areas associated with Preparedness Factor
Two (Elements of Vocational Rehabilitation) varied according to their professional
classiﬁcation. Post hoc comparisons revealed that rehabilitation counselors rated their
preparedness in Elements of Vocational Rehabilitation as higher than business
professionals, nurses, physical and occupational therapists, and "other" professionals
providing disability management services. Furthermore, psychologists and social workers
rated their preparedness in Elements of Vocational Rehabilitation as higher than business
professionals, physical and occupational therapists, and nurses.

When examining the relationship between professional classiﬁcation and
Importance Factor Three (Elements of Facilitative Counseling and Advocacy), signiﬁcant
diﬁ‘erences were found Business professionals rated the importance of Elements of
Facilitative Counseling and Advocacy as less important than rehabilitation counselors,
physical and occupational therapists, and nurses. 0n Preparedness Factor Three, business
professionals rated their preparedness in Elements of F acilitative Counseling and
Advocacy lower than rehabilitation counselors and psychologists and social workers. No
diﬁ‘erences were found on knowledge and skill areas associated with Importance Factor
One or Preparedness Factor One (Fundamentals of Disability Management).

Chapter V

D' .

Ob ati A ut Disab ' Mana t Providers

Respondents from a variety of professional backgrounds comprised the study's
ﬁnal sample. Rehabilitation counselors comprised over 60% of the study's respondents
and were the largest professional group represented in the study. Nurses, physical
therapists, and occupational therapists were the next largest groups of providers but
comprised a much smaller proportion of the sample. Business professionals,
psychologists, social workers and professionals with various other backgrounds also
reported providing disability management services but were represented in much smaller
numbers in the sample. Findings suggest that disability management service providers
who responded to the survey represented various professional backgrounds but were
predominantly professional rehabilitation counselors. Based on this representation of the
rehabilitation counseling profession, many of the study's ﬁndings reﬂected the
rehabilitation counselor’s interpretation and perspective of disability management.
Findings also provided information on how practitioners from other professional
backgrounds viewed the importance of counseling and traditional rehabilitation ﬁmctions
within the context of disability management.

Disability management providers in this investigation were categorized as
representing three employment settings Individuals who work independently or as
employees of ﬁrms providing services on a contractual or fee for service basis directly to
an identiﬁed company were classiﬁed as external providers/consultants. Individuals who
were employed by the identiﬁed company and who directly provided or administered
disability management services within the company were classiﬁed as internal providers.
Individuals employed by insurance carriers or third party administrators that insure or

144

145

administer the identiﬁed company’s disability-related policies were classiﬁed as insurance-
based providers. External disability management providers comprised the largest
proportion of the obtained sample with almost three times the number of respondents than
intemal providers and almost four times the number of insurance-based providers. These
ﬁndings closely parallel ﬁndings ﬁ'om the 1993 pilot study "The Role of the Rehabilitation
Counselor in Disability Managemen " where the number of external providers
outnumbered internal and insurance-based providers by approximately three to one.
Disability management practitioners in this study more often provided services as
consultants employed outside the company. When examining the professional background
of respondents from the three provider settings, it was revealed that rehabilitation
counselors represented a larger proportion of external providers and insurance-based
providers than internal providers This suggests that rehabilitation counselors providing
disability management services for the most part are not employees of companies
requesting services but that they must work to achieve the outcomes of employer-based
disability management from a position outside of the company.

Disability management providers ﬁ'om this investigation were highly educated; the
major portion of the sample had a masters degree or beyond. A masters degree appeared
to be the educational level most characteristic of disability management providers who
responded to the study as over 65% of the ﬁnal sample was educated at this level. Over
half of these respondents had a degree in rehabilitation counseling. Guidance and
counseling was the next most frequently cited masters degree. When disability
management providers in the study reported having an associates degree, they were most
oﬂen nurses. Disability management providers with bachelors degrees were the most
diverse group consisting of degrees in nursing, physical therapy, occupational therapy,
sociology, psychology, and other areas. Providers with doctorates had most often had
degrees in rehabilitation counseling and psychology. Given the focus of this study, and the

146

nature of competencies listed on the Disability Management Skills Inventory, it is
understandable that professionals from a clinical or counseling background might be more
likely to respond and comprise the biggest proportion of respondents.

The disability management providers studied demonstrated a high degree of
professional commitment and concern for professional standards as was evidenced by their
certiﬁcation status. Over 90% of disability management providers in this study held some
type of certiﬁcation or credentials and many held more than one. This ﬁnding should be
interpreted with some caution as one of the sources comprising the sampling frame for the
study was a certifying commission for rehabilitation counselors. Most commonly reported
certiﬁcations were Certiﬁed Rehabilitation Counselor, Certiﬁed Insurance Rehabilitation
Specialist, Certiﬁed Case Manager, Licensed Physical Therapist, Registered Physical
Therapist, Registered Occupational Therapist and Registered Nurse. Many respondents
indicated that certiﬁcation was not required for their job but that they viewed their
credentials as advantageous for their current role in disability management. While not a
requirement, disability management providers who responded to the survey clearly saw a
need to maintain and demonstrate an adherence to standards developed by their respective
professional groups. Service providers with credentials and certiﬁcations are believed to
be highly desired by companies and ﬁrms requesting disability management services.

When considering the age and rehabilitation work experience of the disability
management providers studied, they appeared to be an experienced group of professionals.
The mean age of providers was 43.3 years with almost thirteen years of work eaqrerience
in the rehabilitation ﬁeld. These ﬁndings may suggest that those practitioners providing
disability management services are emerienced and not novices to the ﬁeld of
rehabilitation. In summary, it appears that practitioners providing disability management
who participated in this study can be described as predominantly external/private providers
with backgrounds in rehabilitation counseling. They are most often educated at the

147

masters level and hold one or more professional certiﬁcations. Disability management
providers represented in the study also have a substantial amount of rehabilitation work

experience.

mortance and Preparedness of Knowledge and Skill Areas Aiseciated with Disabm' '

Management Practice
The 101 knowledge and skill items in the Disability Management Skills Inventory

were collapsed into three distinct knowledge and skill domains using common factor
analysis procedures. The three factors identiﬁed were as follows: (1) thdamentals of
Disability Management; (2) Elements of Vocational Rehabilitation; and (3) Elements of
Facilitative Counseling and Advocacy. Respondents rated the perceived importance and
their level of preparedness of items within each on these knowledge and skill domains.
The three knowledge and skill domains which emerged reﬂected a comprehensive review
of the competencies demonstrated by disability management providers within the context
of this study. Tate, Habeck, and Galvin (1986) discussed disability management as an
organizational strategy that combines clinical approaches with case management and
utilizes a, nmlti-disciplinary team approach of rehabilitation and the principles of
organizational development. They indicated that these approaches are combined into a
comprehensive framework of strategies that are managed within organizations. The three
knowledge and skill domains identiﬁed by the factor analysis demonstrated the employer-
based context of disability management along with the clinical orientation that supports
the achievement of goals of the disability management model. The following discussion
will address each of the factors individually with respect to both importance and
preparedness.

148

mortgce and preparedness in Fundamenﬂ of 21g" birty’ Management.
Factor One, Fundamentals of Disability Management describes the context in

which disability management services are provided and the organization-based
interventions utilized to achieve the goals of return to work and disability management.
thdamentals of Disability Management were characterized by organizational strategies
aimed at preventing disability risks and bringing injured or disabled employees back to
work should injury or disability occur. Factor One clearly demonstrated what Habeck,
Leahy, Hunt, Chan, and Welch (1991) described as employer-based initiatives for injury
and disability prevention, early intervention, and service coordination for cost effective
restoration and return to work.

Speciﬁc competencies describing Fundamentals of Disability Management
included: (a) developing, analyzing, and using data to identify risks and promote injury
and disability prevention; (b) facilitating a team approach and coordinating all parties for
return to work; (c) understanding labor union issues regarding disability management and
facilitating labor and management cooperation; (d) training and educating supervisors,
managers and employees to prepare them for their roles in the disability management
process and to facilitate attitudes compatible with a return to work philosophy; (e)
developing and managing return-to-work programs and implementing retum-to-work
solutions; (f) modifying jobs and implementing ergonomic sohrtions for return to work;
(g) consulting regarding disability legal compliance; and (h) developing programs and
managing systems for program evaluation.

Overall, the results from the ﬁnal sample demonstrated that Fundamentals of
Disability Management were highly important to achieving effective disability management
outcomes As a group, however, respondents felt only moderately prepared in these
ﬁmdamentals. An interesting and important ﬁnding was revealed when examining the
professional background and provider setting of respondents with respect to Fundamentals

149

of Disability Management. No signiﬁcant differences were found among respondents from
diﬁ‘erent provider settings and professional classiﬁcations regarding their ratings of
importance and preparedness All professionals and provider groups in the ﬁnal sample
agreed, on average, that competencies characterizing Fundamentals of Disability
Management were critical to the disability management process. These various
professionals and providers also agreed that they are not highly prepared in these
knowledge and skill areas. Therefore, the disability management provider's distance from
the actual work environment (internal, external/private consultant, insurance-based) or
their professional background (rehabilitation cormselors, nurses, physical therapists,
occupational therapists, etc.) did not signiﬁcantly affect perceptions of the importance or
their individual preparedness in Fundamentals of Disability Management. A critical need is
demonstrated here for all professionals providing disability management services and for
those entering the disability management ﬁeld. It would appear that all individuals
providing services must be competent in Fundamentals of Disability Management,
therefore making it appropriate to consider cross-disciplinary training programs for
disability management practitioners in order to bridge this gap between highly important

competencies and only moderate levels of preparation.

Importance and prepgedness in Elements of Veeetipnal Rehabilitation.

Elements of Vocational Rehabilitation were those career counseling, assessment,
and placement competencies which focus on assisting workers with injuries or disabilities
to identify and obtain appropriate alternative employment. These initiatives were
characteristic of traditional rehabilitation cormseling competencies. Speciﬁc competencies
characterizing Elements of Vocational Rehabilitation were: (a) identifying transferable
work skills and matching workers with jobs; (b) using local resources to assist in job

placement; (c) interpreting and counseling workers in consideration of assessment

150

results; (d) conducting job analyses; (e) instructing workers in systematic job search
skills; (f) selecting and utilizing appropriate evaluation instruments; and (g) using labor
market information to assist with job placement. Overall, the sample of disability
management providers felt that Elements of Vocational Rehabilitation were highly
important to achieving eﬂ‘ective disability management outcomes. Providers as a group
also felt highly prepared in these elements. These elements traditionally associated with
vocational rehabilitation were seen as critical to facilitating the disability management
process and returning injured/disabled workers to productive employment.

However, examining the relationship between respondent's professional
classiﬁcations and perceived importance of Elements of Vocational Rehabilitation revealed
that rehabilitation counselors rated this domain as more important than did business
professionals, nurses, physical and occupational therapists, and “other” professionals.
Psychologists and social workers also differed signiﬁcantly from business professionals in
their view of the importance of traditional vocational rehabilitation competencies.
Psychologists and social workers felt that this knowledge and skill area was highly
important while business professionals saw this area as only moderately important. These
ﬁndings are understandable given the professional orientation of these groups.
Rehabilitation counselors, psychologists, and social workers are more likely to receive
training and education in elements associated with vocational rehabilitation, such as career
counseling and assessment. These professionals are more likely to operate from this
ﬁamework when providing disability management services and incorporate these elements
into their roles as disability management providers. This assumption can be conﬁrmed
when looking at the reported preparedness of these groups of professionals.
Rehabilitation counselors felt that they were signiﬁcantly more prepared in Elements of
Vocational Rehabilitation than were business professionals, nurses, physical therapists,
occupational therapists, and “other" professionals. Psychologists and social workers also

151

felt that they were signiﬁcantly more prepared in these elements than did business
professionals, physical and occupational therapists, and nurses These ﬁndings suggest
that professional orientation plays a substantial role how providers determine what
competencies are important to the disability management process and also how they
approach disability management service provision.

Examining the providers' work settings and their impact on ratings of Elements of
Vocational Rehabilitation revealed that extemal providers viewed these vocational
rehabilitation competencies as more important than internal and insurance-based providers.
This ﬁnding makes sense given what is known about the nature of services in this provider
setting group and its distance from their work environment. Internal and insurance-based
providers concentrate eﬁ‘orts on developing the capacities within the company to
accommodate workers with disabilities, including modiﬁed job development for
accommodation (Habeck, Kress, Scully, and Kirchener, 1994). Although external
providers concentrate retum-to-work efforts through the development of transitional or
modiﬁed work opportunities for return to work within the original company, they are
oﬁen contacted after injury or disability occurs to explore vocational alternatives when the
worker is not able to return to the prior employer. Habeck, Kress, Scully, and Kirchener
(1994) stated that when private, external providers are contracted to provide services after
onset, activities of external providers begin to resemble those activities associated more
closely with the traditional model of vocational rehabilitation.

As previously discussed, this ﬁnding can also be explained in consideration of
providers' professional backgrounds. External providers in this study had the highest
proportion of rehabilitation counselors. It would make sense that they viewed Elements of
Vocational Rehabilitation as more critical to the disability management process than other
practitioners. However, no signiﬁcant differences were formd regarding the level of

preparedness providers from the three work settings reported in Elements of Vocational

152

Rehabilitation. It would appear that, as a group, all respondents in the study felt
adequately prepared to provide Elements of Vocational Rehabilitation. While external
providers viewed the competency areas associated with Elements of Vocational
Rehabilitation as more important than providers from the other work settings, it would
appear that, on average, all respondents in the study feel adequately prepared in these
areas. Respondents representing internal and insurance-based provider settings may
possess the necessary competencies in vocational rehabilitation but may not utilize these
competencies as ﬁ'equently in their respective work settings. Respondent's provider
setting or distance from the work environment and a reactive or proactive time of
intervention may inﬂuence how imjrortant they view competencies related to vocational

rehabilitation to be.

ortance d r ar e inElementsofF ' 'e lin
Adyocag.

Elements of Facilitative Counseling and Advocacy were those competencies
supporting workers with injuries and disabilities and mitigating barriers to return to work.
Speciﬁc competencies characterizing Elements of Facilitative Counseling and Advocacy
were: (a) facilitating communication between workers and other parties involved in the
retum-to-work plan; (b) monitoring the medical management of cases; (c) initiating and
coordinating communication between medical providers, other specialists, workers with
disabilities, and company personnel; ((1) developing a therapeutic relationship; and (e)
providing counseling services to workers in order to facilitate timely and appropriate
return to employment. Overall, the sample of disability management providers felt that the
competencies involved in Elements of Facilitative Counseling and Advocacy were highly
important to achieving the outcomes of eﬁ'ective disability management. As a group,
respondents recognized the importance of psychosocial factors and the need to address

153

these factors in order to minimize disability and facilitate return to work Respondents, as
a group, also felt that they were highly prepared in these competency areas.

When examining the professional background of disability management providers,
and their perceived importance of Elements of Facilitative Cormseling and Advocacy,
rehabilitation counselors, physical and occupational therapists, and nurses felt that
facilitative counseling and advocacy was more important to achieving the outcomes of
eﬁ‘ective disability management than did business professionals. Business professionals
also felt that they were less prepared to provide facilitative counseling and advocacy than
did rehabilitation counselors, psychologists, and social workers. This ﬁnding suggests that
professionals from a counseling, therapy, or medical background were more likely to view
these supportive services at the individual case level as critical to the disability
management process than those professionals from a business orientation.

When examining provider’s work setting, no signiﬁcant differences were found
regarding the importance of Elements of Facilitative Counseling and Advocacy. Internal,
external, and insurance-based providers all felt that this set of supportive counseling
initiatives were highly important to achieving the outcomes of effective disability
management. Providers in all three work settings also reported a high level of preparation
in these competencies but it is important to recognize the dominance of the rehabilitation
counseling perspective when interpreting these ﬁndings.

It is important to recognize and acknowledge the dominance of the rehabilitation
counseling perspective when considering all of the above mentioned ﬁndings. The
Disability Management Skills Inventory was developed from the rehabilitation counseling
perspective and the sample was predominantly rehabilitation counselors. Generalimtions
about the transferability of these competency areas to other professional groups providing
disability management cannot be made based on these ﬁndings. Further, other
professional groups providing disability management may deem additional competency

154

areas as important to the outcomes of disability management. Additional competency
areas speciﬁc to other professional groups were not included on the Disability
Management Skills Inventory.

' tions

Results ﬁom this investigation should be considered within the conten of several
important limitations. First, the overall response rate for this study (39.4%) is recognized
as a limitation. Babbie (1979) recommends response rates of at least 50% for adequate
data analysis. Sampling procedures did take into account that survey research typically
yields a 40-50% response rate after two mailings and the overall E obtained was adequate
for subsequent data analysis procedures. While the overall response rate yielded an
adequate number of respondents for data analysis, the ﬁnal sample did contain
substantially more rehabilitation counselors than any other professional group. This was
attributable to the sampling ﬁ'ame used which consisted of two groups with a more
heterogeneous group of disability management providers and two groups that were almost
exclusively comprised of rehabilitation counselors. Based on the number of rehabilitation
counselors in the study, one might logically conclude that the ﬁeld of disability
management is comprised of predominantly rehabilitation counselors, however, this cannot
be deduced ﬁ'om this study. This investigation made a deliberate attempt to identify
rehabilitation counselors providing disability management in order to elucidate and identify
the nature of their involvement in this area of practice. It is important to recognize that
the sample used for this study may be biased toward an rehabilitation counseling
perspective in that all individuals currently comprising the population of disability
management providers did not have an equal chance of being selected for inclusion in the

study.

155

Another limitation is recognized in relation to the major categorical variable,
provider setting. Four options were speciﬁed and respondents' were asked to identify the
provider setting that best described their current employment setting. Upon receipt of
completed surveys, it was discovered that the four provider setting options were not
mutually exclusive and some respondents had diﬁculty choosing only one setting to best
describe their current employment setting. Subsequently, some respondents chose two
categories. Re-categorization was conducted when possible ﬁom other respondent data
but some individuals may have been inaccurately reassigned to a provider category. In
addition, the fourth provider category was designed to eliminate those professionals from
the study who were not currently providing disability management services. Many
respondents specifying this category were supervisors or administrators who closely
monitor disability management services but did not consider themselves "providers”.
These respondents often completed the Disability Management Skills Inventory based on
their involvement and knowledge of disability management. When respondents noted
close supervisory involvement, efforts were made to include their responses in the
analysis, however, some respondent data was lost due to the labeling of this category.

Finally, a limitation is recognized in the number of items comprising the Disability
Management Skills Inventory. The large number of items may have contributed to the low
response rate. Factor analysis procedures yielded three large knowledge and skill domains
representing the 101 items on the DMSI. The level of speciﬁcity obtained in the study
may have been compromised by condensing such a large number of items into three
factors. In addition, had a higher response rate been obtained, a more optimal ratio of
respondents to items would have existed and may have provided a more stable factor
structure. The stability of the current factor structure is unknown based on the 2:1
respondent to item ratio. Further, rehabilitation counselors and various other professional

classiﬁcation groups were used to derive the current factor solution thus, leaving the

156

stability of the factor structure unknown for the larger population of disability

management providers

Conclgsjpns

For the purpose of this investigation disability management was deﬁned as a
proactive approach in the workplace to reduce economic and human costs associated with
disability by preventing disability incidence or remediating its eﬂ‘ects and coordinating
return-to-work strategies for retaining employees with disabilities in emplth
(Carruthers, 1993; Habeck, Leahy, Hunt, Chan, & Welch, 1991; Schwartz, Watson,
Galvin and Lipoﬂ‘, 1989). In order to be ﬁrlly effective, the workplace should be the
context of disability management service provision and should be a proactive approach.
The goals of disability management are to reduce economic and human costs associated
with disability, reduce disability incidence, and maintain the productivity of injured or
disabled employees by coordinating return to work It can be concluded that from the
perspective of this sample, the three general competency areas found to be highly
important to achieving the goals of disability management are: Fundamentals of Disability
Management, Elements of Vocational Rehabilitation, and Elements of Facilitative
Counseling and Advocacy.

At the same time, ﬁndings demonstrated that, while this group of disability
management professionals felt highly prepared in Elements of Vocational Rehabilitation
and Elements of Facilitative Counseling, on average, this group reported feeling only
moderately prepared in Fundamentals of Disability Management. The competencies
associated with the domain of Fundamentals of Disability Management may warrant
special attention ﬁ'om educational and training programs that claim to prepare
practitioners for disability management practice. 8 The challenge seems to be that a number

of diﬂ'erent practitioner groups are involved in the provision of disability management

157

services Training and education programs speciﬁc to these disciplines may be inclined to
separately oﬁ‘er curriculums addressing the training needs of disability management
providers. However, it may be appropriate to consider cross-disciplinary training
programs that would prepare all disability management providers, regardless of their
professional background, in the competency areas that characterize Fundamentals of
Disability Management.

Respondents' professional classiﬁcations accounted for several of the differences
found among the ratings within the sample of importance and preparedness in the
competency areas associated with disability management. Professional groups tended to
view theiimportance of the three competency areas (Fundamentals of Disability .
Management, Elements of Vocational Rehabilitation, Elements of Facilitative Counseling
and Advocacy) somewhat diﬂ‘erently based on their professional background and
orientation. This is tmderstandable given that the nature of their education and their
professional identity and afﬁliation will impact their perspective on the disability
management process.

Professional classiﬁcation groups also reported varying levels of preparedness in
the important competency areas. These ﬁndings suggest that additional and differential
training is needed to prepare professionals to address important competency areas for
supporting the goals of disability management. However, some professional groups may
be better trained to provide the more specialized and clinical services such as vocational
rehabilitation and facilitative counseling. For example, rehabilitation counselors,
psychologists, and social workers may be better prepared in the competencies of
counseling and assessment. Business professionals may be better equipped to handle
administrative and program evaluation competencies. Thus, the question arises: should
all disability management providers be skilled in all of the knowledge and skill areas or
should professionals specialize in components of the process based on their professional

158

backgrounds? Further, is it critical that the competency areas identiﬁed in this study as
highly important, be provided by one practitioner? These issues warrant further
examination of the study's ﬁndings which indicated that as a group, all professional groups
found the three competency areas highly important to the disability management process
but all did not report being highly prepared in all areas

The providers' work settings did not yield many differences with regard to
respondents' ratings of importance and preparedness on the three competency areas
associated with disability management service provision. However, one area of
divergence occurred regarding the perceptions between external providers as compared to
the other two provider groups regarding the importance of Elements of Vocational
Rehabilitation. External providers viewed Elements of Vocational Rehabilitation as more
important than their counterparts in internal and insurance-based settings. This may have
occurred based on the large number of rehabilitation counselors in this provider category
who typically become involved later in the process as providers of individual services
However, clarity needs to be achieved to determine how much weight should be given to
Elements of Vocational Rehabilitation in the disability management process given the bias
toward rehabilitation counselors in the study's sample. As a group, providers from the
three settings felt highly prepared in the competency areas associated with the disability
management approach. This ﬁnding is positive when looking at educational and training
implications as specialized training may not be needed to prepare practitioners for
disability management practice within various settings

Despite its limitations, this investigation marks one of the ﬁrst attempts to access a
sample of disability management providers and to empirically delineate the competencies
needed to provide effective disability management services. Although ﬁndings from this
investigation may not mirror exactly the current state of practice within the larger

population of disability management providers, it has many implications for ﬁrrther

159

deﬁning the ﬁeld of disability management. The respondents for this study were a group
highly committed to disability management and its advancement as a viable professional
ﬁeld. The respondents' commitment to disability management was evidenced by their
certiﬁcation status, educational level, professional aﬁliations, attendance at disability
management conferences, and their participation in the survey. Their perceptions of
importance and their level of preparedness may not be indicative of the larger population
of disability management providers but may be considered as a standard for practice at this

time.

mphcations for the Rehabilitation Coungling Profeegp’ n
The ﬁndings from this investigation appear to have several potentially valuable

applications for rehabilitation counselors and for the ﬁeld of disability management. This
investigation is just the ﬁrst step in further deﬁning the rehabilitation counseling
perspective on disability management practice. The competency areas found to be
important can be a basis for developing standards of practice for rehabilitation counselors
in the ﬁeld of disability management. Currently, no formal standards of practice exist for
rehabilitation counselors in disability management. It is possible that services are being
marketed to employers as disability management but are not truly employer-based
disability management services. Further, rehabilitation counselors may be marketing
typical private rehabilitation services as disability management. Findings from this study
can be a ﬁrst step in attempting to address these issues and developing a standard of
practice for rehabilitation counselors providing disability management. Findings from this
study can also be used for conducting needs assessments of rehabilitation counselor
education programs. Habeck (1993) stated that in order for rehabilitation professionals to
maintain a valued role as partners in disability management, the profession must examine

its current service model. Results from this study can help rehabilitation counselors to

160

adapt their traditional service model so that it truly meets employer's needs and addresses
employer's real disability problems. The ﬁndings can serve as a basis for developing job
descriptions and writing service proposals that truly address employers needs.
Professionals providing disability management services and those wishing to enter this area
of practice can use the derived competency areas as a personal knowledge and skill
assessment on which they can evaluate their level of personal attainment.

As public sector employment options for rehabilitation counselors continues to
decrease and business and industry struggle to remain proﬁtable in a global economy,
employer-based disability management efforts are likely to provide viable employment
options for rehabilitation counselors. Rehabilitation counselors will need to demonstrate
competencies, not only in traditional vocational rehabilitation and counseling areas, but in
the many competencies speciﬁc to the disability management work role. Rehabilitation
counselor educators will need to analyze their programs to determine if these speciﬁc
competency areas are or can be adequately addressed in their curricuhrms. Findings ﬁom
this study can assist educators in structuring curriculums that will enhance employment
options in disability management. It is also important to consider that preparation in the
Fundamentals of Disability Management cannot be addressed in pre-service education in
the depth needed to provide effective services. Rehabilitation Counselor Education
Programs are already crowded and one might question the practicality of adding
specialized courses in disability management to the existing curriculum. Educators will
need to consider separate tracks or certiﬁcation programs for rehabilitation counselors
wishing to enter the disability management service arena. When considering these issues,
it will be critical to review the competency areas identiﬁed in this study as Fundamentals
of Disability Management and realize that the education and training needs for disability
management providers go beyond the traditional preparation of rehabilitation counselors.

Competencies in areas such as risk management, ergonomics, health and safety, beneﬁt

161

and insurance systems, advanced job accommodation, data analysis, program evaluation,
conﬂict resolution, labor union policies, and business operations/management are not
typically addressed in rehabilitation counselor education but an in-depth working
knowledge is needed for effective disability management service provision.

Respondents in this study had substantial rehabilitation work experience and this
may provide a rationale for considering continuing education programs for training
disability management service providers. After obtaining other rehabilitation work
experience, rehabilitation counselors may wish to enter the disability management service
arena and will seek training programs outside of pre-service education programs. The
competency areas associated with Fundamentals of Disability Management were identiﬁed
as highly important and the preparedness levels identiﬁed as moderate; this ﬁnding can be
used to support the need for development of training and education programs aimed at
preparing rehabilitation counselors for effective disability management service provision.
Findings regarding the similarities and diﬁ‘erences in importance and preparedness between
professional disciplines can be examined and utilized as a preliminary step for further
validating the competencies needed by various professionals. Developing appropriate
educational and training models for disability management providers ﬁ'om various
backgrounds will require ﬁuther research and validation in the competencies needed by
these professionals. A critical review of ﬁndings should be undertaken to determine if
cross-disciplinary training programs are realistic or if individual professional groups should

be trained within the context and scope of practice of their individual professions.

Implications for further research.
This investigation into the rehabilitation counseling competency areas associated

with disability management practice is one of the ﬁrst attempts to empirically identify
competencies with respect to this area of practice. It is hoped that this study will provide

162

a stimulus for future research with broader implications for the larger population of
disability management providers. Certain noted limitations in the present study could be
addressed by future research. Rigorous attempts to deﬁne the population of disability
management providers could yield a sample that is representative of the larger population
and could provide valuable information about the many providers involved in disability
management practice. A more heterogeneous sample could provide useful information
about the current state of disability management practice and provide a better overall
picture of the ﬁeld of disability management. The present study uses self-report measures
to infer the importance of disability management competencies and does not link strategies
and interventions to actual disability management outcomes. Future studies can address
and attempt to link disability management interventions with outcomes and assess
competencies based on their known contributions to effective disability management

outcomes.

APPENDICES

163

APPENDD( A

Disability Management Skills Inventory

You are asked in the enclosed Disability Management Skills Inventoryto review a series of
105 knowledge and skill statements for their "importance'I related to achieving the outcomes
ofeﬁ‘ectivedisabilitymamgemerninyomctrrrernemploymemmg. Youarealsoasked
wreviewthuemmforympacdved'prepuedneu'uareukofymneducaﬁon
and training

Plusemethehowhdgeandaldﬂmforbmhhnpmtanceandpreparednasuﬁng
thefollowingﬁve-pointacales:

Scale 1.

IMPORTANCE: Towhatextentaretheeestatementsimportanttoachievingthe
outeomeaofeﬁ‘ectivedisabﬂitymanagermminyouremploymemsetﬁng; how
criﬁeduethesesldnandknowledgestatememsinaehievingtheoutcomesof
eﬁ‘ective disability management? Evaluate the “importance“ as follows:

[0] None: Not at all important
[1] Little: Minor importance

[2] Moderate. Fairly important
[3] High: Substantial importance
[4] Maximal: Essential, crucial

PREPAREDNESS: Towhatdegreedoyoufeelpreparedinthefollowingskill
and knowledge statements as a result of your education and training? Consider
eaehstatemuninrelaﬁontothedegreeinwhiehyoufedprepuedasaremhof
your education or training. Please consider your pie-service, in-service and

contimringeducation. Evaluateyour “preparedness“ asfollowa:

[0] No preparation

[1] Little preparation

[2] Moderately prepared
[31 mahlyprepmd

[4] Very hshly mated

 

164

APPENDIX A

I-IMPORTANCI P-PREPAREDNISS
[0] None: Notatsllimpatant [0] Noprepsrstim

[1] Little: Minorimportance [1] Littleprepsrstim
[2] Mada-ate: Fairlyimpmtam [2] Moderatelyprm'ed
[31W Sub-“MW 91mins“!

[4] Maximal: Manual [4] Veryhrdrlyprepared

Ahidebyethicalandlegalconsiderationsofcasecomnnmicationand
recording(e.g.conﬁdemiality)
Writeeasemtennmmaﬁaandreponssothatotherscanunderstandthe
case

Recogmze‘ psychological problems (eg depression, suicidal rdeatr' 'on)
requrnng' ' consultation for referral

Interpret to disabled workers their diagnostic information (eg., tests,
vocational and educational records, medical reports)
Developandmtegrate' drasbihty' ' management policy consistent’ withthe
FamilyMedicalLesveAetandtheAmericanswithDrsabilm' ' 'esAet
Assessmedicalinfonnaﬁomjobrestrictionsandjobrequirementsto
determinemodiﬁed dutytofadlitatereturntowork

Employ counsehng' technrqu' es (e.g., reﬂection, mterpretatr' 'on,
summanzatr' 'on) to facrhtate' ' the drsab' led worker’s self-atploration

Use assessment information to provide disabled workers with insights into
personal dynamics (e.g., denial or distortion)
Uselabormarketinformationtoassistthedisabledworkerinlocatingand
obtaining suitable employment

Describe Social Securrty’ regulations and procedures regardrng' drsab' ility
determinan' 'on and beneﬁts

Understand insurance claims processing and professional responsibilities in
workers' compensation and other internal beneﬁt programs (eg., STD, LTD,
health/medical beneﬁts)

Prepare and present cases for mediation

Coordrnate' theactrvrtr' ' 'esofallpartiesinvolvedinthereturn-to—workplan
Monitorthemedicalmsnagementofacasetodetermineifthedisabled
workerisreceivingappropriaten'esmnntandiftreaunemishelphrgin
recovery

 

165

APPENDIX A
I-IMPORTANCI r-rmamms
[0] Nare: Notatallimpat-I [0] Nopranatirm
[1] Little: Minmimportance [l] Littleprepsratiar
[2] Moderate: Fairly important [2] Moderatelyprqasred
[3] High: Substantralirmatsnce [3) Highlyprep-ed
[4] Maximal: Manual [4] quhrghlyprqaued

15.

l6.

17.
18.

19.

20.

21.

24.

25.
26.
27.

28.

29.

30.

Addressthepsycho-socialimpactofiﬂnessandinjmytonnﬁgatebaniento
return-to-workandtorérforﬁntherinterventionifneceuary

Idarﬁfysoeialecononﬁcandenvhomennlforccsthatmyadvenelyaﬁ‘ect
andisabledworker’smotivationtowardreturn—to—work
Marketdisabilitymanagementservicestobusinessesandcrganintions
Reviewinjuryanddisabilitydatawiththecompanysafetypersonnelto
developsﬁategiuforprevention
Reconunendmodiﬁcstionsofjobtaskstoaecommodateandisabled
worker‘sﬁmctionallimitations
Anﬂyzedrephysicdworkenvhonmmunployerreauiunernpracticesand
hiringprocedurestodetermineconformancewithADArequirements
Developarrdmanagetransitionalworkprograms
Developandmaintainasystemforprogramevahrationanddocumenting
outcomes
Assessthesigniﬁeance of workers‘ disabilitiesinconsideration ofmedical,
psychological, educational and familial status
Developatherapeuticrelationshipehancterizedbyempathyandpositive
regardforthedisabledworker
Interviewthedisabledworkertoverifytheacarracyofcaseinfonnation
Identifyedueationalandtrainingrequirementsforspeciﬁejobs
Matchthedisabledworker'sneedswithjobreinforcersandtheirapﬁmdes
Iderrtifytransferubleworksldllsbyanalyzingworklristory,ﬁmctional
"esandl" .0”
Provideinformationinordertoassistdisabledworkerstoanswerother
individuals'questionsabouttheirdisabilities
Useloealresourcestoassistwithexternalplacement (e.g., employer
contacts.colleagues,statejobservice)

3

166

APPENDIX A

I - IMPORTANCE
[0] None: Not at all m

[4] Max'mal: EssurtiaLaueial

Possessknowledgeofworkers'compensationlaws, compensableinjuries,
andemployerdisabilitybeneﬁtsystems

Unda'standtheappliesﬁonsofanranlegislationaﬁeetingtheemploymun
ofindividualswithdisabilities

Readpmfessionalliteramre(eg.,heahhcareadminisu'ation.safetyand
prevention, workers' compensation. and rehabilitation)
Monitorthemedicalmanagementofacasetodetermineifthedisabled
workerissatisﬁedwithtrestment.
Asmeregrdarcontactwithdisabledworkerswhoareexperiencinglost
worktime

Respondtoemployer‘sbiasesandcomernsregardingemployingpeuons
wrthdisabilities

Preparempervisorsandmanagerstobeinformedparticipamsinthe
preventionandmanagemﬂofdisabilityintheworkplace

Promoteergonomicanalysisoftasksandworkstationsandadvocstetheuse
ofergonomicinterventions

Utilize occupational mformatr' 'on matenals' suchastheD.O.T., 0.0.H. and
otherpublications
Facilitateinvolvementwithmentalhealthandsubstanceabuseservice
proﬁdersandincorporatetheseserviceshuotheretum40-workphnwhen
necessary ‘

Establishadatagatherrng‘ andmformatr' 'onmanagementsystemtomonrtor'
1' 10' I '1' theempl . .
Preparerehabihtaﬁonphnswithdisabledworku'sthatconsistofnumraﬂy
agreeduponinterventionsandoutcomes

Identrfy' and comply with ethrcal' and legal implications ofchent'

l .0 l'
Adjuteormseﬁngapproaehesorstylesaecordingtothedisabledworka’s
cognitiveandpersonalityeharactensn

 

167

APPENDIX A

I-IMPORTANCI
[0] None: Notatallinpatn

Doctnnemmsigniﬁcantvocationalﬁndingsspeciﬁctothedisabledworker
whicharesuﬁcientforrecordsandlorlegaltestimony
Selectevaluationinstrurnentsandtechniquesaccordingtotheir
appropriatenessanduseﬁrlneasforandisabledworhr
Counselwithdisabled workersregardingeducationalandvocational
implications of test and interview information
Evahratethedisabledworker‘ssodalmpponsystan(famﬂy,ﬁiends,and
commnn'tyrelationships)

Possess knowledge of employer and labor union policies and regulations
relatingtosafety,disability,andrenrmtowork
prognosisandtreatmentplansforworkerswithinjuriesorillnesses
Identiﬁrstereotypicviewstowardpersonswithdisabiliﬁesandprovide
education/trainingtocompanypersonneltoeliminatesuchstereotypes
Coordinateateamapproachtoinjmymanagementbyinvolvinginternal
companyper'sonneLunionrepresernativesandenemalserviceproviders
Fadlitatecommurncaﬁonbetweenphysiciansmddisabledworkerstoasnue
acwratehrfomaﬁonismnspiredthatfaciﬁtuesrecovayandrenuntowork
Educatedientsregardingtheirrightsundert‘ederalandstatelaws
Teachworkershowtoavoidinﬁn'yandillness

Explaintheconcepts andstrategiesofdisabilitymanagementtoemployers
AnalyzethetasksofajobutilizingstandardD.OL.orothermethods
Facilitateconumrnicstionandeooperationaaossdepuunentswithinthe
companytobringemployeesbacktowork
Usecompanydiubﬂitydatatoidarﬁfyproblanmcursaﬁvefactonand
potentiallycostlyeases

Respondtonewtrendsindisabilitymanagemem(e.g.,24-homcovengeand
integ'ationofbeneﬁts)

 

168

APPENDIX A

I-IMPORTANCE P-PREPAREDNESS
[0] None: Notatallimpmtmt [0] Napreparatim

[1] Little: Minorimportanoe [1] Littlepreparatim
[2] Moderate: Fairlyirnpatnt [2] Moda'atelyprqaced
[3] High: Substantialnnportanee [3]

[4] Monmal: EsamtraLcruml [4] Veryhrghlyprqared

62.

63.

65.

67.

68.
69.

70.
71.

74.

75.

Compileandinterpretcaseinformationtomaintainacrm'entreeord .
Confront disabled workers with observations about inconsistencies between
theirgoalsandtheirbehavior

Recommendoccupational and/oreducationalmaterialsfordisabledworkers
toarplorevocationalalternatives

Determineappropriate comrrnrnity services forthedisabled worker‘s stated
needs

Assistdisabledworkersinmodifyingtheirlifestylestoaccommodate
ﬁmctionalhmrtatr’ ' 'ons

Assessandrsab' ledworkers'abilitytopert‘ormindependenthvrng" actrvrtr"'es
Possess basic knowledge of orgarnzatr' 'onal behavior, business' operations,
andmanagernentstrategies
Applypublishedresearehresultstoprofessionalpractice
Statecleadythenanrreofthedisabledworker‘sproblemsforreferralto
outsideserviceproviders
Applytheprinciplesofdisability-relatedlegialationtodailypractice
vaideanhnernaleasemanagernernsystemthatcoordinatesandmonitors
activitieswithhealthcarepmviderainnrnncecaniersandotheromside
participants
Providefollow-uptosupervisorsandemployeesaﬁerrenuntoworkto
onsrrrethatworkdutiesarebeingperformedwithinrestrictions
vaidehrformationregardingtheservicesyouprovidetopersonsvdth
disabilitiesandemployers
ProvideorientationandtrainingonADArequirementstoermre
implementation and employer compliance with regulations
Negotiatewithemployersandlabormrionrepresentativesinorderto
reinstate/hireadisabledworker

169

APPENDIX A

I-IMPORTANCE P-PREPAREDNISS
[0] None: Notatallirnpatant [0] Nomadic:

[1] Little: Minorirnportanoo [1] Littleprepaatiar
[2] Moderate Fairiyirnpatn [2] Modastelyprqraed
[3] High Substantialnnportmoe [3] Highlyprepaed

[4] Manual EasartraLancral [4] Vaylndrlyprnpaod

78.

79.

80.

81.

82.

83.

85.

86.

87.

89.

Applyknowledgeofindividualassistivedevicesandagonomicsandhow
theyimpactonjobmodiﬁcation
Recommendandimplanentmodiﬁcationstoerdstingjobsorjobdutiesto
accommodateworlnerrestrictions
Developanduseaitaiafortheselectionandevahrationofextanalservice
providers
Clarifyforthedisabledworkannrnralertpectationsandthenatureofthe
Counseldisabledworkentohelpthemappreciateandemphasizetheir
pasonalassets
Counselwithdisabledworkersregardingdesirableworkbehaviorstohelp
thanirnproveandmaintainernployability

Review medical infonnationtodeterminethedisablcd worker's ﬁrnctional
limitationsandtheirvocationalimplications

Counsel with disabled workers to identify emotional reactions to disability
Assistdisabledworkasinundastandhrgsn'essandhruﬁlizingmeclunim
forcoping

Applypsychologicaland socialtheorytodcvelop sn'ategiesforrehabilitation
intervention

Counselwithandisabledworka‘sfamﬂytoprovideinfonnationandmpport
.. . ll .
Possusknowledgeofthecompanysavedincludingthejobsperformedand
thecorporatecnltune
Conduct a review of the rehabilitation, medical or workers' compensation
litaatru'eonagiventopicoreaseproblem
Referdisabledworkerstoappropriatespccialistsforspecialservices
Developeﬁ‘ecﬁvesnategiesforidarﬁfyingwork-relatedproblemsandrisk
factorswhichmayleadtolong-termdisabilitycases

7

170

APPENDIX A

I-IMPORTANCI P-PREPAREDNISS
[0] None: Notuallinpatla [0] Noprqsaratiar

[1] Little: Minorimpatance [1] Littlepreparation
[2] Mada-ate: Fairlyirnportant [2] Modaatelyprqaed
[3] High: Snbstanhalimpatanos [3] Highlyprepaed

[4] Manual: EssaliaLancral [4] Vayhrghlyprepaed

91.

93.

95.

97.

3.3

100.

101.

Utiliaeasystematicprocessdesignedtomcettheneedsofdisabled
employeesforthepmposeofbringingthanbacktowork
Interprettheorgamzatr' 'on'spoliciesandregulationstopasonswith
drsab' ilitiesandemployas

Develop cooperative relationships with physicians who serve company
anployeesbyeducatingthemabOtnthecompany'sjobsanditscapabilities
toaccommodateretumtowork

Consultwithcompanysupemsors‘ andmanagementregardrng' accessibility'
and m . . .

Develop and implement return-to-work strategies for employees oﬂ‘work
duetoillnessorinjury

Identrfy‘ essentral' jobelanentsbyamlyzrng‘ jobtasksandphysicaldanands

Identifythecurrentcostsofdisabilityproblemsinthecompanyand
danonstratetotopmanagementhowcostscanbereducedbysolvingthese

problems
Instructdisabledworkersinmethodsofsystematicjobsearchskills
Monitorthedisabledworka‘sprogressnsinggoal—attainmanorothanting
systems
Developmeehanisrnsforlaborandmanagementcoopaationindisability
management

Analyze beneﬁt plans (workers' compensation, short-term disability, long»

termdrsabilrty' ')toensurethattheysupportthegoalsofdrsabilrty° '
managementandretumtowork)

171

APPENDD( B

Demographic Questionnaire

 

Pleaserespondtothefollowingquestions Yourresponseswillbekepteonﬁdential.

IDENTIFYING INFORMATION:

1. Ase—
2. Gender:

EMPLOYMENT INFORMATION:
3. Total number ofyears ofpaid rehabilitation work experience

4. Pleaseehecktheitanthatbestdesaibesyomanrananploymansettingwhen
providingdisabilitymanagementsavices:

A) Acompanyemployeewhodirectlyprovidea/administcrsdisability
managernentservicesin—houseCrnternalprovida)

B) An independent, private provider or an employee ofa ﬁrm that is
contracted to develop and/or provide disability management consultation
and/or services (external provider)

C) Aprovideremployedbyaninsnrancecarriaorthirdpartyadminisn'ator
that provides disability management services (insurance-based provider)

D)Arehabilitationorodsaprofessionalnotanremlyprovidingdisability
managementservices

Ifmclreckeditaubabovecoumlaeudmmthtsbensomhic Questionnaire
only-

5. Job title:

 

6. Totalnumbaofmonthsemployedincun'entposition:

 

172

APPENDIX B

EDUCATION INFORMATION:

7. Belowisaneducationalhistorygrid. Beginwithyourmostrecenteducational
espaienceandﬁninthegridudththeappmpdatemajoranddegreecodaﬁomdre
listsprovidcd

mm mm
l-Associates l-RehabilitationCormselor 9-SpecialEducation
2 - Bachelors 2 = Voc. Rehabilitation Related 10 - Sociology
3-Masters 3-SocialWork ll-Education
4 - Doctorate 4 - Nursing 12 - Business
5 - GuidancelCormseling 13 - Human Resourws
6 - Psychology 14 - other, please
7 - Occupational Thaapy specify
8 - Physical Therapy

PROFESSIONAL IDENTITY/CREDENTIALS:

8. Spedfy/mdicateﬂregroupofpmfaﬁonﬂsthatbeusdesaibesymnpmfesn'ond
identity (check one only):
Rehabilitation Counselor Nurse
Human Resource Manager Educator
Social Worker Psychologist
Occupational Therapist Physical Therapist
Physician Business Managa

otha, please specify

 

 

173

APPENDD( B

9. Specify/indicate your current certiﬁcation/licensure status:

CRC NCC

CIRS CCM

CVE Lisccnsed Professional Counselor (LPC)
RN ARM. CRM

Not Certiﬁed other, please specify

 

10. How desirable are such credentials in your present job?

not needed advantageous mandatory

PROFESSIONAL ACTIVITIES:

To what degree are you involved in performing the following professional activities
related to disability management? Use the following scale to rate your degree of
involvement in each of the following professional activities:

o-No involvernentinthisactivity
1 - Indirectlyinvolved: coordinatethueactivitiesandwhenappropriatereferto
outside providers but do not directly perform them

2 - Directly involved: responsible for personally and directly performing and
administering these activities

personalandvocational counseling

jobanalysis, accommodationandmodiﬁcation

casemanagement

dataanalysisandprogramevahration

medicaleasemanagementandmonitoring

marketing and developing disability management services

safetyandprevention strategies

trainingandeducationof companypasonnel

assessmentandtransﬁrableskillsanalysis
jobplacementwithadiﬁ‘erentcompany

managementofretumtoworkprograms

consulting with companies on implementing and developing disability

managementprograms.

 

174

APPENDIX C

 

 

The Role Of The Rehabilitation
Counselor In Disability Management

This questionnaire asks for information on the roles and functions of rehabilitation
counselors who provide disability management services. The questionnaire will take
about 20 minutes to complete. Your participation in this study is completely voluntary
and your responses will be treated in strict confidence: The identity of participants will
be confidential and not revealed in any report of research ﬁndings. By completing and
returning this questionnaire. you indicate your voluntary agreement to participate.

Please return your completed questionnaire in the enclosed envelope by August 31.
1993. to:

-Susan M. Scully

MSU Rehabilitation Counseling Program
335 Erickson Hall

East Lansing. MI 48824

If you have any further questions or concerns regarding this study please feel free to
contact Susan Scully or Rochelle Habeck (517) 355-1838.

Thank you for your participation.

 

175

APPENDIX C

 

LTSection One i

 

ices '

_A)

B)

C)

D)

_F)

A)
B)
C)

D)

_A)

 

First. some questions about your role in the provision of disability management serv-

1. Please check the item that best describes your current involvement in the pro-
vision of disability management services. I am. . .

2. If you checked A. B. or C above. please list the key tasks you perform in your
job that relate to disability management.

3. If you checked A. B. C. or 0 above. which of the following are included in your
work relevant to disability management ( check all that apply):

A company employee who directly provides/administers disability
management services in-house (internal provider)

An independent. private consultant/provider or an employee of a con-
sulting ﬁrm who provides disability management services (private
consultant/provider)

A consultant/provider employed by an insurance carrier or third party
administrator who provides disability management services (insur-
ance based consultant/provider)

A rehabilitation educator. researcher. or administrator concerned

with disability management issues

A rehabilitation professional. administrator or educator not currently
directly involved in disability management.

Other; please specify:

 

 

 

 

 

 

 

 

 

 

Medical/Group Health Benefits
Workers' Compensation

Short Term Disability
Long Term Disability
Other. please specify:

 

 

 

176

APPENDIX C

 

TSection Two d

This series of items presents a number of skills. knowledges. and tasks that have been
identified as being related to disability management. We are interested in finding out
which of these you perform in the context of your job and how important they are to
your work.

 

In rating the importance of these items to your job. consider factors such as
significance. relevance and amount of time spent on each.

Use the following scale to rate each item:
0 - Not a part of my job/does not apply
1 - Under unusual circumstances may be a small part of my job
2 - A minor part of my job'
3 - A substantial part of my job
4 - A most significant part of my job

1. Having comprehensive knowledge of workers' compensation laws. com-
pensable injuries. and employer disability benefit systems.

2. Being knowledgeable of employer and labor union policies and regula-
tions relating to safety. disability. and retum-to-work.

3. Having basic knowledge of organizational behavior. business operations.
and management strategies.

4. Being knowledgeable of the company served. including the jobs per-
formed and the overall corporate culture.

5. Establishing a data gathering and information management systems to
monitor disability trends within the employer organization.

6. Using company disability data to identify problem areas. causative factors.
and potentially costly cases.

7. Developing other strategies for identifying work-related problems and risk
factors which may lead to long—term disability cases.

8. Preparing supervisors and managers to be informed participants in the
prevention and management of disability in the workplace.

9. Teaching workers how to avoid injury and illness.

10. Providing an internal case management system that coordinates and
monitors activities with health care providers. insurance carriers. and
other outside participants.

11. Utilizing a systematic process dESlgl'led to meet the needs of disabled em.
ployees for the purpose of bringing them back to work.

k J

 

 

177

APPENDD( C

 

: h
Use the following scale to rate each item:

 

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

23.

24.

O - Not a part of my job/does not apply

1 - Under unusual circumstances may be a small part of my job
2 - A minor part of my job

3 - A substantial part of my job

4 - A most significant part of my job

Developing and implementing retum-to-work strategies for employees off
work due to illness or injury.

Coordinating a team approach to injury management by involving internal
company personnel. union representatives. and external service providers.

Monitoring the medical management of a case to determine if the injured
worker is receiving treatment. if the worker is satisfied with treatment. and
whether the treatment is helping in recovery.

Reviewing medical information to determine functional limitations and their
vocational implications.

Assessing medical information. job restrictions. and job requirements to
determine modified duty to facilitate retum-to-work.

Developing a positive working relationship with the injured worker which is
characterized by empathy and positive regard.

Analyzing the physical work environment. employer recruitment practices.
and hiring procedures to determine conformance with ADA requirements.

Providing orientation and training on ADA requirements to ensure imple-
mentation and employer compliance with regulations

Addressing the psycho-social impact of illness and injury to mitigate barri-
ers to retum-to-work and referring for further intervention if necessary.

Having knowledge of community resources and utilizing available re-
sources as appropriate.

Facilitating involvement with mental health and substance abuse service
providers and incorporating these services into the retum-to-work plan
when necessary.

Identifying transferable work skills by analyzing work history. functional ca-
pacities. and limitations.

Assuring regular contact with injured workers who are experiencing lost
work time.

 

J

178

APPENDIX C

 

i F

 

Use the following scale to rate each item:

35.

0 - Not a part of my job/does not apply

1 - Under unusual circumstances may be a small part of my job
2 - A minor part of my job

3 - A substantial part of my job

4 - A most significant part of my job

. Facilitating communication and cooperation across departments within the

company to bring employees back to work.

Recommending and implementing modifications to existing jobs or job du-
ties to accommodate worker restrictions.

. Identifying essential job elements by analyzing job tasks and physical de—

mands.

. Facilitating communication between physicians and injured workers to as-

sure accurate information is transpired that facilitates recovery and return-
to-work.

Developing cooperative relationships with physicians who serve company
employees by educating them about the company's jobs and its capabili-
ties to accommodate return-to-work.

Developing and using criteria for the selection and evaluation of external
service providers.

. Providing follow-up to supervisors and employees after return-to-work to

ensure that work is being performed within restrictions.
Providing expert vocational testimony

Auditing disability claims to prevent service duplication and ensure cost
containment.

Identifying the current costs of disability problems in the company and
demonstrating to top management how costs can be reduced by solving
these problems.

Developing and maintaining a system for program evaluation and docu-
menting outcomes.

 

179

APPENDIX C

 

i f
Use the following scale to rate each item:
0 - Not a part of my job/does not apply
1 - Under unusual circumstances may be a small part of my job
2 - A minor part of my job
3 - A substantial part of my job
4 - A most significant part of my job

36. Are there other skills or tasks you perform which are critical to your role in dis-
ability management that aren't mentioned above?
Yes No

 

 

If yes. please list below. then use the scale rate the importance of each item:

Rating Skills/Tasks

a.

 

 

 

 

 

 

 

 

 

 

(If further space required. please use space below)

 

 

180

APPENDIX C

 

lfSection Three D

 

The National Leadership Forum on Disability Management (1992). conducted by the
Washington Business Group on Health with Michigan State University identified case
management as a key component of disability management. However. further
refinement of the concept of case management and its value was recommended.

1. Do you have a role in case management?
Yes No If yes. please describe your role:

 

 

 

 

 

 

2. Consider the objectives of case management as practiced in your organiza-
tion. Please prioritize the objectives according to the importance they have in
your case management services. Place 1 next to the most important objective
and proceed until all objectives are ranked.

_Facilitate retum-to-work
_Coordination of services

Cost containment

Reduction of time in treatment

Reduction of service duplication

Secure employee involvement in retum-to—work plan

_Other. Please specify

 

3. What particular issues or barriers do you face in regard to case management?
Please describe:

 

 

 

 

 

4. Do you have a method for evaluating the outcomes of the case management

process?
Yes ’__No If yes. please describe this method:

 

 

 

 

 

 

 

 

181

APPENDD( C

 

irSection Four

1

 

Before concluding. we would like to learn more about you and your knowledge or skill
needs relevant to disability management.

1. What degrees. licenses. or certifications do you hold relevant to rehabilitation?
Please specify:

 

 

 

 

 

2. At this point. what are your specific knowledge or skill needs that relate to the
provision of disability management services? Please describe:

 

 

 

 

 

3. What is your current job title:

 

 

 

i IJJ

182

APPENDIX C

if

In conclusion. we wish to inquire about your willingness to participate in the second
phase of this study. This would involve a telephone interview that will take about 30
minutes. If you are willing to participate. please complete the following information:

Name

Name of firm

Address

 

Phone

We appreciate your assistance and cooperation in completing this
questionnaire.

 

 

j

183

APPENDIX D

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184

APPENDIX D

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185

APPENDIX E

INSTRUCTIONS
REHABILITATION PRACTITIONER SURVEY

You are asked in the enclosed Rehabilitation Skills inventory to review a variety of l l4 professional skills for their relative
"importance" in your current iob, and also for your present “attainment" of each skill. The type and level of skills needed will vary
according to your employment setting and rehabilitation specialization.

Please answer all skill items using these five-point scales for b0th "importance" and ”attainment":

Scale I. IMPORTANCE: To what extent is this professional skill important for your primary work role, be it counseling, evaluation,
or placement, in your current iob setting; how critical to your clients’ rehabilitation is your use of this skill in your
job? Evaluate the "importance" of the skill in your own phase of the rehabilitation process as follows:

[0) None: Not at all important
[1] Little: Minor importance

[2] Moderate: Fairly important
[3] High: Substantial importance
[4] Maximal: Essential; crucial

Scale 2. ATTAINMENT: How would you rate your current proficiency in this professional skill in meeting rehabilitation client
service needs; to what extent can you do this independently? indicate your own level of ability, whether or n0t it
is an important client service in the iob you have now. It is essential for you to carefully consider and report accurately
your skill "attainment" on this scale for each item:

[0] None: Unable to perform task (no knowledge or skill)

[l] Little: Limited proﬁciency (training or supervision needed)
[2] Moderate: Fairly proficient (training or supervision helpful)
[3] High: Very proﬁcient (no training or supervision needed)
[4] Maximal: Outstanding (could train and supervise workers)

After you complete the Inventory, please fill in the Demographic Quesrionnaire, enclosed. All of your answers are confidential.

If possible, answer these items immediately while instructions are well in mind. Use this sheet for easy reference. At your earliest
convenience, please return b0th questionnaires in our self-addressed, stamped envelope.

186

APPENDIX E

REHABILITATION SKILLS INVENTORY

e USE A NO. 2 PENCIL ONLY

 

r
SKlLL RATINGS:

 

 

 

 

 

4—

 

 

 

 

 

0 FILL CIRCLES COMPLETELY 1 . Mo.
0 ERASE CHANGES CLEANLY 2: m 2: a:
0 RETURN lN ENVELOPE PROVIDED
IMPORTANCE ATTAl
( 1. Assess the significance of clients' disabilities in consideration of
medical. psychological. educational and familial status. .................................... @®®®® ©®r
2. Interview the client to verify accuracy of case information. .............................. ©®®®® ©®l
3. Evaluate the client's social support system (family. friends
and community relationships). ............................................................. @®®®® ®®l
4. Determine appropriate community services for clients‘ stated needs. ..................... ©®®®® ©®i
5. Determine a client‘s ability to perform independent living activities. ...................... @®®@® @®(
6. Identify transferable work skills by analyzing client's work history
and functional assets and limitations. ...................................................... @®®@@ @0l
7. Assess clients' readiness for gainful employment. ......................................... ©®®®® @Gl
8. Select evaluation instruments and techniques according to their
appropriateness and usefulness for a particular client ...................................... Q®®®® (<90
9. Design appropriate testing environments. .................................................. .@®®@® I090
10. Utilize statistical concepts associated with assessment instruments I
(mean. percentile. standard score). ......................................................... @GQCDQ @G
11. Adhere to the American Psychological Association Test Standards and
Restrictions (classes A. 8. C). .............................................................. ©®®®® @CD
12. Employ newer applications in vocational assessment including computerized techniques. @®®®® @0
13. Evaluate standardized instruments with respect to validity. reliability. '
and appropriate norming. ................................................................... @®®@® @CD
14. Administer appropriate standardized tests and/or work samples. ......................... @®®@® @CD
15. Interpret test and/or work sample results to clients and others. .......................... @®®©© @0
16. Identify client work personality characteristics to be observed and rated on an
actual job or simulated work situation. .................................................... @®®@® ©®
17. Utilize measurable terms to systematically describe and record client behavior. .......... @GGQDQ @CD
18. Utilize behavior observation scales and techniques (e.g.. time sampling,
point sampling). ............................................................................ @®®@@ @G
19. Use behavioral observations to make inferences about work personality '
characteristics and adjustment. ............................................................ @®®@® ©®
20. Adapt evaluation tools and systems to meet special client needs. ........................ @®®@® @G
21. Design work situations for observing specific client behaviors. ........................... ®®@® @®
22. Develop local norms for assessment instruments and techniques. ......................... ©®®©® @CD
23. Integrate assessment data to describe clients' residual capacities for purposes I
of rehabilitation planning. .................................................................. @OOOO OO
24. Match client needs with job reinforcers and client aptitudes with job requirements. ...... @®®@® ©®
25. Make logical iob. work area or adjustment training recommendations based on
comprehensive client information. ............ . ..................................... . ...... ®®®® @G
26. Develop a therapeutic relationship characterized by empathy and positive
regard for the client. ..... . ................................................................. O ®®®® ©®
27. Clarify for clients mutual expectations and the nature ol the counseling relationship. o ®®©® @G)
28. ldentify one's own biases and weaknesses which may affect the development
of a healthy client relationship. ............................................................ o ®®®® @(D
L

 

 

187

APPENDIX E

 

 

 

 

 

 

 

 

l r sltu. same; a - Medus-
o - Halls 3 - High
1 - Little 4 - are-m
WORTANCE ATTAIIME
r29. Adjust counseling approaches or styles according to client cogtitive and
personality characteristics. ................................................................. @®®®® @®®€
30. hterpret to clients diagnostic information (e.g.. tests. vocational and educational
records. medical reports). .................................................................. @®@®® @®®@
3‘— WV psychological and social theory to develop strategies for rehabilitation
intervention. ............................................................................... ©®®®® @®®@
32. Employ cotmseling tacl'lnirpes (e.g.. reflection. interpretation. summarization) to
facilitate client self-exploration. ............................................................ @®®©® ©®®®
33. Identify social. economic and environmental forces that may adversely affect a client's
motivation toward rehabilitation. ........................................................... @®®®® ©0®®
34. Use assessment information to provide clients with insights into personal dynamics
(e.g.. denial or distortion). .................................................................. @®®®® @®®©
35. Prepare with clients rehabilitation plans with mutually agreed upon interventions
and goals. .................................................................................. @OOOO @OOO
36. Assist clients in terminating counseling in a positive manner. thus enhancing their
ability to function independently. .......................................................... @®®@® @®®@
37. Recognize psychological problems (e.g.. depression. suicidal ideation) requiring
consultationor referrals. ................................................................... @®®®@ @®®®~
3a Counsel with clients to identify emotional reactions to disability. ......................... @®®®® ®®®®
39. Assist clients in verbaliaing specific behavioral goals for personal adjustment. ............ @®®©® ©0®®
40. Exolore clients' needs for individual. group or family counseling. .......................... ©®®®® ®®®®l
41. Assist clients in modifying their lifestyles to accommodate functional limitations. ........ @®®®@ @®®@l
42. Counsel clients to help them appreciate and emphasize their personal assets. .' ........... @®®@® ®®®Gl
43. Provide information to help clients answer other individuals' questions about _
their disabilities ............................................................................ @OOOO @OOOl
44. Confront clients with observations about inconsistencies between their goals
and their behavior .......................................................................... @®®®® @®®@(
45. Use behavioral techniques such as shaping. rehearsal. modeling and contingency
management. ............................................................................... @®®@@ @®@@(
. 46. Assist clients in understanding stress and 'st utilizhg mechanisms for coping. ............. @®®®q @®®@(
. 47. Counsel with a client's family to provide information and support positive coping
. behaviors. .................................................................................. @OOOO @O®®(
e 48. Counsel regarding sexual concems related to the presence of a disability ................. @GCDGDG) @®®@(
49. Corneal with clients using group methods. ................................................ @GQQd @®®@(
50. Review medical hformation with clients to determine vocational inplications of their
functional limitations. ...................................................................... @®®@@ @®@@(
51. Counsel with clients regarding educational and vocational indications of test
and interview 'nformation. ................................................................. @®®@@ @GQGC
52. Counsel clients to select jobs consistent with their abilities. hterests and
rehabilitation goals. ........................................................................ @OOOO @OOOC‘
53. Recommend occupational and/or educational materials for clients to explore
vocational alternatives. .................................................................... @®®@@ ©0®®G
54. Relate clients' stated interests and values to vocational choices. ......................... @®®@® @®®@G
55. Discuss with clients labor market conditions which may influence the feasibility of
entering certain occupations. .............................................................. @®®@® @®®@G
56. Discuss clients' vocational plans when they appear unrealistic. ........................... @®®©© @®®@G

 

188

 

 

 

 

APPENDD( E
memes: z - use.
i - u... i. m.
‘ IMPORTANCE ATTAIN
r57. Develop mutually wills vocational counsel‘ng goals. ..................................
58. Identify and arrange for functional or skill remediation services for clients'
successful job placements. ..................................... e .......................... ©®®®® ®®@
59. Use supportive counseling tacl'lniquee to prepare clients for the stress of job
hmtinp .................................................................................... @OOOO @OO
so Instruct clients in methods of systematic job search skills. ................................ @®®®® @@@
61. instruct clients in preparing for the job hterview (e.g.. job application. attire.
interviewing skills.) ......................................................................... ©®®®® @®®
82. Comsdwithclientsngardklgdeskablewakbehaviuatohalpthemknprove
their employability .......................................................................... @GQGQ @®®
63 Develop acceptable client wont behavior through the use of behavioral tecllrliques. ...... ©®®®® @®@
64. Conduct group activities and programs such as job clubs. vocational exploration groups
or job-seeking skills groups. ............................................................... ©®®® @®®
65. Monitor clients' post-employment adjustment to determine need for additional services. @®®@ @®®
66. Apply labor market information influencitg the tasks of locating. obtaining and
progressing in employment. ................................................................ @®®®® @®®l
67. Use local resources to assist with placement (e.g.. employer contacts. colleagues.
state job service). .......................................................................... @®®®® @®®(
68. Use computerized systems for job placement assistance. ................................. @®®®® ©®®i
as. Inform clients of job openings suitable to their needs and abilities ......... ........... @®®®® @@@l
M Identify educational and training requirements for specific. jobs. ........................... ®®®®® ®®®t
Ti’Analyze the tasks of a job. utilizing standard D.O.l. methods ............................. ©O®®® ©®®l
72. Classify local jobs using o.o:r. and/or other classiﬁcation systems.........' .............. @OOOO ©®®t
73. Recommend modifications of job tasks to accommodate a client's functional
limitations ................................................................................. @OOOO @OO(
74. Apply knowledge of individual assistive devices and how they “sweet on job
modification ............................................................................... @OOOO @O@(
2; Utilize occupational information materials such as the D.O.T.. 0.0.H. and
other publications. ............ @®@@® @®@(
78. Determine the level of intervention necessary for job placement (e.g.. job club.
supported work. OJ.T.). .................................................................... @®®®® @®@(‘
77. Understand the applications of current legislation affecting the employment of
disabled individuals ........................................................................ @®®@® @GQC
78. Respond to emﬂoyara' biases and concerns regarding hi-hg persons with disabilities..." @®®@® @GQC’
78. Negotiate with employers or labor union representatives to re‘etstata/reh'ee
an injured worker ....................................................................... @®®®@ ©®®G
80. Provide prospective employers with appropriate infonnetion on clients' work skills
and abilities. ............................................................................... @®®@® @®®G
81. Provide consultation to employers regarding accessibility and affirmative
action issues. .............................................................................. ©0®®® @GQG
82. Serve as a vocational expert to public agencies. law firms. and/or private
businesses. ................................................................................. ©0®®® @GQG
83. Provide expert opinion or testimony regarding employability and rehabilitation
feasibility ................................................................................... @OOOO @OOG
84. Provide information regarding your organization's pregame to current and potential
referral sources. ............................................................................ @®@@d @GQG
. Coordinate activities of all - s involved in a rehabilitation -

 

     

 

 

- n - - LA .- .e

A L- _ ...- -4. - _--_- - - - -4 -_

189

APPENDIX E

 

 

 

 

 

 

 

 

 

 

 

 

sltu names: 1 - Moderate
o - None 3 - High
1 - Little e - Meal-rial
IMPORTANCE ATTAINMEN'I
r 86. Describe Social Security regulations and procedures regarding disability determination
andbenefits. .............................................................................. @OOOO @CDCDGDG
87. Report to referral sources regarding progress of cases. .................................. @®®®® @GCDGDG
88. Monitor client progress using goal-attainment scaling or other rating systems. .......... @®®®® ©®®®G
89. Collaborate with other providers so that services are coordinated. appropriate
andtimely ................................................................................. OOOOO @OOOG
90. Consult with medical professionals regarding functional capacities. prognosis. and
treatment plans for clients. ............................................................... @®®®® @CDGQG
91. Understand insurance claims processing and professional responsibilities in
workers' compensation. .................................................................. @®®@® @GQGG
92. Refer clients to appropriate specialists and/or for special services. ...................... @®®®@ @®®®€
93. State clearly the nature of clients‘ problems for referral to service providers. ........... @®®@® @®®@G
94. Select appropriate adjustment alternatives such as rehabilitation centers
or educational mama. ................................................................. @®®®® @®®@€
row
HERE
ONLY
95. Explain the services and limitations of various community resources to clients. ......... ©®®®® ®®®®€
98. Compile and interpret client information to maintain a current case record. .............. @®®@® @®®@€
97. Write case notes. sumarles. and reports so that others can understand the case. ..... ®®®©® @®®@G
98. Document all significant client vocational findings sufficient for legal
testimony or records. ..................................................................... @®®@@ @OQQG
99. Make sound and timely financial decisions within the context of your
work setting. ............................................................................. ©O®®® @OOOG
100. Negotiate financial responsibilities with the referral some and/or sponsor .
for a client's rehabilitation. ............................................................... @®®®® @®®@G
101. Market rehabilitation services to businesses and organizations. .......................... @®®@® @GQQG
102. Identify and comply with ethical and legal implications of client
relationships .............................................................................. @OOOO @OOOG
103. Abide by ethical and legal considerations of case communication and recording
(e.g.. confidentiality). ...................................................................... @GQCDQ @GQQG
104. Read professional literature related to business. labor markets. medicine
and rehabilitation. ......................................................................... @®®®® @OOOG
105.Conductareviewoftherehabilitationliteretureonagiventopicorcase IO
problem. .................................................................................. ©0®®® ®®@G
roe. Apply published research results to professional practice. ................................ @®®®® @OOOG
22:?
our
107. Apply principles of rehabilitation legislation to daily practice. ............................ @OOOO @OOOG
108. Explain the development and philosophical foundations of rehabilitation
to the general public. ..... ‘ ................................................................ @OOOO @OOOG
109. Educate clients regarding their rights under rederel and state laws. ...................... @OOOO @OOOG
11o Interpret your organization's policy. laws. and regulations to clients and others. ......... @OOOO @OOOG
111. Participate with advocacy groups to promote rehabilitation prom ................... @®®®@ @®®@G
112. Promote public awareness and legislative support of rehabilitation programs. ............ @OOOO OOOOG
111 Identify and challenge stereotypic views toward persons with disabilities .............. OOOO @OOOG
114. Obtain regular client feedback regarding satisfaction with services delivered
and suggestions for improvement. ........................................................ @®®®@ @GQQG
... ’_________J__________

 

. -Ie..l‘\ll. .

190

APPENDIX F

Dear Colleague,

I am writing to request your participation in a nationwide study of disability management
practitioners to determine the perceived importance of speciﬁc knowledge and skill areas to the
provision of disability management services, and the degree to which your education and training
prepared you in these areas. As you maybe aware, one ofthe goals ofdisability management is to
reduce the human and economic costs associated with injury and disability in the workplace. In order
to fully reach this goal and maximize the potential ofdisability management, it is necessary to obtain
information from practitioners who are currently involved in the provision of disability management
semces.

You have been identiﬁed as an individual who may be currently providing disability management
services and it is hoped that you will participate in this study. Disability management, for the purpose
of this investigation, is a coordinated, comprehensive, employer-based approach to managing
disability in the workplace. Furthermore, disability management is a preventive strategy to reduce the
economic and human costs associated with disability by reducing disability incidence and
coordinating return to work Please consider this deﬁnition in relation to your current work role
when assessing your involvement in the provision of disability management services. In order to
obtain valid information that documents the nature of disability management practice and delineates
the importance of speciﬁc knowledge and skills, it is important that you are currently providing
disability management services. If you are not currently involved in the provision of disability
management services, please indicate this and complete only the demographic questionnaire (do not
complete the Disability Management Skills Inventory).

Enclosed you will ﬁnd a Demograch Questionnaire and a Disability Management Skills
Inventory. It is expected that completion of these instruments will take about 30 minutes of your
time. Participation is voluntary and you indicate your voluntary agreement to participate by
completing and returning the enclosed questionnaires. Your responses will be kept conﬁdential.
Please consider participating in this study as your responses are valued and critical to the continued
advancement of disability management.

Please complete the enclosed questionnaires and return in the enclosed envelope by July 17, 1995. If
you would like additional information or have any questions regarding this investigation, please feel
free to contact me at (517) 355-1838.

Thank you in advance for your participation.

Sincerely,

Susan M. Scully, Doctoral Student
Rehabilitation Counselor Education, Michigan State University

191

APPENDIX G

Dear Colleagnne,

I am writing again to encourage you to participate in a nationwide study ofdisability
managennent practitioners. The purpose of this study is to determine the perceived
importance of speciﬁc knowledge and skill areas to the provision of disability management
services. You have been identiﬁed as an individual who may be currently providing
disability management services therefore making your involvenent in this researcln
necessary. \Vnthout your involvement, advancing the ﬁeld of disability management will be
diﬂ'ncult. I realize that your time is valuable, however, your responses are critical to the
outcomes of the study. You may also ﬁnd it helpful to review a comprehensive list of
knowledge and skill areas thought to be associated with disability managenent.

Disability managenent, for the purpose of this investigatiorn, is a coordinﬂed,
comprehensive, enployer-based approach to managing disability in the workplace.
Furthermore, disability management is a preventive strategy to reduce the economic and
human costs associated with disability by reducing disability incidence and coordinating
return to work. Please consider this deﬁnition in relation to your current work role when
assessing your involvement in the provision of disability management services. In order to
obtain valid information that documents the nature of disability management practice and
delineates the importance of speciﬁc knowledge and skills, it is important that you are
currently providing disability management services. If you are not currently involved in the
provision of disability management services, please irndicate this and complete only the
denographic questionnaire (do not complete the Disability Managenent Skills Inventory).

Enclosed you will ﬁnd a Demographic Questionnaire and a Disability Management Skills
Inventory. It is expected that completion of these instruments will take about 30 minutes of
your time. Participation is voluntary and you indicate your voluntary ageement to
participate by comle and returning the enclosed questionnaires. Your responses will be
kept cornﬁdential. Please cornsider participating in this study as your responses are valued
and critical to the continued advancenent of disability management.

To elirrninate the cost of future mailings arid follow-up, please complete the enclosed
questionnaires and return in the enclosed envelope by October 5, 1995. Ifyou would like
additiornal infonnation or have any questiorns regarding this investigation, please feel free to
corntact me at (517) 355-1838.

Thank you in advance for your participation.
Sincerely,

Susan M. Scully, Doctoral Student
Rehabilitation Counselor Education, Michigan State University

192

APPENDIX H

Dear Colleagues,

Attached are copies of the Disability Management Skills Inventory and
Demographic Questionnaire. These questionnaires were developed for use in a
nationwide study of disability management practitioners. The purpose of the study
is to determine the perceived importance of speciﬁc knowledge and skill areas to
the provision of disability management services and the degree that practitioner's
education and trainirng prepared them ill these speciﬁc areas. One of the goals of
disability management is to reduce the human and economic costs associated with
injury and disability in the workplace. To fully reach this goal and maximize the
potential of disability management, it is necessary to obtainn information from
practitioners who are currently involved in the provision of disability management
servnces.

Your participation in this study is critical to advancing the ﬁeld of disability
management and to advancirng our role as professionals in the provision of disability
management services. You may recall participating in a similar study in 1993 at the
Disability Management Conference at Michigan State University. Your responses
proved invaluable and have been utilized by CARP to develop standards for
disability management programs.

It is expected that completion of these questionnaires will take approximately 30
mirnutes of your time. Your participation is voluntary and your responses will be
kept conﬁdential Please complete the attached questionnaires, seal them in the
envelope provided and place them in the designated box that is located in the
Kellogg Center Lincoln Room. Ifyou are unable to complete the survey during
the conference, please return it by mail in the envelope provided by July 5, 1995.

As part of a select and active group of professionals, your participation is extremely
important to ﬁtrther advance the ﬁeld of disability management. Thank you in
advance for your participation and please feel free to contact me if you have any
questions regarding the study.

Thank you,
Susan M Scully

Doctoral Student, Rehabilitation Counselor Education
Michigan State University

193

APPENDIX H

Disability Management Conference Participant,

I hope that you found the conference to be interesting and
informative. In order to advance the ﬁeld of disability
management it is essential to conduct meaningful research about
the knowledge and skills needed to provide effective services. If
you have completed your Disability Management Survey at the
conference, thank you for your participation. If you have not
returned your survey 1 am requesting that you please complete
and mail by July 17, 1995. Returning your survey promptly
will eliminate the cost of mailing another set of questionnaires.
Thank you.

a... a. .24
Michigan State University
Rehabilitation Counselor Education
335 Erickson Hall
East Lansing, MI 48824

194

APPENDIX I

Means and Standard Deviations for Provider Settings on DMSI Items
Internal Providers External Providers Insurance Based

Providers
DMSI Item M S]; _M S_D _M S_D
Imp 1 3.65 .55 3.63 .65 3.64 .63
Imp 2 3.37 .75 3.56 .63 3.46 .60
Imp 3 2.95 .97 3.06 .85 2.97 1.04
Imp 4 2.84 1.13 3.21 .90 2.77 1.18
Imp 5 2.95 1.12 2.73 1.04 2.56 1.29
Imp 6 3.58 .65 3.63 .75 3.67 .70
Imp 7 2.68 1.06 2.92 .91 2.64 1.22
Imp 8 2.42 1.07 2.52 .99 2.56 1.23
Imp 9 1.95 1.17 2.94 1.15 2.77 1.40
Imp 10 1.70 1.26 1.96 1.17 1.90 1.39
Imp 11 3.25 1.04 2.92 1.04 3.38 .88
Imp 12 1.77 1.28 2.07 1.28 2.05 1.39
Imp 13 3.33 .87 3.59 .73 3.62 .59
Imp 14 3.26 .99 3.03 1.11 2.90 1.21
Imp 15 3.11 .86 3.13 .92 3.26 .85
Imp 16 3.19 .90 3.23 .89 3.31 .83
Imp 17 1.88 1.50 2.79 1.09 2.28 1.45
Imp 18 2.39 1.33 2.37 1.35 2.10 1.45
Imp 19 3.23 .91 3.33 .82 3.26 .97

Imp 20 2.45 1.46 2.41 1.30 1.92 1.38

195
APPENDIX I

Internal Providers External Providers Insurance Based

Providers
DMSI Item M S_D M SD, M _sg
Imp 21 2.30 1.46 2.29 1.38 2.18 1.71
Imp 22 3.11 1.23 2.53 1.33 2.38 1.37
Imp 23 2.86 1.11 3.11 .87 3.18 .97
Imp 24 3.26 .79 3.27 .92 3.10 .99
Imp 25 3.23 .82 3.49 .85 3.23 1.09
Imp 26 2.61 1.13 3.12 1.00 2.85 1.23
Imp 27 2.69 1.15 2.99 1.11 2.79 1.38
Imp 28 2.66 1.30 3.32 .98 3.23 1.29
Imp 29 2.25 1.26 2.71 1.20 2.79 1.30
Imp 30 2.00 1.41 2.92 1.05 2.67 1.32
Imp 31 3.40 1.01 3.43 .77 3.46 .72
Imp 32 3.20 .97 3.18 .92 3.18 .85
Imp 33 2.98 .97 2.99 .77 2.82 1.00
Imp 34 2.62 1.33 2.70 1.10 2.59 1.23
Imp 35 3.05 1.06 2.88 1.31 3.18 1.14
Imp 36 3.05 1.13 3.07 1.04 3.08 1.13
Imp 37 2.96 1.23 2.85 1.21 2.59 1.46
Imp 38 2.89 1.12 2.86 1.12 2.87 1.17
Imp 39 2.18 1.23 2.99 1.01 2.79 1.38
Imp 40 2.89 1.14 2.45 1.07 2.49 1.23

Imp 41 2.83 1.28 2.06 1.34 2.28 1.52

196

APPENDIX I

Internal Providers External Providers Insurance Based

Providers
DMSI Item M S12 M SD M SD
Imp 42 3.09 1.26 3.45 .84 3.21 1.15
Imp 43 3.58 .76 3.61 .82 3.59 .68
Imp 44 2.98 1.22 3.29 091 3.10 1.05
Imp 45 2.79 1.23 3.19 1.03 2.82 1.35
Imp 46 2.31 1.34 3.03 1.08 2.46 1.45
Imp 47 2.23 1.39 3.07 1.08 2.49 1.54
Imp 48 2.55 1.26 2.91 .95 2.79 .83
Imp 49 3.11 1.05 2.88 .97 2.74 1.19
Imp 50 3.58 .78 3.50 .74 3.56 .79
Imp 51 2.59 1.11 2.53 1.09 2.56 1.33
Imp 52 3.21 1.17 2.86 1.26 2.95 1.30
Imp 53 3.21 .98 3.12 1.11 3.28 1.15
Imp 54 2.58 1.22 2.68 1.03 1.97 1.25
Imp 55 2.61 1.46 2.59 1.30 2.00 1.41
Imp 56 2.89 1.08 2.68 1.20 2.74 1.29
Imp 57 2.16 1.45 2.82 1.20 2.38 1.37
Imp 58 3.42 .89 2.81 1.29 2.97 1.25
Imp 59 2.85 1.22 2.34 1.48 2.64 " 1.42
Imp 60 2.86 1.09 2.41 1.30 2.90 1.25
Imp 61 3.39 .78 3.20 .82 3.34 .85

Imp 62 3.11 .95 3.24 .91 3.08 1.08

I97

APPENDD( I

Internal Providers External Providers Insurance Based

Providers
DMSI Item M S_D M SD M SD
Imp 63 2.46 1.16 2.94 1.02 2.47 1.47
Imp 64 2.41 1.33 2.77 1.02 2.76 1.26
Imp 65 2.36 1.30 2.73 1.03 2.34 1.34
Imp 66 1.93 1.46 2.30 1.28 2.08 1.34
Imp 67 2.91 1.02 2.77 1.12 2.68 1.21
Imp 68 2.07 1.15 2.33 1.18 2.00 1.34
Imp 69 2.77 1.33 3.07 .98 3.16 1.05
Imp 70 2.82 1.24 2.84 1.08 3.00 .93
Imp 71 3.30 1.19 2.87 1.34 3.32 .93
Imp 72 3.14 1.09 3.14 1.01 3.03 1.26
Imp 73 3.14 1.01 3.21 .90 3.29 1.04
Imp 74 2.61 1.29 2.32 1.27 2.21 1.47
Imp 75 2.50 1.36 2.60 1.22 2.63 1.44
Imp 76 2.79 1.20 2.85 .98 2.76 1.17
Imp 77 3.18 1.02 3.23 .89 3.08 1.17
Imp 78 2.63 1.18 2.29 1.16 2.97 1.22
Imp 79 2.61 1.29 3.10 1.01 2.76 1.24
Imp 80 2.46 1.26 3.10 .96 2.74 1.31
Imp 81 2.75 1.18 3.20 .93 2.92 1.26
Imp 82 3.40 .75 3.52 .75 3.61 .86

Imp 83 2.80 1.15 3.04 .90 2.66 1.19

198

APPENDIX I

Internal Providers External Providers Insurance Based

Providers

DMSI Item M _S_D M S_D M S_D
Imp 84 2.68 1.18 2.86 .92 2.45 1.16
Imp 85 2.47 1.25 2.55 1.06 2.39 1.20
Imp 86 2.05 1.41 2.43 1.10 1.95 1.35
Imp 87 3.47 .71 3.05 .96 3.16 1.03
Imp 88 2.43 1.32 2.47 1.15 2.39 1.37
Imp 89 3.02 1.22 3.00 1.04 3.05 1.23
Imp 90 3.05 1.11 2.68 1.22 2.79 1.54
Imp 91 3.32 1.01 3.15 1.02 3.15 1.16
Imp 92 3.16 1.03 2.46 1.22 2.59 1.31
Imp 93 3.21 1.12 2.81 1.36 2.95 1.38
Imp 94 2.75 1.30 2.30 1.24 2.28 1.41
Imp 95 3.49 .80 3.14 1.22 3.36 1.11
Imp 96 2.88 1.35 3.33 .94 3.18 1.12
Imp 97 2.98 1.24 2.51 1.47 2.72 1.52
Imp 98 2.23 1.48 2.94 1.22 2.64 1.55
Imp 99 2.40 1.42 2.76 1.07 2.46 1.37
Imp 100 2.45 1.33 2.12 1.37 2.49 1.55
Imp 101 2.77 1.24 2.17 1.45 2.67 1.42
Prep 1 p 3.25 .79 3.03 .97 3.18 .95
Prep 2 2.95 .99 3.06 .97 2.97 .88

Prep 3 2.49 1.02 2.71 .96 2.71 .73

199

APPENDIX I

Internal Providers Extemal Providers Insurance Based

Providers
DMSI Item M 52 M _SQ M _SQ
Prep 4 2.81 1.22 2.97 .94 2.82 .93
Prep 5 2.04 1.18 1.90 1.13 1.79 1.30
Prep 6 3.14 .95 3.14 1.02 2.97 1.20
Prep 7 2.59 1.19 2.97 1.06 2.87 1.09
Prep 8 2.21 1.24 2.53 1.08 2.58 1.03
Prep 9 1.87 1.25 2.57 1.38 2.70 1.35
Prep 10 .95 1.02 1.55 1.17 1.42 1.18
Prep 11 2.19 1.44 2.19 1.30 2.63 1.32
Prep 12 1.27 1.31 1.59 1.40 1.89 1.48
Prep 13 2.88 1.13 2.98 1.15 2.82 1.25
Prep 14 2.63 1.25 2.49 1.08 2.79 1.02
Prep 15 2.54 1.12 _ 2.77 1.02 2.79 1.04
Prep 16 2.61 1.06 2.90 1.04 3.05 .87
Prep 17 1.39 1.34 1.89 1.31 1.63 1.32
Prep 18 1.84 1.47 1.72 1.27 1.84 1.42
Prepl9 2.72 1.11 2.62 1.09 2.68 1.21
Prep 20 1.95 1.43 1.99 1.24 2.05 1.43
Prep 21 1.84 1.32 1.79 1.33 1.87 1.32
Prep 22 1.98 1.36 1.86 1.31 2.05 1.18
Prep 23 2.63 1.08 2.85 1.02 3.08 .88

Prep 24 3.33 .81 3.38 .93 3.34 .75

200

APPENDIX I

Internal Providers External Providers Insurance Based

Providers
DMSI Item M so M _sp M sp
Prep 25 3.21 .94 3.37 .93 3.37 .88
Prep 26 2.60 1.24 2.93 1.16 2.89 1.25
Prep 27 2.64 1.20 2.74 1.16 2.79 1.32
Prep 28 2.54 1.36 2.88 1.14 2.92 1.34
Prep 29 2.42 1.24 2.66 1.27 2.66 1.19
Prep 30 2.16 1.38 2.68 1.22 2.45 1.25
Prep 31 2.31 1.39 2.65 1.21 2.74 1.16
Prep 32 2.38 1.28 2.46 1.12 2.24 1.32‘
Prep 33 2.73 A .99 2.76 .39 2.58 .95
Prep 34 2.33 1.28 2.49 1.11 2.45 1.11
Prep 35 2.71 1.21 2.62 1.29 2.87 1.21
Prep 36 2.75 1.34 ‘ 2.65 1.15 2.79 1.26
Prep 37 2.31 1.41 2.35 1.19 2.39 1.31
Prep 38 2.13 1.32 2.00 1.25 2.08 1.34
Prep 39 2.45 1.34 3.04 1.10 2.97 1.28
Prep 40 2.61 1.20 2.40 1.08 2.16 1.03
Prep 41 1.70 1.40 1.50 1.19 1.55 1.20
Prep 42 2.63 1.35 3.18 1.03 3.16 .95
Prep 43 3.33 .92 3.34 .88 3.24 1.05
Prep 44 2.81 1.14 3.04 1.03 3.00 1.07

Prep 45 2.29 1.36 2.86 1.18 2.74 1.31

201

APPENDIX I

Internal Providers External Providers Insurance Based
Providers

DMSI Item M _SQ M _SQ M _S_D
Prep 46 2.28 1.43 2.84 1.14 2.50 1.25
Prep 47 2.27 1.48 2.82 1.31 2.68 1.38
Prep 48 2.54 1.17 2.89 1.02 3.00 .81
Prep 49 2.35 1.26 2.07 1.08 2.18 1.11
Prep 50 2.98 1.06 3.14 .94 3.13 .99
Prep 51 2.45 1.22 2.32 1.17 2.50 1.08
Prep 52 2.54 1.29 2.29 1.28 2.53 1.18
Prep 53 2.72 1.08 2.70 1.15 2.89 1.23
Prep 54 2.14 1.26 2.40 1.16 2.16 1.17
Prep 55 2.23 1.53 2.15 1.26 1.95 1.09
Prep 56 2.40 1.10 2.12 1.29 2.24 1.34
Prep 57 2.09 1.53 2.58 1.35 2.26 1.33
Prep 58 2.56 1.21 2.27 1.27 2.58 1.11
Prep 59 1.84 1.38 1.76 1.34 1.84 1.39
Prep 60 1.71 1.34 1.64 1.31 1.55 1.25
Prep 61 3.14 1.00 2.89 1.07 3.14 1.00
Prep 62 2.91 1.03 3.01 1.02 2.81 1.02
Prep 63 2.48 1.28 2.84 1.20 2.70 1.27
Prep 64 2.29 1.26 2.66 1.02 2.76 1.01
Prep 65 2.34 1.28 2.59 1.02 2.54 1.04

Prep 66 2.15 1.37 2.26 1.22 2.27 1.19

202

APPENDIX I

Internal Providers Extemal Providers Insurance Based

Providers
DMSI Item M S_D M 82 M _s_12
Prep 67 2.32 1.17 2.28 1.27 2.41 1.28
Prep 68 2.16 1.08 2.27 . 1.22 2.24 1.14
Prep 69 2.71 1.20 2.94 1.04 3.24 .86
Prep 70 2.25 1.24 2.38 1.23 2.32 1.06
Prep 71 2.70 1.26 2.20 1.37 2.97 1.09
Prep 72 2.79 1.21 2.75 1.19 2.81 1.29
Prep 73 2.81 1.04 2.87 1.15 3.00 .94
Prep 74 2.30 1.28 2.01 1.33 1.89 1.52
Prep 75 1.93 1.26 1.81 1.23 2.14 1.49
Prep 76 2.18 1.25 2.14 1.11 2.14 1.11
Prep 77 2.60 1.18 2.57 1.07 2.57 1.09
Prep 78 2.27 1.12 1.90 1.22 2.73 1.10
Prep 79 2.63 1.18 3.00 1.08 2.78 1.16
Prep 80 2.68 1.22 2.99 1.08 2.86 1.18
Prep 81 2.73 1.18 3.01 1.03 2.78 1.20
Prep 82 3.11 1.08 3.23 .94 3.19 1.00
Prep 83 2.67 1.07 2.95 1.02 2.68 1.13
Prep 84 2.61 1.04 2.79 .95 2.62 1.11
Prep 85 2.40 1.24 2.60 1.05 2.59 1.17
Prep 86 2.09 1.28 2.53 1.09 2.54 1.26

Prep 87 2.70 1.24 2.40 1.09 2.49 1.10

203

APPENDIX I

Internal Providers External Providers Insurance Based

Providers
DMSI Item M SD M SD M S_D
Prep 88 2.41 1.26 2.55 1.13 2.51 1.24
Prep 89 2.82 1.09 2.78 1.07 2.84 1.07
Prep 90 2.24 1.32 2.21 1.25 2.35 1.21
Prep 91 2.57 1.23 2.57 1.14 2.66 1.05
Prep 92 2.53 1.27 2.00 1.14 2.32 1.07
Prep 93 2.57 1.19 2.28 1.28 2.39 1.28
Prep 94 2.14 1.21 1.83 1.21 2.08 1.30
Prep 95 2.81 1.23 2.56 1.29 2.87 1.17
Prep 96 2.75 1.34 2.79 1.22 2.84 1.13
Prep 97 2.02 1.24 1.74 1.36 1.89 1.31
Prep 98 2.29 1.38 2.74 1.32 2.53 1.45
Prep 99 2.11 1.40 2.40 1.15 2.24 1.34
Prep 100 1.65 1.19 1.44 1.20 1.87 1.53

Prep 101 1.89 1.32 1.47 1.31 1.84 . 1.37

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