Adebate is emerging regarding the best way to ensure the timely and efficient return to work (RTW) of workers who have become long term absent (LTA) for health reasons. Elements of this debate center on the roles of the individual, the rehabilitation agent, the employing organisation and the rehabilitation and reintegration system. Recent years have seen the emergence of new approaches to managing LTA, mostly focusing on disability management and on amendments to welfare and rehabilitation systems. This paper discusses these trends in the light of a 6-year research programme carried out in Ireland, involving both national and transnational studies which have sought to identify the key elements of successful LTA policies and practices. It also reviews recent international work in the area in order to assess the relative importance of systemic, organisational and individual factors in ensuring timely and effective LTA policies and practices.

In this study, the author reviewed 32 studies, published in The Australian Journal of Rehabilitation Counselling (AJRC) from 1995 to 2000, that examined the authors' theoretical perspectives and how the authors and/or rehabilitation counsellors (RCs) as research participants defined quality practice. Their theoretical perspectives ranged from systems, psychological and psychosocial theories and specific disability or minority group issues. These theoretical perspectives were examined in relation to the methods of quality practice advocated by AJRC authors and/or their RC-research participants, these being: relationship building, assessment, goal setting, affective and vocational counselling, case management, self-care, and evaluation of services. Notwithstanding a commendable diversity in the range of theory and quality practice reported, several AJRC authors observed a lack of clarity regarding the professional identity of RCs; and the research papers lacked consistency and clarity in defining the characteristics of RC-participants. There were also opposing views concerning where RCs stood in relation to other stakeholders in the rehabilitation process. Further research is recommended to better understand the diversity evident in the roles and functions of Australian RCs in different rehabilitation settings.

This paper reports the results from a qualitative study aimed at identifying the factors influencing the rehabilitation experience of people living with an amputation in a rural setting. Following the conduct of an initial focus group, 24 rural-based individuals responded to an invitation to participate in the study's in-depth interviews. Fourteen of those interviewed lived in a ‘regional’ setting (the regional group) and the other ten lived in more remote locations (the ‘distant’ group). Consistent with this population's demography, the sample was comprised mainly of older people (mean age of 66.8 years) who had suffered their amputation as a result of vascular disease. While the groups differed with respect to two aspects of their rehabilitation experience (with the distant group reporting more problems with accommodation and access to health services), many common themes emerged from the interviews, including an overall positive acceptance of the surgical intervention, the call for increased post-operative counselling services, and an endorsement of the usefulness of peer-support (and more generally of social support) services. Results are discussed in terms of their implications for service delivery and endorsement is made of the suggestion that rural health planning be more community-focussed.

Commonwealth Rehabilitation Services (CRS) Australia provides vocational assessment services to a client group whose rehabilitation is funded by Family and Community Services. Currently, the assessment of client skills, abilities and needs is based on the case management model. This model was expanded in the Assessment Plus study with the addition of a four-week assessment schedule and a series of educational group sessions. The program was conducted by a multi-disciplinary team at CRS Australia's Maroubra Unit, NSW. Forty-six CRS clients meeting inclusionary criteria formed the subject group for the study. Data was collected for the first eight months following implementation of the Assessment Plus program. The outcomes for study participants were compared with a matched group of 46 clients referred for assessment during the same period in 1999 prior to the implementation of Assessment Plus. The results of the study program showed a statistically significant increase in employment outcomes in the Assessment Plus group, with 12 (26%) clients recorded in employment compared with 3 (6%) in the control group. There was also an improvement in service delivery factors. These included a shorter assessment phase, an increase in the number of vocational goals identified and required reports filed. The results suggest that providing a time-based assessment framework plus intensive client involvement and participation improves vocational outcomes and service delivery.

Audiometric tests do not adequately reflect the hearing handicap experienced by individuals with hearing loss and account for only part of the variance in hearing handicap perceptions (Weinstein & Ventry, 1983). The present study investigates the relationship between degree of hearing impairment, psychosocial factors and hearing handicap in a New Zealand war veteran sample. Forty-seven veterans (Mean age = 77.51, SD = 5.99) with some degree of hearing impairment completed a questionnaire which included the Hearing Handicap Inventory (HHI) (Newman et al., 1990), the SF36 sub-scales for general health and mental health (Ware, Kosinski & Keller, 1994), questions relating to hearing aid use and demographic details. Audiometric test information for each veteran was accessed through the national war pensions organisation. Analyses revealed no significant relationship between percentage hearing loss and perceptions of hearing handicap. Those who reported lower satisfaction with their hearing aids, those in poorer physical health and those who had been using hearing aids for a longer time reported higher scores on the HHI. These findings suggest that aspects of the rehabilitation process are important factors in the individual's experience of hearing handicap and that non-auditory factors (such as general health) may be essential considerations in this process.

The ability to secure and maintain gainful employment for people who have a mental disorder (such as schizophrenia) is limited and often complicated by personal, environmental and social barriers. The administration of inappropriate vocational evaluation tools for people who experience schizophrenia, has been identified as further contributing to this dilemma (Rybak, 1998). In an attempt to address this issue, Rybak (1998) developed a five-stage model for promoting successful vocational outcomes for people who experience schizophrenia. The purpose of this article is to review Rybak's model in terms of its appropriateness for this population. As a result of several shortcomings in Rybak's approach there is a need to develop an alternative vocational evaluation approach that is responsive to the characteristics unique to these individuals.

Risk factors associated with post-injury return to work are well documented. Less is known of the impact of PTSD on work outcomes. Information on worker and accident risk factors was obtained by survey, hospital records and personal interview with 40 road trauma survivors two years post-accident: Results suggest that while PTSD was an independent risk factor for negative work outcomes, PTSD also significantly contributed to the overall adverse impact of anxiety, depression and pain on work outcomes. The lack of improvement in work outcomes between from 12 weeks post-accident for those with PTSD indicated that early vocational interventions are critical for this population.

Disability is commonly viewed as permanent loss of physical, cognitive and social aspects of self. Rehabilitation interventions are aimed to return the individual to full health by either restoration of past physical, cognitive or social capabilities or strengthening aspects of self to counter such loss. However, rehabilitation interventions do not result in a complete return to past physical, mental or social health. Does this mean that people with disability can never be healthy? Or does it indicate that our perception and definition of health does not reflect the essence of health? We argue that when people with disability redefine themselves in terms other than levels of physical, social and cognitive functioning, good health is an attainable goal. We discuss evidence that suggests why spirituality could be a primary determinant of health.

Rehabilitation counsellors have long been interested in back injuries among at-risk occupational groups such as nurses. Back injuries have a high prevalence among nurses, with enormous financial costs being incurred by health agencies and governments. Consequently the prevention of back injuries is a high priority for all concerned. Following a discussion of prevalence studies and risk factors for back injuries, we selectively review research on the effectiveness of multi-component (education and exercises) preventive programs designed specifically for nurses. While there is some empirical support for preventive programs, research in the area is still in its infancy. Looking at the broader picture, we conclude that preventive efforts must ultimately address the design of the workplace and the availability of proper equipment. Importantly, nursing unions and governments are moving towards “no lifting” policies and re-organisation of work practices. For effective rehabilitation, though, of those who do suffer back injuries, the adoption of a Workplace Disability Management approach (rather the traditional OH&S and return to work services provided by health and rehabilitation professionals) is advocated.

It is estimated about 200,000 Americans have been diagnosed with Muscular Dystrophy (MD), a neuromuscular disease characterized by gradual degeneration and atrophy of the muscle cells and fibers (Siegel, 1999). Functional limitations associated with MD include cognitive, social, physical/vocational, and emotional functioning. Rehabilitation counselors are advised to use a holistic approach to serving clients with MD. Compassion is key to building a meaningful professional relationship between the client and the rehabilitation counselor. However, rehabilitation counselors should neither communicate an overly pessimistic outlook nor raise false hope.