Jimma University

College of Education and Behavioral Science

Department of Psychology

Program: PhD in Counseling Psychology

Assignment submitted for in partial fulfillments of the course special

Population counseling and rehabilitation
Course Code: Psych 8111

Title: Special Population rehabilitation counseling service arrangement,

process and challenges: Review of literatures

By: Fikadu Tafesse ID. NO. Rp0118/2012

Advisor: Getachew Abeshu (PhD, Associate Professor)

May 20/2022

Jimma/Ethiopia

1
Contents
1. Introduction..............................................................................................................................3
2. Assessment methods for special population.............................................................................4
7. Services arrangement and provision in special population rehabilitation center.....................7
7.1. Major services delivered for special population in rehabilitation center..........................7
7.2. The benefits of rehabilitation............................................................................................8
8. Role of rehabilitation counselor...............................................................................................8
Rehabilitation Counselor role (ACA 2019):............................................................................9
Rehabilitation Counselor Requirements:................................................................................10
9. Challenging issues in rehabilitation center.............................................................................11
10. Positive forwards................................................................................................................12
11. Summery.............................................................................................................................13
References......................................................................................................................................14

2
 1. Introduction

Rehabilitation is defined as a set of interventions designed to optimize functioning and

reduce disability in individuals with health conditions in interaction with their environment.  
Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in
everyday activities and enables participation in education, work, recreation and meaningful life

roles such as taking care of family.

With the passage of the 1973 Rehabilitation Act Amendments emphasizing services to
people with severe disabilities, the philosophy of rehabilitation has evolved from an economic-
return philosophy to a disability rights philosophy. Issues related to consumerism have received
considerable attention, particularly in recent years, in the field of vocational rehabilitation. The
demand for consumerism was first reflected in the legislative arena with the passage of the 1973
Rehabilitation Act Amendments, when consumer involvement was mandated in the
rehabilitation planning process.

Rehabilitation counseling emerged as a distinct profession in 1920 with the passage of

the Smith-Fess Act, which established the federal-state vocational rehabilitation (VR) program
(Rubin SE, Roessler R. 2001). As a result of emerging service delivery trends, the expansion of
knowledge areas, the counselor licensure movement, legislative mandates, and the growing
diversity of settings in which the practice of rehabilitation counseling takes place, rehabilitation
counselors must necessarily broaden the scope of their own knowledge in order to continue the
provision of effective rehabilitation counseling services to their clients.

It does so by addressing underlying conditions (such as pain) and improving the way an
individual functions in everyday life, supporting them to overcome difficulties with thinking,
seeing, hearing, communicating, eating or moving around. Anybody may need rehabilitation at
some point in their lives, following an injury, surgery, disease or illness, or because their
functioning has declined with age.

Rehabilitation is an essential part of universal health coverage along with promotion of

good health, prevention of disease, treatment and palliative care. Rehabilitation helps a child,

3
adult or older person to be as independent as possible in everyday activities and enables
participation in education, work, recreation and meaningful life roles such as taking care of
family.
Globally, an estimated 2.4 billion people are currently living with a health condition
those benefits from rehabilitation (World health organization, 2021). The need for rehabilitation
worldwide is predicted to increase due to changes in the health and characteristics of the
population. Example; People are living longer, but with more chronic disease and disability.
According to world health organization report (2021); during this year, the need for rehabilitation
is largely unmet. In some low- and middle-income countries, more than 50% of people do not
receive the rehabilitation services they require.

2. Assessment methods for special population

It is important for psychologists to understand the potential influence of their own
paradigms as well as their clients’ in establishing and maintaining a therapeutic relationship and
weighing clinical decisions. Several models of disability provided in the literature that have
different therapeutic implications are described below.
The moral model views disability as an embodiment of evil, a punishment for a family member’s
or ancestor’s transgression, a divine gift, fate, or a test of faith and opportunity to overcome a
challenge (Groce, 2005; Mackelprang & Salsgiver, 2016; Olkin, 2012).

Without realizing it, psychologists and their clients may be affected by these historical
constructs in a way that influences their relationship. For example, a therapist may not
understand a client who, based on the moral model, feels challenged by fate, and a client, in turn,
may feel pressured by a therapist to change circumstances the client believes are dictated by fate.
The scientific models of disability reflect medical, social construction, and functional traditions
of conceptualizing disability (Altman, 2001; Chan et al., 2009; Smart & Smart, 2007).

The biomedical model views disability as a medical problem that deviates from the norm
(Gill, et al., 2003). Dokumaci (2019) describes the medical model as a linear sequence, that is,
pathology to disease to disability. The model emphasizes finding a cure and relieving or
eliminating symptoms caused by impairment. The focus is on the person’s deficits and
elimination of the pathology or restoration of functional capacity. Based on this model,

4
significant treatment advances have been made, particularly in symptom mitigation. On the other
hand, its emphasis on cure or amelioration of symptoms may be negatively internalized by some
individuals with disabilities to mean something is wrong with them, resulting in less effective
coping. While many traditional psychological therapies (e.g., behavioral, cognitive-behavioral,
and psychodynamic) are grounded in this model to target symptom removal or adjustment to
disability, it is important to consider contemporary applications of these interventions in
individualized ways that support the specific client and their needs.

Given the medical model ’s focus on disability and chronic disease and its
management, a primary weakness of the model is its omission of social determinants of health.
Although psychologists extending the medical model may incorporate assessments of function
and encourage active patient participation, particularly in treatment decisions, the model still
operates based on individual problems that need to be addressed. In this model, assessments are
manifestations or indirect expressions of the disabling process itself (i.e., symptom checklists,
functional limitations based on injury or chronic disease) (Dokumaci, 2019).

ACA 2019 Suggested that in assessment process rehabilitation counselor should:

1. Demonstrate sensitivity about how some tests and assessments are products of an
ablest culture and may reflect and/or reinforce stereotypes or disability-negative
perspectives about the abilities and characteristics of PWDs. When scoring and
interpreting test results, counselors should remain cognizant of the potential ways
disability, culture, orother considerations may result in misinterpretation of results.
• Exercise caution when using tests and assessments that lack normative data for PWDs
and when making interpretations or diagnoses based on the results of such tests.
• Select tests and assessments normed on PWDs when appropriate and possible. When
such assessments are unavailable, counselors will consider accessing and
incorporating other useful information (e.g., behavioral observations, interviews, and
contextual/environmental assessments).
 Understand that the commonly held view of disability as a deficit may result in biased
interpretations of tests and assessments and lead to misdiagnoses.

5
2. Remain aware of notable within group differences among PWDs and exercise caution in
interpreting data normed on the general population or disability groups other than that
with which the client identifies.
3. Realize that contextual/environmental conditions in an individual’s life (e.g., worksite,
family, and housing) may impact function and goal attainment. Comprehensive
assessment should examine barriers/complications as well as environmental
resources/supports rather than an exclusive focus on factors within the PWD.
4. Understand that accommodations may be needed during the administration of tests and
assessments (e.g., due to the physical requirements for responding to the test items,
cognitive or physical load imposed by testing that may affect performance). Adaptations
may include the use of computers or adaptive technology, additional time, or test
administration in different locations to minimize the effects of disability on test-taking.
Further, standardized administration may result in invalid results if it requires tasks and
functions that are affected by disability. If the counselor is uncertain about the
appropriateness of accommodations, the counselor will consult with the PWD and others
with expertise relevant to the situation.
5. Note all accommodations in the standardized administration of vocational assessments
and career counseling in reports and consider them in the interpretation of results.
Counselors will apply this understanding during the supervision of trainees or other
personnel charged with test administration.
6. When performing an assessment and prior to establishing a diagnosis, make every
attempt to ensure the clinical impression reflects an enduring psychological state and is
not a function of current psychosocial adaptation to the disability (e.g., initial impact;
shock and anxiety, anger, denial, changing perceptions of disability or life
circumstances). Understand that PWDs are at greater risk for trauma and abuse and
screen for these issues during initial assessments.

6
 7. Services arrangement and provision in special population
rehabilitation center

Rehabilitation is highly person-centered, meaning that the interventions and approach selected
for each individual depends on their goals and preferences. Rehabilitation can be provided in
many different settings, from inpatient or outpatient hospital settings, to private clinics, or
community settings such as an individual’s home.

The rehabilitation workforce is made up of different health workers, including but not
limited to physiotherapists, occupational therapists, speech and language therapists and
audiologists, orthotists and prosthetists, clinical psychologists, physical
medicine and rehabilitation doctors, and rehabilitation nurses.

7.1. Major services delivered for special population in

rehabilitation center
 Exercises to improve a person’s speech, language and communication after a brain injury.

 Modifying an older person’s home environment to improve their safety and independence
at home and to reduce their risk of falls.

 Exercise training and education on healthy living for a person with a heart disease.

 Making, fitting and educating an individual to use prosthesis after a leg amputation.

 Positioning and splinting techniques to assist with skin healing, reduce swelling, and to
regain movement after burn surgery.

 Prescribing medicine to reduce muscle stiffness for a child with cerebral palsy.

 Psychological support for a person with depression.

 Training in the use of a white cane, for a person with vision loss and other numerous
services are provided.

7
 7.2. The benefits of rehabilitation

Rehabilitation can reduce the impact of a broad range of health conditions,

including diseases (acute or chronic), illnesses or injuries. It can also complement other
health interventions, such as medical and surgical interventions, helping to achieve the
best outcome possible. For example, rehabilitation can help to reduce, manage or prevent
complications associated with many health conditions, such as spinal cord injury, stroke,
or a fracture.

Rehabilitation helps to minimize or slow down the disabling effects of chronic

health conditions, such as cardiovascular disease, cancer and diabetes by equipping
people with self-management strategies and the assistive products they require, or by
addressing pain or other complications.

Rehabilitation is an investment, with cost benefits for both the individuals and
society. It can help to avoid costly hospitalization, reduce hospital length of stay, and
prevent re-admissions. Rehabilitation also enables individuals to participate in education
and gainful employment, remain independent at home, and minimize the need for
financial or caregiver support.

8. Role of rehabilitation counselor

According to American counseling association (2019), rehabilitation counselors help

people with disabilities to achieve their personal, social, psychological and vocational goals.
They counsel people with physical, sensory, developmental and cognitive disabilities and those
with mental health or other health conditions that are acquired at birth or resulting from illness,
disease, accident, military service and/or ongoing stress. Using interventions and other
counseling techniques, they help their clients overcome environmental and attitudinal barriers,
obtain needed services and use technology that can assist them.

In addition to working directly with their clients and families, rehabilitation counselors
evaluate school and medical reports and confer and plan with physicians, psychologists,

8
occupational therapists, and employers to determine the capabilities and skills of the individual.
Conferring with the client, they develop a rehabilitation or treatment plan designed to assist the
individual in achieving goals, which may include training to help the person develop job skills or
activities to assist the client with living independently (ACA Governing Council, 2019).

8.1. Rehabilitation Counselor role (ACA 2019):

1. Make efforts to ensure that client communication is available in alternative formats as
needed (e.g., Braille, closed captioning, and digital versions), including information about
counseling services, cancellation policies, confidentiality, and other information provided
at thebeginning of the counseling relationship.
2. Make efforts to ensure the accessibility of technology used for distance counseling,
websites, social media sites, software, and computer applications.
3. Demonstrate caution about attributing a PWD’s distress, anger, frustration, or negative
outcomes to the disability, or personal reactions to it, without considering the possible
contribution of other external stressors and barriers involved in living with a disability,
including inadequate access or accommodation within the agency or wider service
system.
4. Consider various factors (e.g., time since diagnosis and cognitive capacity) when
screening PWDs for inclusion in group counseling.
5. Recognize that PWDs have often been socialized to believe they are responsible for the
comfort of others and may suppress the expression of their own feelings for the sake of
others.
6. Counselors should invite PWDs to share negative emotions, even if they are directed at
the counselor or others.
7. Resist the tendency to assume the primary reason PWDs seek counseling services is
related to the disability and recognize that holistic assessments must incorporate all major
life domains, regardless of the presenting issue.
8. Understand that some PWDs may have had disempowering developmental experiences
and, where appropriate, counselors should address these concerns.
9. Ask about and provide accommodations, as necessary, for the effective delivery of
individual and group counseling services to PWDs.

9
10. Select treatment/assessment approaches consistent with client strengths and do not rely
upon cognitive, physical or sensory abilities that are directly or indirectly influenced by
disability.
11. Modify sessions as indicated to address specific PWDs needs (e.g., shorter sessions,
frequent breaks).
12. Understand that disability can affect the entire family system. Supportive services and/or
counseling interventions that address family dynamics and concerns may be helpful.
13. Seek to ensure that information and advice about the long-term planning needs (e.g.,
personal futures planning, special needs trusts) is available to PWDs and their families, as
appropriate.
14. Seek services and/or consultation from other professionals when the disability-related
needs of the PWDs exceed their scope of practice as evidenced by education, training,
and experience.
15. Avoid discriminatory referrals based solely on the presence of a disability.
16. Learn how to access referral resources who can consult with or educate current or
potential employers on disability issues and methods to facilitate inclusion in the
workplace (e.g., accommodations, accessibility, staff training, and maintaining a
welcoming environment in the workplace).
17. Acquire knowledge about available disability-related services and service providers (e.g.,
vocational rehabilitation, assistive technology, accommodation and support in
educational settings) for timely referrals and/or collaborations.
8.2. Rehabilitation Counselor Requirements:

 A Council for Accreditation of Counseling & Related Educational Programs (CACREP)

accredited masters degree in rehabilitation counseling, or similar.

 A passing score on the national counselor examination.

 State-prescribed licensing to practice as a rehabilitation counselor.

 Extensive experience with physical and emotional disabilities, including substance abuse,
grief, and emotional trauma.

10
  Competency with electronic health record systems like AVATAR.

 Experience with underlying health conditions.

 In-depth knowledge of how people function mentally, emotionally, and socially.

 Knowledge of laws that may positively or negatively impact people with disabilities.

 Excellent written and verbal communication skills.

 Exceptional interpersonal skills and caring nature

9. Challenging issues in rehabilitation center

Rehabilitation is not only for people with long-term or physical impairments.

Rather, rehabilitation is a core health service for anyone with an acute or chronic health
condition, impairment or injury that limits functioning, and as such should be available
for anyone who needs it.
Rehabilitation is not a luxury health service that is available only for those who
can afford it. Nor is it an optional service to try only when other interventions to prevent
or cure a health condition fail.
For the full extent of the social, economic and health benefits of rehabilitation to
be realized, timely, high quality and affordable rehabilitation interventions should be
available to all. In many cases, this means starting rehabilitation as soon as a health
condition is noted and continuing to deliver rehabilitation alongside other health
interventions.  

However globally rehabilitation has challenged due to the following:

 Lack of prioritization, funding, policies and plans for rehabilitation at a national level.
 Lack of available rehabilitation services outside urban areas, and long waiting times.

 High out-of-pocket expenses and non-existent or inadequate means of funding.

11
  Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1
million populations in many low- and middle-income settings.

 Lack of resources, including assistive technology, equipment and consumables.

 The need for more research and data on rehabilitation.

 Ineffective and under-utilized referral pathways to rehabilitation.

10. Positive forwards

Based on above described challenges of rehabilitation of special population; the following
recommendation were forwarded to government and respective stake holders:

 To increase the capacity of the Disability and Rehabilitation Department for

coordination, monitoring and reporting on government and NGO implemented
rehabilitation services including community based rehabilitation
 To develop a long-term government plan for the oversight and integration of
rehabilitation services within the BPHS and EPHS including budgeting, referral systems,
standards of care, service implementation and quality management.
 To improve Physical Therapy and Orthopedic Services through increased numbers of
professionally trained practitioners at the provincial and community level
 To improve the psychological and social inclusion of persons with disabilities through
cross sector links and referrals.
 To enhance provision of early treatment of children with severe disabilities and care
for persons with spinal cord injury and through research, strengthening of rehabilitation
services, coordination among key ministries, the development of care policies and
guidelines for both medical and non-medical practitioners
 To increase prevention measures that target avoidable disabilities due to accident
and preventable diseases.

12
11. Summery
In this paper different related literatures were reviewed and discussed. The result deduced
that; the primary goal of rehabilitation counseling is to assist individuals with disabilities gain or
regain their independence through their entire life; employment or some form of meaningful
activities. The history and background regarding the professionalization of rehabilitation
counseling; the roles, functions, knowledge, and skill domains central to effective contemporary
rehabilitation counseling practice; the current credentialing standards of rehabilitation counselors
and emerging issues involving state licensure requirements; the emerging knowledge areas and
issues regarding the educational requirements for rehabilitation counselors were discussed and
summarized. Moreover based on the finding possible direction for effective practice in
contemporary special population rehabilitation settings were forwarded.

13
References
ACA. (2019). ARCA’s Disability-Related Counseling Competencies.

Altman, B. M. (2001). Disability definitions, models, classification schemes, and applications. In

G. L. Albrecht, K. Seelman & M. Bury (Eds.), Handbook of Disability Studies.

Dokumacı, A. (2019). A Theory of Microactivist Affordances. The South Atlantic Quarterly.

Gill, C. J., Kewman, D. G., & Brannon, R. W. (2003). Transforming psychological practice and
society: Policies that reflect the new paradigm. American Psychologist.

Ginis, K. A. M., Jetha, A., Mack, D. E., & Hetz, S. (2010). Physical activity an subjective well
being among people with spinal cord injury: a meta-analysis.

Groce, N. (2005). Immigrants, disability, and rehabilitation. In J. Stone (Ed.), Culture and
Disability .

14