The effects of transferring 28 long-stay chronically mentally ill patients from a psychiatric hospital to community placements was evaluated. The Rehabilitation Evaluation Hall and Baker (REHAB; Baker & Hall, 1983) scale was used to assess clients' adaptive and maladaptive behavioural functioning at 12, 18 and 24 month intervals following the hospital baseline. Social contacts and inpatient readmissions were also assessed. The results showed that clients' general adaptive functioning and maladaptive behaviour, on average, remained stable across the hospital baseline and two year follow-up period. Clients with frequent social contacts were found to have significantly better adjustment on a number of the REHAB subscales and those who exhibited more maladaptive behaviour were more likely to be readmitted to a psychiatric inpatient unit. Overall the results were encouraging with relatively low readmission rates, however, approximately 10% of clients showed significant difficulty adjusting in the community. The implications of the findings for chronically mentally ill people and suggestions for community programmes are discussed.

Work stress and burnout are common problems in rehabilitation services. Usually, attempts to account for stress and burnout focus on the qualities of the individual and the demands of the organisational environment. However, the current paper has responded to recent demands in the occupational stress literature to examine burnout from a third perspective, namely the institutional level. This level of analysis transcends the boundaries of organisations and can be defined by the various political, economic, social and legal constraints that characterise a broad area. It is argued that the rapid growth of insurance-based rehabilitation in Australia has created a unique institutional context that has significant implications for the development of stress and burnout among rehabilitation counsellors. Rehabilitation counsellors in this context face a diverse array of conflicting demands within a system that often does not support the goals of rehabilitation. It is proposed that the development of strategies to reduce stress and burnout in this area would benefit from an institutional-level analysis. While individualised stress management training clearly has a role in the minimisation of stress and burnout, it is proposed in the current paper that this issue has human resource management and educational implications that must be addressed.

Childhood sexual abuse (CSA) is a frequently occurring event that has a strong and lasting impact on adult functioning. A significant percentage of adults who are sexually abused as children subsequently meet the diagnostic criteria for posttraumatic stress disorder (PTSD) and demonstrate an increased vulnerability toward further traumatisation. Despite the likelihood that rehabilitation counsellors will encounter clients with this history, published literature on the contribution of rehabilitation counsellors to work with adults who were abused as children is limited. This report discusses ways rehabilitation counsellors can contribute to the inter-professional collaboration required to achieve a reduction in impact of disability and handicap associated with the long-term impact of CSA.

This article describes the development of the current part-time distance education Post graduate and Masters in Rehabilitation Counselling course offered by the School of Community Health, University of Sydney Cumberland Campus, into an online/multimedia instructional medium.. A literature review explored factors involved in the educational technology design process utilising an ACTIONS framework proposed by Bates (1995). The findings confirm that it is appropriate to utilise selected mediums to improve access and maintain teaching standards. However, the review highlights the need to offer a combination of presentation mediums, adequate technical support, and staff development/training. Formative evaluation must be part of the design process, supported by a responsive organisational infrastructure. Evaluation of the first unit of study to be offered online in 2000, Counselling, will form the basis for a follow-up article.

The proportion of older adults seeking rehabilitation services are certain to rise as the population ages. Cognitive rehabilitation techniques can be successfully adapted and used with older adults with a range of clinical diagnoses. An understanding of cognitive changes which could be expected as a result of “normal” (non-disease-related) aging is essential for both assessment and treatment planning for this group. Age-related changes in attention, memory and executive functioning are briefly noted. Common cognitive sequelae of head-injury, depression and dementia are discussed, and useful assessment and rehabilitation strategies described. Case illustrations are used to illustrate major points.

The Work Repertory Grid was developed to investigate a Personal Construct model of burnout for an empirical study involving 60 mental health professionals working in the Illawarra area. This paper backgrounds some of the theories of stress and burnout and the traditional methods of measuring predictor and dependent variables. It also describes the development of the Work Repertory Grid and how it was derived from both Personal Construct and burnout theory. Results from the empirical study suggest a valuable role for the instrument in interpreting and exploring results from future research in conjunction with other objective measures, which, in turn, tend to validate the instrument. By fixing constructs relating to personal attributes and relating styles the Work Repertory Grid holds the promise of early prediction of burnout in stressful work environments.

Rehabilitation providers were the product of the 1987 Workers' Compensation Act in NSW, Australia. They operate in a complex environment and serve many masters. This paper assesses how rehabilitation providers are faring in the management of workplace injury. Using in depth semi-structured interviews, the self-perceptions of rehabilitation providers are presented. Results indicate that the current practice of rehabilitation providers labours under a heavy load of competing responsibilities, difficult clientele, adversarial stakeholders, economic restraints, and an unwieldy and clumsy workers' compensation system. Specific problems highlighted by rehabilitation providers included the identification of their core business and client group; misconceptions, lack of information and failure of communication among stakeholders; and lack of co-operation and overt and covert obstruction to the rehabilitation process. Rehabilitation providers perceived that they could function most effectively if they developed a genuine, trusting relationship with the injured worker, and educated and supported the treating doctor and employer in the rehabilitation and return to work process. Rehabilitation providers linked employer support of the injured worker to their willingness to provide suitable duties. Early referral was also considered an essential element in successful return to work. It was argued that rehabilitation providers should conceptualise themselves as advocates for the rehabilitation process rather than for any stakeholder group. This conceptualisation allows the provider to move comfortably between groups of stakeholders, addressing their diverse needs while maintaining their focus on their core business.

The Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) are evidence of the progress, in relation to civil rights, made in the disability public policy arena. Similarly, much progress has been made in regard to societal values and attitudes toward persons with disabilities. Although much progress has been made for persons with disabilities, there is much work to be done. An abundance of concerns have recently surfaced regarding whether the Rehabilitation Act of 1973 and the ADA effectively address the rights of persons with disabilities. In light of recent concerns, some social scientist have advocated the minority group model as a catalyst for creating public policy that will effectively address the rights of persons with disabilities. The belief is that this perception of persons with disabilities would further progress society's value of promoting the well being of others, respecting the rights of others and promoting the fair distribution of society's resources. Thus, the purpose of this paper is to support the hypothesis that society's perception of persons with disabilities as a bona fide minority group will change societal values resulting in a more progressive public policy.

This paper is the second part of a two part series that examines the perceived roles and effectiveness of rehabilitation providers. The first paper examined the perceptions of rehabilitation providers regarding their roles in, and perceived barriers to, occupational rehabilitation. In this paper, key stakeholders' perceptions of the role of rehabilitation providers in the management of workplace injury were assessed via interviews and surveys. Forty-nine injured workers were interviewed and 407 returned a survey questionnaire. Two surveys of employers were conducted: one in the Newcastle/Hunter region of NSW, Australia (N = 93), the other a state-wide survey (N = 612) of a representative sample of employers in NSW. In addition, nine treating doctors and 14 insurers were interviewed. Results indicated that two thirds of workers were satisfied with the service they had received from the rehabilitation provider. The major concerns of injured workers were the rehabilitation providers' lack of knowledge of the demands of particular workplaces, the problems associated with particular injuries and the pressure on rehabilitation providers from employers and insurers to return the injured worker to work. Sixty percent of employers reported that rehabilitation providers were effective in restoring injured workers to work. Treating doctors were generally hostile to rehabilitation providers, claiming that they were unprofessional, inexpert and poorly trained. Finally, insurers complained of stereotypical case management plans, role confusion, and over-servicing.

Individuals with psychotic disorders, such as schizophrenia, have been found to have less successful vocational rehabilitation outcomes than other disability groups. A contributing factor may be that existing traditional vocational assessment methods and tools simply lack characteristics that would make them most useful for individuals with schizophrenia. Specific symptomatology present in the schizophrenic disorders interferes with the individual's ability to properly complete traditional assessment tools. Alternative methods of assessment are therefore needed for individuals with schizophrenia to get the most benefit from the vocational rehabilitation process and reach their vocational potential. A five-stage model is proposed which attempts to address issues that arise during the vocational assessment process for people with schizophrenia.