Journal of Rehabilitation Research & Development (JRRD)

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Guest Editorial

Volume 49 Number 8, 2012
   Pages xiii — xvii

Michelle L. Sporner, MS, CRC
Michelle L. Sporner, MS, CRC

Servicemembers and veterans with disabilities: Addressing unique needs through professional rehabilitation counseling

Rehabilitation counseling is an invaluable profession whose counselors are uniquely qualified to work with veterans and servicemembers because they understand the medical and psychosocial aspects of various disabilities and disabling conditions and have a basic appreciation for assistive technology. Rehabilitation counseling, according to the Commission on Rehabilitation Counselor Certification (CRCC), is–

a systematic process which assists persons with physical, mental, developmental, cognitive, and emotional disabilities to achieve their personal, career, and independent living goals in the most integrated setting possible through the application of the counseling process. The counseling process involves communication, goal setting, and beneficial growth or change through self-advocacy, psychological, vocational, social, and behavioral interventions [1].

Further, CRCC states that –rehabilitation counselors are the only professional counselors educated and trained specifically to serve individuals with disabilities– [1]. As of May 2012, the CRCC has certified more than 35,000 counselors.

Rehabilitation counselors are trained to use case-management processes to facilitate a skilled service delivery process. Additionally, all rehabilitation counselors work to assess an individual–s abilities and strengths to facilitate a return to work and achieve his or her personal and independent living goals.

Rehabilitation counselors have a national credential, the Certified Rehabilitation Counselor, and, in many states, are licensed as professional counselors. The Council on Rehabilitation Education (CORE) is the national credentialing body for Master–s programs in rehabilitation counseling. The CORE accreditation process promotes effective delivery of rehabilitation services to individuals with disabilities; continuing review and improvement of Master–s-level rehabilitation counseling education programs; program self-improvement based on outcome-oriented data obtained from feedback from graduates, students, and employers; meeting the personnel needs of both public and private rehabilitation agencies; and providing graduates who have the skills, knowledge, and attitudes necessary to provide rehabilitation counseling services to individuals with physical, mental, and/or emotional disabilities [2]. Currently, 96 CORE-accredited rehabilitation counseling programs exist in the United States.

Rehabilitation counselors have a rich history of working with servicemembers and veterans with disabilities. Vocational rehabilitation originated in early U.S. legislation to provide rehabilitation services to veterans with disabilities and assist them in achieving their independent living and vocational goals. In 1918, Congress passed the Soldier–s Rehabilitation Act of 1918 that later established the Federal Board of Vocational Rehabilitation. The purpose of the Soldier–s Rehabilitation Act was to develop vocational education programs for veterans with disabilities during World War I [3]. This act was monumental to the field of rehabilitation counseling because it marked the –official– beginning of the field. The need for rehabilitation counselors was further strengthened with the passing of the 1943 Disabled Veterans Act and the 1944 Servicemen–s Readjustment Act, which arose as a result of World War II [3]. The Disabled Veterans Act sanctioned vocational support, while the Servicemen–s Readjustment Act provided vocational training and education for servicemembers whose careers were shortened by serving in the military. In addition, World War II created a shortage of traditional workers. As a result, servicemembers with disabilities were hired to fill these vacancies, which allowed them to demonstrate their ability to participate competitively in the workforce. As a result of the legislation and vocational support for servicemembers and veterans with disabilities, additional legislation was passed that broadened vocational rehabilitation and education for civilians. The Korean War resulted in additional legislation in 1952, the Veterans Readjustment Assistance Act, which provided vocational education to Korean War veterans [3]. Veterans with service-connected disabilities also benefit from vocational rehabilitation services under chapter 31 of title 38 of the U.S. Code. The Department of Veterans Affairs (VA) system provides veterans with significant disabilities ongoing therapy and community reintegration as a required initial step in the vocational rehabilitation process. These prevocational services are offered under an independent living program [4]. Additionally, veterans who served at least 90 total days and were honorably discharged since September 10, 2001, or who served 2 continuous years since July 1, 1985, may also be eligible for the Post-9/11 Veterans Education Assistance Act of 2008 (chapter 33) of the Education Benefits under chapter 30, 1606, or 1607 of the Montgomery GI Bill [5].

According to Leahy [6], along with professional associations including the American Rehabilitation Counseling Association and the National Rehabilitation Counseling Association, the following knowledge domains are essential to a certified rehabilitation counselor:

Counseling theories, techniques, and applications: mental health counseling, group and family counseling, individual counseling, psychosocial and cultural issues in counseling, foundations, ethics, and professional issues.
Career counseling, assessment, and consultation services: vocational consultation and employer services, job development and placement services, career counseling and assessment techniques.
Rehabilitation services and resources.
Case and caseload management.
Healthcare and disability systems.
Medical, functional, and environmental implications of disability.

Some fundamental rehabilitation philosophies are shared by the spectrum of rehabilitation professionals. Rehabilitation is a continuous process that is applied as long as help is needed. Another key principle is that every human being has inalienable value and is worthy of respect for his or her own sake; additionally, every person has membership in society and rehabilitation should cultivate full integration. As a result, the client is seen not as an isolated individual, but rather as part of a larger group that includes others. When a person with a disability is working with a rehabilitation team, the treatment needs to be comprehensive and involve the whole person, not just specific areas or specific functional limitations that the person may be facing. The whole person needs to be addressed in every aspect of the rehabilitation process because life areas are interdependent and treatment should vary and be flexible in dealing with the person–s special characteristics. For individuals with disabilities, assets and strengths should be emphasized, supported, and developed. More specifically, when setting goals, rehabilitation counselors focus on the strengths, not on the disability or functional limitations.

Within military treatment facilities, the focus on servicemembers who sustain significant disabilities has also changed. During these current conflicts, more servicemembers are staying on Active Duty than in any previous conflict. This shift in focus also represents a shift in the military focus to rehabilitation as opposed to a strictly medical model that often required injured servicemembers to be discharged.

The Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the Department of Defense (DOD) each operate a complex and detailed system of benefits that supports vocational rehabilitation for servicemembers with a service-connected disability. The VBA supports veterans through the Vocational Rehabilitation and Education Office.

Veterans and servicemembers from the current conflicts tend to have a multifaceted set of needs. Because wounded, injured, or ill servicemembers and veterans tend to have complex needs, this group more than ever benefits from a team effort that offers multiple support systems. More servicemembers are now being afforded the opportunity to return to duty and stay in the military after sustaining significant injuries. As a result, rehabilitation counselors can work with servicemembers to understand the effect of continuation on Active Duty or transition to the civilian workforce. Some of the areas rehabilitation counselors can work with servicemembers on include restructuring certain nonessential job functions or identifying appropriate accommodations, identifying an appropriate change in military occupational specialty, or facilitating the transition from military to veteran status. The scope of practice for rehabilitation counselors allows for many opportunities to work with wounded, injured, or ill servicemembers.

Rehabilitation counselor competencies include mental health counseling. Servicemembers with disabilities sustained during combat, as well as servicemembers without disabilities who are transitioning into the civilian role, may benefit from counseling services provided by a rehabilitation counselor. Mental health considerations such as posttraumatic stress disorder, anxiety, and/or depression may be coupled with additional adjustment to disability issues. Rehabilitation counselors are sensitive to the mental health needs of individuals while having a unique understanding of the needs of individuals with complex disabilities. The wounded servicemember or veteran is not the only one affected by disability. Rehabilitation counselors also highly value the inclusion of the family in the rehabilitation and counseling process. Rehabilitation counselors would work with the veteran and the family to understand the changes–functional, cognitive, and emotional–to aid in coping.

Rehabilitation counselors are also well versed in multicultural considerations throughout the counseling process. The military has a unique culture that must be considered when working with a servicemember or veteran. Aside from the military culture itself, a diverse population exists within each military branch. As a result, each servicemember or veteran–s unique situation must be taken into consideration during the counseling process. In addition to these cultural aspects, there is a special part of the military culture that emphasizes a group mentality. This cultural difference may manifest when working individually with a servicemember or veteran, and difficulty (resistance) may be encountered when trying to shift his or her point of view from a –we– focus to an –I– focus. Because servicemembers often better relate to other servicemembers who have experienced similar situations, rehabilitation counselors may also facilitate group sessions or peer-mentoring encounters. Group sessions may work better because they also take the focus off an individual and place it back on a group.

Rehabilitation counselors are required to practice within their ethical and professional boundaries. This is especially important when working in a military setting because each servicemember or veteran is treated by a multidisciplinary team. Rehabilitation counselors are qualified to be an integral part of a multidisciplinary team.

Rehabilitation counselors were introduced by working with veterans with disabilities to get them back into the workforce. The current structure of the military is voluntary enlistment and also consists of a large number of reservists and National Guardsmen. Many individuals who decided to join the military did so because they did not want to continue formal education after high school, while others wanted to do their part to serve their country. When a servicemember sustains an injury and is forced to reconsider career options, rehabilitation counselors are vital for career counseling, as well as job development. Job development and placement services are currently being done in the VA, both VBA and VHA. Rehabilitation counselors work with veterans to determine career goals. While still in the military, servicemembers benefit from rehabilitation counseling services to identify career goals, both while continuing on Active Duty and after their military career. Veterans and servicemembers work with a rehabilitation counselor to determine educational and career goals, ranging from going back to school to even beginning their educational pursuits after high school or entering the civilian workforce. A special characteristic of rehabilitation counseling is that it is based on each person–s strengths. Rehabilitation counselors promote the strengths of their clients, and highlighting their military strengths to employers is a major key to the successful employment of these servicemembers and veterans. Rehabilitation counselors also work on adjustment issues pertaining to the civilian work world. Servicemembers and veterans often talk about difficulty in taking orders from nonveteran supervisors and coworkers, so rehabilitation counselors work with the veteran to identify coping strategies and to effectively self-advocate for his or her needs. These counselors also identify adjustment needs of veterans returning to school as nontraditional students to identify required supports and encourage veterans to reach out to their peers.

Vocational consultation and employer services are also key job components for rehabilitation counselors. For reservists and National Guardsmen who may have left employment when they became activated and may have sustained injuries, rehabilitation counselors will work with employers to identify reasonable accommodations to ease the transition back into the workforce.

Another key component for any rehabilitation counselor–s scope of practices is having a vast knowledge of rehabilitation services and resources. For servicemembers transitioning back home, establishing local services is critical for successful transition. Rehabilitation counselors would work with the servicemember to identify local community resources and services for rehabilitation planning. Additionally, for servicemembers with multiple disabilities, a rehabilitation counselor would coordinate with their local VA to understand the additional treatment options and services for addressing their complex needs.

While case management is not unique to rehabilitation counselors, the field is primed to work with servicemembers and veterans with significant disabilities. A core component of rehabilitation counselors– knowledge is an understanding of system processes, including case finding, service coordination, referral to, and utilization of other disciplines and client advocacy. Since rehabilitation counselors are trained to understand the needs of people with disabilities, they make ideal case managers. Rehabilitation counselors identify the needs of their clients and refer them to the appropriate service. Military treatment facilities and VA have the unique ability to share information about servicemembers or veterans across the continuum of care because clients– health records follow them to whatever entity they access in the system. As part of the care continuum, a rehabilitation counselor would work with the servicemember to identify his or her needs and advocate for the client to ensure that appropriate services are received. VA hospitals and military treatment facilities are complex healthcare delivery systems. A requirement for competent rehabilitation counselors is the ability to utilize rehabilitation services in diverse settings. A key principle in case management is identifying techniques for working effectively in teams and across disciplines.

Servicemembers injured in the current conflicts are surviving with severe injuries that previously would have proven fatal, creating an increase in the number of complex cases that need to be served by a multidisciplinary team. Because of the nature of rehabilitation counseling, these counselors are especially well suited to be a part of the multidisciplinary team. Specifically related to disability issues, rehabilitation counselors identify environmental barriers that may limit an individual–s ability to be independent. Physical and functional capacities of individuals with disabilities would also be identified, focusing on the strengths an individual has as opposed to what he or she may not be able to do.

Within the military, there has been a shift toward rehabilitation. Individuals are staying on Active Duty, which also reflects a change in the view of disability. For individuals who want to stay on Active Duty, rehabilitation counselors would identify transferable skills as well as appropriate alternative military occupational specialties for which the servicemembers are qualified and capable of doing. If a servicemember wishes to transition out of the military, rehabilitation counselors would facilitate a transition into the civilian education pool or workforce based on previous military work history and experiences that may transfer more easily into a civilian position. The skilled rehabilitation counselor would conduct functional assessments and community-based assessments to understand each veteran–s strengths and weaknesses and identify appropriate supports to highlight strengths and strategies to minimize weaknesses or difficulties a person may have as a result of injuries or disability.

The rehabilitation counseling field has a long history of working with veterans with disabilities. This unique discipline pays special attention to person-centered client factors and encourages a long-term team effort. Another important characteristic of the field is that each client is uniquely assessed to identify strengths and not deficits. In doing so, rehabilitation counselors work with clients to set goals based on their strengths, with the ultimate goal of a high quality of life. Advocacy is an essential part of the rehabilitation counselor–s job. Counselors are strongly committed to the concepts of holistic counseling, full inclusion in society and in the counseling process, and empowerment. Rehabilitation counselors place an emphasis on the rights of individuals with disabilities to live independent, integrated lives and on collaboration between counselor and client.

For persons with disabilities, the journey to full community participation has been a long one that can be described as a work in progress. The movement away from the perspective of care and protection to expectation and involvement of persons with disabilities in planning for their future is reflected in the growing use of person-centered planning strategies [7, p. 387].

Michelle L. Sporner, MS, CRC

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Last Reviewed or Updated  Tuesday, December 11, 2012 9:47 AM

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