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Clinical Judgment/Clinical Decision Making in the Rehabilitation Counseling Process
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Clinical Judgment/Clinical Decision Making in the Rehabilitation Counseling Process
Kayla Smith
Rehabilitation Counseling
The primary goal of rehabilitation counseling is to assist individuals with disabilities gain or regain their independence through employment or some form of meaningful activity no matter who the person is.
Rehabilitation Counselor
Chan, F., Chronister, J., Catalana, D., Chase, A., Eun-Jeong, L. (2004). Foundations of rehabilitation counseling. Directions of Rehabilitation Counseling, 15, 1-11.
Definition of Clinical Judgment/Decision Making
Strohmer, Douglas & Leierer, Stephen defines clinical judgment by stating that rehab counselors make a variety of important and difficult decisions, which may involve issues of eligibility, feasibility, counseling strategy, treatment/training modality, closure, termination, and referral. These decisions are critically important, they are frequently made under a condition of uncertainty- that is with limited or incomplete information and can result in judgmental errors for clients.
Clinical Judgment/Decision Making
Strohmer, Douglas & Leierer, Stephen. (2000). Modeling Rehabilitation Counselor Clinical Judgment. Rehabilitation Counseling Bulletin - REHABIL COUNS BULL. 44. 3-9. 10.1177/003435520004400102.
Judgmental error/bias can adversely affect counseling outcomes:
A counselor's bias against clients because of certain characteristics could negatively influence diagnostic impressions and decisions about eligibility determination, plan development, service provision, and rehabilitation outcomes for their clients. Judgments regarding client potential may determine the educational and career opportunities that clients ultimately pursue, dramatically affecting their future direction and quality of life.
Judgemental Error/Bias
- Race
- Age
- Gender
- Disability status
- Sexual preference
- Social class
Strohmer, Douglas & Leierer, Stephen. (2000). Modeling Rehabilitation Counselor Clinical Judgment. Rehabilitation Counseling Bulletin - REHABIL COUNS BULL. 44. 3-9. 10.1177/003435520004400102.
Rehabilitation Counselors can prevent judgmental errors
Preventing judgmental error/bias
To become more aware of these types of errors, rehabilitation counselors must develop a clearer understanding of the process they follow in making judgment about their clients.
In such situations, rehabilitation counselors must use knowledge based on experience with previous clients, as well as relevant research, and theory to supplement existing client data.
Rahimi, Maryann; Rosenthal, David A; Chan, Fong. Rehabilitation Counseling Bulletin; Washington Vol. 46, Iss. 3, (Spring 2003): 157
Age
Race
Characteristic Biases
As the number of older adults grows, members of the counseling profession are increasingly likely to encounter older people who seek to benefit from counseling services. Research reviews show that there are many causes of ageism, consequences associated with negative age stereotypes, and gaps in research related to how the counseling profession should respond.
ageism- discriminatory beliefs or practices that are based on the age of a person or group
Studies of vocational rehabilitation (VR) agencies data have reported the existence of unfair patterns of rehabilitation counseling service delivery for African American clients and have suggested that they are less likely than white Americans to be accepted to rehabilitation services. Also, services provided for African Americans clients are more likely to end without achieving successful employment, or they result in lower earnings than are those provided for white American clients.
Gender
Disability Status
Gender/Disability Status
Women of parenting age from typically marginalized socioeconomic, ethnic, and racial groups are under represented in rehabilitation research.
The literature indicates that women with disabilities and low socioeconomic status
have poor outcomes related to employment and independent living
Type and severity of disability impacts the chance of employment
From an archival data set of 53,629 clients:
A person with mental disability was 27% less likely to be employed
than a person with
sensory-communicative disabilities.
A person with physical disability
was 30% less likely to be employed than a person with sensory-communicative disabilities.
A person with the most severe disability was 35% less likely
to be employed than one with a less significant
disability.
Sexual Preference
Social Class
Sexual Preference/Social Class
Counselors fail to incorporate client gender into their practice.
Studies show counselors typically: ignore the relevance of gender, they are hesitant to ask gender related questions, or they acknowledge gender but do not talk about it because of lack of gender-sensitive training.
Class as a central idea in identity has been under-researched in counseling and other disciplines.
Because of its complexity, research suggests that class cannot be made alone without all the other classifications that accompany it such as race, gender and sexuality.
Besides occupation, subjective factors are frequently used to define class such as the way people speak; where they live; their friends; the school they attended; their spending patterns; the way they dress; the car they own.
Summary
According to the CODE OF PROFESSIONAL ETHICS FOR REHABILITATION COUNSELORS,
Rehabilitation counselor's commitment involves providing respectful and timely communication, taking appropriate action when cultural diversity issues occur, and being accountable for the outcomes as they affect people of all races, ethnicities, genders, national
origins, religions, sexual orientations, or other cultural group identities.
Summary
Approach to effective Rehabilitation counseling:
Summary con't
- Studies have recognized that clinical training for rehabilitation counseling programs are needed to prepare students to use clinical judgment skill competencies that address cultural bias, cognitive complexity, confirmatory bias, and evidence-based practice.
- A Qualitative research approach offer avenues into understanding the lives and experiences of people with disabilities and those people and systems with whom they interact.
- An evidence-based practice approach promotes ethical rehabilitation counseling practice by better protecting clients from harmful services, improving efficiency in utilization of limited resources, and providing people with chronic illnesses and disabilities the opportunity to exercise self-determination and informed choice.
Resources:
Resource Links
Ageism and the Counseling Profession: Causes, Consequences, and Methods for Counteraction – The Professional Counselor. (2021). Retrieved 18 September 2021, from https://tpcjournal.nbcc.org/ageism-and-the-counseling-profession-causes-consequences-and-methods-for-counteraction-2/
Austin, B. S. (2018). Educators’ Perceptions of Clinical Judgment Skill Competencies in Rehabilitation Counseling. Rehabilitation Research, Policy, and Education, 32(3), 192–208.
Ballinger, L., & Wright, J. (2007). “Does class count?” Social class and counselling. Counselling & Psychotherapy Research, 7(3), 157–163. https://doi-org.subr.idm.oclc.org/10.1080/14733140701571316
Chan, F., Chronister, J., Catalana, D., Chase, A., Eun-Jeong, L. (2004). Foundations of rehabilitation counseling. Directions of Rehabilitation Counseling, 15, 1-11.
Chan, P., Keegan, J., Muller, V., Kaya, C., Flowers, S., & Iwanaga, K. (2016). Evidence-based practice and research in rehabilitation counseling. In I. Marini & M. A. Stebnicki (Eds.), The professional counselor's desk reference (pp. 605–610). Springer Publishing Company.
Code of Professional Ethics for Rehabilitation Counselors
https://www.michigan.gov/documents/wca/wca_vr_code_ethics_473348_7.pdf
David A Rosenthal, John F Kosciulek
Journal of Applied Rehabilitation Counseling 27 (3), 30-36, 1996
Hanley-Maxwell C, Al Hano I, Skivington M. Qualitative Research in Rehabilitation Counseling. Rehabilitation Counseling Bulletin. 2007;50(2):99-110. doi:10.1177/00343552070500020801
Lindsay S, Kolne K, Barker DJ, et al. Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation. JMIR Form Res. 2021;5(3):e23568. Published 2021 Mar 15. doi:10.2196/23568
Strohmer, Douglas & Leierer, Stephen. (2000). Modeling Rehabilitation Counselor Clinical Judgment. Rehabilitation Counseling Bulletin - REHABIL COUNS BULL. 44. 3-9. 10.1177/003435520004400102.
Trenz, R. C., Seruya, F. M., & Dondorf-Brooks, K. (2020). Predictors of employment among underrepresented women and TANF recipients that completed vocational rehabilitation services. Journal of Vocational Rehabilitation, 53(2), 249–256. https://doi-org.subr.idm.oclc.org/10.3233/JVR-201101
Ufere, N., Gaskin, J., Ufere, C. N., Garrett, L., & Satterwhite, K. (2019). Practice motivated research: Application of an evidence-informed prognostic model in vocational rehabilitation to increase the chance of employment at closure. Journal of Vocational Rehabilitation, 50(2), 219–242. https://doi-org.subr.idm.oclc.org/10.3233/JVR-181002