An introduction to using structural equation models in rehabilitation psychology.

Objective: To provide an overview of structural equation modeling (SEM) using an example drawn from the rehabilitation psychology literature. Design: To illustrate the 5 steps in SEM (model specification, identification, estimation methods, interpretation of results, and model modification), an example is presented, with details on determining whether alternative models result in a significant improvement to fit to the observed data. Data are from a sample of 274 people with spinal cord injury. Issues commonly encountered in preparing data for SEM analyses (e.g., missing data, nonnormality) are reviewed, as is the debate surrounding some aspects of SEM (e.g., acceptable sample size). Conclusion: SEM can be a powerful procedure for empirically representing complex and sophisticated theoretical models of interest to rehabilitation psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear, prejudice, and neglect: Discrimination against mentally disabled persons.

Historically, the law has directly discriminated against mentally disabled persons and has failed to protect them from discrimination by private parties. Despite the arguments of the American Psychological Association and other mental health organizations, the Supreme Court has refused to consider state-sanctioned discrimination on the basis of mental disability as requiring a higher level of judicial scrutiny to ensure that it is related to important governmental objectives. Without such scrutiny, policy decisions based on prejudice and fear may jeopardize fair and humane treatment of mentally disabled persons in community and institutional settings. Such inadequate legal protection for mentally disabled persons heightens the significance of the professional responsibility of psychologists and other mental health professionals to promote respect for the personal autonomy of their clients and to strive to preserve their clients' constitutional rights of due process and equal protection under the law. To further legislative advocacy efforts on behalf of mentally disabled persons, an overview of existing federal antidiscrimination statutes is provided, along with a discussion of more recent legislation granting mentally disabled persons affirmative rights in a variety of contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State vocational agency practices in the purchase of psychological services.

Reports findings of a national survey on the use of psychological services for rehabilitation programs of the socially handicapped (e.g., alcoholics). 44 state vocational agencies responded to the mailed questionnaire. It was found that agencies varied greatly in (a) standards and methods of selection, qualification, and performance of psychologists; and (b) estimated figures of monies spent, clients referred, and psychologists utilized. Inconclusive data were obtained on the way in which psychologists' reports influence rehabilitation decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Important implications for psychologists of the Americans with Disabilities Act: Case in point, the patient who is deaf.

Increased implementation of the Americans With Disabilities Act of 1990 (ADA), which empowered persons who have disabilities, has begun in earnest with recent federal court action. Three legal opinions have far-reaching implications for psychologists whose practices include disabled clients. These implications are especially true for those psychologists who are most likely to work at least occasionally with deaf, hard-of-hearing, or otherwise disabled individuals. However, ADA court decisions also apply to psychologists in group practices and managed care corporations. In this article, these legal opinions are reviewed. The authors consider the implications of the decisions on psychologist practitioners, with special emphasis on their legal responsibilities to deaf clients and on liability and related malpractice concerns. The authors also consider the profound impact of these decisions on deaf and hard-of-hearing individuals in need of psychological services. (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)     

Should extended disability be an exclusion criterion for tertiary rehabilitation? Socioeconomic outcomes of early versus late functional restoration in compensation spinal disorders

STUDY DESIGN: A prospective cohort design with two groups of patients representing short-term or long-term disability (n = 497) who were selected from a larger cohort (n = 938) of consecutively treated spinal disorder patients with chronic compensation injuries. OBJECTIVES: To prospectively evaluate the impact of length of spinal disability on socioeconomic outcomes of medically directed rehabilitation. SUMMARY OF BACKGROUND DATA: Despite an increasing tendency of managed care organizations to limit rehabilitation services for disabled workers with chronic spinal disorders, there has been a surprising lack of prospective research evaluating the impact of length of disability on objective socioeconomic treatment outcomes. Although only approximately 10% of all patients with spinal disorders are disabled beyond 4 months, they account for nearly 80% of all workers' compensation expenditures. Little is known about whether relatively early intervention improves outcomes after chronicity has been established or whether any predictors distinguish between these groups. METHODS: Two comparison groups of functional restoration tertiary treatment graduates were identified from the same community referral pool. The "long-term disabled" group involved a minimum of 18 months of disability (n = 252). This group was compared with a "short-term disabled" group (n = 245), no more than 8 months since injury, but chronic based on a minimum of 4 months after injury. The long-term disabled group showed significantly higher rates of pretreatment surgery than the short-term disabled group (P < 0.001). All patients were evaluated prospectively with specific physical, psychological, and occupational measurements. They also underwent a structured interview 1 year after treatment evaluating work status, health care use, and recurrent injury. RESULTS: The short-term disabled group showed statistically higher return to work (P < 0.001) and work retention (P < 0.05) relative to the long-term disabled group. However, health care use and recurrent lost time injury claims were low in both groups and did not differ significantly. No predictors of outcome were found among the prospectively collected physical performance or psychosocial variables. CONCLUSIONS: This study suggests that early tertiary nonoperative care, once patients with chronic spinal disorders are identified as having potentially high-cost chronic pain and disability, is efficacious in achieving goals of better work return and work retention. Such early rehabilitation may also prevent significant indemnity expense, as well as some late surgical interventions sought by progressively more desperate patients. However, individuals with long-term disability achieve respectable work return and retention rates, while faring no worse on other socioeconomic outcomes that represent major "cost drivers" to the workers' compensation system. Early intervention is not a panacea or a necessary condition for the successful rehabilitation of workers with disabling chronic spinal disorders.     

Challenging licensure and certification.

Reviews the various legal theories that have been or might be used to challenge licensure and certification statutes in the courts to clarify the legal context in which the regulation of professional psychology is embedded. It is argued that many of the common regulatory concerns of psychologists (e.g., the validity and the possible discriminatory effects of the Examination for the Professional Practice of Psychology) are probably not legally vulnerable, whereas other requirements (e.g., residency requirements, oral examinations) are potential sources of major legal problems. (141 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal Reflections.

If we check the social class origins of many of the disabled activists, we will find that large numbers were children of the white middle class. Their parents were not deprived; they were reasonably comfortable. Their parents were themselves products of the dream of the meritocracy, which holds that hard work is rewarded and that education, diligence, and good character produce a good life. These parents obtained what medical, educational, and rehabilitation services were available for their children, often ensuring that they studied and played with nondisabled as well as disabled peers. Imbued with the notion that effort paid and that what looked to others like limitations could be easily mastered, their children tried to do their best--to cultivate winning personalities, pleasing appearances, and good minds; to develop their independence and their physical and mental capacities; to minimize their oddities; to become desirable intellectually, socially, and emotionally; and to stress their similarities with others rather than their differences from others, rather than their differences from others. Sometimes they succeeded--in high school, college, even graduate school. Like others of their education and class, they sought their places in the adult world. But when they hit the adult world, they found that their individual strivings and accomplishments meant very little. Were it not a social problem, disability would require no discussion. In a more just world, disability might not be a social, economic, or political problem. It would not be a topic for meetings and discussions. I write out of conscience, anger, and disappointment--that to live with myself, to better myself and others like me, I have no choice but to speak about what could have and should have been a rather inconsequential part of myself and my life. I write in neither pride nor shame, but simply because I have no other choice. I long for the day when I, other disabled psychologists, and other disabled people will go into any room in any convention, any meeting, or gathering or job in the world and be greeted, evaluated, rejected, or accepted for who we are as total beings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating rigorous qualitative research in rehabilitation psychology.

Qualitative research methods have much to contribute to theoretical and applied knowledge in rehabilitation psychology. However, as a discipline, rehabilitation psychology has been behind the curve in employing qualitative methods. Objectives: This article is a summary of the state of qualitative research in rehabilitation and an introduction to various methodological dimensions to consider in implementing qualitative rehabilitation psychology research. Types and examples of qualitative rehabilitation research are presented. Criteria for evaluating qualitative research are discussed. Finally, the majority of this article is devoted to presenting the various methodological dimensions on which researchers must make decisions in designing and implementing rigorous qualitative research (e.g., paradigms, methods, data collection strategies, data analysis procedures, reliability/validity). Conclusions: Rehabilitation psychology has much to gain through qualitative research, and success in incorporating qualitative evidence will be ensured by rehabilitation psychologists learning and rigorously implementing qualitative methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute cholecystitis and gallbladder neoplasms: the experience of 2215 cases

PURPOSE: To argue the case that patients who are severely disabled by stroke may benefit from rehabilitation. To identify critical areas where more research may be helpful. METHOD: Discussion of four negative views which could be cited as drawbacks to rehabilitation in this group. These are: (1) that patients with severe stroke do not recover; (2) that they are too ill to receive rehabilitation; (3) that rehabilitation is ineffective even when possible; and (4) that even if rehabilitation is effective, it is not cost-effective. RESULTS: There is little work in this area. There are problems with measurement of disability in this group. None of the four negative views are supported by current evidence, and what little evidence there is provides grounds for optimism that further work could be worthwhile. CONCLUSIONS: Specific recommendations for further work include: (1) the development of better measurement scales; (2) to determine the cost of care of severely disabled stroke patients; (3) to gain a better appreciation of the value of changes in disability states; and (4) to perform an overview analysis of rehabilitation interventions examining the degree to which severity of disability affects the response to treatment.     

Survey of Psychological Services to Clients With Disabilities: The Need for Awareness.

Objective: To identify barriers to, strategies for, and supports for psychological services for clients with disabilities. Design: Mail survey. Participants: Four hundred eighty-one psychologists who were American Psychological Association members. Measure: A survey that ascertained psychologists' perceptions of access barriers, success factors, and support needs in providing services to clients with disabilities, as well as experiences with bias or sensitivity. Results: Barriers to service provision include funding, accessibility, lack of provider knowledge, limited training in disability issues and services, and lack of sensitivity. Conclusions: Additional training for psychologists in disability issues, legal requirements regarding public accommodations, and disability resources is needed. Psychologists with disabilities may be an important resource. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tamara Dembo (1902–1993): Obituary.

Outlines the contributions of Tamara Dembo, one of the originators of psychological field theory, who did pioneering work in rehabilitation psychology. The effects of her research (e.g., how rehabilitation often involved adjusting environments to people) on disabled populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Roles of the psychologist on a traumatic brain injury rehabilitation team."

Asserts that the blend of talents suggested by P. Barry and J. O'Leary (see record 1990-02635-001) to be necessary for psychologists on a head injury rehabilitation team is an excellent outline but that the issues presented (e.g., team facilitation, behavior management) need to be more fully described. The present authors suggest that other elements, such as the development of a working model of personality, should be integrated into a comprehensive brain injury rehabilitation environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The law, standards of practice, and ethics in the practice of psychology.

Reviews the book, The law, standards of practice, and ethics in the practice of psychology by David R. Evans (see record 1997-36222-000). The strength of this book, as the title suggests, is its focus on Canadian law, legal precedent, and ethical standards. The book covers, among other things, informed consent, confidentiality, assessment and treatment of children and adults, custody and access assessments, assessment of young offenders and treatment of correctional clients, the practitioner as expert witness, and malpractice. This text is destined to become a standard, and because the law is constantly changing as cases set new precedents, it will have to be revised on a regular basis. In that context, I offer some minor criticisms that are intended to be possibilities for making the text stronger in future revisions: I would suggest that an index of names be added to the present subject index, and an index of the Canadian legal cases cited. At present these cases are merely referenced after each chapter without the page numbers that one would get in an index. There are appendices after most chapters (I counted 14 separate appendices). Next time around, Evans might consider adding a list of appendices, with hints about their contents, after the table of contents. These criticisms aside, laudatory reviewers sometimes say "all psychologists (lawyers, doctors, etc.) should have this book on their shelves." In the case of this new book on legal and ethical rules concerning the practice of psychology in Canada, I can make that claim without hyperbole. For Canadian psychologists, particularly those who transact business with the public, this book is essential. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The psychology of disability.

Reviews the book, The psychology of disability by Carolyn L. Vash (see record 1978-12832-001). The goal of this book, according to the author is "to dislodge preconceptions, thus opening up new ways of looking at the disability experience." This book was designed as a textbook for students in rehabilitation training programs and as a resource for practitioners in the various rehabilitation professions. This book is a one person's view of the meaning of disability, based on personal experience and professional observations. It also contains suggestions and recommendations for rehabilitation practitioners and disabled people as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological impairment under the Americans with Disabilities Act: Legal guidelines.

This article introduces mental health care providers to changes in the law defining a disability within the meaning of the Americans With Disabilities Act. The impact of these changes, based on recent U.S. Supreme Court cases, is reviewed in terms of how they affect psychologically disabled persons who allege employment discrimination on the basis of their impairment. Common pitfalls are identified for practitioners to avoid when consulting about psychologically impaired employees. Critical threshold questions are outlined, and 5 types of discrimination claims involving mentally impaired individuals are illustrated. The potential contribution of psychologists in disability cases is examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal research techniques: What the psychologist needs to know.

Discusses the increasing importance of legal research for psychologists, the structure of the US judicial system, and the means by which relevant legal decisions can be retrieved. The use of 3 categories of legal materials is described: primary sources on case, statutory, and administrative law; finding tools such as case digests, computerized search services, and law journals; and secondary sources such as encyclopedias, texts, and specialized law/psychology or law/mental health journals. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal and ethical issues in debt collection strategies of professional psychologists.

Maintains that the improper use of aggressive collection techniques (e.g., by collection agencies or small claims court) presents an ethical and legal risk to psychologists. Clinical accounts are viewed as confidential information that may not be ethically released to collection services without the permission of the client—a form of consent probably rarely obtained by therapists. Moreover, previous work has shown that fee disputes represent one of the major forms of legal action taken against psychologists. A survey of 148 clinical psychologists revealed that a majority have used collection services and that a minority of clinicians routinely inform clients on the limitations of confidentiality. Specific recommendations, such as the use of credit cards or payment at time of visit, are offered on how to avoid the potential legal and ethical risks associated with these collection techniques. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychologist as novelist.

Exacting change in patients, students, supervisees, and other parties need not be limited to the classroom, consulting room, self-help books, or psychological texts. Authors may also educate and impact others through fiction. Specifically, the literary or commercial novel affords psychologists the opportunity to enlighten, empower, or otherwise touch the lives of those not normally privy to our expertise. To be sure, some mental health professionals have made the leap into fiction, but psychologists have been slow to follow, especially when compared with other professions (e.g., law, medicine). This article invites psychologists to apply their knowledge of human behavior and facility with the written word to the modern novel. Steps for starting are itemized as is other information pertinent to persisting in the face of opposition and resistance. A case study briefly describing this author's journey is also offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in personnel selection.

Industrial/organizational psychologists have made many contributions to the development of modern selection procedures. Such procedures are used by organizations in making decisions about individual employees (e.g., hiring and promoting). This article briefly reviews the methods used in selection (i.e., psychological tests, personal histories, projective techniques, and interviews); summarizes the professional and legal issues that their use has raised; and discusses current trends and future developments in selection. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)