Clinical data illustrating the need for greater involvement of behaviourally-oriented psychologists in the design and delivery of rehabilitation services

Abstract

Post-injury vocational achievement is an important index of successful rehabilitation. This study involved the identification of factors reported to influence (positively or negatively) labour force participation of people with spinal cord injury (SCI). Forty participants were selected from a larger study of 450 based on the most extreme prediction errors from the application of a discriminant function analysis, which aimed to predict vocational achievement (both in and not in the labour force) post-SCI. Participants were interviewed to gain an understanding of their explanations for their labour force status. Factors nominated as most influencing post-injury achievements were family, friends and representatives of pre-injury employers. Implications of these findings for the delivery of rehabilitation services are presented, including the value of having service plans based on a behaviour analysis of the influence of environmental factors. Key words: vocational rehabilitation, social support, spinal cord injury. ********** In a previous paper (see Murphy, Young, & Reid, 2003) we proposed that, based on an analysis of the contents of selected contemporary behaviour therapy and rehabilitation journals, behaviourally-oriented psychologists at the start of the 21st century are far less involved in rehabilitation service delivery research than they were in previous decades. The current paper presents data from a recent study of vocational achievement following traumatic spinal cord injury that allows an examination of the extent to which behaviour analysis can usefully contribute to enhanced rehabilitation outcomes. Of all injuries, spinal cord injury (SCI) is arguably one of the most devastating. By definition, SCI implies permanent impairment and is associated with potential disabilities that affect not just mobility and sensation but also, inter alia, such diverse areas as sexual functioning, body temperature regulation, and bowel and bladder function. In addition, chronic pain is highly prevalent within the population. In order for persons with SCI to return to community participation and achieve a good quality of life, much new learning is required and new goals need to be set. In theory, behavioural psychologists are the best placed of the rehabilitation professionals to design environments supportive of identified rehabilitation goals. Because most spinal cord injuries occur to the young adult (see Stover & Fine, 1986), the achievement of vocational goals is especially important, as is a proper understanding of the antecedent and consequent stimuli that prompt and reinforce job-seeking behaviour. For almost all injury groups, return to work is the gold standard by which to judge the success of the rehabilitation effort (see Britell, 1991). However, in order for rehabilitation services to maximise their success in terms of vocational rehabilitation achievements made by clients, an understanding of the individual and environmental factors that impact on disability employment rates needs to be developed. The current study contributes to that more developed understanding through the examination of the post-injury experiences of a group drawn from a larger study involving the prediction of labour-force participation following spinal cord injury (see Murphy, Young, Brown & King, 2003). In that study, approximately 75% of the cases were able to be correctly classified in terms of their post-injury labour force status. The original study involved over 450 participants who were assessed on fourteen predictor variables, encompassing demographic, injury and psychological variables. Significantly, all these predictor variables involved "attributes of the individual" and excluded examination of any environmental variables. In an effort to learn more about the range of factors impacting on participants' lives post-injury, a sample was drawn from the most extreme prediction errors from the original study. …