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.

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.

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.

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.

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.