Psychologists and rehabilitation: New roles and old training models.

The role of psychologists in physical rehabilitation settings has expanded considerably over the past decades. Unfortunately, the lack of clarity regarding roles, functions, and research of psychologists in inpatient and outpatient rehabilitation settings has hampered efforts to establish guidelines for training graduate students to work in rehabilitative settings. Despite ongoing debate since the Princeton Conference in 1958, no guidelines have been recommended by Division 22 of the American Psychological Association (Division of Rehabilitation Psychology) for training doctoral students in clinical and counseling psychology programs for work in rehabilitation. This article asserts that psychology graduate students who want to work in physical rehabilitation settings should (a) have core training in psychology and (b) receive coursework and practica in working with persons who have chronic illnesses and injuries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inpatient rehabilitation diabetes consult service: A rehabilitation psychology approach to assessment and intervention.

Problem: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. Objectives: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. Results: A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Conclusions: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subacute rehabilitation: New opportunities and challenges for rehabilitation psychologists.

Changes in the health care delivery system have obliged rehabilitation service providers to consider alternatives to the traditional model of comprehensive acute inpatient rehabilitation. An option of growing popularity among third-party payers is subacute rehabilitation. This type of rehabilitation is usually provided within a skilled nursing home, provides fewer hours of therapeutic intervention, and uses less professional staff, but may achieve similar outcomes. As subacute rehabilitation has grown, rehabilitation psychologists have been used in these settings, but uncertainties exist as to appropriate roles and reimbursement opportunities. This article provides a framework for understanding the current status of subacute rehabilitation as a part of the rehabilitation continuum of care and how rehabilitation psychologists can maximize their effectiveness in this environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wanted: Champions of psychiatric rehabilitation.

Psychiatric rehabilitation has been shown to significantly impact the course of severe mental illness. Unfortunately, its impact has been muted by organizational barriers that impede implementation of these strategies in many treatment settings. Identifying champions from the ranks of the treatment team who will be responsible for start-up and maintenance of treatment innovations is one of many strategies that helps overcome these barriers. Some psychologists have excellent credentials for assuming the role of champion. Implications for becoming leaders of program development in terms of its impact on the psychologist's role per se are discussed. If more psychologists are to become active leaders in program development in hospital settings, graduate schools need to commit greater resources toward recruiting and training students in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effective delivery of rehabilitation psychology services: The responsible utilization of paraprofessionals.

The new and rapidly changing health care environment necessitates innovation on the part of rehabilitation psychology to achieve cost-effectiveness. This innovation could take the form of rehabilitation psychologists' responsibly using bachelor's-level technicians, or paraprofessionals, in the delivery of clinical services. This article proposes a pyramid model of rehabilitation psychology service delivery using paraprofessionals and psychology trainees. Specific clinical activities appropriate for paraprofessionals are outlined. Controversies regarding use of bachelor's-level paraprofessionals and the inflationary process of over-credentialing doctoral-level psychologists are discussed. It is proposed that psychology interns and residents be cross-trained in allied health skills so that psychology trainees can provide clinical support to other health care disciplines, thereby improving the cost-effectiveness of, and preserving, hospital-based psychology training programs. The article emphasizes the need for doctoral-level rehabilitation psychologists to adopt administrative roles in medical settings in order to implement innovative service models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical issues in pediatric rehabilitation: Exploring an uneven terrain.

Discusses issues that arise during the stages of the pediatric rehabilitation process as they relate to such ethical principles as patient autonomy, provider beneficence/nonmaleficence, and fairness/justice.These include initial decision making in rehabilitation, information sharing and negotiation, treatment consent/refusal, transitioning from rehabilitation to community, and long-term planning. Case examples are used to illustrate potential resolution of specific dilemmas. Future directions for pediatric rehabilitation psychologists are outlined. Among these are rationing of care, integration of systems, research on pediatric rehabilitation outcomes, training, and responsible use of technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fellows Address: Excellence in rehabilitation psychology—The ABPP diplomate in rehabilitation psychology.

Rehabilitation psychology, Division 22 of the American Psychological Association, has successfully completed a program for defining excellence among rehabilitation psychologists. This program is certified under the American Board of Professional Psychology (ABPP) and awards a diplomate based upon a thorough examination of education and experience, and the successful passing of a rigorous examination. Excellence in rehabilitation psychology is characterized by a very broad educational base, as well as a training base which includes more than a casual acquaintance with information from literally hundreds of areas of life. This very broad-based education and training is applied to a highly specific population of persons requiring and seeking rehabilitation. The diplomate in rehabilitation psychology marks a milestone in providing health service providers with highly trained and credentialed psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Head injury rehabilitation: Psychological issues and roles for the rehabilitation psychologist.

Points out that rehabilitation psychologists are critical members of the health care team in the provision of diagnostic, remediational, and consultative services to the victims of head injury, family members, and relevant social welfare and 3rd-party payers. The present authors consider the roles of the rehabilitation psychologist when the head-injured are involved in the legal process, including consulting with attorneys, serving as an expert witness, and acting as an advocate for clients. Case illustrations are provided of additional psycholegal issues, such as the use of psychological data as evidence, eligibility criteria for various programs, and the need for the psychologist to act as a liaison with educational and vocational systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of rehabilitation psychologists in the treatment of disease and disability.

It is contended that rehabilitation psychologists have remained content to continue using the same techniques for the same types of problems that they used more than a decade ago. Because of a temerity of thought, rehabilitation psychologists have not extended their particular research and technological expertise into the more major areas of health care. Examples are presented in which such psychological techniques as conditioning and biofeedback were employed to treat successfully a variety of serious health problems. Rather than leave the major areas of investigation and treatment to others, as has traditionally been the case, rehabilitation psychologists are urged to utilize their skills in studying and treating the major physical problems of their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdisciplinary process: Implications for rehabilitation psychology.

Suggests that the rehabilitation process can be enhanced by working toward development of an interdisciplinary, as distinguished from multidisciplinary, mode of operation. That approach fosters a symbiotic and interactive process among professions and professionals that goes beyond a consultative relationship. Rehabilitation psychologists, by fostering and encouraging an interdisciplinary team and, within that context, by the studied use of behavioral methods, can considerably enhance their impact on patients and professionals alike. Examples of modifications of the treatment environment are presented. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On psychological identity and training: Boulder is better for rehabilitation psychology.

This article addresses issues of training in applied psychology, generally, and rehabilitation psychology, specifically. The long-term success and growth of rehabilitation psychology will depend, in part, on how the field answers the following questions: How do rehabilitation psychologists define their area of competence? How is this competence to be achieved? A review of recent literature suggests that rehabilitation psychology has yet to resolve fully the fundamental issues of a young subspecialty: identity, training, and long-term direction. We maintain that the scientist-practitioner model should continue to be the framework for training future rehabilitation psychologists. Furthermore, subspecialty and cross discipline training should be completed following core training in an appropriate specialty of psychology (i.e., counseling or clinical). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and intervention by rehabilitation psychology in long-term care.

Argues that an effective program of rehabilitation psychology in long-term care depends on an understanding of the conceptual bases for such care—the dynamic relationship between support and autonomy and the strategy of incremental gains. Ideally, rehabilitation psychology involves 2 forms of assessment: one to establish generalized function and the other (a more traditional clinical assessment) to establish the basis for clinical intervention. The role of psychologists in management should range from standard interventional techniques with patients to a significant role in helping the institution and the residents themselves as a group in dealing with institutional care. The many barriers to the delivery of mental health services, particularly in reimbursement, may be overcome through creative enterprise. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expanding the concept of acculturation in Mexican American rehabilitation psychology research and practice.

The acculturation process is increasingly being viewed as an important variable that provides a context for understanding Mexican American health disparities. Although rehabilitation psychologists have noted the importance of utilizing acculturation in research and practice, scholars continue to use out-dated conceptualizations and models of acculturation. Objectives: The authors provide a brief overview of current trends in acculturation theory and research. Limitations of current rehabilitation research and how acculturation theory can help explain Mexican American health outcomes are discussed. Finally, recommendations for rehabilitation research and practice are provided. Conclusions: The authors recommend that rehabilitation scholars develop and test theoretical models that incorporate multiple dimensions of acculturation in order to understand how it influences Mexican American health outcomes. Rehabilitation professionals should incorporate acculturation theory and culturally informed interventions into rehabilitation practice with Mexican Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Full circle to Boulder: A commentary on rehabilitation psychology training.

This article presents a point of view on the training needs of rehabilitation psychologists. It is based on the author's understanding of rehabilitation philosophy and on the realities of the professional marketplace. This commentary was inspired by 2 recent Rehabilitation Psychology articles (K. R. Thomas & F. Chan, 2000 [see record 2000-13209-005]; S. T. Wegener, T. R. Elliott, & K. J. Hagglund, 2000 [see record 2000-13209-006]) that set forth very different approaches for appropriate training of rehabilitation psychologists. The present article seeks to synthesize these differing approaches and turns to the Boulder conferees for assistance in doing so. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cardiovascular rehabilitation: A comprehensive approach.

Reviews the book, Cardiovascular rehabilitation: A comprehensive approach, edited by Lyle H. Peterson (1983). This book is a thorough and concise book for the physician, psychologist, rehabilitation counselor, physical therapist, or nurse involved in a treatment team approach to cardiovascular rehabilitation. The text includes research data, philosophical rationale, current references, and an explanation of the theoretical bases of various treatment approaches. Of interest to psychologists are chapters dealing with specific tests, treatment modalities, and the role of the psychologist in the rehabilitation team. The authors attempt to prove with logic, data, and eloquence how a comprehensive cardiovascular rehabilitation center can benefit patients. They also attempt to show the importance of the management of psychological problems in rehabilitation. This text represents an attempt to incorporate psychology into parity with other disciplines in rehabilitation, and as such could be read with profit by both psychologist and nonpsychologist alike. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is rehabilitation psychology in need of rehabilitation?

Discusses the "Golden Age" of rehabilitation psychology, when rehabilitation of persons with traumatic brain injury was the fastest growing areas in all health care, and comments on the current state and possible future directions of the field. The author's care plan for the future includes a focus on chronic conditions in addition to the field's current primary focus on end results (disability). The new focus would involve branching out beyond the field's traditional work in inpatient and outpatient rehabilitation facilities. The author points out rehabilitation psychology's unique focus on a team approach to treatment, and notes that this model can be transported to treating other chronic conditions, typically seen in more acute or primary settings. In an effort to introduce their model into hospitals around the country, rehabilitation psychologists need to expand their clinical practices, modify their training model, and broaden the scope of their research efforts. As corporations are concerned about disability and chronic illness and are largely unaware of what rehabilitation psychology could offer them, a logical step in their care plan is to work more closely with corporations and employee benefit services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.     

Streamlining assessments and treatments for geriatric mental health in medical rehabilitation.

The past decade has seen dramatic health care changes that profoundly affect the way rehabilitation psychologists are able to provide care for older adults. Increased medical comorbidities and decreased lengths of stay have made it necessary for rehabilitation psychologists to streamline their services. This commentary shares the authors' experience in creating new tools to increase efficiency while retaining effectiveness. The four areas the authors discuss include (a) a tool for triaging cases, (b) a brief battery for cognitive evaluations, (c) a treatment approach for depression that can be delivered in the hospital or outpatient clinic setting, and (d) increased interdisciplinary team communication and function. Each of these approaches has been researched, validated, and cross-validated in geriatric settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)