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Journal of Rehabilitation Volume 81, Number 2

THE JOURNAL OF

Rehabilitation April/May/june 2015Volume 81, Number 2

NATIONAL REHABILITATION ASSOCIATION

Research and Practical Considerations forRehabilitation Transition CollaborationKathleen Marie Oertle and Kathleen J. Seader ......................................................................................... 3

Knowledge Utilization and ADA Technical AssistanceInformationGlenn T. Fujiura, Janet Groll, and Robin Jones ........................................................................................19

The Role of Hope in Predicting SupportedEmployment SuccessWilliam R. Waynor and Kenneth J. Gill ..................................................................................................26

Ethics and the Family in Rehabilitation CounselingMary Barros-Bailey ..................................................................................................................................32

Excellence is Within Your Reach: The Importance ofPlanning for Performance in the State-FederalVocational Rehabilitation ProgramDarlene A.G. Groomes, David Vandergoot, Michael Shoemaker, and Steven W. Collins ......................................................................................................................................39

Vocational Rehabilitation Transition Outcomes:A Look at One State’s EvidenceSong Ju, Larry Kortering, Kimberly Osmani, and Dalun Zhang ..............................................................47

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Journal of Rehabilitation Volume 81, Number 2 Journal of Rehabilitation Volume 81, Number 2

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EditorWendy Parent-Johnson

University of South Dakota

OfficersTarea Stout, President

Mississippi

Eleanor Williams, President-ElectVirginia

Ellen Solkolowski, Past-PresidentAtlantic, Iowa

Jason Easley, TreasurerMadison, Mississippi

StaffFrederic K. Schroeder

Executive DirectorSandra Mulliner

Administrative AssistantPatricia Leahy

Governmental Affairs DirectorMichael Romero, CEM

Membership CoordinatorVeronica Hamilton

Office Manager

The Journal of Rehabilitation (ISSN 0022-4154) is theofficial publication of the National Rehabilitation Associ-ation. Opinions expressed in the Journal are those of the writer and not the policy of the National Rehabilitations Association NRA is a non-profit organization dedicated to improving the quality of life for people with disabilities. Published quarterly (January, April, July, October). Copyright 2015. Reproduction without permission of the NRA is prohibited. Printed in U.S. Periodical postage paid Alexandria, Virginia and additional mailing offices. Notice of change of address should be sent along with old mailing label to NRA at least eight weeks prior to moving. Subscription price for members is $10.50 per year and is taken from annual dues. The price for non-members is $95 per year in the US., $105 in Canada and $125 for all other countries. Single issue copies are $25 each for domestic and $35 each for Canada and foreign orders and includes postage. Not all back issues are available. POSTMASTER: Send all address changes to the Journal of Rehabilitation, P.O. Box 150235, Alexandria, Virginia 22315. Publication No. 867220. You may visit our website at:

http://www.nationalrehab.org

Research and Practical Considerations forRehabilitation Transition CollaborationKathleen Marie Oertle and Kathleen J. Seader ...................................................... 3

Knowledge Utilization and ADA TechnicalAssistance InformationGlenn T. Fujiura, Janet Groll, and Robin Jones .....................................................19

The Role of Hope in Predicting SupportedEmployment SuccessWilliam R. Waynor and Kenneth J. Gill ................................................................26

Ethics and the Family in RehabilitationCounselingMary Barros-Bailey ..............................................................................................32

Excellence is Within Your Reach: The Importance of Planning for Performance in the State-Federal Vocational Rehabilitation ProgramDarlene A.G. Groomes, David Vandergoot, Michael Shoemaker, andSteven W. Collins ...................................................................................................39

Vocational Rehabilitation Transition Outcomes: A Look at One State’s EvidenceSong Ju, Larry Kortering, Kimberly Osmani, and Dalun Zhang ...........................47

In Review .........................................................................................................54

T H E J O U R N A L O F

ARTICLES

Rehabilitation

1

Departments


Anita C. All (2016)Auburn University

Bryan Austin (2017)University of Idaho

Karen Barrett (2016)University of Maine-Farmington

Malachy Bishop (2017)University of Kentucky

Daniel Boutin (2015)Northern Illinois University

Eileen J.Burker (2017)University of North Carolina at Chapel Hill

Jack R. Clarcq (2015)Rochester Institute of Technology

Ralph M. Crystal (2017)University of Kentucky

Mary Lou Duffy (2016)Florida Atlantic University

Thomas L. Evenson (2015)University of North Texas

Clayton Faubion (2016)University of Maryland Eastern Shore

Michael Frain (2017)Florida Atlantic University

Juliet H. Fried (2016)University of Northern Colorado

James T. Herbert (2017)The Pennsylvania State University

Kenneth Hergenrather (2017)George Washington University

Robert L. Hewes (2015)Springfield College

Linda L. Holloway (2016)University of North Texas

Timothy P. Janikowski (2017)State University of New York, Buffalo

Tammy Jorgensen-Smith (2017)University of South Florida

Joseph E. Keferl (2016)Wright State University

John Lui (2017)University of Wisconsin-Stout

Dan Lustig (2016)University of Memphis

Lisa A. Ochs (2017)Arkansas State University

Adele Patrick (2015)The University of Georgia

Jared C. Schultz (2015)Utah State University

Amy L. Skinner (2017)The University of Tennessee

Steven G. Sligar (2017)East Carolina University

James L. Soldner (2017)University of Massachusetts-Boston

David Strauser (2015)University of Illinois at Urbana-Champaign

John S. Trach (2016)University of Illinois at Urbana-Champaign

Geoffrey Waghorn (2016)Queensland Centre for Mental Health Research

(Australia)

Keith B. Wilson (2015)Southern Illinois University at Carbondale

Lisa Zheng (2017)University of Maryland Eastern Shore

EditorWendy Parent-Johnson

University of South Dakokta

Associate Editors for Book Reviews Statistical Consultant Gregory G. Garske Alan Davis John Johnson Bowling Green State University South Dakota State University University of South Dakota

Editorial Board

In keeping with person-centered, inclusive approaches to education, all high school students are encouraged to pur-sue postsecondary education and/or employment to their

optimal capacity. Influenced by research evidence and legis-lation highlighting transition planning and services, students with disabilities are entering postsecondary education and competitive employment in greater numbers than ever before (Newman et al., 2011). Yet moving from the entitlement sys-tem, which is the basis for primary and secondary education, to the qualification-based adult support system often results in disproportionally poorer postsecondary outcomes (e.g., Baer, Daviso, Queen, & Flexer, 2011; Banks, 2014; Taylor & Selt-zer, 2011). Consequently, students with disabilities still lag behind their peers without disabilities in terms of high school completion, employment rates, and postsecondary education access (Harkin, 2013; Kessler Foundation & National Organi-zation on Disability, 2010; Luecking & Luecking, 2013; New-man et al., 2011).

The term transition has become common vernacular of rehabilitation and special education professionals in refer-

ring to the planning and service needs of secondary students with disabilities in their movement to postsecondary settings (Cobb & Alwell, 2009). Encompassing social, career, and aca-demic goals, transition is a multi-phased, multiple-stakehold-er endeavor requiring transition-specific professional training, curricula/program planning, and service delivery approaches (Cobb & Alwell 2009; Plotner, Oertle, & Kumpiene, 2015; Plotner, Trach, Oertle, & Fleming, 2014; Trach, Oertle, & Plotner, 2014). Partly because transition services cross pro-fessional lines and partly because of fragmented regulations, services to high school students with disabilities are often un-der-coordinated and hence not optimally effective (e.g., Bas-sett & Kochhar-Bryant, 2006; Oertle & Trach, 2007; Taylor & Seltzer, 2011).

Theoretical models based in organizational behavior, so-cial psychology, and management have been found to be appli-cable to collaboration (Bryson, Crosby, & Stone, 2006; Thom-son & Perry, 2006; Thomson, Perry, & Miller, 2007; Kester, 2013), which is commonly viewed as a significant component of effective transition practices (Kohler, 1993; Kohler, 1996; Noyes & Sax, 2004; Plotner, Trach, & Strauser, 2012; Rou-leau, 2012; Sax & Noyes, 2008). However, more research is necessary to firmly establish theoretical parameters of collab-oration in transition. Although there are numerous examples of successful formalized transition projects, many of which incorporate collaboration (Albright, Hasazi, Phelps, & Hull,

Transition collaboration has been discussed as a potential coupler, joining second-ary and postsecondary professionals’ efforts to improve transition outcomes. Al-though transition collaboration remains understudied and under discussed, there is growing attention to rehabilitation professionals’ participation. Among rehabili-tation professionals involved in transition are state vocational rehabilitation coun-selors, community rehabilitation providers, and centers for independent living per-sonnel, all of which have related but distinctive roles. The purpose of this article is to stimulate discussion and generate knowledge regarding transition collaboration by updating and extending the Oertle and Trach (2007) transition literature review that emphasized rehabilitation professionals’ involvement in transition collabora-tion. Operationally defined practices and a structural and measurement model are proposed. The implications for rehabilitation are discussed and recommendations for improvement are offered.

Research and Practical Considerations forRehabilitation Transition Collaboration

Journal of Rehabilitation2015, Volume 81, No. 2, 3-18

Kathleen Marie Oertle Utah State University

Kathleen J. Seader Utah State University

Kathleen Marie Oertle, Department of Special Education and Rehabilitation, Utah State University, Logan, UT 84322. Kathleen J. Seader is now at the Utah State Office of Rehabil-itation, Division of Rehabilitation Services.


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Journal of Rehabilitation Volume 81, Number 2 Journal of Rehabilitation Volume 81, Number 24 5

cess. Similarly, Hasnain and Balcazar (2009) found signif-icant interactions between race/ethnicity, gender, education, and socioeconomic level and inclusion in community-versus facility-based employment (i.e., sheltered work), with people of color less likely to be employed in competitive, communi-ty-based settings than their White peers. A few studies have focused on intrinsic characteristics that correlate to postsec-ondary employment and/or education, including Newman et al. (2011) who found long-term implications of social interac-tion and outcomes, and Essex (2012) who found correlations between transition success and measures of self-determina-tion. Similarly, Banks (2014) found a connection between cul-tural and social capital and postsecondary transition success.

Curricular methods and interventions. Career prepa-ration and development that includes (a) access to the general curriculum (e.g., Division of Career Development and Tran-sition [DCDT], 2012; Test, Mazzotti, et al., 2009), (b) career and technical education (e.g., Cobb et al., 2013; Kalchik & Oertle, 2010; Kohler, 1993; Rabren, Carpenter, Dunn, & Carney, 2014; Test, Mazzotti, et al., 2009), and (c) paid and unpaid work experiences during high school have been re-peatedly shown to predict positive postsecondary outcomes (e.g., Benz et al., 2000; Cobb & Alwell, 2009; Kohler, 1993; Luecking & Fabian, 2000; Rutkowski, Daston, Van Kuiken, & Riehle, 2006; Test, Mazzotti, et al., 2009). Further, Kohler (1993) found that along with participation in career and tech-nical education; parent involvement in the transition process, and interagency collaboration were cited in 50% of the litera-ture as key to postsecondary success. Landmark et al. repeat-ed Kohler’s methods in 2010, finding similar results.

The Current State of and What’s Neededin Transition Collaboration Research

At the core of the transition process are collaborative efforts that are within-and cross-systems, typically occur-ring among secondary school personnel (i.e., general, career and technical, and special educators; school counselors) and rehabilitation professionals as well as other community ser-vice providers (e.g., college disability services professionals; healthcare specialists; social security administrators; child welfare caseworkers; WIOA employment counselors). The Individuals with Disabilities Education Improvement Act (IDEA, 2004) and the Rehabilitation Act and its Amendments (Rehabilitation Act) are the two major laws that govern transi-tion practices and specifically pertain to special education and VR so their partnership receives the most attention. Among other responsibilities, IDEA (2004) mandates special educa-tors coordinate with appropriate entities in establishing and meeting Individual Education Plan (IEP) transition goals, while the Rehabilitation Act contains transition provisions for rehabilitation professionals. Both IDEA and the Rehabilita-tion Act contain directives for the secondary education and VR systems to work in coordination but leave it up to the state and local levels to establish how this will be executed. Unfor-tunately, the U.S. Government Accountability Office [GAO] (2012) has determined that state level agreements have not translated into effective local partnerships, and although lo-cal level community transition teams have been shown to in-

crease collaboration (Kester, 2013; Noonan et al., 2013), these teams operate with great variation with little study of their efficacy.

Additionally, IDEA provides transition funding to the secondary school system and the Rehabilitation Act funds both VR and CILs. To the contrary, CRPs are neither direct-ly governed by nor do they receive funding from either act. Though more complicated and therefore often left out of the dialogue, CILs and CRPs must be included in the transition collaboration discussion because of the critical role they play in the effective VR service delivery (Holloway, Evenson, Haag, & Garber, 2008).

Formalized Transition Model Projects Demonstration model projects offer a forum for exper-imentation using an ecological approach to transition re-search. Because IDEA and the Rehabilitation Act do not specify the components of transition collaboration (Bassett & Kochhar-Bryant, 2006; Oertle & Trach, 2007), and case law generally does not establish precedent, demonstration projects may provide a baseline from which profession-als can craft successful, collaborative transition practic-es.

Several transition projects funded by state and federal entities have yielded many promising approaches that focus on curricula, training, service delivery, and collaboration. The “Youth Transition Project,” the “Great Oaks Project,” and “Teaching All Students Skills for Employment and Life” (TASSEL) have yielded consistent attention (see Izzo & Lamb, 2003). All three projects improved students’ transi-tion outcomes by integrating multi-scale collaboration with student-specific interventions in academics and life skills, and focused development of self-determination and career devel-opment skills (e.g., Aspel et al., 1999; Benz et al., 1999; Izzo & Lamb, 2003).

Demonstration also offers a comprehensive way to apply theory-based frameworks such as Kohler’s “Taxonomy for Transition Programming” (Kohler, 1996), the National Col-laborative on Workforce and Disability for Youth’s “Guide-posts for Success” (NCWD/Y, 2005), or demand-side employ-ment strategies (Gilbride & Stensrud, 1992; Chan, 2009). For example, resulting in increased successful student transition outcomes, “Project SEARCH High School Transition Pro-gram” (Project SEARCH), used targeted collaboration among employers, educators, VR, and community agencies within a demand-side model which stressed local employer demand (Rutkowski et al., 2006).

A few projects have focused specifically on improve-ment of interagency collaboration; for example, Horn et al. (1998) reported on a jointly funded transition-to-work project between a state VR agency and the state education agency in which IEP and Individual Plan for Employment (IPE) plans were coordinated; 77.8% students in the program were em-ployed upon graduation. Another example, the “Maryland Seamless Transition Collaborative” (MSTC), was based on a

1981; Aspel, Bettis, Quinn, Test, & Wood, 1999; Benz, Lind-strom, & Yovanoff, 2000; Brewer et al., 2011), these model projects have yet to be widely implemented or made perma-nent. What’s more, even though vocational rehabilitation’s (VR) involvement in transition has been shown to increase the likelihood of students’ postsecondary success (Agran, Cain, & Cavin, 2002; Herbert, Lorenz, & Trusty, 2010; Honeycutt, Thompkins, Bardos, & Stern, 2015; Horn, Trach, & Haworth, 1998), research is only beginning to be conducted to identify rehabilitation-specific transition competencies. To contribute to the growing body of transition literature, the purpose of this article is to update and extend the suggestions made by Oertle and Trach (2007) regarding rehabilitation professionals’ (i.e., VR counselors, Community Rehabilitation Providers (CRPs), and Centers for Independent Living personnel (CILs)) in-volvement in transition collaboration and intrinsic to this, to suggest research and the applied needs of rehabilitation pro-fessionals for improvement.

Rehabilitation Professionals and Transition The National Center for the Study of Postsecondary Ed-ucational Supports (2000) estimate that 80% of high school students with a disability who attempt postsecondary educa-tion will need assistance to manage services; a logical leap could be made that students entering the workforce will need similar support. Demonstrating the need for employment ser-vices, nearly 60% of high school students with and without disabilities were unable to identify career characteristics or pathways to secure employment despite being able to identi-fy their desired career (Solberg, Gresham, Phelps, & Budge, 2010). Furthermore, Wagner, Newman, Cameto, Levine, and Marder (2003) observed that as many as 98.6% of students who receive special education services have limited to no par-ticipation in a number of employment preparation and career development activities.

In 2000, the transition-age population was 13.5% of the total VR consumer base (Hayward & Schmidt-Davis, 2000). However since that time, the transition-age population receiv-ing VR services has more than doubled, making them 33% of the total population being served by the state VR system (Hon-eycutt et al., 2015). The transition-age population has reached a critical mass, and as such is receiving greater attention in the field of rehabilitation, with 88% of state VR agencies re-porting having dedicated state transition leadership and 76% having designated VR counselors with transition caseloads (The Study Group, 2007). The benefits of VR services have not gone unnoticed by the U. S. federal government which has pushed for even greater VR involvement (Harkin, 2013). In addition, the recent amendments to the Rehabilitation Act of 1973 outlined within the new Workforce Innovation and Opportunity Act (WIOA, 2014) reinforced the role of VR in transition planning and services to begin while students are still in high school. With this movement, the need for under-standing the rehabilitation perspective and its impacts on ef-fective transition practices becomes even more imperative.

Overview of Transition Research Since the term transition was first used by Madeline Will of the United States (US) Office of Special Education and Rehabilitation Services (OSERS) (Will, 1984, 1986), rough-ly thirty years of research have yielded a handful of theoreti-cal and applied models. These models have been utilized to ground and organize the four overarching themes found in transition:

• curricula/interventions (e.g., Condon & Callahan, 2008; Koch, 2000; Morningstar et al., 2010; Plotner & Oertle, 2011; Rouleau, 2012; Test, Fowler, et al., 2009; Test, Mazzotti, et al., 2009);

• planning and service delivery frameworks (e.g., Halpern, 1985; Kohler 1993, 1996; Kohler & Field 2003; Noyes & Sax, 2004; Oertle & Bragg, 2014: Plotner, Trach, & Strauser, 2012; Rouleau, 2012; Sax & Noyes, 2008; Will, 1996);

• training and professional competencies (e.g., Benitez, Morningstar, & Frey, 2009; deFur & Taymans, 1995; Plotner, Trach, & Shogren, 2012; Stodden, Yamamoto, & Folk, 2010); and

• collaboration among stakeholders (e.g., Agran et al., 2002; Benz, Lindstrom, & Latta, 1999; FIESTA, 2014; Kester, 2013; Noonan, Erickson, & Morningstar, 2013; Noyes & Sax, 2004; Oertle & Trach, 2007; Oertle, Plotner, & Trach, 2015; Oertle, Trach, & Plotner, 2013; Rouleau, 2012; Scarborough & Gilbride, 2006; Taylor, 2013; Test, Mazzotti, et al., 2009).

Collaboration, however, has lagged behind the other three major themes in terms of theoretical development and empir-ical testing as evidenced by the limited research in which ev-idence-based practices have been identified (Cobb & Alwell, 2009; Cobb et al., 2013; Landmark, Ju, & Zhang, 2010; Test, Fowler, et al., 2009) and the predictive relationship to out-comes has been determined (Test, Mazzotti, et al, 2009).

Predicting Student Success Though collaboration serves as the backbone on which effective transition service delivery is based, a brief look at how a few other areas of transition research are faring is nec-essary to place collaboration into context. More specifically, research in which individual and institutional predictor vari-ables have been found to be associated with postsecondary employment and education could to be influential in identify-ing collaboration activities among stakeholders. In particular, malleable variables could be used to shape student preparation and guide transition planning and service delivery.

Individual and cultural factors. Many researchers have reported on demographic variables that correlate with post-secondary outcomes; for example, Baer, Flexer, and Dennis (2007) and Baer et al. (2011) found that disability severity, academic proficiency in high school, and amount of transi-tion assistance required by a student predicted transition suc-


synthesis of transition research called, “Guideposts for Suc-cess” (NCWD/Y, 2005). Early MSTC descriptive research by Luecking and Luecking (2013) has contributed to the evi-dence base by documenting the steps involved in, “systemati-cally delivering seamless transition services” (p. 2) statewide. Further, Fabian and Luecking (2015) observed that transition-ing youth were significantly more likely to have secured jobs at VR case closure when teams rated highly on the Levels of Collaboration survey (Frey, Lohmeier, Lee, & Tollefson, 2006). However, in contrast, Fabian & Luecking (2015) found when using the Questionnaire on Collaboration (QoC) (as cit-ed in Fabian & Luecking, 2015), that “the odds of successful rehabilitation would decrease as the team scores on the QoC increased…” (p. 3). Based on these early findings, they con-cluded that the intention of the collaboration appeared to be influential on VR youth case closure outcomes. Fabian and Luecking (2015) further added, “collaboration is obviously a complex construct, requiring significant additional research to define and develop measures to operationalize it” (p. 3).

Professionals directly involved in transition as well as leaders and policy makers have much to learn from these demonstrations. Common to these model projects were em-phasis on (a) transition as a formalized and structured process, (b) the student taking leadership of their plan formulation, (c) parents and families actively involved in the decision-making process for IEP transition components, and (d) professionals from both the school and area agencies having well defined duties and responsibilities. Such short term demonstration projects have the potential to become templates for implemen-tation and evaluation of long-term, large-scale efforts.

Theory Development Theories have a tendency to appear abstract; however, theories anchor assertions (Parsons, 1938). The knowledge generated through the theory development process “contrib-ute to that community’s collaborative knowing” (Stahl, 2004, p.4). Parsons further contends that, …the alternative for the scientist in the social or any other field is not as between theorizing and not theorizing, but as between theorizing explicitly with a clear consciousness of what he is doing with the greater opportunity that gives of avoiding the many subtle pitfalls of fallacy, and following the policy of the ostrich, pretending not to theorize and thus leaving one’s theory implicit and uncriticized, thus almost certainly full of errors (1938, p. 15). Intrinsically, researchers use theories to decipher the gaps, shape their research questions and design, guide their choice of the variables to be researched, and ultimately, they use theory to set the context for how they interpret their findings (Parsons, 1938; Stahl, 2004). Fundamentally, theory serves as a basis from which researchers can use empirical stud-ies to validate practices (Carter et al., 2013; Kohler, 1993; Landmark et al., 2010). Applied to transition collaboration, theory could be used to advance both research and practice. Yet, collaboration theories have not been widely adapted for serving the transition-age population but development of col-

laboration theories may help to further define collaboration, delineate collaboration responsibilities and expectations, and improve measurement of its impact on transition outcomes (Oertle & Trach, 2007; Trach, 2012).

Transition collaboration theory development and its cal-ibration are needed steps in the process of formalizing tran-sition to improve outcomes. A combination of professional opinion and observed outcomes of interventions, theories serve as a logical starting point for policy, model, and pro-gram development and for this reason collaboration theories from other fields can be found applicable to transition. More specifically, organizational behavior theories could be of use because, just like in business, they allow conceptualization of how separate entities can address and solve complex problems and share responsibility and cost for their attainment while allowing those entities to contribute their strengths while re-maining autonomous (Gray & Wood, 1991; Wood & Gray, 1991). Parsons (1938) described the benefits of looking to related fields for theory development as, “…a source of cross fertilization of related fields of the utmost importance. This often leads to very important developments within a field which would not have taken place had it remained theoretical-ly isolated” (p. 20).

Defined in general as “an interactive process between organizations that involves negotiation, development and assessment of commitments, and implementation of those commitments” (Wenger, 2000, p. 98), the most prevalent col-laboration theories tend to be based on resource dependence theory (Pfeffer & Salancik, 1978), which concerns interde-pendence of organizations with limited resources (Thomson et al., 2007; Thomson, Perry, & Miller, 2008), and social learn-ing theory, which posits that organizations benefit best from taking a learning-oriented role with attention paid to both intraorganizational and interorganizational relationship-build-ing (Thomson et al., 2007, 2008; Wenger, 1998). Responding to Wenger’s (2000) call for more social science collaboration research, Thomson et al. (2007) conceptualized and measured collaboration with a sample of directors of organizations par-ticipating in AmeriCorps and used their findings to construct a multidimensional model of collaboration. Thomson et al. (2008) later advanced their prior research (2007) by empiri-cally tying the collaboration process to outcomes.

Operational Definition Collaboration is repeatedly noted as a factor in transition outcomes in both theory (Kohler, 1996; Kline & Kurz, 2014) and practice (e.g., Noyes & Sax, 2004; Oertle & Trach, 2007; Honeycutt et al., 2015; Riesen, Morgan, Schultz, & Kopfer-man, 2014); however few scholars have set forth operational definitions for transition collaboration or have discussed the within- and cross-systems influences on collaborative practic-es that add to its complexity. The lack of operational defini-tion and guidelines for practices can be linked back, in part, to IDEA and the Rehabilitation Act. Despite common use of the term collaboration as a significant component of transition planning and service delivery, this term does not appear in

neither IDEA nor the Rehabilitation Act in connection with transition, but, rather the term coordination is used (IDEA, 2004; Rehabilitation Act).

In transition practice and research, coordination and col-laboration have been used interchangeably; but, they obvious-ly have different meanings. Yet, the components of coordi-nation and collaboration are theorized as interrelated along a spectrum (Frey, et al., 2006). Whereas coordination, an earlier stage, consists of “shared information and resources, defined roles, frequent communication, and some shared de-cision making” (Frey et al., 2006, p.387), collaboration is the final stage and is more nuanced (Frey et al., 2006). In collab-oration, “members belong to one system, have frequent com-munication that is characterized by mutual trust, and reach consensus on all decisions” (Frey et al., 2006, p.387). Defined in this way, collaboration becomes part of an overall transdis-ciplinary approach to transition planning and service delivery. Drawing from the fields of healthcare and early childhood ed-ucation, transdisciplinarity has been described as “transcend-ing the disciplinary boundaries…[in which] members from different disciplines work together using a shared conceptual framework, goals, and skills” (Choi & Pak, 2006, p. 356) to develop a shared mission (King et al., 2009).

Substantiated by the literature, approaches to transition service delivery continue to evolve with collaboration dis-cussed as an operational goal among professionals. Further-more, while relatively new to the transition conversation, the use of transdisciplinarity has the potential to advance transi-tion efforts by moving beyond multi- and interdisciplinary ap-proaches (Choi & Pak, 2006, 2007) to an approach that may be more in-line with the goals of transition (i.e. successful seamless movement from secondary to postsecondary set-tings). According to King et al. (2009), to unlock the potential benefits of using a transdisciplinary approach the profession-als involved need (a) “a sound understanding of principles of interprofessional teamwork” (p.221), (b) “detailed and up-to-date dual purpose reports documenting roles and plans” (p. 221), (c) a “personal responsibility to engage”, and (d) “sys-tematic and deliberate teaching of skills to [professionals] with different viewpoints, experiences, and levels of under-standing” (p.220).

Measurement The application of collaboration theory and its measure-ment is a relatively new area of transition research. However there are a few examples. Applying Thomson et al.’s (2007) collaboration construct to transition and the interagency col-laboration strategies identified by Noonan, Morningstar, & Erickson (2008), Noonan et al. (2013) measured the impact of a collaboration focused, year-long training on community transition teams. Noonan et al. (2013) found increased levels of collaboration. In 2013, Kester conducted an empirical study of the application of Wenger’s 1998 social theory of learning to a cross-systems transition communities of practice, also finding improvements in collaboration. These researchers are the first to apply collaboration theory to transition. Much more research is strongly needed to fully operationalize and

measure collaboration in transition and uncover its impact on outcomes (Fabian & Luecking, 2015).

To assist in closing the gaps in transition research, the Transition Collaboration Model (TCM) is proposed (see Fig-ure 1). The TCM was primarily constructed from the work of Thomson & Perry, 2006; Thomson et al. (2007, 2008), the literature reviewed for this paper, the experiential background of the first author, and the research synthesis upon which the proposed operational definition is based (see Operationally Defined Practices section). Specifically within the context of transition, the factors (a) leadership (i.e., as measured by structures for shared mission/vision and processes for joint decision-making along with mechanisms for accountability), (b) interest (i.e., as measured by organizational self-interest, collective interest, and the benefit/challenge payoff), and (c) trust (i.e., as measured by truth-telling, follow-through, and consequences) are hypothesized to have shared properties that are associated with collaboration, and as such, have predictive relationships.

The TCM is a structural frame within which to measure the precision of the indicators (depicted in squares, see Fig-ure 1), their related factors (Leadership, Interest, and Trust depicted in circles, see Figure 1) as well as the strength and direction of the predictive relationships with the transition collaboration construct (depicted in the largest circle in Figure 1). What’s more, the individual and cultural factors, curricu-lar methods and interventions, among other transition-related variables could be analyzed as covariates. Further, once the TCM structural and measurement components are specified, the predictive relationships of the transition collaboration construct with transition outcomes could be tested. Typical sources of outcome data such as Indicators 1, 2, 8, 13, and 14 (IDEA, 2004) and VR’s statuses 22, 26, 28, 32, and 34 along with RSA-911 data could be used; but, the identification and collection of additional outcome data is necessary to fully ac-count for the impact of rehabilitation as the data collection currently falls short in scope. The use of the TCM to measure transition collaboration has the potential practical benefits of (a) making theory more concrete, (b) strengthening strategic planning, (c) providing an avenue for discussion and estab-lishment of priorities and expectations, (d) developing con-sensus, (e) evaluating and developing policies and practices, and (e) being a reflective tool for relationship building.

Operationally Defined Practices Perhaps because the field has yet to summarily define col-laboration and develop theory within its bounds, there exists only a few examples of empirical research in which interagen-cy transition practices were analyzed. In one study, Noonan, McCall, Zheng, & Erickson (2012) used mixed methods to investigate current and changing collaboration practices of established state-level transition teams, and in another study, Warmington et al. (2004) conducted a large scale review of the interagency and cross-professional collaboration literature in the UK. These researchers found that common interagency practices that led to success were (a) information sharing, (b) flexibility in scheduling, and (c) shared leadership with open


communication. These findings compliment the interagency transition practices proposed within the “Taxonomy for Tran-sition Programming” (Kohler, 1996) and the collaborative partnership competencies presented within the conceptual VR transition model (Plotner, Trach, & Strauser, 2012).

Large scale reviews such as Warmington et al. (2004) have yet to be replicated in the US. However, combining what has been learned from collaboration research in related fields and transition-specific research, these findings serve as a starting point for operationally defining and establishing an evidence-base for transition collaboration practices. Synthe-sizing the identified interagency practices (Choi & Pak, 2006; Choi & Pak, 2007; Frey et al., 2006; King et al., 2009; Kohler, 1996; Plotner, Trach, & Strauser, 2012), transition collabora-tion could be operationalized as

• using formal interagency agreements that document the incentives for working together, establish a shared conceptual person-centered and family-centered framework along with stating the common transition goals and vision; • having an identified leader that changes as needed, involving all relevant stakeholders with clearly defined roles and responsibilities that transcend disciplinary boundaries;

• developing an orientation manual and disseminating it through a comprehensive orientation to services;

• using standardized, formal and informal assessment methods from multiple disciplines simultaneously to develop, coordinate, and evaluate intervention plans;

• communicating frequently to exchange and pool information, knowledge, skills, and resources;

• attending and actively participating in planning meetings;

• developing and participating on a local transition planning council;

• participating in ongoing skill enhancement through planned joint professional development; and

• using constructive, ongoing evaluation of performance among team members.

As operationally defined, transition col-laboration can manifest into and be used as (a) quality indicators to guide implementa-tion and evaluation of policies, (b) standards for teaching transition competencies, (c) activities for practical applications, and (d) items on an instrument to be used and an-

alyzed within the TCM. Moreover, instrument development and subsequent research would complement; and extend the scope and capability of current transition collaboration be-cause of the focused measurement of transition specific col-laboration activities. Therefore this instrument could be used independent of or in tandem with other instruments such as the Transition Collaboration Survey (Noonan et al., 2013) and/or the Levels of Collaboration (Frey et al., 2006) which have been used to measure change.

Implications for Rehabilitation To continue the conversation started by Oertle and Trach (2007), there is value-added when rehabilitation is involved in transition because outcomes are improved. Educators, re-searchers, and practitioners interested in improving transition outcomes must collaborate to continue to make advances and address the on-going barriers that exist. Although connected, specific implications for education, research, and practice are presented next.

Education Pre-service. Opportunities for pre-service transition ed-ucation have been growing. More common are special educa-tion programs that have certificates or endorsements in tran-sition. However, rehabilitation counseling master’s programs have begun to include concentrations in transition with some joint coursework (i.e., involving pre-service VR counselors and special educators) which is providing early opportunities for transition training.

Plotner’s and Fleming’s (2014) survey of university reha-bilitation counselor curricula offers one of the few quantitative studies that focuses on how much and what transition infor-mation master’s students are learning. Of the Program Chairs who responded, 33% were from departments that housed both rehabilitation counseling and special education. Nevertheless, regarding transition education and training, only five of the 30 rehabilitation master’s programs had a certificate or spe-

cialized degree in transition and 86% of programs offered no courses specifically focused on transition. In contrast, 52% reported that transition content was infused into coursework and 72% responded that students had options for transition internships/practicums. Yet, this growing but still limited ex-posure to transition content has been repeatedly shown to be insufficient in preparing counselors for work in transition (Ki-erpiec, 2012; Oertle et al., 2013; Plotner & Fleming, 2014).

In-service. In transition research conducted by Oertle et al. (2015; 2013), in-service VR counselors, CRPs and CIL personnel with transition caseloads were surveyed about their transition participation, expectations, and collaboration. In both studies, well over one-half of the rehabilitation profes-sionals reported attending conferences and workshops to learn about transition. However, the majority reported that their ma-jor source of transition training was on-the-job. Highlighting the need for formalized training specific to transition, as many as a third of these rehabilitation professionals reported some-times or often not knowing what is expected of them. What’s more, nearly a quarter reported not knowing what is expect-ed of them during transition planning meetings. Similarly, Plotner, Trach, and Strauser (2012) and Plotner, Trach, and Shogren (2012) found that VR counselors perceived the pro-visions of career planning and counseling, career preparation experiences, and establishing and maintaining collaborative ties as important areas of competency in transition service de-livery, yet reported only little to moderate preparation in these areas.

Currently, there are no national transdisciplinary organi-zations or subgroups focused on the networking, professional development, or the continuing education needs of profes-sionals involved in transition. As a subgroup of the Council on Exceptional Children (CEC), the DCDT has a website, hosts an annual conference specifically addressing special educa-tion transition professional development and networking, and has crafted and disseminated, the “CEC Advanced Special Education Transition Specialists Standards” (CEC, DCDT, 2013). On the other hand, transition has not garnered the same level of attention from rehabilitation organizations such as the National Council on Rehabilitation Education (NCRE), the American Rehabilitation Counseling Association (ARCA), nor the National Rehabilitation Association (NRA). Although, NRA does have the Transition Specialties Division, thus far, however, there has been no national transition conference for rehabilitation professionals. Furthermore, only a few transi-tion-focused presentations have been typically offered at these rehabilitation organizations’ annual conferences.

There are some statewide transition conferences (e.g., Il-linois, Wisconsin) that have multi-stakeholder audiences (i.e., educators, healthcare providers, rehabilitation professionals, postsecondary educators, and transitioning students and their families). However, these statewide transition conferences are not nationally connected via social media, the web, or any other method, making cross-state collaboration nearly impos-sible. Furthermore, there is no national source of information about these statewide transition conferences and there are no

means for state transition leaders to connect with each other. The whereabouts of a home for and structure of a national transdisciplinary transition dialogue has yet to be discussed or addressed.

Note on CRPs and CILs. Despite the role that CRPs and CILs play in transition service delivery within and outside of the VR system, their education and training needs have had little comprehensive attention. CRPs and CILs have inconsis-tent educational and training requirements resulting in varying levels of preparation (Holloway et al., 2008); leading to frag-mented services and a wide-range of success rates (Plotner & Trach, 2010). The oversight of the transition-focused edu-cational needs of CRP and CIL personnel must be addressed given their integral involvement in transition planning and services (Oertle et al., 2015; Oertle et al., 2013).

Putting it all together. It follows that research must be put into practice in the form of in-service and pre-service training specific to transition. Transition-specific training must begin while the educators and rehabilitation profession-als are still in school and continue while in the field. Presently, special education and rehabilitation counseling students gen-erally do not share classes during school and rarely attend the same transition-specific in-service trainings (Oertle & Trach, 2007; Plotner, Trach, & Shogren, 2012). As collaboration will be an intrinsic part of the working futures of professionals in-volved in transition planning, early efforts at joint education, emphasizing division of labor and knowledge plus applica-tion of the use of different agencies is essential. Curricula borrowed from business management and education training, especially use of mock case studies in collaboration, could be developed to train both special educators and rehabilita-tion professionals in simulations of future real-life situations (Brazil & Teram, n.d.). Transition training must incorporate how to collaboratively develop curriculum and structure the student’s IEP and postsecondary rehabilitation plans such as VR’s IPE to connect secondary efforts to postsecondary op-portunities and outcomes.

Plotner and Fleming (2014) raised an important question about the capabilities of rehabilitation counseling faculty to provide transition-specific education. Based on the results of a systematic content analysis of rehabilitation counseling journals where only 4% of articles were on transition (Plotner, Shogren, & Strauser, 2011), it can be concluded that faculty are not prepared or at the very least are underprepared. Facul-ty preparation, curriculum mapping for cross-curricular com-parison and development as well as more transdisciplinary pre-service and in-service opportunities through joint train-ings (i.e., education and rehabilitation together) are greatly needed.

Research Rehabilitation transition research and practice have drawn heavily from what has been learned through the lens of special education. Research from the special educator’s point of view does have value in adding to the rehabilitation knowl-

9

Figure: 1 Proposed Transition Collaboration Model

Leadership

Trust

Interest

Structure

Decision-Making

Accountability

Self-Interest

Collective Interest

Benefit/Challenge

Truth-Telling

Follow Through

Consequences

Transition

Collaboration

Structural model

[Measurement model]


edge base; for example, Shaw, Dukes, and Madaus (2012) focused on what special educators can do to improve transi-tion, while Test and Cease-Cook (2012) offered a review of evidence-based transition practices primarily generated from the special education literature translated for rehabilitation. Further, Shaw’s and Dukes’ (2013) call for a research agenda on evidence-based transition to postsecondary education prac-tices can also be applied within the context of VR. However it is only when rehabilitation-specific research adds to the tran-sition knowledge base that deeper understanding of the impact of rehabilitation professionals’ involvement in transition can be fully realized.

Rehabilitation transition research. Researchers have used a variety of research methods to understand rehabilita-tion influences on transition. For instance, Lamb (2003) used case study to investigate the role of VR counselors in transi-tion; in this study, interview and survey methods were used to assess opinions of VR counselors regarding their role in and understanding of the transition process. Other authors have come forth with suggestions on the role of rehabilitation generated from reviews of the literature (e.g., Oertle & Trach, 2007) and competencies identified through survey of in-ser-vice VR counselors (e.g., Plotner, Trach, & Strauser, 2012). Results of large-scale comprehensive studies such as that by the Study Group (2007), in which nationwide statistics were analyzed on the most-often used, most successful, and least successful transition practices of VR counselors are valuable, yet least-often implemented. However, in recent research by Honeycutt et al. (2015), mixed methods were used in a na-tionwide investigation of transition within the VR system to assess current VR involvement and its impact. Simply stated, investigations from a rehabilitation perspective offer informa-tion about transition that is absent without it.

CRPs and CILs. Only a handful of researchers have in-cluded CRPs (Oertle et al., 2015; Oertle et al., 2013; Riesen et al., 2014) and even fewer have involved CILs (Oertle et al., 2015; Oertle et al., 2013) in their transition research. There-fore, much of the rehabilitation transition point of view has been primarily generated from VR counselors. Much like with their oversight in education, CRPs and CILs must be included in rehabilitation transition research because CRPs and CILs are pivotal community entities and are instrumental in the de-livery of services within and outside of the VR system (Hollo-way et al., 2008; Oertle et al., 2015; Oertle et al., 2013).

Furthermore, little is known about the intricate relation-ship among CRPs, CILs and VR counselors; from what has been learned, these rehabilitation professionals are working in collaboration and independent of each other and have dis-tinctive roles when it comes to transition (Oertle et al., 2015; Oertle et al., 2013). It is logical to conclude that to advance the understanding of transition collaboration from a rehabilitation perspective, CRPs’ and CILs’ transition involvement must be incorporated within more of the transition research

So Many More Questions, So Few Answers. Some of the research questions proposed by Oertle and Trach (2007)

have received attention. However, there are many questions that remain unanswered (see Table 1).

The current literature still does not provide answers to these questions. As Oertle and Trach (2007) speculated, “The answers could be helpful in developing strategies to improve interagency collaboration efforts during transition activities” (pp. 42-43). The operational definition and proposed TCM could be used to address some of these transition research questions. Clearly, more studies that focus on the rehabilita-tion professionals’ perspectives regarding transition service delivery within- and cross-systems collaboration are neces-sary.

Synergetic dissemination. As discussed earlier, there is currently no national transition professional organization or conference across disciplines. Likewise there are no peer-re-viewed cross disciplinary transition-focused scholarly jour-nals. The CEC’s DCDT does have an official journal, Career Development and Transition for Exceptional Individuals (CD-TEI), which is peer-reviewed, but is predominantly directed toward a special education audience. Rehabilitation profes-sionals do not have any scholarly journal solely dedicated to transition and only 4% of articles in rehabilitation journals were found to have transition content (Plotner et al., 2011). Therefore, no national forum exists for transition researchers to disseminate, critique, and generate knowledge; as such, transition research is somewhat fragmented which only adds to the difficulty of knowledge translation. What appears to be needed however is not another field-specific transition organi-zation, but a national transdisciplinary transition organization from which to generate, launch, and share knowledge through networking, research, and professional development.

Practice Oertle and Trach (2007) synthesized the typical and need-ed transition practices of educators and rehabilitation profes-sionals (see Oertle & Trach, 2007, Table 1, p. 39). Many of these practices are still typical which means much of the need-ed changes in transition practices proposed in 2007 remain today. Furthermore, Johnson (2000) argued that (1) increas-ing collaboration, (2) engaging students’ and their families’ involvement, (3) facilitating opportunities for postsecondary community-based outcomes, (4) ensuring inclusion and prepa-ration, and (5) ensuring meaningful completion of secondary education were the top five transition service challenges. All of the challenges presented by Johnson (2000) continue to ex-ist as well.

Rehabilitation professionals are finding themselves in-volved in the transition process now more than ever before (Honeycutt et al., 2015). Moreover, rather than waiting for an invitation to participate, rehabilitation professionals are increasingly taking the initiative to encourage collaboration with their local school districts and other adult service provid-ers through outreach and marketing of their services, initiation of contact, and regularly attending IEP meetings (Oertle et al., 2015; Oertle et al., 2013). However, collaboration has been

found to be linked with successful transition outcomes (Fa-bian & Luecking, 2015; Noonan et al., 2013) as well as to be a barrier to success (Fabian & Luecking, 2015: Riesen et al.,

2014).

1110

Table 1Rehabilitation Transition Questions That Remain Unanswered

Level Unanswered Question

Student How can parent and family involvement facilitate collaboration efforts across systems?*

What are emerging adults with disabilities and their families saying about their transition experiences and interactions with rehabilitation professionals?

Where do IEPs and IPEs intersect and how can IEPs/IPEs be developed and utilized to improve collaboration to support individuals’ transition goals and outcomes?

How are WIOA’s Employment Plans (EPs) and school counselors’ Individualized Career Plans (ICP) used in transition planning and services and what impact do they have on collaboration and transition outcomes?

How can secondary education support services be translated to support integrated postsecondary community participation (i.e., employment, continued education, and/or independent living)?

Professional What incentives are there for rehabilitation professionals who are involved in transition collaboration?* How can rehabilitation professionals become more actively involved in the transition process?* Who are transition specialists and what is their impact on transition collaboration?* What impacts do CRP and CIL involvement have on transition collaboration and outcomes?* How do investigations that go beyond the typical one-dimensional study of transition collaboration (i.e., special education and rehabilitation counselors) add to and change what is known about transition best practices?

What impact does the involvement of other professionals (e.g., school counselors, college disability services professionals, healthcare providers, social workers, SSA, and WIOA employment counselors) have on rehabilitation professionals’ transition role, collaboration, and outcomes?

How can transdisciplinary education opportunities be established?

How can transdisciplinarity be practiced within rehabilitation transition service delivery and what is its impact on collaboration and transition outcomes?

Policy What is the rehabilitation vision for serving emerging adults with disabilities?

What are the existing policies? What is needed?

What rehabilitation transition policies are most connected to supporting evidence-based collaboration practices?

How is rehabilitation transition policy enhancing and impeding state transition leadership?

How can transition initiatives through VR, WIOA, TRIO, and Perkins work in collaboration?

Theory How can transition collaboration theory be developed so that meaningful measurement of collaboration can be conducted and tied to improving transition outcomes?

Note. *Adapted from “Interagency Collaboration: The Importance of Rehabilitation Professionals’ Involvement in Transition” by K. M. Oertle & J. S. Trach, 2007, pp. 42-43. Journal of Rehabilitation, 73, 36-44. Copyright 2007 by the National Rehabilitation Association. Reproduced with permission from the National Rehabilitation Association P.O. Box 150235 Alexandria, VA 22315


Documentation. In addition to role confusion, unclear expectations, and limited preparation impacting rehabilitation professionals’ transition participation (Oertle et al., 2015; Oer-tle et al., 2013; Plotner, Trach, & Shogren, 2012), documen-tation and its use is field specific and, as such, does not easily translate from secondary to postsecondary settings. Compli-cating matters further, transition assessment procedures can be overlapping and findings conflicting (Luft, 1999). To con-tinue the work began at the 2003 National Transition Docu-mentation Summit (Kochhar-Bryant & Izzo, 2006), leadership must provide the legs for the structuralization of IEP, IPE, and Summary of Performance (SOP) as a priority for strength-ening within- and cross-systems collaboration (Lamb, 2007; Kochhar-Bryant & Izzo, 2006; Steere & DiPipi-Hoy, 2013) and increasing the fluidity of the transfer of transition-relat-ed information among stakeholders (Kochhar-Bryant & Izzo, 2006).

Recommendations for ImprovementRecognize Transition as a Specialized Field Of overarching concern is the need to formalize transition as a specialized field within both education and rehabilitation. This idea involves a multitude of corollaries. First, profes-sionals at all levels (researcher, administrator, and practitioner as well as agencies and professional accrediting bodies as a whole) must recognize that the unique population of emerg-ing adults (i.e., usually defined as ages 16 through 22 when referencing transition; Arnett, & Schwab (2012) extend this distinctive developmental period to age 29) require unique services that necessitate specific interventions (Arnett, 2000; Lamb, 2007; Plotner et al., 2014). Second, funding for pro-grams, hiring, and pre-professional/professional development must be directed to specifically target the needs of the transi-tion-age population. Third, leaders and educators must rec-ognize transition as a specific transdisciplinary subfield that is characterized by sharing information and skills across dis-ciplinary boundaries in collaboration as defined by the needs of the transitioning student and their family (King et al., 2009) with application within a multi-tiered system of supports (MTSS) (Morningstar, Bassett, Kochhar-Bryant, Cashman, & Wehmeyer, 2012). Finally, professional organizations and legal/accrediting bodies of education and rehabilitation must be utilized to offer opportunities for certification in transi-tion-specific competencies and chances for transition-specific professional meetings and conferences that reach across disci-plines (Honeycutt et al., 2015; Oertle & Trach, 2007; Plotner, Trach, & Shogren, 2012).

Address the Need for Transition-Specific Rehabilitation Training Standards As the field of transition becomes a specialty unto itself, not only will effective interventions continue to be estab-lished, but the training requirements of those who implement them will also continue to need to be identified and formalized to cultivate highly qualified transition professionals prepared to work in collaboration to make positive changes in the post-secondary trajectory of the transition-age population with dis-

abilities.

Professionals in the rehabilitation field serving the tran-sition-age population have clearly different roles than that of general rehabilitation counselors (Plotner et al, 2014); while some research has been done to identify professional com-petencies of VR counselors (e.g., Plotner, Trach, & Strauser, 2012), most researchers have concentrated on the needs of sec-ondary school educators (e.g., Test, Fowler, et al., 2009; Test, Mazzotti, et al., 2009). Nonetheless, there is a growing empir-ical transition research base in rehabilitation. For instance, VR counselors’ transition competencies within the domains of a conceptual VR transition model have been identified (Plotner, Trach, & Strauser; 2012; Plotner, Trach, & Shogren 2012) ex-tending the research of Kohler (1996) and deFur and Taymans (1995). In addition, the differences in service delivery for transition-age VR consumers have been documented (Plotner et al., 2014). Although the rehabilitation professionals’ tran-sition competencies have not been studied collectively (i.e., VR counselors, CRPs, and CILs) the research based on VR counselors provides a basis for further development and ap-plication in existing and developing pre-service and in-service education offerings.

Research the use of Long Term, Evidence-Based Transi-tion Collaboration Practice Transition can only be strengthened by applying the re-sults of empirical research in the long-term implementation of evidence-based practices firmly grounded through the devel-opment of transition-specific collaboration theory. These for-malized practices need to be standardized and sustained across local and/or state education agencies. Components should be similar or standard across schools and students (Bullis, 2013; Dowdy, 1996), but include flexibility within the curricular and programming to account for differences in demographics, cul-tural linguistic diversity (CLD), communities, and labor mar-kets (Anderson & Smart, 2010; Condon & Callahan, 2008).

Despite a shortage of quantitative transition collaboration studies that meet the Institute of Education Sciences (IES) What Works Clearinghouse (WWC) standards (Cobb et al., 2013) and correlational studies that include predictor and out-come variables (Test, Mazzotti, et al., 2009), researchers have shown that collaboration leads to greater outcomes for stu-dents (e.g., Benz et al., 1999; Fabian & Luecking, 2015; Horn et al., 1998; Rutkowski et al., 2006; Test, Mazzotti, et al., 2009). Complimenting Hasazi, Furney, and DeStefano’s find-ings (1999), Oertle et al. (2015) found that formal collabora-tion mechanisms supported by the administration were among the top reasons rehabilitation professionals reported for their involvement in transition collaboration. Furthermore, reha-bilitation professionals stated that transition collaboration led to valued partnership and better outcomes (Oertle et al., 2015). Similarly, Winsor, Butterworth, and Boone (2011) re-ported greater success in interagency collaboration when the administrative environment encouraged shared contribution in-kind. In addition, Jorgensen-Smith and Lewis (2004) found that components of successful interagency collaboration in-

clude clear delineation of roles and structure in the program setup.

Clearly, the evidence-based practices generated through multiple studies and model demonstration projects that em-phasize collaboration must be more widely implemented. Fur-thermore, rehabilitation policies and practices that promote the development and refinement of transition collaboration can only come to fruition with the evaluation of its long-term use and investigation of the impacts on transition outcomes. Therefore, to be effective, rehabilitation must commit to the long-term use and study of evidence-based transition practic-es that are implemented and tested through a consistent policy framework.

Conclusion Transition must become a recognized, distinct subfield within both education and rehabilitation professions that has collaboration as a central component. Particular to rehabili-tation, certifying and accrediting bodies for students and pro-fessionals must recognize transition as a unique field through establishment of competency standards and endorsement of pre and in-service training. Furthermore, rehabilitation pro-fessionals must continue to take the initiative to work with local schools and other providers while working together to create a common set of implementation plans and outcome standards. Rehabilitation educators must continue to address the knowledge, skills, and abilities needed to meet the needs of the changing make-up of VR consumers that this growing transition-age population entails. The synergy of research, ed-ucation, and field leadership is necessary to advance transition efforts across disciplines in collaboration.

Leadership is greatly needed to organize, connect, and develop a cohesive transition research agenda along with tran-sition-focused pre-service and in-service education. Planned comprehensively, rehabilitation leaders could advance tran-sition collaboration by reaching out to secondary transition leaders to not only further develop their own transition knowl-edge, skills, and abilities but also those of cadres of in-service and pre-service professionals. Delivery of evidence-based, transition-specific education can be used to advance transition efforts by cultivating qualified professionals who are transdis-ciplinarily educated and networked.

Historically, the responsibility for transition implementa-tion fell largely upon the shoulders of special educators. Spe-cial educators are still responsible for initiating the transition process and establishing the first transition plan for each stu-dent (IDEA, 2004). However rehabilitation professionals are playing an increasingly greater part in developing transition plans with students while they are still in high school and ac-tualizing these plans after high school in their communities; thus rehabilitation professionals have an influential part in the resulting transition outcomes. As more and more of the tran-sition-age population and their families access the public VR system, education, research, and field leaders will be looked upon to provide direction. In particular, of great need in the

field is evidence-based guidance to more clearly define tran-sition roles and deliberate and articulate expectations as well as develop collaboration measurement models with strategies to improve efficacy. The proposed operationally defined tran-sition collaboration and TCM could be of use in meeting this need.

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With the growth of disability-related initiatives in do-mestic policy making in the postwar era and pas-sage of rights based legislation focused on access

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Current examples of these latter efforts include Employer Assistance and Resource Network (EARN), Job Accommo-dation Network (JAN), and the National Collaborative on Workforce and Disability for Youth (NCWD/Youth) funded through the U.S. Department of Labor; Center for Parent In-formation and Resources through the Office of Special Edu-cation Programs (OSEP); and the national network of regional centers focused on the Americans with Disabilities Act sup-


Knowledge Utilization and ADATechnical Assistance Information

Glenn T. FujiuraUniversity of Illinois at Chicago

Robin JonesUniversity of Illinois at Chicago

Janet GrollUniversity of Illinois at Chicago

Using a knowledge utilization framework in a mixed method design, the study eval-uated how and why consumers and professionals used rehabilitation related tech-nical assistance (TA) information. Brief interviews were conducted with 326 users of an Americans with Disabilities Act (ADA) information center. Narrative data were reduced via content analysis into dichotomous themes (e.g., needed legal clarifica-tion, working on policy changes) and statistically modeled using latent class cluster analysis methods. Four “market segments” of users were identified: persons with a disability seeking an accommodation, professionals involved in structural design, other providers of TA, and those who sought out services based on credibility. Study implications are described in terms of looking beyond labels in identifying consumer needs, and the need to better understand the processes by which users translate information into outcomes.

Glenn T. Fujiura, Ph.D., Department on Disability and Human Development (M/C 626), College of Applied Health Sciences, University of Illinois at Chicago, 1640 W. Roosevelt RoadChicago, IL 60601.


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ported by the National Institute on Disability and Rehabilita-tion Research (NIDRR), among others.

How is information used by our stakeholders and to what effect? The question is deceptively simple. The effectiveness of information dissemination and informational technical as-sistance (TA) remains largely an article of faith in rehabil-itation. Since the 1993 Government Results and Reporting Act (GPRA) and its provisions for assessment and objective measurement of the impact of federal programs, agencies have been committed to outcome-based evaluations. In turn, the use of outcome measurements is increasingly part of the mantra of accountability among recipients of federal funding (Borden, 2011; Rivard, 2012). The conventional “process” measures that use TA activities -- phone calls answered, num-ber of businesses contacted, etc. – have largely been devalued as indicators of program efficacy (Ellig, McTigue, Ellig, & Wray, 2012). But the lack of data on outcomes is understand-able: there are significant conceptual and technical challenges in evaluating the use and utility of technical information. The type of information, the manner in which it is distributed, to whom it is given, and how the information is used encom-passes an incredibly diverse range of activities. Assuming the information does have an effect on a program outcome, it is likely indirect, and occurs in a complex, layered environment where other factors likely impede or facilitate its utility. Only rarely is it possible to directly assess the processes by which the act of technical assistance leads to substantive changes.

Partly in response to ambiguity over the impact of infor-mation dissemination, the process of producing and using in-formation has been the object of considerable attention, most notably in the health services field (Bowen & Graham, 2013) and recently in rehabilitation applications (Bezyak, Ditchman, Burke, & Fong, 2013). The conceptual framework most com-monly applied has fallen under the broad conceptual umbrella of knowledge translation (Canadian Institutes of Health Re-search, 2004). There are a number of variations (Estabrooks, Thompson, Lovely, & Hofmeyer, 2006; Graham et al., 2006; Straus, Tetroe, & Graham, 2013) with common core themes: the systematic consideration of how information is generated, constructed, disseminated, used, and linked to a presumptive outcome. Partly in response to the proliferation of models and perspectives, Graham et al. (2006) argued on behalf of a broader label -- “knowledge to action” – noting that the con-siderable conceptual confusion around different variations of the terminology that tend to emphasize different facets of the process from knowledge production to outcome.

While much of the research on knowledge translation has focused on the gap between research production and the appli-cation of their findings by stakeholders, particularly in health related fields, the concepts are particularly useful in guiding evaluations of the utility of information dissemination (Esta-brooks et al., 2006; Rogers et al., 2009). For example, in an early prototypical model of knowledge translation, The Otta-wa Model of Research Use (Logan & Graham, 1998), the re-lationship of information to outcome is affected by a number of process dimensions such as the features of the information,

strategies for dissemination, characteristics of users, and the needs of the setting within which the information is applied. A growing body of implementation literature has identified the importance of planning and collaboration in the use of information, organizational values regarding research based information, format and medium for the content, and the match between material, medium and user of the information, timing in the use of technical assistance, among others (Mit-ton, Adair, McKenzie, Patten, & Perry, 2007; Pentland et al., 2011). Broadly speaking, much of the research attention can be characterized as having been directed to the early and latter stages of the KT process. We know very little about what hap-pens during the information exchange process.

In an effort to better understand this information exchange process, the present study explored how technical assistance (TA) information regarding the Americans with Disabilities Act (ADA) was used from the end user’s perspective. Passed into law in 1990, the ADA has been both far reaching in intent and ambiguous in terms of implementation. ADA related TA is a particularly useful test case for examination of informa-tion transfer and utilization. While a legal mandate, adherence and enforcement of many of its provisions may depend upon an individual or organizational interpretation of guidelines (Locke, 1997). The ADA National Network was developed to assist with these interpretations. Comprised of ten regional centers, the network provides technical assistance and training to Americans with disabilities, businesses, and to all levels of government on ADA matters. The network is funded through grants provided by NIDRR. What the ADA regional centers do on a daily basis -- responding to questions from the field, providing information, and hoping that it is adopted and used – are very much representative of these mid-phases of knowl-edge utilization models in which adopters must access and decide to use information.

The intent of the study was to identify patterns of infor-mation use among consumers of ADA related TA information. The present study sought to statistically model these patterns drawing from brief interviews coded for themes based on topics and forms of information use. Since adopters are not homogeneous in their information needs and their use of TA information, even within a relatively narrowly defined topic such as the ADA, then, segmentation is a critical first step in subgroups within which working models of how TA efforts effect change – an assessment of the “black box.” In effect, the present study was an initial effort to better understand how and for what reasons TA information is adopted and used in disability information dissemination applications.

Methods A mixed-methods design was employed based on prag-matic considerations. The present study represented two dis-tinct research tasks: incorporating a qualitative approach in an open ended exploration of how consumers use information followed by statistical modeling to quantitatively organize and model the knowledge utilization themes. Specifically, the study design was a sequential mixed-design (Tashakkori &

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Teddlie, 2003) where narratives derived from open-ended in-terview questions were evaluated using a content analysis to identify user themes. The presence or absence of these themes in the narratives were then converted to dichotomously cod-ed variables and employed in a cluster analysis in order to statistically organize and model different subgroups among consumers of TA. Project procedures involved three study phases: (1) interviews of recipients of ADA Center services; (2) coding of interview data using qualitative methodologies; and (3) identification of clusters of TA user groups based on knowledge utilization themes.

Sample Survey respondents were former recipients of technical assistance from the Great Lakes ADA Center at the Univer-sity of Illinois at Chicago. Given the focus on knowledge utilization, we attempted to narrow the sample selection to those who were attempting to resolve a specific ADA relat-ed problem. Thus, email recruitments were sent only to those customers who had contacted the Center on two or more oc-casions regarding a specific problem that the center was as-sisting with. The rationale for the purposive sample to limit the sample to repeat users was that many single contacts for the Center represent simple informational requests such as re-ferral phone numbers. Of the approximately 11,000 multiple contact users of services over a five-year period, 1,200 had identifiable contact information. Per the university IRB guide-lines, a modified email consent protocol was employed; a total of 343 repeat customers agreed to participate in the study. A very small percentage of interviewees could not recall the TA event (17 respondents); in these instances, the interview was terminated. The remaining 326 respondents self-identified as belonging to one of 5 major categories of TA users: con-sumer/advocate (38%), public entity (24%), disability orga-nization (13%), professional services (15%), or other (10%). Included in the consumer/advocate group were persons with disabilities, family members or friends; disability organiza-tions were primarily CILs, and other service groups; public entities included all levels of government (mostly local and state) and education settings such as schools or universities. Professional services were represented primarily by architec-tural firms and to a lesser extent physician offices. “Other” was a mixed bag of businesses, and other entities such as the media.

Interview Protocol Data were collected through telephone-based interviews. Each former TA recipient was prompted with the approximate date and general description of problem that had been origi-nally presented to the ADA Center. Prior contact information was routinely collected as part of each TA event and stored in the project database. An interview consisted of four simple questions: (1) was the TA useful? (2) why or why not? (3) how was the information used? and (4) did any changes occur because of the information? This abbreviated open-ended in-terview protocol reflected the qualitative character of the first study phase and allowed users to respond with their own ver-sion of how the information was used and to what end. The intent was to keep the interview process as simple and time

limited as possible while providing the flexibility for elabora-tion and clarification by the respondents when probed by the interviewer. Among the few respondents (6%) who indicated lack of usefulness, only a few provided any narrative elabo-ration. All interviews were conducted by a single interviewer; responses were typically brief and were transcribed during and immediately after the interview.

Analysis There were three components in the analysis: (1) the identification of knowledge use themes using a content anal-ysis of the 326 interview responses, (2) dichotomous coding of each interview narrative to indicate the presence or absence of the derived themes, and (3) statistical modeling to identi-fy groupings or “segments” of information users via a latent class analysis of the codes. Responses to the interview ques-tions were treated as a single narrative and every thematic is-sue identified in the content analysis was coded as “present” or “absent” in the interview. Narratives were brief, typically a few sentences averaging less than 100 words per transcript.

Content analysis and coding. A basic content analysis was used to organize the “raw data” of the interview notes into a set of dichotomously coded variables indicating the pres-ence or absence of a knowledge utilization theme. Responses to the four questions were combined into a single narrative and themes extracted from the narrative. A grounded theory approach was employed, using two coding phases: an open preliminary coding and a phase where similar themes were consolidated into a reduced set of codes (Glaser & Strauss, 1967). This iterative process was used to refine and improve the coding of the notes. In the initial open coding phase, the interviewer reviewed and labeled any statement reflecting how or why information was used in an effort to identify a preliminary set of themes. No constraints were imposed on the number of themes. Labeling was conducted manually by making notations made in the transcript notes. These initial open codes were very specific and quite numerous (n =47). All codes were reviewed by a second analyst. In the consol-idation phase, the initial codes were collapsed and organized into 15 thematic groups and attention given to the conceptual relationships themes, and new code labels were introduced as needed to accommodate the grouping of themes. A listing of the themes and examples of the consolidation is summa-rized in Table 1 under Results. Once developed, each of the interviews was reviewed and dummy coded in terms of its presence or absence in the transcript: “1” if present in the interview or “0” if not.

Modeling. Since the data were nominal data, a latent class analysis was employed to identify distinctive groups or “market segments” for our TA efforts based on the pattern of themes. Again, the intent of the analysis was to explore wheth-er different “market segments” use ADA technical assistance information in different ways and for different reasons. In contrast to power calculations, there are no exact standards for optimal sample size; consensus converges on the 200-300 range (Albein-Urios, Pilatti, Lozano, Martínez-González, & Verdejo-García, 2014; Chuah, Drasgow, & Luecht, 2006),


though in all cases the optimal number is affected by model complexity and the fit of the model to data.

Results A summary of the original 47 open coded themes and fi-nal 15 coded themes is summarized in Table 1. For example, the theme “clarification” included the following open phase codes regarding use or value of information provided in the TA: (1) clarified the law, (2) clarified policy, (3) clarified other information already available, (4) clarified interpretation of compliance, and (5) stimulated new ideas.

Twenty-six interview transcripts were randomly selected and coded by the senior author for the presence and absence of each of the themes. Interviews were independently coded by the second author. Inter-rater reliability of the coding was computed using a Kappa reliability index (Cohen, 1960) since there were many null agreements, that is, agreement on the absence of themes. The Kappa adjusts reliability estimates by taking into account extremely high or low frequency events. Kappa reliability was .46; although there are no standards for a “good” Kappa value, .40 is a widely used convention as the lower boundary for “good” agreement (Landis & Koch, 1977; Sim & Wright, 2005).

Latent Class Cluster Analysis The initial latent class cluster analysis included all 15 thematic indicators listed in Table 1. A likelihood ratio test was employed to evaluate the best fitting model, based on the

number of clusters and how well the indicators reproduced the observed data. Using the general convention, models were tested starting with a 2-cluster solution up to the maximum plausible number of classes, statistically testing each fit. Any variable whose coefficient was not statistically significant at the p < .05 level was excluded in subsequent tests. An optimal fit was provided in the four-cluster model (L2 = 51.08, df = 96, p = .608). The likelihood ratio chi square (L2) statistic represents the degree of association among the variables unexplained by the model; larger values indicate poorer fit and the probability values reflect the likelihood that the data were consistent with the model by chance. Only those thematic variables that differentiated groups were retained in the final model.

Table 2 shows the coefficients for the indicators across the four clusters derived in the analysis; each column (C1-C4) represents the “market segments” of users of ADA technical assistance. Coefficients within each of the clusters indicate the “effect” of the cluster on each of the indicators and the p values, a test of the null hypothesis that the coefficient value is zero. The R2 value represents the variance in the indicator that is accounted for the four-cluster model. The indicators, customer service, trustworthiness, design change and accommodations, were significant at the .05 level.

Table 3 summarizes the proportion of subjects within each cluster (% of cases in cluster) and the conditional probabilities that members of a cluster would cite that particular theme in their contact with an ADA Technical Assistance Center. For

22 23

example, nearly two-thirds of the sample (62%) fell into Cluster 1, and these TA users were most likely to cite ADA use in terms of: (1) seeking supplemental information (.302) and (2) seeking information for accommodation or services (.495).

Based on these probabilities of responding “yes” to a thematic indicator, we characterized the four clusters in terms of their use of ADA TA information: (1) accommodation seekers (Cluster 1); (2) design changers (Cluster 2 customers were more likely to cite ADA Technical Assistance Center information for use in design issues and to help clarify guidelines); (3) TA providers (Cluster 3 customers were more

likely to gather information to pass on to other users); and (4) trust seekers (Cluster 4 users sought out the ADA Centers for reasons of trustworthiness and customer service).

Table 4 summarizes the distribution of customers in the traditional categories of ADA TA users -- Consumers, Public Entities, Disability Organizations, Professional Services, and “Other” -- across the four market segments. Each of the columns represents one of the market segments and on the basis of the conditional probabilities were labeled: (1) Seeking Accommodations, (2) Design Changers, (3) TA Providers, and (4) Trust Seekers. Percentages add up across the rows.

As shown in the table, among all consumers or advocates who were repeat users of the ADA Technical Assistance Center services, 93.5% were classified into the market segment largely defined in terms customers seeking a specific accommodation or service. Among disability organizations, the majority (47.5%) fell into the TA provider segment.

Generally speaking, the distribution of TA user groups across the market segments in Table 4 reflect expected patterns of use. Among persons with disabilities and advocates, technical assistance is used to identify needed or mandated

accommodations. Similarly, public organizations seek information on accommodations but use the information in ways that reflect the mixed roles that they play. Disability organizations are looking for credible information to use in their own TA efforts and professional services focus on the question about designs, architectural plans and other parameters of services being accessible or up to code. “Other” in part reflected its heterogeneous makeup, made up mostly of requests for information on accommodations but was distributed in significant proportions across all categories.

Discussion Results are suggestive in terms of how use and need were segmented across groups, and more broadly, as an illustration of the potential of more systematically targeting rehabilitation related TA and dissemination efforts. The use of labels to broadly define the information needs of sub-

Table 1 Preliminary and final coding

Final Code Set Preliminary Code Set (n = 47) % Cited (N =326)

1 Supplementation of Information

(1) additional information (2) answered a specific question (3) better understanding of disability/ADA (4) better personal understanding of disability.

28.5

2 Advocacy (5) used for advocacy 1.5 3 Clarification (6) clarified law (7) clarified other information user had (8) clarified policy (9) clarified interpretation

of compliance (10) provided new ideas. 27.3

4 Credibility (11) gave user credibility (12) DTBAC TA better explained than other info (13) provided confidence 9.8 5 Customer Service (14) anonymity (15) customer service skills (16) easy to understand (17) presented professionally (18)

provided support (19) quick response (20) Spanish speaking 9.8

6 Trustworthiness of Source

(21) accuracy of information (22) trustworthiness of the source 19.9

7 Decision Making (22) information used to make a program or policy decision (23) information helped with decision 7.4 8 Design Change (24) architectural design (25) structural modifications of existing layout 12.0 9 Information Passed

On (26) passed on to others for their use (27) information is used to produce ADA related materials 16.0

10 Legal Action (28) information was used for legal action 3.4 11 Policy or Procedure

Change (29) information changed procedures (30) information changed policy 1.2

12 Provided Specifics (31) useful because very specific 4.6 13 For Accommodations

or Services (32) evaluate compliance (33) filed for disability claim (34) for referrals (35) employer conflict (36) provided direction (37) provide better services (38) tried to get a job (39) tried to get accommodation (40) got a referral (41) helped get an accommodation (42) tried to get accessibility/accommodation (43) tried to get services

32.2

14 Starting point (44) provided the user with a starting point (45) provided direction and orientation 6.1 15 Verification (46) used to verify a decision (47) used to verify direction 9.8

Table 2 Reduced latent cluster model: Parameter estimates for the indicators a

Clusters Summary

Indicators C1 C2 C3 C4 Wald p-value R2

Supplementation 0.521 0.583 0.564 -1.67 1.44 .700 .0338

Clarification -0.157 0.375 -0.178 -0.040 5.17 .160 .0404

Customer Service -0.248 -1.991 0.771 1.467 14.46 .002 .2629

Trustworthiness -1.277 -0.171 0.134 1.165 24.45 .000 .3315

Design Change -0.888 1.393 -1.677 1.172 10.24 .017 .3401

Information -0.366 -0.277 2.226 -1.583 6.06 .110 .5837

Accommodations 1.516 -1.092 -1.184 0.759 7.61 .055 .2315

a L2 = 51.08, df = 96, p = .608

Table 3. Conditional Probabilities for Themes Appearing within Cluster

Clusters Items C1 C2 C3 C4

Supplementation .302 .329 .320 .005 Clarification .228 .461 .221 .272 Customer Service .040 .001 .241 .561 Trustworthiness .053 .275 .411 .846 Design Change .009 .467 .002 .360 Information .059 .070 .918 .006 Accommodations .495 .005 .004 .178 % of cases in cluster 62% 18% 12% 8%

Table 4. Percentage of Different Groups of TA Customers by Market Segmentation

Clusters

TA Customers

C1 (Seeking Accom-

modation)

C2 (Design

Changers)

C3 (TA

Providers)

C4 (Trust

Seekers)

N (326)

Consumer/Advocate 93.5 2.4 3.2 0.9 124 Public Entity 65.0 9.6 13.7 11.0 78 Disability Organization 35.0 5.0 47.5 12.5 42 Professional Services 32.0 56.0 4.0 8.0 49 Other 50.0 12.5 28.1 9.4 33


groups in rehabilitation, distinguishing “professionals” from “consumers” for example, do not wholly explain TA needs and uses of persons within these groups. While the need and use of information tended to be more alike than dissimilar within consumer groups, they were not wholly defined by group identify. Thus, while persons with disabilities and their families tended to seek information on accommodations, and disability organizations were more likely to be securing information for use for advocacy or additional dissemination, there were other uses and reasons for obtaining information as well. The analysis illustrates the diversity of need and use within groups; these may be the more important determinants of the characteristics of successful knowledge transfer. Within the dissemination and TA literature, clearly defining your target audience is a standard recommendation (Wilson, Petticrew, Calnan, & Nazareth, 2010). The question posed by the results of the analysis is the matter of how to define the target. To date, we have largely framed groups targeted through dissemination in terms of labels. The practical implication, particularly for the providers of ADA related TA, is that we need to look beyond labels of information and consumers in anticipating the needs and uses of the information assistance. A label may predict some degree of need but only imperfectly. The results suggest rehabilitation related TA should be more strategic in identifying needs within groups for the purposes of better meeting their needs or better matching our efforts to those we reach out to. Perhaps we can learn from the marketing field for whom labels are merely a starting point for determining consumer needs and behaviors (Foedermayr & Diamantopoulos, 2008).

A second study implication is the illustration of the value of directly evaluating the “black box,” that is, research focused on the interaction between information and the rehabilitation professional or consumer who seeks out the information. The study of such processes requires consideration of the user perspective by asking how and why information is useful. Rather than assuming the provision of information is the “mechanism of change” (Judge & Bauld, 2001), the user perspectives provide a foundation upon which a model of information use can be developed that provide a more sophisticated understanding of the process of knowledge translation – the “how’s” and “why’s” of information that are intermediate stages between a program action and outcomes.

Directly measuring immediate outcomes is a significant challenge in applied settings. More often than not, outcomes are events distal to the provision of information and more likely the result of many different direct and indirect effects. For example, a common outcome proposed for the provision of employment and ADA related technical information is the increased employment of Americans with disabilities. This may well be an effect, but one that is largely an act of faith, unsubstantiated on large scales, and certainly linked in indirect and convoluted ways to the discrete event of passing along information. In terms of the importance given to indicators of effectiveness, using outcomes so distant and indirectly linked to the act of information technical assistance is not particularly convincing.

A number of conceptual and methodological limitations suggest that interpretations be drawn with the appropriate degree of caution. Results of the cluster analysis are presented as a test of concept rather than as a confirmation of a theoretical model. The sample was large but restricted, representing users of TA services who for the most part were successful in using the information. The degree to which the derived model would be skewed if the sample were expanded is unknown. This study was not intended as a “test” of an established theory but rather an effort to begin this process of systematic research on how our dissemination, training, and TA efforts translate into action. It is intended as a “heuristic” – a preliminary guidepost for future studies of effectiveness.

The study of knowledge to action will require moving beyond inspection of TA activities in isolation and then assuming their association with program outcomes. While readily measured, programmatic “outputs” may only be partly and indirectly related to informational “inputs.” Future research must focus on the direct study of the processes through which information is adopted, implemented and used to affect practice. This will require a perspective of TA as a causal chain of events in the same manner as Logic Models though with greater emphasis on analysis of causal connections and model development. It was in this spirit that the present study is offered as an initial exploration of KT perspectives to rehabilitation ADA related technical assistance.

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The Role of Hope in PredictingSupported Employment Success

William R. WaynorRutgers, The State University

Kenneth J. GillRutgers, The State University

Objective: This study tested whether hope would be a positive predictor of an employment outcome in supported employment (SE) programs for persons with serious mental illness (SMI). Method: A total of N=105 participants with SMI receiv-ing SE entered the study. Research staff met with the individuals at baseline and collected demographic information and data on hope and psychiatric symptoms. For the follow-up assessment at 6-months, data was collected on the participants, hope, psychiatric symptoms and employment activity. Results: An N=82 met with study staff at the 6 month follow-up, 38% of these participants had attained an em-ployment goal. Surprisingly, a point-biserial correlational analysis found that base-line hope was not a positive predictor of achieving an employment goal, but in fact was negatively correlated with attaining employment. Discussion: These findings suggest that greater hope may not be a predictor of employment at the outcome level for this population.


Hope is an important factor in studies assessing various clinical and rehabilitation outcomes (Brown, Ramp-fer, & Hamera, 2008; Lewine, 2005). Hope is also

necessary to continue to survive in times of significant loss, hardship and personal suffering (Brown & Mueller, 2014). The psychiatric rehabilitation literature contains numerous first person accounts of the importance of hope for people whose lives and dreams have become completely disrupted by the onset of serious mental illness (SMI). A common theme in these stories is that regaining hope was a critical component to the recovery process (Deegan, 1988; Lette, 1989). Hope is often considered an early phase of active recovery in stage theories of recovery from SMI (Andersen, Oades, & Caputi, 2003; Jacobson & Greenley, 2001; Noordsey et al., 2002). As a clinical outcome, greater hope appears to be crucial to de-creasing the risk of suicide (Lewine, 2005; Litterell, Herth, & Hinte, 1996; Yanos, Roe, & Lysaker, 2010). Additionally, re-cent research has found an inverse relationship between hope and psychiatric symptoms (Brown et al., 2008; Waynor, Gao,

Dolce, Haytas, & Reilly, 2012). Thus, the utility of hope is well established in psychiatric rehabilitation.

Hope Theory Recent literature has proposed the application Snyder et al.’s (1991) hope theory as a useful construct in the rehabilitation field (Brown & Mueller, 2014; Coduti & Schoen, 2014; Hong, Polanin, & Pigoyy, 2012; Waynor, Gao, & Dolce, 2012). Hope as conceived by Snyder et al. (1991) forms around three critical elements: goals, pathways, and agency (Coduti & Schoen, 2014). Like other conceptualizations of hope, Snyder et al.’s view is related to expectancy, concerned with anticipation of the future. Snyder proposed the term agency to denote a sense of motivation towards the achievement of a goal, while he considered pathways the ability to produce a plan of action to meet a goal (Coduti & Schoen, 2014; Magaletta & Oliver, 1999; Snyder et al., 1991).

The central component of Snyder’s theory is focused on the achievement of goals, which is critical in the rehabilitation process. The second component of Snyder’s theory, pathways is concerned with thinking of ways and means to achieve a goal. People with a high level of hope generate more specific pathways, while people with limited hope tend towards vague, less specific paths towards goal achievement (Coduti & Schoen, 2014). Accordingly, people with a greater level

William R. Waynor PhD., CRC, Department of Psychiatric Re-habilitation and Counseling Professions, School of Health Re-lated Professions, Rutgers, The State University, 40 East Laurel Road, Stratford, New Jersey 08084 .


of hope would be more likely to develop a specific plan of action towards the pursuit of a goal. Snyder considered the third element, agency related to motivation to overcome obstacles, which is critical in all phases of the goal pursuit process (Coduti & Schoen, 2014; Hong et al., 2012). Self-talk is an important skill in agency thinking, as high hope people tend to engage in positive self-talk statements that help with movement towards goal attainment (Coduti & Schoen, 2014). Coduti & Schoen (2014) contend that the Snyder et al. theory of hope is cogent as a predictor of rehabilitation outcomes for persons living with disabilities. Therefore, it is highly relevant to the rehabilitation counseling field with its focus on assisting consumers with the achievement of rehabilitation goals (Coduti & Schoen, 2014).

Hope and Employment Snyder’s hope theory is highly relevant for individuals in rehabilitation programs such as supported employment (SE), as people with the goal to return to work may need to generate more than one pathway to access community employment. Obtaining employment typically requires numerous interviews; job seekers also need the agency, or motivation to persist with the process after experiencing rejection. These attributes are necessary to be successful in SE services.

Until recently, there has been a paucity of literature examining the relationship between hope and employment for persons with SMI (Yanos et al., 2010). Nevertheless, two recent studies utilizing hope theory appeared in the literature with a focus on individuals with mental health issues and employment. One examined the employment outcomes for SE participants living with SMI in the United Kingdom (Schneider et al., 2009), and the other examined the job procurement self-efficacy of homeless women living in a shelter (Brown & Mueller, 2014).

Schneider et al. (2009) studied the relationship between hope and employment. They examined participants in different phases of the SE process for 12 months that included those already employed, and individuals in different pre-placement phases who were not employed and seeking employment. They found that participants who were working at baseline had significantly higher hope compared to those not yet employed (t (141) = 3.0, p=.003). In addition, they found that for the entire group of participants, hope increased over the 12 month period (t (141) =- 2.91, p=.004). Nonetheless, they did not find a significant increase in hope among those who began the study unemployed and obtained employment during the study.

A recent study by Brown and Mueller (2014) examined the relationship between Snyder’s hope construct and job procurement self-efficacy (JPSE), which measured the expectation of obtaining employment among a sample of homeless women residing in a shelter program. Although this study did not explicitly examine a sample of people with SMI, Brown and Mueller state that the typical shelter resident lives with a mental health diagnosis and likely has a co-occurring substance abuse disorder. The findings indicated that the

State Hope Scale, a brief version of the 12-item hope scale by (Snyder et al., 1991) was significantly related to JPSE (r (67) = 0.41, p =0.01).

In the above mentioned studies the definition of employment outcome varied, with the Brown and Mueller (2014) study utilizing a job procurement self-efficacy construct as the employment variable, while the Schneider et al. (2009) study assessed whether or not participants obtained employment. Therefore, the one finding that examined the relationship between hope and whether or not an employment goal was obtained, and found no relationship was based on a small sample of N=102. More research is necessary to elucidate the relationship between hope and employment for persons living with SMI. The current study will examine the relationship between hope, and employment success for individuals living with SMI who were not employed, and seeking employment in SE programs after controlling for the effects of psychiatric symptoms and time receiving SE services. The study hypothesis is that hope will be a positive predictor of achieving an employment goal.

MethodParticipants The sample consists of 105 individuals with SMI recruited from five state funded SE programs housed in community mental health programs in the Northeast region of the United States. The SE programs all utilized a place then train approach that emphasized rapid placement into competitive jobs that paid at least the state minimum wage. Additionally, these jobs were in inclusive settings without people with disabilities, and were based on consumer choice. The SE programs provided job development and placement services, job coaching if indicated, benefits planning, and they collaborated with clinical staff. To participate in the study, individuals were required to be enrolled in SE at baseline, were not employed, seeking employment, and have a diagnosis of a serious mental illness, as required by the state regulations. Self-reported diagnoses were categorized as: 1) Schizophrenia spectrum disorder, 2) Bi-polar disorder, 3) Major depressive disorder, and 4) Other. Table 1 displays the demographic characteristics of the study participants.

MeasuresThe State Hope Scale The State Hope Scale (SHS) (Snyder et al., 1996) is a six-item instrument that generates a total hope score. This measure uses an eight-point Likert scale ranging from 1 = definitely false to 8 = definitely true. Items include: “At the present time, I am energetically pursuing goals” and “I can think of many ways to reach my current goals.” Scores can range from 8 to 48. The SHS also contains two subscales, agency and pathways which are three items each. The SHS is a brief version of the 12-item hope scale (Snyder et al., 1991). Snyder et al. (1996) reported alpha coefficients for the SHS ranging from 0.79 to 0.95. For the current study the alpha coefficients for the subscales was 0.78 for agency and 0.60 for pathways, the alpha coefficient for the entire scale was 0.81.

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Brief Symptom Inventory. The Brief Symptom Inventory (BSI; Derogatis & Melisarato, 1983) is a 53-item self-report measure of psychiatric symptoms. This scale uses a five point scale ranging from 0 = not at all, to 4 = extremely. This scale asks the individual if they experienced any of the following problems for a period within one week, items include, “Feeling no interest in anything” and “Numbing and tingling in parts of your body.” Additionally, a Global Severity Index (GSI) is computed, and a score of 1.39 among all items answered is considered to be clinically significant (Derogatis & Melisarato, 1983). In the current study, the alpha coefficient was 0.96 for the entire scale.

Time in SE. There was considerable variation in the time participants had received SE services at the baseline interview. Therefore, the time enrolled in SE at baseline was measured in months and included as a variable in the analyses.

Employment Outcome The criterion measure is a discrete dichotomous variable of whether or not an employment goal was achieved. Therefore, the employed group is defined as obtained employment in either a part-time or full-time competitive job that paid at least the state minimum wage and included individuals without disabilities during the six month period of assessment. The not employed group consists of those participants who did not obtain employment. The employed group was coded as 1, while the not employed group was coded as 0.

Procedure The study protocol and SE program sites were approved by the University IRB. The data collection process began in 2008 and was completed in 2012. The research team consisted of one graduate student and several university faculty members who functioned as research staff. The Principle Investigator met with SE program site staff and explained the purpose and protocol of the study, and provided them with a script to notify SE participants of the study. If interested, the SE participant signed the form that indicated they were willing to be contacted by a member of the study team to learn more about the study. If the participant indicated interest in entering the study, a meeting was set up at a time and place convenient to the participant. During the face to face meeting with the potential participant, the research assistant confirmed that they were not employed for at least one month, and were seeking competitive employment. Individuals who did not meet these criteria could not enroll in the study. After completing the informed consent process, participants were asked to complete an intake questionnaire to gather data on demographic information including educational level, work history, benefit status, diagnoses, disability history, and time receiving SE services. Data was also

collected on the participant’s level of psychiatric symptoms using the BSI and hope using the SHS. Research staff subsequently met with participants for a six month follow-up assessment. At the follow-up meeting research staff collected data on employment outcomes. Participants were asked to report on their employment activity, including, participation in job seeking activities such as whether or not they were filling out applications and participating in job interviews, if employed, the number of days employed, title and type of job, type of industry in which the job falls, number of hours per week employed, salary and benefits, date of job termination (if applicable). Participants received a payment of $10 for their time for each meeting.

Data Analyses Hierarchical logistic regression was utilized to assess

whether hope predicts employment outcomes for persons with SMI seeking employment in SE. This method has the advantage of allowing the researcher to input the variables in an order consistent with their theoretical importance in the model (Hoyt, Leierer, & Millington, 2006). The analysis examined the relationship between the criterion variable of whether or not an employment goal was achieved at the six month follow-up, and the predictor variables at baseline. Predictor variables were entered in two blocks in the following order: 1) baseline BSI and baseline time in SE and 2) baseline SHS. Thus, this method examined whether the Snyder’s hope construct is a significant predictor of gaining employment after controlling for psychiatric symptoms and length of time receiving SE services. Additionally, a point-biserial correlational analysis was utilized to assess the univariate relationship between the SHS and the employment outcome variable.

Results A total of N= 82 participants met with study staff for the 6 month follow-up, indicating an attrition rate of 22%. A total of N= 31 out of the 82 participants who met with study staff at 6 months achieved an employment goal, signifying a success rate of 38% among those participants who met for the follow-up assessment. Participants obtained employment

primarily in part-time entry level positions in the secondary labor market, which typically include no benefits and have high turnover; however, there was a wide range of jobs, including: construction, computer technician, peer provider, clerical and office worker, retail sales, and maintenance and janitorial work. Table 2 includes wage data for those who gained employment and table 3 includes descriptive statistics for the predictor variables.

With a high attrition rate, to determine if there were differences between participants who were lost to contact after the baseline interview (N= 23), and those with 6 month data, chi square analyses were utilized to assess whether there were differences between the groups in terms of their diagnoses, race or gender. In addition, independent samples t tests were used to determine if there were any differences on the mean scores of psychiatric symptoms, hope, time in SE, employment history, age or educational level. Findings indicated no group differences on any of these variables.

Hypothesis testing The predictor variables were entered in two blocks in the following order: 1) BSI and baseline time in SE and 2) SHS. None of the variables were significant positive predictors of successful employment outcome at the six month follow-up.

Table 4 includes the results.

A point-biserial correlational analysis found that baseline hope was a negative predictor of an employment outcome at six months, (r (80) = -.23, p =0.04). Surprisingly, this relationship indicates that less hope was a predictor of an employment outcome. To further elucidate this unexpected finding, a supplemental independent samples t test was performed to determine if there were differences

in the mean score of the SHS between the employed and not employed groups. The findings were significant (t (80) = 2.1, p=.04). Participants who became employed had a mean SHS score of 33.2, while those who were not successful in achieving employment had a mean SHS score of 37.

Discussion The current study found that hope was negatively correlated with successfully

achieving an employment goal in SE. However, this relationship did not hold up in a multivariate analysis after accounting for psychiatric symptoms and baseline time in SE. Nonetheless, the inverse relationship was unexpected, and contrary to the trend in the rehabilitation literature contending that hope ought to be an ideal positive predictor of rehabilitation outcomes for persons with disabilities (Brown et al., 2008; Coduti & Schoen, 2014; Schneider et al., 2009). It is likely that these findings are related to the stage of recovery of the participants who

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Table 1 Participant characteristics N = 105 ___________________________________________________________ Demographics n (%) Mean SD _____________________________________________________________ Gender Men 62(59%) Women 43(41%) Age at baseline 105 44 10.8 Ethnicity-Race White 60(57.1%) African American 38(36.2%) Hispanic 3(2.9%) Asian 1(1%) Other 3(2.9%) Benefit Status SSA 74(67.9%) SSDI 40(36.9%) SSI 20(19%) Both SSI & SSDI 14(13.3%) General Assistance 11(10.5%) Other 13(12.4%) None 6(5.7%) Not reported 1(1%) Educational Level No HS diploma 10 (9.5%) HS grad or GED 42 (40%) Some college 27 (25.7%) Associate’s degree 6 (5.7%) Bachelor’s degree 14(13.3%) Master’s degree 6(6%) Diagnoses Schizophrenia Spectrum 41(39%) Bipolar Disorder 34(32.5%) Major Depressive Disorder 24(22.9%) Other 6(5.7%) Marital status Never married 61(58.1%) Married 7(6.7%) Living as married 1(1%) Separated 7(6.7%) Divorced 27(25.7%) Widowed 2(1.9%)

Table 2 Employment data _____________________________________________________________ Time interval n employed Mean hourly wages SD _____________________________________________________________

6 months 31 $8.97 3.3

Table 3 _________________________________________________________________ Measure at baseline n Mean SD _________________________________________________________________ Hope 105 35.5 8.0 Psychiatric Symptoms- BSI 105 0.93 0.67 Months in SE 105 8.3 13.5

Table 4 Logistic regression results for baseline predictors and 6 month employment outcome (n=82) _____________________________________________________________ Variables Wald df p _____________________________________________________________ Time in SE .38 1 .54

BSI .002 1 .96

SHS 3.5 1 .06


were living with SMI, and seeking an employment goal in an SE program. It appears that the participants who were successful in obtaining employment were no longer content to be out of the hospital and experiencing a level of stability with their illness, which are important issues during the onset of illness, and earlier phases of recovery (Andersen et al., 2003). Therefore, these participants may have been more motivated to seek employment, as lower hope may have indicated a greater level of dissatisfaction with their unemployed status.

The role of hope in the recovery literature is crucial in the initial phases of the recovery process (Andersen et al., 2003; Jacobson & Greenley, 2001; Noordsey et al., 2002). However, an important point to consider is that individuals participating in SE could be considered in a “more advanced” phase of the recovery process (Andersen et al., 2003; Yanos et al., 2010). It is plausible that the role of hope may not be as salient as individual’s progress through to more advanced phases of recovery. The act of registering for SE services can be viewed as challenging an identity as a person living with SMI (Yanos et al., 2010), and an attempt to rebuild one’s career after the onset of disability. Therefore, it may be that individuals with SMI need a certain level of hope just to consider registering for SE services. Furthermore, Andersen, Caputi and Oades (2010) contend that a plateauing or leveling off of empowerment before taking concrete action towards the pursuit of a goal is conceivable. Such a plateauing in hopeful feelings may have occurred with the current study’s participants in SE services. The utility of hope may be to help individuals get to the point of engaging in goal directed behaviors, but more sober, realistic feelings of possible “failure” may set in later on. Similarly, Levitt (2014) recently found a retreat of positive affect and increased negative feelings as individual’s progress towards greater recovery.

A further point to consider is that individuals registering for SE often confront a labor market for which they are ill prepared. In the current sample most of the participants were on SSA benefits and had limited recent work history. Additionally, the mean age for the study participants was 44, and with limited recent work history the vast majority of the participants were only qualified for entry level jobs in the secondary labor market. Contending with the reality of a competitive labor market, and being mostly middle aged, it is reasonable to feel less hopeful returning to work while participating in SE services. This realism is apparently somewhat predictive of the return to work.

Limitations The major limitation of this study is the high attrition rate of the participants, as 22% of the study participants at baseline did not meet for the six month follow-up. Nonetheless, the analysis on the participants who were lost to contact was able to mitigate this limitation to some extent, as the finding indicated no differences between those who were lost to contact and those who continued in the study on all of the variables measured. However, with the hope variable approaching significance in the multivariate analysis of the prediction of employment (Wald X2 (1) = 3.5, p = .06) a larger

sample with more statistical power may have resulted in a significant finding. Another issue was related to participant recruitment and the usual self-selection issues. It is not clear if the characteristics of the individuals in the study differ from those who did not participate. Finally, the study took place during the “great recession” and it is not clear how this may have impacted both study outcomes, but also the participant attrition rate. Negative news in the media about the terrible state of the economy, including the high unemployment rate and the lack of hiring by employers, which was common at that time, may have been a confounding factor in a study about hope.

Implications Future research should assess the relationship between the recovery variable of hope, and whether or not it is predictive of the interest to pursue an employment goal. In addition, rehabilitation researchers can assess the relationship between hope and the various phases of recovery and psychosocial adjustment to disability to help clarify these complex relationships. Although this was one study, the findings suggest that too much hope may not be helpful to the rehabilitation process at a certain point. Therefore, more research is indicated to replicate this finding to determine if this is indeed a phenomenon related to the relationship of rehabilitation variables and phases of recovery.

Conclusion This study found an unexpected inverse relationship between a key recovery variable, hope and a key recovery outcome employment. Andersen et al. (2010) and Levitt (2014) argue that recovery outcomes have different meanings between consumers and providers. They also contend that the meaning of recovery variables may be dependent on the phase of recovery. All of the participants in the current study registered for SE services, which denotes a level of seriousness about pursuing an employment goal. It is probable that they needed a certain level of hope just to take this action, and at that point there was a plateauing or ceiling effect, with higher hope no longer being associated with the outcome variable of achieving employment. Thus, rehabilitation providers may need to reconsider the salience of hope once consumers are at the point in their recovery of pursuing rehabilitation goals. A better understanding of these complex relationships can help guide rehabilitation providers working with individuals in various phases of their recovery.

ReferencesAndersen, R., Oades, L., & Caputi, P. (2003). The experience

of recovery from schizophrenia: Towards an empir-ically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586-594.

Andersen, R., Oades, L., & Caputi, P. (2010). Do clinical out-come measures assess consumer-defined recovery? Psychiatry Research, 177, 309-317.

Brown, C., & Mueller, C., T. (2014). Predictors of employ-ment among sheltered homeless women. Com-

munity, Work & Family, 17(2), 200-218. doi: 10.1080/13668803.2014.890562

Brown, C., Rempfer, M., & Hamera, E. (2008). Correlates of insider and outsider conceptualizations of recovery. Psychiatric Rehabilitation Journal, 32(1), 23-31. doi: 10.2975/32.1.2008.23.31

Coduti, W. A., & Schoen, B. (2014). Hope model: A method of goal attainment with rehabilitation services cli-ents. Journal of Rehabilitation, 80(2), 30-40.

Deegan, P. E. (1988). Recovery: The lived experience of reha-bilitation. Psychosocial Rehabilitation Journal, 11, 11-19.

Derogatis, L. R., & Melisaratos, N. (1983). The Brief symp-tom inventory: An introductory report. Psychologi-cal Medicine, 13, 595-605.

Hong, P. Y. P., Polanin, J. R., & Pigott, T. D. (2012). Valida-tion of the employment hope scale: Measuring psy-chological self-sufficiency among low-income job-seekers. Research on Social Work Practice, 22(3), 323-332. doi: 10.1177/1049731511435952

Hoyt, W. T., Leierer, S., & Millington, M. J. (2006). Analysis and interpretation of findings using multiple regres-sion techniques. Rehabilitation Counseling Bulletin, 49(4), 223-233.

Jacobson, N., & Greenly, D. (2001). What is recovery? A con-ceptual model and explication. Psychiatric Services, 52, 482-485.

Lette, E. (1989). How I perceive my illness. Schizophrenia Bulletin, 15(2), 197-200.

Litterell, K. H., Herth, K. A., & Hinte, L. E. (1996). The expe-rience of hope in adults with schizophrenia. Psychi-atric Rehabilitation Journal, 19, 61-65.

Levitt, A. J. (2014). A Self-Regulation Model of Recovery from Psychiatric Disability Doctoral Dissertation. Scotch Plains, NJ: Rutgers University.

Lewine, R. J. (2005). Social class of origin, lost poten-tial, and hopelessness in schizophrenia. Schizo-phrenia Research, 76, 329-335. doi: 10.1016/j.schres.2004.07.006

Magaletta, P. R., & Oliver, J. M. (1999). The hope con-struct, will, ways: Their relations with self-effica-cy, optimism, and general well-being. Journal of Clinical Psychology, 55(5), 539-551. doi: 10.1002/(SICI)1097-4679(199905)55:5<539

Noordsy, D., Torrey, W., Mueser, K., Mead, S., O’Keefe, C., & Fox, L. (2002). Recovery from severe mental illness: An intrapersonal and functional outcome definition. International Review of Psychiatry, 14, 3118-326.

Schneider, J., Slade, J., Secker, J., Rinaldi, M., Boyce, M., Johnson, R., … Grove, B. (2009). SESAMI study of employment support for people with Severe mental health problems: 12-month outcomes. Health and Social Care in the Community, 17(2), 151-158. doi: 10.1111/j.1365-2524.2008.00810.x

Snyder, C.R., Harris, C., Anderson, J. R., Holleran, S. A., Ir-ving, L. M., Sigmon, S. T., Harney, P. (1991). The will and the ways: Development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60, 570-585.

Snyder, C.R., Sympson, S.C., Ybasco, F. C., Borders, T. F., Babyak, M. A., Higgins, R. L. (1996). Development and validation of the state hope scale. Journal of Per-sonality and Social Psychology, 70(2), 321-335.

Waynor W.R., Gao, N., & Dolce, J. (2012). The paradoxi-cal relationship between hope and educational lev-el. American Journal of Psychiatric Rehabilitation, 15(3), 299-311. doi: 10.1080/15487768.2012.703560

Waynor, W. R., Gao, N., Dolce, J. N., Haytas, L., & Reilly, A. (2012). The relationship between hope and symp-toms. Psychiatric Rehabilitation Journal, 35(4), 345-348. doi: 10.2975/35.4.201.345.348

Yanos, P. T., Roe, D., & Lysaker, P. H. (2010). The impact of illness identity on recovery from severe mental illness. American Journal of Psychiatric Rehabilita-tion, 13(2), 73-93. doi: 10.1080/15487761003756860

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Ethics and the Family inRehabilitation Counseling

Mary Barros-BaileyIntermountain Vocational Services, Inc.

The ethics of family involved in rehabilitation counseling has not been addressed in the professional literature, although the recognition of the family in the process has been acknowledged since the first Professional Code of Ethics for Rehabili-tation Counselors (Commission on Rehabilitation Counselor Certification, 1987). This article explores the trajectory of the inclusion of the family in rehabilitation counseling codes of ethics and contemporary considerations for future code re-visions, including specific consideration for ethical decision making when families are involved in rehabilitation counseling.

Mary Barros-Bailey, PhD, CRC, NCC, Intermountain Voca-tional Services, Inc., P.O. Box 7511, Boise, ID 83707-1511.



Families have been part of the process of many specialty areas of counseling for decades, including rehabilita-tion counseling. The code of ethics becomes the banner

that announces and affirms professional and societal values. Millington, Jenkins, and Cottone (2015) declare that “Finding the family ethos in rehabilitation counseling begins with an understanding of community values” (p. 52). Ultimately, they conclude that “rehabilitation counselors are agents of social justice … advancing an applied theory and practice of com-munity values” (p. 44). Indeed, rehabilitation counseling “is unique among counseling specialties in that is exists in the space of society’s ethical failure in this specific regard. The profession was legislated into being to address the exclusion of people with disabilities from society” (p. 44).

The literature in the field of rehabilitation counseling has not yet focused on ethics specific to the family, although families have been part of the professional ethical codes for decades. Recent developments in accreditation standards for professional counselors involved in clinical mental health counseling for people with disabilities – what is being called clinical rehabilitation counseling – has lead to an historical affiliate agreement between the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Council on Rehabilitation Education (CORE) around the clinical standards. Although the empirical foundation for the CACREP clinical rehabilitation counseling standards is not found in the literature, these clinical rehabilitation standards

are part of the CACREP standards revision process estimat-ed to be completed by 2016 (Milsom, Bobby, & Gunderman, 2014). Consequently, considering ethics when the family is involved in rehabilitation counseling is timely, not only be-cause of the new CACREP clinical rehabilitation counseling standards, but also as CORE completes its revised accredita-tion standards in 2015 (F. Lane, personal communication, Jan-uary 8, 2014) and the Commission on Rehabilitation Counsel-or Certification (CRCC) task force begins the process towards reviewing the Code of Professional Ethics for Rehabilitation Counselors (L. Shaw, personal communication, October, 8, 2014).

The Family in RehabilitationCounseling Codes of Ethics

The first Code of Professional Ethics for Rehabilitation Counselors (herein referred to as “Code”) over a quarter cen-tury ago considered the family within the rehabilitation coun-seling context. Specifically, Rule 2.7 states,,

Rehabilitation counselors will recognize that fam-ilies are usually an important factor in the client’s rehabilitation and will strive to enlist their under-standing and involvement as a positive resource in achieving rehabilitation goals. The client’s permis-sion will be secured prior to any family involvement (p. 4, Commission on Rehabilitation Counselor Certification, 1987).

This single standard in that first Code stood out to recognize that the individual receiving services from a rehabilitation counselor is typically part of a greater community of indi-viduals whose composition, traditions, values, mores, and behaviors could affect rehabilitation outcomes. From the be-

ginning, the profession understood that the family was not an appendage or afterthought in the rehabilitation process, but an important consideration within such practice. This first rule served as a beacon for rehabilitation counselors to take note of the importance of family integration in rehabilitation.

In this article, I explore the vibrant trajectory and vast growth of the inclusion of the family in rehabilitation counsel-ing ethics from its first mention nearly three decades ago until the contemporary Code. Understanding that a published code of ethics is merely a snapshot to reflect an ongoing active so-cietal process of professional behavior in the client-counselor relationship, I examine current shifting paradigms and how these might impact future ethical considerations.

Question: What’s in a Definition? Answer: Sometimes confusion. Definitions become the stars on the marquis of any dialogue limiting and delimiting the reader’s orientation. When addressing ethical issues in re-habilitation counseling and families, definitions can be mul-tifaceted. There are a variety of definitions of disability that complicate and confuse delivery of services. For example, in examining over 40 national programs for employment of people with disabilities, the United States (U. S.) Government Accountability Office found that “officials from 34 programs collectively reported using at least 10 different definitions of disability, and 10 programs reported having no specific defini-tion for disability” (2012, p. 8).

Equally as complex is the number of definitions exist-ing for families. For the first time in its most recent Code, the CRCC (2010) provided a definition in its glossary giving insight into its reference to immediate family members as “a child, spouse, parent, grandparent, or sibling. Immediate fam-ily members are also defined in a manner that is sensitive to cultural differences” (p. 36)..

At the national level, the U. S. Census Bureau (1991) de-fines family as “a group of two or more persons related by birth, marriage, or adoption who reside together. Every family must include a householder. A household may contain a pri-mary family and one or more subfamilies” (para. 2). At the international level, the U. N. Department of Economic and Social Affairs (2013) defines families as “those members of the household who are related, to a specified degree, through blood, adoption[,] or marriage” (para. 4). These definitions of family are all vacant of the concept of “partner,” regardless of sexual orientation or of legal or religious recognition of the relationship, or perhaps of other family systems that provide a broader definition than the traditional family unit. Bodenhorn (2005) says it best when she states that “… counselors need to be at the forefront of welcoming and supporting all configura-tions of families” (p. 319)..

Superimposing these two complex systems of definitions for disability and family upon each other may cause havoc to the rehabilitation counseling practitioner. In this article, by recognizing that these definitions are attempts by organiza-tional or national and international bodies to provide param-

eters to systems that have considerable variability, I simplify the definition and anchor it to the concept of the client. Al-though the rehabilitation counselor may practice within a sys-tem where such definitions may delimit services, for purposes of exploring the ethical considerations of families within re-habilitation counseling, I define family to mean any individual identified by a client as being a member of his/her family unit. As explained later, a client may be any or all members of that unit.

The Literature A review of the literature did not find material specific to ethics in family rehabilitation counseling. Related litera-ture, however, is available in academic books and articles in counseling families that lend to the treatment of the subject as applied to rehabilitation counseling.

Cottone and Tarvydas (2007) and Corey, Corey, and Cal-lanan (2007) posit that in working with families, the counsel-or’s focus is on the family system; it is on the empowerment of the unit overall and not at the expense of one member of that family over another. The complexity of working with families in strength-based approaches provides particular challenges to the rehabilitation counselor when the disability of one or more members of that unit is at issue. Corey, et al. (2007) declare that,

Because most couples and family therapists focus on the family system as the client rather than on the individual’s dynamics, potential ethical dilemmas can arise from the first session … Because of the increased complexity of their work, [counselors] are faced with more potential ethical conflicts than are practitioners who specialize in [working with individuals. Those attending to] multiple family members often encounter dilemmas that involve serving one member’s best interest at the expense of another member’s interest (p. 441).

Codes of Ethics in Family Counseling Hendricks, Bradley, Southern, Oliver, and Birdsall (2011) state that the role of the counselor in working with families is “to protect family relationships and advocate for the healthy growth and development of the family as a whole and each member’s unique needs” (p. 217). They summarize the 2010 updated Ethical Code for the International Association of Marriage and Family Counselors (IAMFC) and its main sec-tions. The nine sections of the IAMFC Code generally cor-relate with the Code of the American Association for Mar-riage and Family Therapy ([AAMFT], 2012), which provides guidance for those working with families and family systems in the helping professions. Eight principles of the AAMFT Code that receive the greatest amount of attention in the fami-ly counseling literature provide a helpful outline for the treat-ment of ethics for families and become a guideline for con-sidering the application within rehabilitation counseling: (a) Responsibility to Clients; (b) Confidentiality; (c) Professional Competence and Integrity; (d) Responsibility to Students and Supervisees; (e) Responsibility to Research Participants; (f)


Responsibility to the Profession; (g) Financial Arrangements; and, (h) Advertising. Most of the literature involving ethics in family counseling deals with the first two sections of the IAMFC Code, which are also the first two Principles of the AAMFT Code.

Counseling relationships with clients. Crews (2005) and Hill (2005) identified the need to be clear on whom the client is as part of the ethical lens when diagnosing within family counseling. Who is the client in a family rehabilitation counseling relationship? Given that the rehabilitation counselor is working with all members of the family, the members of the unit itself are clients. Particular-ly, Cottone and Tarvydas (2007) note that “counselors simply define the couple or the family as the unit to which they are responsible and focus their activities on doing what is right for the relationship or the family as a whole” (p. 233). A vital component of helping the family dynamic is allowing those members involved in the process to understand what the re-lationship entails and what approaches are used (e.g., those that have limited confidentiality such as open-forums as de-scribed by Hartshorne, Sperry, & Watts, 2010), benefits being involved in the process, as well as financial or other costs and risks. These and other aspects of disclosure and informed con-sent required by codes of ethics, or appropriate to a legal juris-diction governing practice, pave the manner in which families can engage in the counseling relationship. Specifically, Fall and Lyons (2003) advise: (a) ensuring that clients understand the nature of counseling and its inherent risks; (b) assessing accurate boundaries within the family; and, (c) assessing the impact of any disclosure upon the family unit. Attention to their recommendations should be part of the disclosure and informed consent process.

Beyond identifying the client as the family unit and per-forming adequate disclosure and informed consent, Cottone and Tarvydas (2007) state that “relationships are the primary cause of disturbance in individuals and also can affect a posi-tive change in observed behavior” (p. 231) and note that “cer-tain relationships outside of the counseling relationship can be viewed as very helpful to clients” (p. 231). Because of the complexity of working with families and different members of that family unit, counselors need to be particularly mindful of the intent behind the roles they play with different members to safeguard that dual or multiple relationships within or out-side of the counseling process remain supportive to the family and not detrimental to the process.

The more members of a family unit, the greater poten-tial for variability across all socioeconomic, gender, cultur-al, behavioral, disability, and other aspects of being. Thus, respecting diversity is inherent in the support of a complex family unit in that “no cultural group or cultural norm can be viewed as better or more valid than any other. Each cultural norm derives from a reality established in the context of social relationships within cultural boundaries” (p. 236). Related to diversity at times is acculturation of different members of a family that may not be native to the country and the binding, delegating, and expelling struggles that require the counselor

to balance the autonomy of the different members of the fam-ily with advocacy (Hartig & Steigerwald, 2007).

Confidentiality in family counseling As in group counseling, the more people involved in the treatment process, the greater the challenge in maintain-ing confidentiality. Cottone and Tarvydas (2007) indicate that confidentiality in family counseling ethics is particularly problematic because “two or more people overhear what other individuals communicate … [and] … there is no one-to-one confidential relationship” (p. 229). Furthermore, they state that,

privileged communication is referenced in statutes most typically as related to one-to-one communica-tion … [and] … if the statute provides for privileged communication, it must be examined as to whether the privilege extends to all people in a session, or whether it is limited to one-to-one communication made to a counselor. (p. 231)

Understanding the dynamic of confidentiality in counseling and discerning its limitations with families could be an ongo-ing process as issues emerge. What information is kept con-fidential between and among family members, and timing of any disclosure within or outside the unit, becomes a crucial point of decision-making for the counselor (Fall & Lyons, 2003). Because family units can include members who are under the age of majority or individuals who might not be able to give consent, there are exceptions to the confidentiality rule like when counseling is mandated by law such in cases of abuse, if it is necessary to protect one or more individuals, if the helping professional is a defendant in a malpractice suit, or if the parties have consented to the disclosure in writing (Corey, Corey, & Callanan, 2007).

Because of the potential vulnerability of some family members who might be part of a protected class in society – those who cannot give consent – much of the literature per-taining to family counseling involves the minor members of these units. In the most recent revision of the Ethical Code, the American School Counselor Association expanded termi-nology from “parent” to include “guardian” and other such global language to acknowledge the multiplicity of potential decision-makers and family members involved in the coun-seling process and to align the codes more with current legal mandates (Bodenhorn, 2005). Because of the vulnerability of some of these populations to self-harming behaviors, counsel-or ethics and standards of care are mentioned in the literature (Berg, Hendricks, & Bradley, 2009). In working with elderly members of families, Bradley, Whiting, Hendricks, and Wheat (2010) suggest that codes of ethics “include characteristics such as respect, compassion, cultural competence, and con-fidentiality, representing the virtues not only of an individual counselor[,] but also a community of counselors interfacing with elder families” (p. 218).

Emergence of Family Considerations inRehabilitation Counseling Ethics

As cited earlier, the first Code for rehabilitation coun-

selors included one standard that acknowledged the need for consideration of the family in the successful outcome of the rehabilitation process. Inherent in the standard was the need for informed consent by the client for the inclusion of the fam-ily in such process.

The 2002 Code Revision With the first revision of the Code that took effect in 2002, however, came the expansion of the ethical standards pertain-ing to families, and a greater perceived understanding of their role in the rehabilitation process. Instead of one standard, the mention of families in the Code trebled to the following:

• A.3.f. CLIENT RIGHTS: f. Involvement of SIgnIfIcant otherS. Rehabilitation counselors will attempt to enlist family understanding and involvement of family and/or significant others as a positive resource if (or when) appropriate. The client or legal guardian’s permission will be secured prior to any involvement of family and/or significant others (p. 3).

• A.6. NON-PROFESSIONAL RELATIONSHIPS WITH CLIENTS: a. PotentIal for harm. Rehabilitation counselors will be aware of their influential positions with respect to clients, and will avoid exploiting the trust and dependency of clients. Rehabilitation counselors will make every effort to avoid nonprofessional relationships with clients that could impair professional judgment or increase the risk of harm to clients. (Examples of such relationships include, but are not limited to, familial, social, financial, business, close personal relationships with clients, or volunteer or paid work within an office in which the client is actively receiving services.) (p. 4).

• B.2. GROUPS AND FAMILIES: b. famIly counSelIng. In family counseling, unless otherwise directed by law, information about one family member will not be disclosed to another member without permission. Rehabilitation counselors will protect the privacy rights of each family member (p. 6).

The 2002 revised Code reaffirmed the importance of the fam-ily, as appropriate, in successful rehabilitation outcomes and informed consent. The additional standards, however, seemed to acknowledge two important factors. First, as is the case in the general counseling literature, when family members are included in the client-counselor relationship, extra care be-comes important in drawing boundaries with those family members because these multiple relationships have the poten-tial to create harm to the client; thus, the need for awareness and safeguards against confidentiality breaches increase. Sec-ond, the Code widens the net of practice settings in which rehabilitation counselors work to those in clinical rehabilita-tion where it may be common for family counseling sessions to occur in connection to the individual counseling process. Indeed, emerging professional issues in counseling shed an interesting light on ethics and family as it applies to clinical rehabilitation counselors – those counselors who are trained

in mental health as well as rehabilitation and disability issues. The draft clinical rehabilitation counseling standards from CACREP licensed to CORE affirm that the clinical rehabil-itation counselor “recognizes the importance of family in the provision of those services, for and treatment of people with disabilities” (p. 3). In assessment and diagnosis of clients, the standards further state the clinical rehabilitation counselor “knows the effect of co-occurring disabilities on the client and family” (p. 5).

The 2010 Code Revision: Ethics in Current Family Rehabilitation Counseling

Today, the state of ethics in family rehabilitation coun-seling as presented in the Code shows a greater depth and breadth to reflect that an emerging part of practice associated with family rehabilitation counseling has come into its own. Table 1 summarizes all standards involving family in the cur-rent 2010 Code.

The 2010 Code calls for family members to be part of the rehabilitation team. The autonomy of those members and the individual with disabilities is recognized through the dis-closure and informed consent process, as is appropriate to age, linguistic, and functional factors of the individual with disabilities or family members. Boundaries by the rehabilita-tion counselor are outlined, particularly in relationships that might be detrimental because of power differential, such as sexual intimacies. At times, dual or multiple relationships that might change over the course of the counselor’s involvement may actually be beneficial to the family rehabilitation coun-seling process. Hence, guidelines involving procedures and continued disclosure and informed consent in these complex and changing relationships are addressed by the Code. Of im-portance in navigating these evolving and complex scenarios is peer and professional supervisory consultation to serve as a check and balance from the initial intent of benefiting the family to safeguard against causing harm. Finally, for nearly two decades since the first code in counseling addressed the use of online technology for counseling (National Board for Certified Counselors, 2012) the need for establishing bound-aries in the use of such technology with families is considered (Bradley & Hendricks, 2008; Pollock, 2006).

Ethical Decision-Making in FamilyRehabilitation Counseling

In rehabilitation counseling, the 2010 Code emphasized the need for the use of an ethical decision-making model. Dif-ferent models can be used in working with families. Bradley and Hendricks (2008) state that “The path to good ethical de-cision making begins with the counselor knowing and under-standing how to implement the code of ethics” (p. 261). Yet, in a study of the ethical decision-making process of family therapists, these codes were secondary to legal considerations and state laws (Burkemper, 2002). Southern (2005) explores models as they pertain to marriage and family counseling and suggest that an emerging model might emphasize virtue and aspirational ethics that involve “exploring fundamental mod-


els of helping, as well as contemporary issues in community systems” (p. 459).

Cottone and Tarvydas (2007) point out two considerations in the application of any decision-making model. They ad-

vise that, “When using a decision-making model in … family counseling, it is wise to view a concern or dilemma from the perspective of each of the involved parties” (p. 237). Further, they note that counselors “must be hyperalert to the social factors that may influence the decision” (p. 237). In attempt-

ing to determine the need to break confidentiality in working with families, for example, Reamer (2005) recommends: (a) consulting colleagues; (b) obtaining proper supervision; (c) reviewing relevant ethical standards; (d) reviewing relevant regulations, laws, and policies; (e) reviewing relevant litera-ture; (f) obtaining legal consultation when necessary; and, (g) documenting decision-making steps. The chosen method for decision-making on breaking confidentiality might be part of the ongoing disclosure and informed consent process.

Sometimes ethical decisions are not only between the rehabilitation counselor and his/her clients, but also among members of the family unit itself. Because of the dynamic complexity of family systems, and the potential inclusion of members of those systems who are unable to make decisions for themselves (such as children or those with severe cog-nitive impairments), Elliott, Gessert, and Peden-McAlpine (2009) suggest a method for the helping professional to assist families in their own ethical decision making process, such as for those working with families who have to make decisions for members at the end of life. Elliott et al.’s decision-making process includes: acquiring decision-making authority, defin-ing the role (assumed, delegated, or self-appointed), making short- and long-term decisions, and justifying the decisions (balancing everyone’s interests, requests of the affected fami-ly member or surrogate take precedence). Because of the pop-ulations served by rehabilitation counselors, these profession-als may see themselves in practice settings where they serve as surrogate decision-makers. In these circumstances, Elliott et al. (2009) recommend that these professionals advise fam-ily members to make “life choices … in ways that are consis-tent with personal and family history” (p. 256)

The Future of Ethics and Familiesin Rehabilitation Counseling

Although the family has been included in rehabilitation counseling professional ethics for nearly three decades, the guidelines in the codes imply a one-to-one client-counselor re-lationship rather than a family system-counselor relationship. As the Commission on Rehabilitation Counselor Certification Code enters a year of revision in 2015, considering family rehabilitation counseling issues through the lens of disability within the family system model may provide the rehabilitation counseling community with a richer perspective and ability to better serve consumers and become the agents of social justice described by Millington et al. (2015).

Conclusion Recognizing the family within professional codes has been present and expanded with each Code revision. Clini-cal rehabilitation counseling lends disability considerations to the discussion of mental health practice through the CACREP clinical rehabilitation counseling standards. Related counsel-ing disciplines working with couples and families examine ethics within family systems across the lifespan. Internation-al standards provide advocacy and social justice language to the definition of families. Collectively, all contributions to the

topic of ethics in family rehabilitation counseling converge to focus on strengthening the guidelines for ethical behavior when working with families and disability.

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Table 1Family Ethical Standards in the 2010 Code of Professional Ethics for Rehabilitation Counselors

Number StandardA.3.e. CLIENT RIGHTS IN THE COUNSELING RELATIONSHIP: SUPPORT NETWORK INVOLVEMENT. Reha- bilitation counselors recognize that support by others may be important to clients. Rehabilitation counselors consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends, and guardians) as resources, when appropriate, with consent from clients.A.3.d. INABILITY TO GIVE CONSENT. When counseling minors or persons unable to give voluntary consent, rehabilitation counselors seek the assent of clients and include clients in decision-making as appropriate. Rehabilitation counselors recognize the need to balance the ethical rights of clients to make choices, the mental or legal capacity of clients to give consent or assent, and parental, guardian, or familial legal rights and responsibilities to protect clients and make decisions on behalf of clients.A.5.a. ROLES AND RELATIONSHIPS WITH CLIENTS: PROHIBITION OF SEXUAL OR ROMANTIC RELATION- SHIPS WITH CURRENT CLIENTS. Sexual or romantic rehabilitation counselor–client interactions or relationships with current clients, their romantic partners, or their immediate family members are prohibited.A.5.b. SEXUAL OR ROMANTIC RELATIONSHIPS WITH FORMER CLIENTS. Sexual or romantic rehabilitation counselor-client interactions or relationships with former clients, their romantic partners, or their immediate family members are prohibited for a period of five years following the last professional contact. Even after five years, rehabilitation counselors give careful consideration to the potential for sexual or romantic relationships to cause harm to former clients. In cases of potential exploitation and/or harm, rehabilitation counselors avoid entering such interactions or relationships.A.5.d. NONPROFESSIONAL INTERACTIONS OR RELATIONSHIPS OTHER THAN SEXUAL OR ROMANTIC INTER-ACTIONS OR RELATIONSHIPS. Rehabilitation counselors avoid nonprofessional relationships with clients, former clients, their romantic partners, or their immediate family members, except when such interactions are potentially beneficial to clients or former clients …. Examples of potentially beneficial interactions include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); pur- chasing a service or product provided by clients or former clients (excepting unrestricted bartering); hospital visits to ill family members; or[,] mutual membership in professional associations, organizations, or communities.A.5.f. ROLE CHANGES IN THE PROFESSIONAL RELATIONSHIP. When rehabilitation counselors change roles from the original or most recent contracted relationship, they obtain informed consent from clients or evaluees and explain the right to refuse services related to the change. Examples of role changes include: (1) changing from individual to group, relationship or family counseling, or vice versa …B.4.b. GROUPS AND FAMILIES: COUPLES AND FAMILY COUNSELING. In couples and family counseling, rehabilitation counselors clearly define who the clients are and discuss expectations and limitations of confidentiality. Rehabilitation counselors seek agreement and document in writing such agreement among all involved parties having capacity to give consent concerning each individual’s right to confidentiality. Rehabilitation counselors clearly define whether they share or do not share information with family members that is privately, individually communicated to rehabilitation counselors.F.2.c. REHABILITATION COUNSELOR FORENSIC COMPETENCY AND CONDUCT: AVOID POTENTIALLY HARM-FUL RELATIONSHIPS. Rehabilitation counselors who provide forensic evaluations avoid potentially harmful professional or personal relationships with individuals being evaluated, family members, romantic partners, and close friends of individuals they are evaluating …J.3.a. CONFIDENTIALITY, INFORMED CONSENT, AND SECURITY: CONFIDENTIALITY AND INFORMED CONSENT. Rehabilitation counselors ensure that clients are provided sufficient information to adequately address and explain the limits of: … (4) an authorized or unauthorized user including a family member and fellow employee who has access to any technology the client may use in the counseling process ...J.12.c. DISTANCE COUNSELING RELATIONSHIPS: BOUNDARIES. Rehabilitation counselors discuss and establish boundaries with clients, family members, service providers, and/or team members regarding the appropriate use and/or application of technology and the limits of its use within the counseling relationship.

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Excellence is within Your Reach: TheImportance of Planning for Performance in the

State-Federal Vocational Rehabilitation Program

Darlene A.G. GroomesOakland University

Michael ShoemakerUtah State Office of Rehabilitation

David VandergootWorkLife Resources, Inc.

Steven W. CollinsFlorida Division of Vocational Rehabilitation

Leadership across the state-federal Vocational Rehabilitation (VR) Program must be strategic in demonstrating accountability for employment outcomes given ev-er-present internal and external challenges to its operations. In order to reach for excellence in performance, leadership must have a lens toward systems thinking and build the components of a high performing organization. The authors intro-duce rehabilitation professionals to a context of performance in the state-federal VR Program and discuss the planning processes involved to manage a system that addresses employment outcomes. We provide information on the compo-nents of high performance organizations; systems thinking; strategic development, implementation, and leadership; and tools for use in project planning and tracking effectiveness of state agency services and practices. We discuss training and practice implications.


Recent rehabilitation counseling (RC) literature advo-cates for knowledge about the types of services that improve employment rates for persons with low em-

ployment outcomes, and discusses the need to demonstrate the use of evidence-based interventions in RC practice (Del Valle et al. 2014; Fleming, Del Valle, Kim, & Leahy, 2012; Leahy et al. 2014; Rubin, Chan, & Thomas, 2003). Accord-ing to Sherman et al. (2014), there is mounting pressure for the state-federal Vocational Rehabilitation (VR) Program to demonstrate accountability for employment outcomes. Cur-rent challenges such as 1) budget deficits, 2) changes in im-plementation of services due to legislative mandate, 3) shifts among common measures of performance (e.g., six primary indicators of performance for both adults and youths served under programs authorized under the Rehabilitation Act), and 4) the need to provide objective evidence to justify rehabilita-tion services (Chan, Rosenthal, & Pruett, 2008) require lead-

ership within the VR Program to harness a cohesive strategy and focus on performance improvement.

Contemporary views of quality performance within the VR Program define achieving outcomes in the form of em-ployment, increased health, social participation, and indepen-dence for citizens with disabilities. The VR Program is a hu-man service organization that serves about 1.2 million people each year, and through the Rehabilitation Act of 1973, all VR state administrators are required to submit a State Plan that describes how these services will be administered. Through-out this paper, we use the term organization rather than agency in order to promote depth/breadth of group structure and ac-knowledge that each state agency plans and performs in ways specific to its structure.

The quality and value inherent in the VR organization’s service delivery processes are shown by program evaluators and quality improvement (PEQI) specialists housed internally to the organization. These PEQI specialists are assets to the state-federal VR organization, who derive knowledge from data collected from state-specific annual evaluations of per-formance. Current legislation, the Workforce Innovation and

Darlene A.G. Groomes, PhD, CRC, LPC, Oakland University, Department of Human Development and Child Studies, 405 E. Pawley Hall, Rochester, Michigan 48309-4401.



Opportunity Act, mandates that VR now work in partnership with other core programs (i.e., Adult, Dislocated Worker, and Youth formula programs; Adult Education and Literacy pro-gram; and Wagner-Peyser Act employment services program) to improve employment rates of citizens across the nation. It is the call to improve outcomes that promotes the identifica-tion of best practices and the push toward excellence in VR performance management.

Excellence is within the reach of a VR organization when its strategic planning and management is executed in the context of achieving high performance. The Rehabilita-tion Program Evaluation Network (RPEN), which is the Na-tional Rehabilitation Association’s professional division for performance management, serves the broader rehabilitation community with information on performance management, organizational effectiveness, and quality improvement. As VR organizations seek more productive habits that lead to cost savings, pleasant work climates for employees, and valu-able goods and services for customers, planning for success becomes critical. The purpose of this article is to introduce rehabilitation professionals to a context of performance in the state-federal VR Program and to enhance understanding of the planning processes involved to manage a system that addresses employment outcomes. We will discuss the com-ponents of high performance organizations; systems thinking; strategic development, implementation, and leadership; and tools for use in project planning and tracking effectiveness of state agency services and practices. We discuss training and practice implications for 1) staff who affect the quality services that engage customers, and 2) state managers and ad-ministrators who persistently encounter the challenges in the current VR landscape. With tools in place that enhance the VR organization’s guiding plan to manage daily operations, then it is well-situated to achieve outcomes and continuous performance improvement.

Components of a High Performing Organization. According to Latham (2012), a focus on organizational learning and systems allows an organization to create a model for self-examination, which helps the organization to achieve mission success through evaluation, improvement, and shar-ing of information and promising/best practices. Moreover, learning within a VR organization means that VR identifies what is important to measure and monitor; how the data are collected, analyzed, and reported; and how employees throughout the organization use those reports to identify op-portunities to make improvements. If people see themselves as part of something grand, they will create joy in their work and continue to evaluate, share their thinking, and make im-provements within the system (Wayne, 2008).

In order for VR organizations to improve outcomes, then, staff should develop a systems view whereby focus is on changing processes and methods in the system, and equipping individual workers to implement desired changes (Scholtes, 1998). In reference to the Deming Management Method (Walton, 1986), the Baldrige Criteria for Excellence (Nation-al Institute of Standards and Technology (NIST), 2013), or

some other general model for organizational performance, the sources have in common concepts regarding the learning or-ganization and systems thinking. A systems thinking approach is the degree to which one understands how all the divisions, departments, and processes interact to affect each other. Many organizations, including VR, tend to compartmentalize its ac-tivities. This may result in a lack of full understanding of how one department’s activities may impact other depart-ments, or the entire organization. Terms such as “siloing” or “stove-piping” describe this kind of non-systems thinking. For example, if a state VR agency’s Contracts Department de-velops a new contract for technology services, but it fails to have the information technology department review and val-idate that the case management system can adequately track the performance of the contracted service, then there is risk of entering into a contracted service without any understand-ing of how well the service is working. Since the contract is executed, the VR organization would still be responsible for paying invoices. This would place the VR organization at risk of spending contracted services dollars on services that could not be tracked in terms of quantity or quality.

The federal government’s Rehabilitation Services Ad-ministration (RSA) reviews and monitors processes that con-tribute to emerging practices within the VR program, while seeking to reach for best practices in program evaluation. There is a need for best practices in VR program evaluation in order to enhance the likelihood that performance across the VR organization (i.e., practice from all levels: administration, supervisory, practitioners, support staff) results in continuous improvement, value, and innovation. Three questions to ask of any improvement effort are: (1) what should be realized?, (2) what change may result in improvement?, and (3) how will one recognize that the change resulted in improvement? To better assist with process modifications, we review in Table 1, characteristics and actions of high performing organizations as the critical step in reaching excellence. Leaders in VR or-ganizations should strive toward making these core character-istics a common part of the organizational culture.

Strategic Planning Development and Implementation. Many VR program evaluators and quality improvement specialists note that without learning and structured planning (i.e., strategic planning), performance often stagnates. When opportunities for strategic improvement are missing within an organization, the system slows down and there is less attention paid to employee and customer satisfaction. Organizational development literature (Ashkenas, 2013; El Namaki, 2013; Madsbjerg & Ramsmussen, 2014) describes consequences experienced by organizations that do not prioritize a high per-formance mindset. We list these repercussions below, specific to the state VR context, in order to show how the VR Program is at increased risk if a focus on strategy development for de-sired change does not occur:

*Loss of state and federal funding *Increased employee turnover * Reduced customer satisfaction and increased customer complaints

* Missing opportunities for strategic improvement * Diminished results for key outcome measures, such as successful placement.

Deliberate planning that considers the VR organization as a system that must demonstrate results will serve to reduce the above-mentioned risks (McFarlane, Schroeder, Enriquez, & Dew, 2011). Future success is more likely when an organi-zation develops a strong planning process, and then follows through on tracking strategies until they are fully implement-ed.

In terms of planning, a VR organization should focus on the capability to align with the components of high per-formance, as shown in Table 1. VR leaders who focus on re-sults and opportunities to improve are individuals that help the VR system to remain flexible and responsive to changing landscapes (e.g., Workforce Innovation and Opportunity Act (WIOA), 2014). Planful leaders engage with staff to ques-tion what they are trying to accomplish and whether changes will result in improvement. Effective administrators are those who now participate in actions that promote opportunity for

results under WIOA. Large planning efforts are underway in many of the 80 VR agencies across the nation to anticipate forthcoming rules to adequately implement the new federal legislation.

Another important aspect to planning in a strategic way is to develop, influence, and expect challenges among key partnerships (e.g., State Rehabilitation Councils, employers, community rehabilitation programs) when prompting changes in service provision. For example, working with State Reha-bilitation Council leadership requires engagement, negotia-tion, and knowledge sharing when implementing an appropri-ate customer satisfaction survey process. A second example may be anticipating a new technological advancement (e.g., case management system, data visualization strategy) that can directly connect with partners and ease data collection and analysis efforts. The inclusion of those key partners in the re-view and feedback of new program and technology prototypes helps to strengthen the relationship.

Strategy development without strategy implementation is not helpful to change management efforts. Performance ex-

Table 1. Characteristics of a High Performing Organization. Note: Visit http://www.nist.gov/baldrige/publications/upload/2013_2014_Baldrige_Criteria_Brochure.pdf for more information.

Visionary Leadership Send messages of inspiration to allow individuals to contribute, learn, and embrace change. Include the mission and vision statements in the strategic plan and make sure that key projects support the mission and vision.

Customer Focus Appreciate customer needs and anticipate future desires. Remain sensitive and adjust to ever-changing customer issues. Identify key customer groups in which there may be gaps in service and performance. Include projects to improve services to those groups in the strategic plan.

Valuing Employees Show a commitment to the workforce—to their engagement, satisfaction, and development. and Partners Create a network among external partners to improve knowledge sharing. Survey employees and partners and actually use the results of the survey to develop strategic projects to improve climate, training, and partner relationships.

Managing for Remain flexible and adapt rapidly to changes. Integrate innovation into work across the Innovation organization and promote the value of the learning culture. Invite employee teams to identify innovative ways in which to leverage new technologies to improve performance.

Management by Facts Use measures that provide data about processes, outputs, and results. Derive performance measures from customer and employee needs as well as desired outcomes. Communicate expectations to managers and employees that business decisions should be based on collection and analysis of data, as opposed to solely on “gut feel” and intuition. Create a transparent performance management system so that all employees can see and understand current situations and trends in performance.

Focus on Results and Use results to create better service and support for customers, workforce, and partners; theseCreating Value results build loyalty and contribute to a learning community. Focus management meetings and strategic planning events on results, with subsequent identification of strengths and opportunities to improve results. When performance gaps are identified, leaders play a key role to instill a culture of “hope and opportunity” as opposed to “fear and blame.”


cellence literature is replete with examples of good plans that never get implemented. The best laid plans are literally laid on credenzas in all kinds of organizations and are never reviewed again until it is time to write another plan. This is a critical juncture in which committed and visionary leaders take re-sponsibility. State VR Directors must be committed to ensur-ing that strategic projects are fully resourced from a finan-cial, technological, and human resource perspective, and that progress measured against strategies is regularly reviewed by senior leadership. The organization must design an efficient process for tracking objectives, train staff to meet these ob-jectives, and analyze the quality of performance as strategies are carried out. Key measures need to cover all areas of the strategic management plan, and include:

• Performance projections for short- and long-term time horizons that can be used to identify key gaps in performance • Identification of short- and long-term goals with measurable objectives; • Strategic projects or key activities designed to address the goals and objectives of action plans tied to projects; • Resource allocation plans to support the projects from a financial, technical, and workforce perspective; • Strategic communication plans; • Adjustments to data collection and analysis to assess the impact of plans and projects, • Opportunities for plan and project reviews, modifications as needed; and • Reviews of the planning process itself, so that it can become more effective and efficient.

As the strategy is implemented and tracked with effective monitoring tools, VR organizations will be able to achieve and report performance improvement. The organization’s leaders, workforce, and partners become reinforced to contin-ue to learn and achieve quality performance. The Utah State Office of Rehabilitation (USOR, 2013) is a fine example of success in an organization that developed a planful approach to the development and implementation of strategy. Their story of reaching for excellence centers on a strategic project designed to improve the presumption of eligibility for those who receive Social Security benefits.

In 2008, the USOR organization undertook a renewed effort to make sure its applicants who were SSI/SSDI recipients were presumed eligible as soon as possible after verifying required documentation showed that they were recipients. After reviewing the data, at the time of application, the performance management staff learned that only 66% of customers were presumed eligi-ble. In developing a plan for improving this rate, there were three implementa-tion steps that the organization followed which led to six years of consecutive in-

crease in the rate of those presumed eligible. By FY 2013, the success in their planning efforts resulted in a 21% increase to now 87% of SSI/SSDI customers presumed eligible.

The first step was that staff established a plan to measure performance in this specific area. Often a decision to measure performance requires a tradeoff because most organizations measure only their highest priority areas on a consistent and ongoing basis. When presumptive eligibility for vocational rehabilitation services emerged, the organization communi-cated to staff its plan to monitor performance in this area. The second step involved informing the 10 district directors state-wide of these results and to consider evaluating, training, and reminding its rehabilitation counselors to immediately docu-ment eligibility of services for those customers receiving SSI/SSDI benefits. The third step required field service directors, who supervise district directors, to follow up to see at the end of the next year if performance had improved, worsened or stayed the same. Follow-up is a key step that is often forgot-ten, not planned for, or not implemented for one reason or another. Figure 1 below illustrates how the performance in presuming eligibility steadily increased over the six years of performance management.

Strategic Leadership System As a VR organization attempts to focus on strategy de-velopment for learning and change, there are various manage-ment processes that can assist in the course of chosen actions. As systems go through a maturation process, they are always subject to improvement and adjustment. One helpful structure to consider is the use of a strategic leadership system.

Strategic leadership entails a shared sense of purpose among leaders and all members across the VR organization (Beatty & Quinn, 2010). The components of a strategic lead-ership system are really quite simple to discuss, but can be quite difficult to implement without the aforementioned com-mitment from leadership. These components include the fol-lowing:

1) Identify and monitor key performance indi-cators—this process allows for the identifica-tion of current or potential performance gaps that should be prioritized for attention in the planning process. It should be noted that the indicators will come from a variety of sources,

including customer complaint and satisfaction data, process performance data, financial mea-sures, technology utilization measures, feed-back from key stakeholder groups, and direc-tives from federal and state legislative bodies.

2) Employ perspectives of a wide range of stake-holders to develop a strategic direction—this builds a coordinated approach to processes that vary within the organization. Sharing view-points among stakeholders, whether customers, employers, legislators, finance, human resourc-es, and others provides the VR organizational system with a way to develop, implement, and track each role’s impact on the organization’s mission and vision.

3) Deploy appropriate resources that can have impact on the VR organization’s mission—this remains critical in any strategic leadership frame because there are often situations in human service organizations that require limited resourcing of initiatives. Leadership’s ability to prioritize actions and use performance indicators to show where resources can best be allocated will bolster the VR organization’s ability to meet goals regarding its customers. It will be likely that other priorities will not be addressed due to lack of time, funds and/or employees. Defining core mission priorities for your agency can provide a framework of where you will decide to allocate resources.

4) Create a culture of influence—this allows others to see the value in creating an expanded team. Make clear the expectations of indi-viduals across the organization and provide them with authority to fulfill their recognized responsibilities. Have a system of accountabili-ty that informs all people on the quality aspects and improvement actions needed to complete a job well done. The ability to share power and recognize that everyone can influence within the organization helps to build participation, communication, and commitment. Accord-ing to Murphy (2014), the performance of an organization requires leaders who truly involve others and see value in a systems approach.

Planning Tools There are also several types of planning tools with which the entire VR system can engage, which promote fluid move-ment through a process, identification of projections and/or modifications, and learning outcomes. A VR organization’s experience in utilizing planning tools varies just as it operates its system in unique and variable ways. Guerra-Lopez and Hutchinson (2013) advocated strongly against utilizing one approach or tool for planning purposes. We now discuss two planning process tools for developing and deploying strategy, then move into describing a mechanism for tracking strategic plan effectiveness.

Key Driver Maps. A driver map is a symbolic repre-sentation that identifies the critical factors that affect a spe-

cific performance out-come. Maps define key success factors that are measured by your measurement sys-tem—those few that actually contribute to an outcome. In Figure 2, we show a driver map for the common Evaluation Standards and Performance Indi-cators put forth by the Rehabilitation Services Administration. Key performance indicators are used to measure the drivers of performance. Readers can see the VR indicators that help to drive performance around closure rates, average hourly wage, and customer satisfac-tion. These key drivers then measure VR’s ef-fectiveness on its over-all performance objec-


tive: employment outcome. Depicting the many drivers that affect specified and defined outcomes through mapping can help leadership to visualize its focus on performance excel-lence.

Strategic Project Plan. The purpose of engaging in a stra-tegic project plan is to translate a VR organization’s goals so that senior leadership teams can ensure that key projects are completed and fully implemented. VR organizations are graded now on more than peak performance; these are being graded yearly by our state funding streams on the ability to communicate evidence of the value in services provided to citizens with disabilities. Through the use of a strategic proj-ect plan, leadership can address concerns across the organiza-tion and use the plan as a catalyst for possible solutions.

Figure 3 illustrates the elements of a project plan spe-cific to improving customer success and satisfaction, which is one of several goals outlined in any organization’s larger strategic planning document. Readers can see a systems ap-proach to planning, which includes identifying the strat-egy used to accomplish objec-tives, the leader team member responsible for strategy fol-low-through, a listing of the start/end dates, and the mea-sure of performance for each strategic step in carrying out the plan. Additionally, there is a box to highlight current performance when meeting as a team to discuss success in meeting plan objectives.

Tracking Effectiveness. A VR organization’s ability to track effectiveness over time greatly assists in making healthy business decisions. The best way to approach looking at effectiveness is to look at whether the organi-zation is moving in the right direction, not whether indi-viduals have met a particular target. By tracking effective-ness, leadership can identify gaps, point out areas of weak-ness, and make necessary im-provements. Inspecting the system deliberately allows leadership to understand vari-ation across the organization and to modify strategic plans and project plans accordingly. Leadership will want to take action on making adjustment

so that the organization is moving in the planned direction.

In utilizing these organizing tools and processes, it is likely that opportunities for strategic improvement will re-main prominent within an organization. The learning in an organization will flow easily and more attention will be paid to employee and customer satisfaction. As VR organizations focus on strategy development for desired change, then sus-tainability and agility can be maintained.

Implications for Training and Practice From a systems thinking lens, every employee in a VR organization is significant and contributes to the overall per-formance. Therefore, all employees (e.g., counselors, techni-cians, supervisors, financial team members) need to be aware of and contribute to the planning and implementation of the program improvement and performance management process. All employees need to learn about the approach the organiza-tion is taking to improve its performance and outcomes and what role they must play in implementing it. The organization

should provide all employees with a thorough overview of the strategy, which highlights the general role and function each classification of employee has for its implementation. Then training should be offered to each employee group that speci-fies what each member from that group needs to do.

Supervisors have to learn how to interpret the data and make conclusions about acting on the data. They need to learn how to communicate results to staff and gain their cooperation in planning how to move forward. Counseling staff in partic-ular are critical to the improvement effort since they are re-sponsible for providing services. This places them in the best role to interpret the needs of customers and what services will most likely address the needs. Supervisors and managers are responsible for creating the environment for counselors and other service staff that will encourage the flow of informa-tion from them to organization executives who are decision makers. These decision makers are responsible for using this information to acquire and organize resources so that service staff has the capacity to provide to customers what they need for achieving employment success. Technicians and assis-tants, who complement the work of VR counselors, need to know what they must do so that counselors and supervisors can focus on their key roles. This is very significant since the performance management effort depends on good data that accurately represents all the key factors that contribute to or-ganization success. If too much of data entry and logistical detail are placed on service staff to complete, they will not be able to offer services in the way they want or the data will be inaccurate due to time constraints. Neither of these responsi-bilities should be constrained since organizational improve-ment and success depends on them. Allocating the data collec-tion capacity across all employee groups will be important so that no one group is overburdened. Finally, there needs to be a well-trained staff specifically focused on performance man-agement and improvement. This group is typically referred to as program evaluation and quality improvement (PEQI) staff. They have the responsibility for providing the proper tools for all the other employee groups to use in implementing the strategy. This includes how to design and conduct assess-ments, build data collection systems, and analyze and report data.

The Summit Group on Performance Management in Vocational Rehabilitation (2015) sponsors a learning com-munity for VR staff that creates opportunities to acquire the knowledge and skills needed to design and implement state-of-the-art performance improvement strategies. On its pro-fessional website, The Summit Group provides information, documents, assessments, opportunities to share information, and links to other sites. Summit Group members have con-tributed to the development of several online courses focusing on aspects of performance management that can be accessed through the website and which provide Certified Rehabilita-tion Counselor (CRC) credits. Finally, the Annual Summit on VR Performance Management provides workshops and pre-sentations of the latest information and technologies associat-ed with program performance techniques and strategies spe-cific to vocational rehabilitation. These learning opportunities

are building continuously and can be discovered through the website.

The important message about a VR organization’s reach toward excellence is that it requires the development and im-plementation of strategic plans for continuous learning and improvement. In order to fully identify best practices and to improve upon organizational and strategic processes, leader-ship across VR organizations must be deliberate in demon-strating accountability for employment outcomes. Leadership must engage their program evaluation and quality improve-ment (PEQI) specialists, have a lens toward systems think-ing, and strive to build the components of a high performing organization. We believe continuous program improvement is reachable in the most challenging of circumstances and en-courage finding the unique pathways that lead toward VR per-formance excellence.

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Vocational Rehabilitation State Agency Three-Year Strategic Plan

Mission: To help individuals with disabilities to enhance independence, and to find and maintain employment

Goals and Objectives Strategy Lead Start/End Dates

Performance Measures Current Performance

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Review and revise state’s system for finding employment and link to federal employment opportunities web portal

Design and implement enhancements to the vendor profile for customer use in making informed choices

Julie 11/2013 thru 12/2015

Acquire baseline use of vendor profile and measure increase in use

Figure 3. State Strategic Project Plan—assists in translating VR organization’s goals so that senior leadership teams ensure key projects are completed and fully implemented.


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Vocational Rehabilitation (VR) has an over eighty-year history of providing services to adults with dis-abilities as they enter and prepare for the workplace

(U.S. Department of Education [US DOE], Office of Special Education and Rehabilitative Services [OSERS], 2006). As a service provider, VR helps adults become employable, secure or maintain employment, and attain promotions in suitable and productive careers through an Individualized Plan for Employment (IPE). More specifically, in 2002 more than 1.4 million adults received services with over 90% meeting VR’s definition of significant disability (US DOE, OSERS, 2006). The actual federal dollar amount for VR funding was at 2.5 billion in 2002 (US DOE, OSERS, 2006) and 2.8 billion in 2009 (Stapleton, Honecutt, & Schlechter, 2010). The term significant disability refers to clients whose disability reflects the following three criteria: a severe physical or mental im-pairment that seriously limits one or more functional capaci-ties (e.g., mobility, communication, self- care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome; their VR needs can be expected to require multiple services over an extended period of time; and they have one or more physical or mental disabilities that

cause comparable substantial functional limitation (Hager, 2004).

Historically, VR has served an adult population with a focus on providing employment-related services that lead to positive employment outcomes. In terms of outcomes, “in general the employment rate of people receiving VR ser-vices are consistently found to be around 60%” (Dutta, Ger-vey, Chan, Chou, & Ditchman, 2008, p. 327). Nationally in 2005, based on a stratified random sample of 15,000 clients, the success rate (status 26 closures) varied by VR’s unique grouping of disabilities from a high of 75% for those with sensory or communicative disabilities to 56% and 55% for those with physical impairments and mental impairments, respectively. The latter grouping includes specific learning disabilities (SLD), serious behavior or emotional disabilities (SED) and intellectual disabilities (ID) (Dutta, et. al., 2008) or those primary disabilities resembling a large majority of former students with Individualized Educational Programs (IEP). In terms of potentially effective services for the lat-ter group, job placement, on the job support and maintenance were each significantly correlated to a successful outcome while other services (e.g., job placement assistance, counsel-ing and guidance, remedial training, university training, job readiness training, transportation services, and rehabilitation technology) had a marginal correlation.

Vocational Rehabilitation (VR) provides employment-directed services to adults with disabilities, including young adults who transition from high school. This study examined the relationships and effects of participation in VR programs and school work-related transition programs on employment outcomes for young adults. Data came from a state database involving 7,587 individuals who received VR services. Structural equation modeling (SEM) was used to perform data analysis, including multiple-group analyses. The study found a majority received VR services for over a year and most were individuals with cognitive disabilities. Also, participation in VR services and school transition programs had positive effects on work hours and salary.

Vocational Rehabilitation Transition Outcomes: A Look at One State’s Evidence


Song JunUniversity of Cincinnati

Kimberly OsmanirOklahoma Department of Rehabilitation Services

Larry KorteringAppalachian State University

Dalun ZhangTexas A&M University

Larry Kortering, Appalachian State University, Reading Edu-cation and Special Education, Boone, NC 28608.

E-mail: [email protected]

47


The recent transition from school to work legislation and corresponding policy have ushered in a focus on preparing youth who have an IEP for positive post-school outcomes in terms of post-secondary education or training, employment and independent living. This policy includes the codifica-tion of Indicators 1 (school completion), 2 (school dropout), 13 (provision of transition services and planning), and 14 (post-secondary outcomes) to monitor how well states provide transition-related services this population, along the require-ment that all graduates leave with a Summary of Performance (SOP). The SOP provides information and documentation to help exiting youth access adult services like Vocational Re-habilitation. This group of unique clients includes the nearly 200,000 youth with disabilities who are graduated with a reg-ular diploma each year and others exited with non-standard diplomas or the 125,000 who exit as dropouts (Office of Spe-cial Education, 2006). This transition focus brings attention to whether this group of consumers is ready for VR’s traditional employment services that have traditionally served an older and more experienced adult consumer. Similarly, Plotner, Trach, and Strauser (2012) have asked whether VR counsel-ors are ready for this group of clients, while the Government Accounting Office (2012) outlines the need for better coordi-nation between schools and VR agencies for students transi-tioning from high school.

Several earlier studies have examined aspects of whether former students who had an IEP are ready for VR or if VR is ready for them. In terms of getting in the door at VR, an earlier study of 1,200 students with disabilities who had been recent-ly graduated from high school in Washington state showed that 9% had contacted VR for services (Kortering & Berven, 1988). Of note, is that ‘contact’ was applying for services only and not whether they had actually been accepted for or re-ceived services. A national longitudinal study of VR services and outcomes showed that 14% of clients served were youth with disabilities (ages 18 to 25) and that 67% of these had IEPs in high school (Hayward & Schmidt-Davis, 2000). More recently, Cimera and Oswald (2009) reported that nationally between 2002 and 2006 some 22% of all clients had an IEP while public or private K-12 schools accounted for 14% of all VR referrals. Most recently, Migliore, Butterworth, and Zale-waka (2013) examined VR service delivery and outcomes for 16 to 26 year-old youth from a national sample from 2006-2010. They reported several interesting findings, including the feature that youth with autism who exited VR more than doubled (130%) over the period, the number of youth with intellectual disabilities decreased (-10%), and the number of youth with other disabilities increased by 11%.

As for services and outcomes, Hayward and Schmidt-Da-vis (2000) report that job placement (67%), vocational train-ing (60%) and support for further education (51%) were the three top services provided youth with disabilities and that 63% successfully obtained competitive employment. Dun-ham, Schrader, and Dunham (2000) examined whether a spe-cific group of 98 persons with a borderline intellectual dis-ability and SLD benefitted from VR. Fifty five (56%) of the participants found employment and were closed successfully.

Likewise, a study of 613 VR clients with an average of around 20 years and identified as SLD who had an initiation of ser-vices in the 1991-92 fiscal years showed that 361 (59%) were successfully closed as employed (Dunahm, Koller, & McIn-tosh, 1996). Of note, is that those who were unsuccessful closures had significantly higher full scale IQ (95.2 v. 92.4) and verbal scale scores (91.2 v. 88.3) and were significantly more likely to have received college training (37% v. 24%) guidance and counseling (16.3% v. 9.4%) as VR services or treatments. Along a similar vein, Benz, Lindstrom, and Latta (1999) demonstrated the effectiveness of an ongoing and col-laborative effort of public schools and VR that led to the youth transition program model. This program served 1,511 youth with disabilities as they prepared for their transition from school to work. Long-term outcomes showed that at program exit 77% had jobs, a rate that held stable for up to 24 months after exit. A later evaluation of the youth transition program showed the female young adults with disabilities, relative to male age peers, had comparable rates of employment but low-er wages ($4,360 per year) and this wage gap persisted for at least six years (Doren, Gau, & Lindstrom, 2011). Research involving students with SLD participating in the Ohio Longi-tudinal Transition Study showed that 79 (19%) of the partic-ipants were able to rate the perceived usefulness of services. On a four-point scale, the average rating for VR services was 2.90--well behind that for paid work experience (3.24), tech-nical education (3.24), job shadowing (3.15) and extracurric-ular activities (3.11). In contrast, ratings were well ahead of proficiency testing (1.89) and in line with IEP and transition meetings (2.84), preparation for college entrance exams (2.83) and school-supervised work (2.82). Most recently, Migliore, et al. (2013) found a slightly better successful closure rate for youth with autism (50%) versus that for peers with intellectual disabilities (44%) or other disabilities (46%).

Given the importance of the transition from school to a productive adulthood for youth with disabilities, this study examined one state’s Vocational Rehabilitation database to answer the following questions: 1) What are the participation rates in transition-related programs for youth by disability grouping, gender and race? 2) What are the average employment outcomes for transi-tion youth by disability grouping, gender and race? 3) Does participation in specific VR programs and transi-tion related programs affect employment outcomes? 4) Does participation in specific VR programs or transi-tion-related programs have a different affect on outcomes for individuals with cognitive versus non-cognitive disabilities? 5) Do work-related transition programs (e.g., work ad-justment, work study) affect employment outcomes?

MethodSource of Data The Oklahoma Department of Rehabilitation Services (ODRS) provided the database for this study. The database includes 7,587 transition-age youth who applied for ODRS services from 1981 to 2011 and whose cases were closed be-tween 1998 and 2012. At the time of application, individuals

were from 12 to 21 years old, with a large majority being 14 to 18 years old. More than half were individuals with cogni-tive disabilities; the second largest group was individuals with orthopedic impairments. The category of cognitive disabili-ties includes former students with SLD, SED, and ID. The database reported numbers and percentages of individuals in each of five racial groups, with Caucasians accounting for a large majority and African American and American Indian/Alaskan Native being evenly represented. Table 1 provides more specific and additional demographic information on all 7,587 individuals in this database.

In Oklahoma, ODRS provided various transition pro-grams to help former students with disabilities obtain em-ployment. For instance, each high school has a vocational rehabilitation counselor assigned to work with students with

disabilities—some have dedicated transition caseloads, while others also serve adults in that same area. These programs include work study (including school-based work study, worksite learning, and employer work study), high school transition program, work adjustment training, stepping stone stimulus, on-the-job training stimulus, job retention stimulus, AgrAbility, American Indian Tribal VR Program, Hispanic CoShare, Hissom, Project SEARCH™, and Tech-Now. The school work-study service consists of part-time paid work experiences for high school youth in their school district or the community. Work adjustment Training (WAT) provides foundational employability skills training (e.g., job search, in-terview skills, work ethic) as well as an introduction to hard and soft skills in community businesses. Stepping Stone was a stimulus funded summer program for high school youth where they utilized public transportation, participated in on

the job training, and received employability skills over a weekend’s time. ODRS also has several Tribal VR pro-grams in the state and co-share cases with the various tribal programs to best meet the needs of clients. Additionally, ODRS has a Hispanic Unit that may co-share cases with local VR counselors for families who are Spanish speak-ing. Project SEARCH™ is a two semester program that provides three ten-week unpaid internships to youth with disabilities in a host business. Tech-Now is an elective technology class focusing on transition activities for youth with disabilities. The database reports whether the individ-ual received any of the services and reports employment status of the individuals, including work status, employ-ment dates, employer name, job title, hours worked per week, compensation amount, compensation unit, and hour-ly wage.

Measures Observed variables. Observed variables in our analy-sis include demographic variables and transition program variables. Table 1 provides the general information on de-mographic variables, such as ethnicity, gender and types of disabilities. Demographic variables were covariates in our model. Based on our analysis plan, we further divided types of disabilities into two existing OKDRS categories, including cognitive disabilities and non-cognitive disabili-ties, to examine moderator effects. To examine the effects of VR program services, two measures were in the model, age at beginning participation in VR program and length of attending the VR program. The school transition program variable was constructed from three observed variables (participation in school work study, special programs and school to work adjustment). The variable was coded “1”, if students attended any school transition programs (e.g., School Work Study, Special Programs, work adjustment training). If students had not attended any types of transi-tion-related program the variable was coded “0”.

Latent variables. The latent construct “employment out-comes” was the outcome variable in our analysis. It was operationalized with two observed measures, including “Hourly Wage” and “Weekly Work Hours”. “Hourly wage” measures average wage that students earned. “Weekly

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Table 1. Demographic Information

Demographic Characteristics (n = 7,587) Gender Male Female

4,394 (57.9 %) 3,193 (42.1%)

Age 12-13 years 14-18 years 19-21 years

4 (<.1%) 5,464 (72%)

2,119 (27.9%) Ethnicity Caucasian

African American American Indian/Alaskan Native

Hispanic/Latino Asian and other

5,377 (70.9%) 927 (12.2%) 982 (12.9%) 233 (3.1%)

67 (.9%) Disability Cognitive Impairment Speech impairment

Psychosocial Impairment Other Mental Impairments

Hearing impairment Visual impairment Orthopedic impairment Respiratory Impairments Deaf-blindness

3,916 (51.6%) 117 (1.5%) 586 (7.7%) 261 (3.4%) 267 (3.5%) 402 (5.3%)

1674 (22.1%) 359 (4.7%) 5 (<.1%)

Lengths in VR program 6 months or under 6 to less than a year 1 year to less than 5 years 5 years and above Transition Programs

30 (<.1%) 245 (3.2%)

3802 (50.1%) 3510 (46.3%)

School to Work Study Yes No School to Work MOU Yes No High School Transition Program Yes No Work Adjustment Training Yes No

Employment Status Integrated Employment Extended Employment Self-Employment Homemaker Other Types of Employment

1884 (22.1%) 5703 (67%)

671 (7.9%)

6916 (81.3%)

781 (9.2%) 6806 (80%)

148 (1.7%)

7439 (87.4%)

7152 (94.3%) 64 (.8%) 71 (.9%) 67 (.9%)

233 (.3%)


Work Hours” measures average weekly hours students spent on the job.

Data Analysis This study examined the effects of school transition pro-grams in combination with VR support on employment out-comes of youth with disabilities. We also sought to detect any moderator effects, including gender, ethnicity and types of disabilities. Structural equation modeling (SEM) allowed us to perform path analysis with latent variables, identify caus-al relationships between predictor and outcome variables, and compare group differences (Chin, 1998). Analyses were performed in SPSS V.17.0 and Mplus software (Muthén & Muthén, 2012). Missing data were retained in the analysis and treated in Mplus by using the full information maximum like-lihood (FIML) approach.

The data analysis included three specific steps. First, we obtained descriptive statistics for each observed vari-able through SPSS. Second, we tested the hypothesized la-tent model to examine the direct effects of VR programs and school transition programs on employment outcomes. Last, to test the moderate effects of covariates (e.g., gender, race and types of disability), we used multiple group analysis to examine different group effects based on chi-square differ-ence tests, which are to compare chi-square values between the configural and other models with imposed constraints on specified parameters (Byrne, 2009).

ResultsDescriptive Statistics Table 1 presents general de-mographic information. As illus-trated, a majority of individuals were Caucasian and male. Over half of students had cognitive impairments. Nearly all of the individuals had been with VR programs for over a year and nearly half were in for over five years. A near majority partic-ipated in some type of school transition programs (e.g., school work study, work adjustment training, high school transition program). The average hourly wage was $9.39 (SD = 5.13) and the mean of weekly work hours was around 35 hours (SD = 8.8). Table 2 provides the correlation matrix of the observed variables along with employment status.

The Structural Model We conducted a path anal-ysis on our hypothesized model (see Figure 1). The estimated standardized coefficients and

factor loadings of the final model are also in Figure 1. Three commonly used fit indexes determined the fitness of the mod-el, including comparative fit index (CFI), root mean square er-ror of approximation (RMSEA), and standardized root mean square residual (SRMR). Our model had a CFI value of 0.96, a RMSEA value of 0.048 and a SRMR value of 0.016, all of which together suggested a goodness-of-fit to the data.

Figure 1 shows that school transition program (β=.15, p <.001) positively predicted the latent variable of employment outcomes. Individuals who participate in school transition programs will have 0.15 (or about 15%) unit increase in over-all employment outcomes in terms of hourly wages and work hours. Both age at the beginning of VR programs (β=.11, p <.001) and length of attending (β=.35, p <.001) had a posi-tive impact on employment outcomes. Individuals who start early in VR programs achieved better employment outcomes. Likewise, individuals who stay in VR programs longer had improved employment outcomes. Together all the predic-tors achieved an R2 of 0.28 for employment outcomes, which means 28% of the variance in employment outcomes has been counted for in the model and the effect is moderate.

Multiple-Group Analyses: Comparisons between Cognitive and Non-Cognitive Disability Group We examined whether path coefficients differ between in-dividuals with cognitive disabilities and those with non-cog-nitive disabilities through multiple group analyses. We first fit the overall model with freely estimated path coefficients

to obtain the baseline chi-square statistics, and then we con-strained all path coefficients to be equal for both the disability groups. The chi-square difference statistics, ∆χ2 = 212.56, ∆df = 5, p < .01, indicated that path coefficients varied by types of disability. As a result, we independently estimated path coef-ficients for each group.

Comparing the effects of school transition programs on employment outcomes between the two groups, the stan-dardized path coefficient for non-cognitive disability group (β=.33, p <.001) is larger than for cognitive disability group (β=.052, p <.01). It’s indicated that school transition programs might have greater effects for individuals with non-cognitive disabilities than those with cognitive disabilities. Similarly, the standardized path coefficient of VR program length for non-cognitive disability group (β=.451, p <.001) is also larg-er than for cognitive disability group (β=.196, p <.001). On the contrast, the path coefficient of age one begins the VR program for the non-cognitive disability group (β=.068, p > 0.05) is not significant, while it is significant for the cognitive disability group (β=.110, p <.01). It is suggested that for in-dividuals with non-cognitive disabilities, age for starting VR programs does not have a direct effect on employment out-comes, but for individuals with cognitive disabilities it is a significant predictor for positive employment outcomes.

Discussion State vocational rehabilitation (VR) agencies are the most important adult service and transition partners for schools. These agencies play a key role in helping students with disabilities make a successful transition from school to independent competitive community employment. However, limited research has been done to investigate youth employ-ment outcomes upon exiting VR services; studies that analyze large-scale VR databases are especially lacking. The current study addresses this lack of research by examining youth em-ployment outcomes through analyzing one state VR agency’s database. The results provide information to help us better understand who uses VR services, what the relationships are

between participation in certain school programs and employ-ment outcomes, and factors affecting employment outcomes.

The results of the current study show that the majority of individuals received VR services for over a year. This finding indicates that the VR agency followed federal policies regard-ing the time frame for services. However, more than 45% were in the system for over five years. This finding is interesting because on one hand, it may indicate that the agency opened cases while students were still in high school so that a smooth transition can be made from school to VR services. The fact that the database includes information about youth’s partici-pation in certain school-based employment-related programs indicates that VR closely worked with schools to provide ser-vices to students while they were still in school. On the other hand, five years of VR services may be too long because these services should be short-term. It may also indicate that these youth came to VR with limited employability and that this status warranted longer term services. The results also show that more than half of the individuals who received VR ser-vices were individuals with cognitive disabilities. This result is reasonable as youth with cognitive disabilities make up a large portion of the state’s special education Child Count, and teachers refer all youth on IEPs for VR services by the age of 16. This trend will only enhance the state’s ability to meet the requirements of the Workforce Innovation and Opportunities Act (WIOA) with its emphasis on transition, especially for those with significant and intellectual disabilities. It is encour-aging to see 46% of youth in the database participated in some type of school transition program that focused on enhancing their general and specific employability. However, nearly half of them did not participate in any school transition programs and therefore were not able to benefit from these early em-ployment-related experiences.

It is especially encouraging that over 94% of the individ-uals ended up employed in integrated settings. This seems to be a great success in achieving the goal of special education and VR services which aims to help those with disabilities achieve employment in integrated and competitive settings.

However, the average wage of $9.39 and 35 work hours per week indicates an annual wage ($17,000), assuming the individual works all 52 weeks, that is barely above the federal poverty lev-el of $15,730 for a family of two (U.S. Department of Health and Human Ser-vices, 2014). Unfortunately, the data-base does not contain more specific in-formation about the nature of work and earnings.

Participation in school transition programs served as a positive predic-tor of employment outcomes. That is, those who participated in school tran-sition programs tended to have better employment outcomes (work hours and wages). This finding further verifies the

50

Table 2. Correlations Between Measured Variables.

Variables Gender Ethnicity Types of Disability

School Programs

Age Starting VR

Length in VR

Hourly Wage

Weekly Work Hours

Gender ─

Ethnicity <0.01 ─

Types of Disability

.12** .08** ─

School Programs

-.11** -.06** -.52** ─

Age Starting VR

-.07** -.02 -.34** .56** ─

Length in VR

-.11** -.11** -.30** .23** -.13** ─

Hourly Wage

.03* -.07** -.29** .29** .15** .34** ─

Weekly Work Hours

.08** -.01 -.12** .15** .10** .07** .25** ─

Note: *p < .05. **p < .01.


importance of involving students with disabilities in school transition programs (see Gold, Fabian, & Luecking, 2013). The earlier an individual started to receive VR services, the better their employment outcomes were. It seems that there is a need for policy changes to further encourage schools and VR to collaborate on services at an earlier age. Findings also show that receiving longer VR services led to better employ-ment outcomes. This seems to indicate VR services do make a difference in promoting employment outcomes. However, it may not be feasible to extend VR services for all individuals because VR services are meant to be time limited services. A related issue involves considering whether schools are doing an appropriate job of promoting the employability of youth before they receive VR services. For example, are they con-ducting transition assessments that facilitate career develop-ment (Kortering & Braziel, 2012; Lee & Carter, 2012), get-ting students into courses of study that prepare them for an appropriate career and working with parents to provide out of school experiences that foster employability (Rojewski, Lee, & Gregg, 2014; Trainor, et. al., 2011). It also may be necessary for VR agencies to connect with other agencies so consumers can access agencies that provide longer-term em-ployment services in integrated work settings (Cimera, 2010).

Participation in school transition programs had a different effect on students with non-cognitive disabilities compared to those with cognitive disabilities. These programs seemed to result in better employment outcomes for those with non-cog-nitive disabilities. This finding is perplexing because these programs should help students with cognitive disabilities on an equal basis. This differential effect might be attributed to the way students learn and experience these programs. There may be a need to revise the programs or change instruction so that individuals with cognitive disabilities benefit more in terms of employability and employment outcomes. The find-ing that students with cognitive disabilities benefited more than those with non-cognitive disabilities for longer time of VR services indicates the need for providing extended time of services to individuals with cognitive disabilities.

Limitations of the Study The current study has several limitations. For instance, the database has disadvantages associated with most large-scale databases even though it offers many advantages. The major issue is the lack of detailed information in certain areas. This lack of detailed information (e.g., types of jobs) limited our ability to make some inferential analyses, similarly the data base covers a period of time of change relative to transi-tion legislation at the federal and state level. The lack of de-tailed information on specific school transition programs and limited our ability to obtain the nature and extent of effect of the programs on employment outcomes. In addition, the VR database does not allow for detailed outcome information on more specific disability groups that comprise the category of intellectual disabilities, including those with specific learning disabilities. Finally, the dataset was from one state. It does not necessarily represent the cases in other states. Future studies are needed to analyze either a national database or a represen-tative sample of all states or regions in the U.S. so that we can

obtain a broader understanding of the national VR services and consumer employment outcomes.

Conclusion The promise of preparing youth with disabilities for a productive adulthood is at the heart of the initial preamble supporting the need for special education legislation (United States Congress and Administration News, 1975). As educa-tors strive to fulfill this promise, VR represents a key collab-orating partner that provides adult services that help former students access productive employment in competitive and integrated settings. As with any successful partnership, to ef-fectively work with VR, educators must leverage transition assessments, courses of study, annual goals, and related expe-riences to facilitate the employability of our students so that they are prepared for and able to benefit from the time-limited nature of VR services. Educators, as a partner, also must view the Indicator 13 and Summary of Performance process as a means to provide the necessary career and school information to help VR counselors develop effective Individual Plans for Employment. These partnerships are in an effort to ensure we do not relegate former students to an unproductive adulthood, including under or unemployment, premature dependency on social security, or involvement in the judicial system. Instead, the partnerships are in an effort to provide our youth with the tools and resources to build economic self-sufficiency and in-dependence for a meaningful and productive future.

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Hayward. B., & Schmidt-Davis, H. (2000, July). Longitudi-nal Study of Vocational Rehabilitation Service Pro-gram: Fourth interim report (Characteristics and Outcomes of Transitional Youth in VR). Raleigh: Re-search Triangle Institute.

Kortering, L. & Edgar, E. (1988). Special education and vo-cational rehabilitation: A need for cooperation. Re-habilitation Counseling Bulletin, 31,178-184.

Kortering, L. & Braziel, P. (2012). Age appropriate transition assessment as a strategic intervention to help keep youths with emotional or behavioral disorders in school (pp. 124-142). In D. Cheney (Ed.), Transition of Students with Emotional or Behavior Disorders: Current approaches for positive outcomes (2nd Edi-tion). Champaign, IL: Research Press.

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Plotner, A., Trach, J., and Strauser, D. (2012). Vocational Re-habilitation counselors’ Identified transition compe-tencies: Perceived importance, frequency, and pre-paredness. Rehabilitation Counseling Bulletin, 55, 135-155.

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52


This review concerns Clinical Supervision and Administrative Practices in Allied Health Professions, edited by Flowers, Soldner, and Robertson. This is a timely work in view of the complex challenges currently facing health care administrators. The book focuses on both managerial issues and supervision practices, is well organized, and leaves few important stones unturned. This fresh contribution to the management literature features originality and responsiveness to real-world challenges. Of particular note is the fact that the authors have chosen to combine issues of managerial administrative importance with clinical supervision roles and functions. While management and supervision roles differ significantly, it is a fact that the two hats are often worn by the same individual in the field. This text does an excellent job of clarifying the differences. I recommend this text both as a training tool in pre-service education as well as a source of continuing education for health care managers in the field.

The contributing authors represent an impressive collection of rehabilitation counseling educators, drawn primarily from the highly regarded Southern Illinois University at Carbondale (SIUC). The selection of contributing authors indicates that the text has obvious value for managers in the rehabilitation counseling field, but it covers issues and practices that are important across a broad spectrum of allied health professions. Individual chapters are well researched and presented. Despite the variety of authors, the chapters are uniformly clear and comfortable to read, with remarkable similarity of style. Educators and students will appreciate the fact that all chapters include case studies and discussion questions to illustrate and promote further examination of the issues presented.

The chapters are arranged into four sections:1. Foundations:2. Management:3. Human Resources and Supervision; and4. Resources.

The first section begins with Bruce Reed’s chapter on leadership. This chapter succinctly covers such vital management considerations as values, organizational mission, and leadership traits. Reed does an outstanding job of illustrating the diversity of critical skills and personal qualities needed for effective management. Additionally, this chapter

Edited by Flowers, C. R., Soldner, J. L., and Robertson, S. L.Linn Creek, MO: Aspen Professional Services (2015)$49

Clinical Supervision and Administrative Practices in Allied Health Professions

In Reviewintroduces an awareness that grows throughout the text of the diverse and considerable demands placed on contemporary health care managers. A chapter by Robertson and Nowlin, examines public relations, communication, and marketing in allied health. This chapter will be of value in helping organizations in what is often a poorly understood but critical need, development of a marketing strategy to connect with potential service recipients and major stakeholders. The section concludes with a chapter by Flowers, Pregowski and Burnett presenting essential concepts and issues related to financial management and auditing procedures. Both profit and non-profit organizational contexts are addressed.

Kupferman and Gilkes lead the Management section of the text with a chapter on innovative technologies for best practices in allied health education, management, and supervision. The importance of technological applications in every area critical to management success becomes abundantly clear in this chapter. The section continues with Lewis and Flowers chapter on the allied health management environment. In clear presentations, they familiarize the reader with crucial perspectives such as total quality management, management by objective, project management, and continuous improvement. Soldner follows with a chapter on performance management, covering concepts and methods to activate and direct both individual and organizational behavior. This chapter is especially helpful in illustrating the use of positive reinforcement as well as methods of measuring and documenting performance. The section concludes with a chapter by Lewis on program evaluation. Lewis first offers an overview of the types and advantages of program evaluation approaches, then takes the reader through a nuts-and-bolts description of how an effective program evaluation system could be designed and implemented.

The third section of the book provides two chapters on the topic of clinical supervision of personnel. This is the key addition so often missing in texts concerned with management theories and procedures. A chapter by Russell and Rogers, and then one by Robertson and Boston, provide detailed presentation of contemporary theories and models of supervision, as well as examination of important factors such as individual employee differences.

The final section explores resources. The leading chapter by Schultz examines ethical practices in human services administration, as critical an issue as ever. While presenting models of current ethical thinking in the health care professions, Schultz deftly covers the dual challenge of ethical self-improvement in addition to promotion of ethical practice by supervisees. Wilson, Gines, Gary, and Brown then provide a chapter on diversity and multiculturalism among personnel, emphasizing hiring, staffing, and supervising an emerging workforce. This chapter does an excellent job of detailing the changing demographics of the American health care workplace, and the special features of a diverse and culturally complex organization. Kupferman’s chapter on job accommodations and assistive technology adds to the contemporary flavor and value of this text. The role and importance of assistive technology in the job accommodations process is made clear.

In conclusion, Clinical Supervision and Administrative Practices in Allied Health Professions, edited by Flowers, Soldner, and Robertson, should stand for some time as a valuable resource for managers and supervisors. In the rapidly expanding world of health care there is a need for concise articulation of current perspectives and best practices. It is also the case that educators and students will benefit from this high quality resource. Despite a minor flaw (from Chapter 8 onward, the Table of Contents reports incorrect page numbers) this collaborative work is extremely impressive. Perhaps the greatest strength of this text is its close blend of theoretical overview with situational usefulness. It should be of value to a broad audience. I highly recommend it.

Alan Davis, Ph.D

54


The Journal of Rehabilitation is published quarterly as a publication of the National Rehabilitation As-sociation. Its content reflects the broad perspectives of the Association’s membership.

ArticlesArticles are written by professionals in the field of rehabilitation, and are peer-reviewed. They should present, describe, and discuss rehabilitation con-cepts and related research.

Manuscripts are acknowledged upon receipt and, following preliminary review by the editor, are sent to members of the Editorial Review Boards for anonymous review. Each manuscript should contain a separate cover sheet with the manuscript title, the authors’ names, their degrees, affiliations and complete mailing addresses, phone numbers and email address for contact person. An abstract of approximately 100 words should appear on page two providing a brief summary of content. The first page of the text should contain only the title, with the author’s name(s) omitted.

Upon review, manuscripts are either accepted, re-jected or returned for revision. Approximately three months may elapse between submission and decision. Accepted articles are usually published in the order of their receipt.

Manuscript SubmissionRequirementsManuscripts should be original work not currently being considered by any other publishing source. Manuscripts must be submitted via email in Micro-soft Word Document version 97-2003.

Submissions should be sent as an attachment to the attention of Dr. Wendy Parent-Johnson, University of South Dakota and should be emailed to:

[email protected]

In ReviewReviews of pertinent books, audiovisual materials and computer software are published in each issue. Reviews should be 1-4 pages in length and should include authors’ names, publisher, year of publica-tion, length (in pages), minutes or software require-ments, and list price. Publishers interested in hav-ing materials reviewed, and persons interested in reviewing materials, should contact:

Greg G. GarskeBowling Green State UniversityEmail: [email protected]

Stylistic RequirementsAll submissions should follow the style require-ments of the Publication Manual of the American Psychological Association- 6th Edition. Authors should maintain the integrity of people with disabil-ities by avoiding language that equates people with their conditions, e.g. “the mentally ill”. They should instead employ terminology which emphasizes the individual, e.g. “people with mental illness.”

Submissions which do not adhere to these guide-lines will be returned.

For further information regarding the Journal pub-lishing process, contact:

Wendy Parent-Johnson, Ph.D., CRC, CESPExecutive Director, Center for Disabilities

Professor, Department of PediatricsSanford School of MedicineUniversity of South Dakota

1400 W. 22nd StreetSioux Falls, SD 57105Phone: (605) 357-1468

Fax: (605) [email protected]

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Journal of Rehabilitation Volume 81, Number 2

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