Congratulations to all of you and ASORC on your 25th Anniversary. It is great to be able to be here with you at this historic time. I want to express my appreciation to organizers of this conference, ASORC and each of you here. I want to thank Trevor Hawkins for inviting me, and also to acknowledge Bert Biggs who gave me the opportunity to be involved with the Journal during the past few years.

I also want to thank you for the honor of being able to share a few thoughts with you about rehabilitation counseling. It is particularly pleasing to me to be here, in that this presentation is on the eve, as some of you may know, of my leaving Australia, having been here for three years. It has been a wonderful time both personally and professionally — an opportunity not many have to practice their profession in a different country and culture — albeit not one that was totally foreign in that you all use English.

I want to share a few thoughts today related to the rehabilitation and rehabilitation counseling profession and think a bit about what I see as happening as we stand on the brink of a new millennium. It is not new thinking nor particularly original, borrowing as I have from many sources, though I must take full responsibility for what I say. Also, I should emphasize that it is not offered as advice but rather a reinforcement of what many of you already know. As an educator and university professor, I do get stuck in one mode sometimes overemphasizing what I consider important. My remarks are based on my obviously American background but hopefully tempered with some of my experiences and observations here in Australia.

This paper examines employment issues concerning deafened adults, especially those with cochlear implants. The analysis shows that deafened people have fewer educational qualifications and are less likely to be in paid employment when compared with people without a hearing disability. In consequence, they report lower income levels. Conversely, respondents with cochlear implants reported higher levels of employment and income. In addition to disability, social factors such as age and sex may contribute to a person's socio-economic status. As such, rehabilitation interventions need to consider the person's social as well as auditory needs.

The present paper concerns the prevention and management of disability due to chronic pain. The problem of disabling chronic pain is presented and the impact on the community is highlighted. The scientific rationale for current approaches to management is discussed and the available empirical evidence reviewed. In particular, the present paper advocates application of the biopsychosocial model for the prevention and management of chronic pain-related disability. As such, the components of the biopsychosocial model are reviewed and recommendations for rehabilitation counselling practice are presented.

Measurement in Rehabilitation Medicine commences with clear definitions of the terms used and clear ideas about the nature of the entity being measured. In this lecture, issues such as goal based measurement, the difficulties of comparison, weighting systems, different types of scales, and the mathematical problems they present are discussed. Scales discussed include the American Medical Association Guides to the Evaluation of Permanent Impairment, and the Functional Independence Measure (FIM). Caution is necessary when drawing conclusions from statistics generated from ordinal scales, especially when comparisons are being made. The Australasian Faculty of Rehabilitation Medicine supports the use of standard measures and has developed an Australian Standard Data Set for Rehabilitation Medicine. The functional measure used in this data set is the FIM.

Demonstrating the effectiveness of health care interventions requires valid measurement of the impact, or outcome of those interventions. It is increasingly suggested that Quality of Life (QoL) is the ‘gold standard’ outcome internationally (Bowling 1995) and in Australasia (Mordue & Parkin, 1997). Although a number of QoL measures are now available, questions remain about the definition of the concept itself and the psychometric properties of those measures. A consequence of major concern is that health services research or clinical studies of healthcare interventions using inadequately defined outcomes or invalid measures will in turn produce results that lack validity. This paper explores a number of such issues concerning the concept of QoL and the way it is measured.

In a period of legislative reform, New South Wales' workers compensation stakeholders can learn at least broad lessons by making comparisons with the experience of other countries in post reform review. This article considers the overall impact of the 1993 reforms on the Californian workers' compensation system, with focus on reforms and outcomes in the Vocational Rehabilitation sector. It was found post reform that the number of claims and paid benefits have decreased substantially, and total premiums paid and Vocational Rehabilitation expenditures are down dramatically. However, the changes are blamed for an increase in legal complexity, as return-to work outcomes and post-injury earnings for injured workers appear to have worsened. Additionally benefit levels remain a continuing concern.

This grounded theory study explains how health professionals work in interdisciplinary teams in health services where the call for new collaborations is intensifying. Forty-four participants from four teams in two major acute-care hospitals participated in the study. In total there were eighty hours of interviewing and eighty hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Underpinning the study are the premises of symbolic interactionism that are assumed to shape the focus of this study, team interactions, and collective action within an acute care setting. The study participants' patterns of behaviour would suggest that, when interdisciplinary practice is well established, an attitude of cooperative inquiry pervades joint actions and interactions that focus on meeting service needs.

In this investigation of rehabilitation professionals in Australasia, where the profession of rehabilitation counselling might be described as emerging, the appropriateness of the Rehabilitation Skills Inventory for use in Australasian settings was evaluated. This resulted in an amendment to the original instrument and the development of the RSI (Amended) instrument. The instrument validation is discussed and the four component solution described.

The advent of managed care as a system driving purchasing in the health sector has brought with it an emphasis on purchasing outcomes rather than inputs. Although any change in purchasing schemes will have an effect on service providers, it should not prove to be too disruptive for those of us in rehabilitation since rehabilitation as a service system has always been outcome driven. In fact, our entire system is driven by needs based assessment and directed toward the meeting individually identified goals for service. These goals reflect the desired outcome of the service we provide for each individual served. The challenge we face, then, is translating our emphasis on goal directed, outcome driven services to meet the language, understanding and expectations of our funding agents as they begin to adopt a regime of outcome based contracts. The purpose of this paper is to argue the validity of individually determined outcomes as opposed to institutionally determined measures and to propose one method of measuring those outcomes in a manner that is applicable to the needs of the purchaser.

People born in non-English Speaking Countries (NESCs) and resident in Australia make up 14.2% of the Australian population and a sizeable proportion of the current immigration program — the humanitarian and non-humanitarian components. This article presents some background about the numbers of overseas born people resident in Australia especially those from NESCs, a brief history of the Australian immigration program, and the present policy of multiculturalism in the context of settlement. Some of these overseas born people have already, or are likely to, participate in rehabilitation counselling, and it is argued that rehabilitation counselling processes will be enhanced with a knowledge of such clients' culture as well as the practical application of general cross-cultural casework skills.

This paper explores the thorny question, what is this thing called rehabilitation? The concept is examined with a view to refining some of the values lying behind the rehabilitation process. A practitioner's viewpoint is taken and melded with a consumer bias to present two relatively simple working definitions of rehabilitation, and some dilemmas that challenge practitioners in an evidence-based climate. By asking when should rehabilitation services be used and what are rehabilitationists really about, we discover an intensely human process that calls for personal qualities and scholarship that are exemplary in the eyes of society. The paper concludes with an assessment of rehabilitation services in New Zealand.

In the developing field of Life Coaching, Rehabilitation Counsellors can find an approach that when applied in the Rehabilitation setting can get real results. The profession of life coaching is discussed with regard to its origins and applications, and then compared to the field of psychology and rehabilitation counselling. The ‘Coach Approach’ is offered as an exciting new paradigm that creates an effective partnership in assisting clients to reach their full potential.

Rehabilitation Counsellors utilise comprehensive skills that have strong parallels with the Human Resources environment. As facilitators of development, improvement and goal achievement, Rehabilitation Counsellors are best equipped to deal with the ever changing face of people and organisations. There are key competencies in both fields that allow for the link between the two to be established, therefore creating an alternative career option for Rehabilitation Counsellors. The Human Resources field provides opportunities for Rehabilitation Counsellors to access large organisations with potential for higher remuneration and career development. Furthermore, the Human Resources field allows rehabilitation counsellors the platform to showcase their range of skills in order to achieve an organisations goals and objectives.

There have been various factors and events that have contributed to the development of the rehabilitation field in Australia. This paper particularly examines the social, economical and political influences, which have made significant impact on the field. Having established the historical basis of rehabilitation, this paper examines the current changes that are happening in the field and make some suggestions for future developments in both the field and in the profession of rehabilitation counselling.

The paper presents data on the use of physician services by 354 older adults in New Zealand. Utilization of physician services and predisposing factors were ascertained by structured interview in a cross-sectional sample of men (n = 155) and women (n = 199) aged 60 years or over. Interview responses were used to test the hypothesis that a combination of predisposing, enabling, and need characteristics are better predictors of physician service use, than need characteristics alone. Hierarchical regression results predicting the use of medical services support our hypothesis, underscoring the importance of need and enabling characteristics for service use. Research applying the behavioral model to the use of services among older adults could be enriched by the inclusion of enabling and predisposing characteristics.