MEDICAL ASPECTS OF DISABILITY FOR REHABILITATION COUNSELORS
REHAB 496
Spring, 2010
3 Credits
Course Chair: Kurt L. Johnson, Ph.D., C.R.C.
Professor and Head
Division of Rehabilitation Counseling
Department of Rehabilitation Medicine
School of Medicine, RJ-30
University of Washington
Seattle, WA 98195
206.543.3677 VOICE
206.685.3244FAX
206.616.1396 TTY
kjohnson@u.washington.edu
Instructor of record: Kathe F. Matrone
Director, CCER, CHID
Department of Rehabilitation Medicine
School of Medicine
University of Washington
6912 220th St. SW, Suite 105
Mountlake Terrace, WA 98043
425.771.7436 VOICE
425.774.9303 FAX
matrok@u.washington.edu
This three credit, graduate-level course is designed for vocational rehabilitation counselors and other professionals. A combination of didactic lecture, teleconferencing, WWW-based conferencing, field experience, and review of study materials will be employed in this course.
Learning Objectives:
- to demonstrate a command of the knowledge base related to the medical aspects of a variety of disabling conditions;
- to demonstrate an understanding of the functional limitations approach rehabilitation assessment;
- to demonstrate the application of information about functional limitations to return-to-work and community-re-entry rehabilitation plans.
Textbook
Zaretsky, H., Richter, E., & Eisenberg, M. (Eds.)(2005). Medical aspects of disability: A handbook for the rehabilitation professional, 3rd ed. New York: Springer.
Evaluation
Grades will be assigned on the following basis: "A" grade for demonstrated competence with excellence; "B" grade for demonstrated competence; "C" grade for marginal competence; "F" grade for failing to meet the basic requirements of a graduate level course. Incomplete grades are given only in the cases of extreme, documented emergencies.
Course assignments will receive the following weights in calculating final grades:
Student-Instructor Contract..... signature/electronic validation required to proceed
Course Attendance............................................................................................... 40%
Site visits and report (complete/incomplete.....................................................10%
Final examination (graded)..................................................................................20%
Term Paper (graded)............................................................................................ 30%
Submitting Assignments
Assignments should be emailed as attachments in either ascii text or Microsoft Word to the instructor at the address above.
Due Dates
Site Visit and Report TBA
Term Paper TBA
Final Exam TBA
Seeking Faculty Consultation
Faculty consultation is available to students seeking discussion or wishing to ask questions about course or related materials by telephone, email, or in person by appointment.
Course Format
Students will attend an intensive, 24 hour face-to-face March 3, 4, and 5, 2009. Students will complete an additional 6 hours of interactive instructional web-based activities. Outside of class, students will complete the assigned readings and course assignments.
Site visit
- Identify a rehabilitation service provider in your community with whom you are not familiar, and interview the provider for at least 15 minutes to elicit information about the provider’s perceived skills, specialization, and beliefs about rehabilitation and disability. Consider interviewing an orthopedic surgeon, physiatrist, physical therapist, occupational therapist, prosthetist/orthotist, speech pathologist, medical rehabilitation counselor, rehabilitation psychologist, or assistive technology specialist. Collect any print material the provider has for clients.
- Write a brief summary of your interview, along with an evaluation of how you can use this information. For example, you might discover that a provider holds a strong allegiance to the medical model and believes that the client’s (or patient) primary responsibility is to follow the provider’s “prescription.” What is the impact of this belief on the rehabilitation process and how does it fit with your role?
- This paper should be approximately three pages in length. Do not transcribe the interview word-for-word. You might use the categories: background information on the person interviewed (education, length of experience in the field), nature of the services provided, what kinds of clients this service provider sees, provider’s “rehabilitation philosophy,” and your summary evaluative comments.
Term Paper
The paper should be written in the prose style of a formal evaluation with appropriate headings. Information should flow logically, and conclusions and recommendations should clearly relate to data presented in the body of the evaluation. As a subject of the evaluation, select a client or case with which you are familiar and have adequate access to case records and/or client interview. To protect client confidentiality, do not reveal (modify, if necessary), identifying information. I will provide you with careful feedback on the term paper and return it to you. Depending on your relationship with the client, you may elect to share the revised evaluation with the client. In any case, evaluations should always be written with the assumption that documents are to be read by clients.
As a general guide, remember my lectures on Functional Assessment and your knowledge of Psychosocial Aspects of Disability. Rehabilitation (and the instructor grading these papers) strongly values client-centered assessments and interventions in which the client is viewed respectfully, as an equal participant, as an individual who happens to have various medical or other conditions which may or may not result in various functional limitations which may or may not lead to various levels of disability, and as an individual who has a number of resources to bring to bear on his or her problems.
Use the attached protocol of a comprehensive assessment. Obviously, not all elements will apply to all cases, and additional information may be pertinent. I recommend that after reviewing all available information, you complete a Functional Assessment Inventory to serve as a guide for you in writing the evaluation.
Final Examination
The final examination will include questions from each of the topics covered and will require a three to five sentence response from you. The examination will be “open book.”
Didactic Topics
Overview of body systems
Neuromuscular Disabilities
Spinal Cord Injury
Chronic Pain
Cerebral Palsy
Multiple Sclerosis
Hearing Impairment
Prosthetics & Orthotics
Psychosocial Issues
Speech and Language Disorders
Visions
Carpal Tunnel
Diabetes
Brain Injury
Protocol for Functional Assessment
I. Referral Information
--Client Name (pseudonym)
--Your Name (no pseudonym!)
--Date of birth
--Referring agent
--List of social service agencies active in case
II. Referral question or reason for referral
--Client's reasons
--Referring agent's reasons
--Vocational goal(s)
--Independent living goal(s)
--Other rehabilitation goal(s)
III. Review of medical conditions
--List in order of apparent functional impact
-- For each condition, describe the incidence, location or nature of pathology, etiology, signs or symptoms, likely related conditions and complications, treatment to date, anticipated treatment, and general prognosis.
-- Describe treatment in progress
IV. Review Psychosocial Information
-- Describe family of origin, including parent educational level and occupations.
-- Describe current family or relationship status, including non-married significant others, children, extended family who serve either to facilitate or inhibit rehabilitation. Note educational level and occupations.
-- Note financial status of client and family. Include earned income, investment income, income from insurance and trust funds, bartered goods and services, and income and in-kind benefits derived from various social services. Note any health insurance resources. Note major current and anticipated expenses.
-- Describe avocational activities of family members, including recreational, social, and "hobby" interests
-- Describe any particular resources present in the family (e.g., support, security, etc.) which may facilitate rehabilitation goals
-- Describe any particular dysfunction or barriers present in the family that may disrupt progress toward rehabilitation goals
V. Psychological Status
-- Review any psychological/personality evaluations
-- Review any assessment of intellectual capacity (e.g., WAIS)
-- Review any assessment of aptitude (e.g., GATB)
-- Review any psychiatric evaluations
-- Review behavioral observations
-- Summarize data related to psychological adjustment
-- Summarize data related to psychopathology (if present)
-- History of treatment
VI. Substance Use and Abuse
-- Prescription Drugs
-- List; Purpose
-- Used as prescribed
-- Used recreationally, no apparent function impact
-- Abused
-- Over the counter medications
-- List; Purpose
-- Used as directed
-- Used recreationally, no apparent function impact
-- Abused
-- Alcohol
-- Use
-- Abuse
-- History of substance abuse treatment
-- Orientation (social learning, AA, etc.)
-- Inpatient
-- Outpatient
-- Self-help
VII. Educational History
-- Progress (high school, GED, College, etc.)
-- Achievement (grades, other evidence)
-- Standardized testing, if available (e.g., S.A.T. scores)
-- Interests (what was fun, what came easily, what was difficult
-- Extracurricular activities (Do not limit this to those sanctioned by school. Many individuals would respond by saying their extracurricular activities were "partying" rather than "Activity Center," and this is important data)
VIII. Vocational History
-- List of jobs and job tenure
-- Other, related vocational activities
-- Characteristic demands of vocational activity (physical demands, aptitude, experience, etc.)
-- List of transferable skills (derived from job analysis, DOT, OASYS, interview, etc.)
-- Vocational Interests (stated, tested if available, demonstrated)
-- Work values (stated, tested if available, demonstrated)
-- Recurrent vocational themes (frequent job loss, trouble with supervisors, considered "loyal employee," prefers work with clear expectations, etc.
IX. Assessment of Functional Strengths and Limitations (remember to be behaviorally specific!)
-- Using the Functional Assessment Inventory and by reviewing other data collected, list strengths, assets, and resources the client can bring to bear on his or her rehabilitation
-- Using the Functional Assessment Inventory and by reviewing other data collected, list deficits and limitations which may serve as barriers to rehabilitation.
X. Accommodations or Prosthetics to address barriers to rehabilitation
-- Applied to the client (includes various prosthetic limbs, memory devices, wheel chairs, counseling, etc.)
-- Applied to the social environment (includes family counseling, teaching friends to provide instructional prompts, modifying expectations of neighbors, identifying advocates, teaching family members to sign, etc.)
-- Applied to local community (includes mobilizing community resources to provide respite for families, building community advocacy, developing and securing jobs for clients, modifying job tasks, teaching supervisors new supervisory styles, helping teachers to use new teaching styles, changing community attitudes about allowing group homes to be built, changing laws, etc.)
-- Applied to the environment (includes manipulating temperatures, building shade screens, curb cuts, increasing the stimulus quality of variables to which the client should attend, modifying equipment on the job site, modifying public transportation, etc.)
XI. Conclusions
Paint a picture here of the client in a paragraph or two that summarizes the assessment data and draws conclusions about current status and prognosis. The conclusions should reference the referral questions; vocational, independent living, and other rehabilitation goals, and lead directly to the recommendations.
XII. Recommendations
-- Make sure recommendations arise directly from assessment data (no rabbits out of the hat!)
-- Specify a priority or logical order in the recommendations
-- Designate who has responsibility for facilitating each recommendation (e.g., rehabilitation counselor, client, family member, other agency, etc.)