Julie Chronister

Measuring social support in rehabilitation

Purpose. To provide a comprehensive and up-to-date literature review of social support and a description of available assessment measures in order to facilitate a theoretical and operational framework for incorporating social support in rehabilitation interventions. Method. An overview of the different theoretical models and conceptual dimensions and a description of specific measures of social support are given. The implications of social support assessment for rehabilitation and recommendations for future research are discussed. Conclusion. To move forward in this area, a consensus on the definition and dimensions of social support needs to occur which could be obtained through an evaluation of existing measures 1. Practitioners and researchers in rehabilitation need to study measures of social support in order to provide empirical support for scales used in professional practice and in research to expand understanding of this important construct.

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: A CHAID analysis

Purpose. To examine demographic and service factors affecting employment outcomes of people with orthopedic disabilities in public vocational rehabilitation programs in the United States. Method. The sample included 74,861 persons (55% men and 45% women) with disabilities involving the limbs or spinal column who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2001. Mean age of participants was 41.4 years (SD = 11.2). The dependent variable is employment outcomes. The predictor variables include a set of personal history variables and rehabilitation service variables. Results. The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement services significantly enhanced competitive employment outcomes but were significantly underutilized (only 25% of the clients received this service). Physical restoration and assistive technology services along with support services such as counseling also contributed to positive employment outcomes. Importantly, clients who received general assistance, supplementary security income, and/or social security disability insurance benefits had a significant lower competitive employment rates (45%) than clients without such work disincentives (60%). Conclusion. The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, service patterns, and competitive employment rates through the segmentation of the sample into mutually exclusive homogeneous subgroups.

The association of stress-coping variables to quality of life among caregivers of individuals with traumatic brain injury

The purpose of this study was to determine the degree to which stress-coping variables contribute to quality of life (QOL) among caregivers of individuals with traumatic brain injury (TBI). This study examined the direct effects of the following variables: functional competency, caregiving appraisal, coping, perceived social support, and family needs on QOL. In addition, the unique variance accounted for in QOL by each set was investigated, and whether perceived social support, coping, and family needs mediate or moderate the relationship between caregiving appraisal and QOL. The sample consisted of 108 caregivers recruited from support groups who were predominantly white females. The majority of care-recipients had a severe head injury. Measures administered were the Interpersonal Support Evaluation List, Family Needs Questionnaire, Modified Caregiving Appraisal Scale, and the World Health Organization Quality of Life--Brief Version. Results showed that the full model accounted for 68% of the variance in QOL; caregiving appraisal, perceived social support and family needs remained significant after other stress-coping variables were partialled; and of these sets, emotional social support, social needs, and perceived burden were the significant individual predictors. Emotional social support and social needs mediated the relationship between perceived burden and QOL.

The Effects of Psychosocial Factors on Quality of Life among Individuals with Chronic Pain.

This study investigated the psychosocial factors affecting the quality of life (QOL) of 171 individuals with chronic pain. Participants completed a battery of self-rated inventories measuring three sets of predictor variables—demographic (age, gender, income, marital status), pain-specific (chronicity, severity, duration, frequency, pain impairment), and psychosocial (interference, social support, depression, coping)—and one criterion variable with five models (physical, psychological, social, environmental, total). Hierarchical multiple regression indicates that income predicts the psychological and environmental domains of QOL. Across all five models, 56% to 76% of the variance was accounted for with the three sets of variables. Demographics remained minimally predictive of all models. Pain impairment was predictive of all five models. Depression was predictive of all but physical QOL, and coping was predictive of all but physical and environmental QOL. The pain impairment variable and the two psychosocial variables (depression and coping) remained imperative in predicting QOL of individuals with chronic pain.

Vocational rehabilitation services and employment outcomes for adults with cerebral palsy in the United States

The aim of this study was to examine the relationship between vocational rehabilitation services provided and work outcomes among people with cerebral palsy (CP), taking in to account demographic characteristics.

Social Tie Characteristics and Psychiatric Rehabilitation Outcomes Among Adults With Serious Mental Illness

Social support has achieved national attention as a key component of the mental health recovery paradigm for persons with serious mental illness (SMI). The aim of this study was to investigate the amount of variance accounted for by four social tie characteristics (social network orientation, emotional support, tangible support, and negative exchange) in three outcomes (mental health recovery, loneliness, and quality of life [QOL]). This study also investigated whether social tie characteristics mediated the link between symptom distress and rehabilitation outcomes. Participants were 101 adults with SMI, living in New York City and Boston. Eight measures were used to assess the above constructs. Bivariate correlations and hierarchical regression were conducted. Social tie characteristics contribute significantly to loneliness and recovery, with the amount of variance accounted for by symptom distress in loneliness and mental health recovery increasing significantly when social tie characteristics were added to the model. Mediator analyses revealed that emotional support and negative social exchange mediate the relationship between symptom distress and loneliness. Tangible support mediates the relationship between symptom distress and recovery. Rehabilitation counselors need to assess and inquire about social tie characteristics. Future researchers should investigate the types of support/nonsupport specific to people with SMI.

Vocational Services as Intervention for Substance Abuse Rehabilitation: Implications for Addiction Studies Education.

ABSTRACT This study examined factors influencing employment outcomes of people with substance-related disorders (SRDs) in state vocational rehabilitation (VR) agencies. The sample included 34,774 VR clients with SRDs from fiscal year 2001. Mean age of participants was 38.35 years. Predictor variables included personal and service variables and the criterion was employment. The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement was the most significant predictor of employment for people with SRDs. Additional variables predicting employment were other services, substantial counseling, restoration services, case expenditures, being married, and work disincentives. The CHAID analysis provided useful information about effective VR services for people with SRDs. Implications for addictive studies education were discussed.

Psychometric validation of the Multidimensional Acceptance of Loss Scale

Objective: To develop and field test the Multidimensional Acceptance of Loss Scale to measure disability acceptance based on the four value changes identified by Beatrice Wright. Design: Quantitative descriptive design using exploratory factor analysis to determine the factorial validity of the Multidimensional Acceptance of Loss Scale. Setting: The Canadian Paraplegic Association. Subjects: One hundred and sixty-one members of the Alberta, Saskatchewan, Nova Scotia and Manitoba chapters of the Canadian Paraplegic Association were recruited for the current study. Results: A four-factor structure accounting for 50% of the total variance was found for the Multidimensional Acceptance of Loss Scale. The internal consistency reliability coefficients (Cronbach’s alpha) for the four factors ranged from 0.80 to 0.88. Three clusters of participants with high, moderate and low disability acceptance were identified based on their profiles of Multidimensional Acceptance of Loss Scale subscale scores using cluster analysis. MANOVA results indicated that participants in the three clusters significantly differed on self-esteem, F(2, 154) = 19.78, P<0.001 and quality of life, F(8, 236) = 5.16, P<0.001. Participants with high Multidimensional Acceptance of Loss Scale scores have higher self-esteem and quality of life scores than those with lower scores. Conclusion: The Multidimensional Acceptance of Loss Scale was found to measure the four value changes in Beatrice Wright’s disability acceptance theory in a sample of Canadians with spinal cord injuries. It demonstrated good internal consistency reliability and construct validity.

The meaning of social support for persons with serious mental illness.

OBJECTIVE This study sought to better understand the population-specific types of social support relevant to adults living with serious mental illness (SMI). Our study was exploratory and used a qualitative approach that centered on uncovering the types of social support meaningful and relevant to persons with SMI. METHOD The sample comprised of 52 adults receiving county mental health services in the San Francisco Bay Area. Data was gathered from 6 focus groups and analyzed using NVivo10 and Consensual Qualitative Research (CQR; Hill et al., 2005; Hill et al., 1997). RESULTS Six qualitative domains were identified: (a) supportive conditions, (b) day-to-day living, (c) illness management, (d) resources and information, (e) guidance and advice, and (f) community participation support. DISCUSSION While the 6 support domains share some broad-based conceptual underpinnings with traditional models of emotional and instrumental support, the domains emerging from our study represent supports uniquely tied to the stressors associated with living with SMI, and therefore hold conceptual distinction from traditional types of support. CONCLUSIONS/IMPLICATIONS Findings from this study offer a conceptual framework for understanding social support for persons living with SMI and lay the groundwork for the development of a SMI-specific measure of social support. In addition, our research permits future researchers to investigate the conditions under which social support buffers the impact of SMI stressors, assisting service providers in more effective identification of individual support needs for clinical intervention.

Training Needs of Rehabilitation Counselors concerning Alcohol and Other Drugs Abuse Assessment and Treatment.

Forty-two rehabilitation counselors participated in a study regarding perceived training needs concerning alcohol and other drug abuse (AODA) treatment and assessment. Participants reported that 85% of consumers with whom they worked had AODA issues, yet over half rated their graduate training in AODA treatment and assessment as poor, and their practices were marginally proficient. Referral to self-help groups and cognitive-behavioral coping skills training were common intervention approaches. A change of curriculum requirements, continuing education opportunities and other professional training websites should be considered as an outlet to improve rehabilitation counselors’ competency to serve consumers with AODA issues.