Application of the KVI-R to Assess Current Training Needs of Private Rehabilitation Counselors

Abstract

The primary purpose of this mixed-methods study was to identify the current training needs of rehabilitation counselors in the private sector. Four hundred twenty-six participants completed the Knowledge Validation Inventory–Revised. The self-reported needs for training are reported across the 10 knowledge domains of rehabilitation counseling. The overall training needs (TN) score for the sample was moderate. For the broader knowledge domains, respondents reported the highest mean TN scores for Case Management and Utilization of Community Resources, Disability Management, Vocational Consultation, and Services for Employers. A secondary purpose was to compare the self-perceived training needs of rehabilitation counselors who are certified rehabilitation counselors (CRCs) with those of counselors who do not possess a CRC. Higher reported training needs were indicated for individuals without CRCs. A third purpose was to examine the relationship between counselor demographic variables and training needs. Gender and years of experiences were significant predictors of perceived training needs. Finally, the following areas were identified as the most significant training needs for private rehabilitation counselors in the field today: multicultural competence, private vocational rehabilitation, labor market research skills, ethics, and forensic case management.

Keywords

rehabilitation counseling training needs CRC KVI-R

Rehabilitation counseling is an evolving field that requires continued development of training programs that specifically address these training needs (Ethridge, Rodgers, & Fabian, 2007; Zanskas & Leahy, 2007). In rehabilitation counseling and vocational rehabilitation (VR), services partition into three distinct sectors: (a) public, (b) private non-profit, and (c) private for-profit. Trends in the field have indicated that rehabilitation counselors are increasingly finding more employment opportunities within the private-for-profit sector (Barros-Bailey, Benshoff, & Fischer, 2009; Roessler & Rubin, 2006; Zanskas & Leahy, 2007; Zanskas & Strohmer, 2011). According to the Commission on Rehabilitation Counselor Certification (CRCC, 2008) Annual Salary Report, the primary work settings of rehabilitation counselors are as follows: State/Federal Rehabilitation Agency (36%), Other (18%), Private Practice (12%), College or University (9%), Private/Proprietary Rehabilitation Company (8%), Private Non-Profit Rehabilitation Center (7%), Insurance Company (4%), Medical Center or Hospital (3%), and Mental Health Center (3%). The evolution of employment trends for rehabilitation counseling demonstrates a considerable need for training programs to address and integrate components of the private sector into their curricula.

Literature Review

Historically, research has focused primarily on the public sector as opposed to the private for-profit sector (Zanskas & Leahy, 2007; Zanskas & Strohmer, 2011). As the field of rehabilitation counseling evolves, the need to identify training specific to private rehabilitation becomes more nuanced. Zanskas and Strohmer (2011) explained that there was more consideration for systems approaches in addition to a focus on individual development. Those systems approaches refer to the idea that training should include the work environment, work roles, and types of clients, rather than focusing solely on skill development. There are other factors (e.g., interactions with clients, employers, ethics, consultation with other rehabilitation professionals) beyond just the individual that affect his or her professional development.

Differences Between Public and Private

The evolution of rehabilitation counseling practice demonstrates the significant differences between the public, private non-profit, and private for-profit sectors, most notably with the differences in work environment (Chan et al., 2003; Zanskas & Strohmer, 2011) and in work identity, including roles and functions relating to disability management (Chan et al., 2003; Ethridge et al., 2007). Specifically, multiple sources point to a common work role of disability management (Ethridge et al., 2007; Zanskas & Leahy, 2007). This role of disability management, although common with public VR counselors, is often applied to workers’ compensation, personal injury, long- and short-term disability claims. Consequently, knowledge and expertise regarding financial effectiveness of VR services is an added component that is necessary for the private rehabilitation counselor (Zanskas & Leahy, 2007).

Furthermore, the role of disability management tends to position rehabilitation counselors in the role of consultants (Zanskas & Leahy, 2007). As a result, rehabilitation counselors in the private sector also provide their expertise to employers, working with workers’ compensation or personal injury claims. Furthermore, private rehabilitation counselors offer guidance regarding compliance with workers’ compensation laws, including the Americans with Disabilities Act (ADA) and implementing appropriate rehabilitation strategies to workers experiencing on-the-job injuries and disabilities. These tasks require more expertise with organizational systems and structures (unions), which differ for every state, to ensure that appropriate services are provided to workers with disabilities. Another important function of private rehabilitation counselors as consultants includes their expertise in providing expert testimony in litigation processes. These litigation processes generally relate to workers’ compensation claims, personal injury, long-term disability, marital dissolution, and medical malpractice cases.

Ethridge et al. (2007) posited that private rehabilitation practices take a preventive approach due to its increased emphasis on disability management. This preventive approach emphasizes the ability to reduce the harm of an injury or a disability for an individual that affects the individual’s ability to work. Private rehabilitation counselors focus on reintegrating individuals to return to the workforce quickly after displacement due to a disability (i.e., return to work in modified or light-duty positions). The focus, therefore, may be more on case management and return to work as opposed to the counseling process.

Training Needs

Knowledge

A review of the rehabilitation literature indicated that private rehabilitation counselors have articulated a need in developing their skills for disability management, use of Internet modalities, workers’ compensation laws, benefits for employees, and work accommodations (Chan et al., 2003). These training needs were specific to the private sector of rehabilitation counseling. However, Chan et al. (2003) also identified that rehabilitation counselors overall desired more training in the clinical counseling domain. Specifically, the researchers noted that knowledge, regarding multicultural counseling, substance abuse counseling, and diagnosis, should be the primary focus for rehabilitation counselor training needs. This desire reflects a more integrative knowledge base for rehabilitation counselors that prepare them to work with a diversity of clients. There is no one type of rehabilitation counseling client. Clients present with a broad severity of mental health issues that can potentially affect job placement, accommodations in the workplace, and work identity.

A diverse clientele elicits an increased complexity in the rehabilitation counseling process. For example, clients’ identification with their disability can be affected by another cultural identity, such as ethnicity, socioeconomic status, gender, and sexual orientation. Participants’ notable desire to obtain knowledge of diagnosis and psychopathology is relevant to a broad range of mental health issues in addition to the VR needs. For example, Accordino, McReynolds, Accordino, and Bard (2009) noted that clients’ psychiatric disabilities represent an increased complexity for private rehabilitation counselors, especially when considering how insurance companies reimburse for treatment of psychiatric disabilities. Further knowledge of psychopathology may better prepare rehabilitation counselors to effectively manage the barriers facing reintegration into the workforce.

Chan et al. (2003) also emphasized private rehabilitation counselors’ training needs regarding forensic rehabilitation and disability management. Consequently, the training needs from that sector focused primarily on expertise with testifying in court, disability management concerns, and workers’ compensation laws which may vary from state to state. In relation to the Chan et al. study, Zanskas and Leahy (2007) explained that knowledge about case management practices was highly relevant to private rehabilitation settings. Zanskas and Leahy further identified the significance of career counseling knowledge. Career counseling knowledge is relevant, as private rehabilitation counselors heavily focus rehabilitation services on their clients’ reintegration into the workforce.

Work environment

The work environment, especially between proprietary (private-for-profit) rehabilitation counselors, private non-profit, and public rehabilitation counselors, tends to be markedly different. Specifically, the work environment is related to the types of interests, values, and personal characteristics of each individual. Individuals within the private and public sectors, although providing related counseling skills, often differ in their areas of focus. The public sector may focus heavily on counseling skills across its work environment, whereas the private sector may focus more on case management and disability management (Ethridge et al., 2007; Zanskas & Strohmer, 2011). Proprietary rehabilitation counseling often involves extensive amounts of consultation. Most private for-profit rehabilitation settings involve a complex and fast-paced process of working with other professionals in the community. These professionals include lawyers, medical professionals, and business executives. Hamilton and Shumate (2005) supported the notion that private rehabilitation counseling tends to be more fast-paced and “cost-effective” (p. 17).

Roles and functions

Connecting to the knowledge in professional development of rehabilitation counselors, the private sector focuses heavily on skills regarding disability management, forensic rehabilitation, and expert consultation. Therefore, the role of private rehabilitation counselors includes consultation for organizations that are implementing practices consistent with the ADA and with each state’s unique workers’ compensation laws. Many researchers also noted that case management is a significant component in the private sector. Ethridge et al. (2007) noted that private rehabilitation is “employer driven” (p. 28), which requires an enhanced skill in case management. The case management skills include the ability to obtain resources and advocate for clients in a timely manner.

Ethics

Private rehabilitation counselors face a different set of ethical issues that prompt continued training in this area (Beveridge, Karpen, & France, 2013). Due to extensive involvement with litigation processes and consultation, private rehabilitation counselors experience a higher complexity of ethical dilemmas. Vaughn, Taylor, and Wright (1998) explained that managed care often places demands on the rehabilitation counselors that may not match with the client’s desired choices. For example, a specific ethical situation could include the conflict between meeting the expectations of a larger organization (i.e., employers, insurance companies) and the welfare of the client. Consequently, this type of dilemma can develop numerous issues, including delivery of services, counseling relationship, and detraction from the profit-oriented work environment.

In addition, Reid and McReynolds (2007) explained the necessity for continued development of ethics for the rehabilitation counseling profession. As testifying in court is one of the many primary roles for private rehabilitation counselors, ethics regarding being an expert witness is necessary. According to Reid and McReynolds, the type of training regarding ethics for the role of expert witness is rarely discussed in most rehabilitation counseling programs. Furthermore, private rehabilitation counselors work heavily as consultants on a fee-for-service basis. This role becomes even more complicated ethically due to the more nuanced power differential for clients. As clients may seek consultation from rehabilitation counselors, it is more likely that values of the counselor can easily be imposed on the clients. In addition, this type of dynamic becomes even more nuanced with cultural values. Values of a private rehabilitation counselor may have a stronger effect on clients. Reid and McReynolds suggested that training programs need to address these roles, the ethical dilemmas, and increased awareness of counselor–client dynamics. Specifically, they identified that multicultural counseling and awareness would be significant to implement in training across different types of rehabilitation counselors.

Implications for Graduate Education Training

Currently, there are 98 rehabilitation counseling master’s degree programs within the United States that are accredited by the Council of Rehabilitation Education (CORE, personal communication, January 17, 2014). Only two of those programs offer forensic rehabilitation counseling programs. Many researchers provide recommendations regarding graduate training programs as a result of the evolution of research in private for-profit rehabilitation counseling. For example, Zanskas and Leahy (2007) offered multiple recommendations to address increased employment in the private sector. They observed that practicum or internship placements in the private sector would be extremely useful to apply experiential learning interchangeably with the classroom. In addition, they explained that student associations would offer a network of “learning communities” and professionals that could enhance knowledge regarding this area (p. 212). Zanskas and Leahy (2007) also explained that “development of a counselor’s professional identity, writing skills, problem solving skills, critical decision-making ability and the ability to interact with people from diverse backgrounds” should be at the core of graduate training that incorporates private rehabilitation counseling constructs and skills (p. 212). Accordino et al. (2009) added that private rehabilitation counselors could benefit more from their graduate training by gaining more knowledge on psychiatric disabilities, considering the complex nature of financial compensations and evidenced disability. As private rehabilitation counseling is more profit oriented, utilizing language within business education is a primary component of training regarding the private (for-profit) sector.

Utilizing business language in rehabilitation counseling education also reinforces the questions posed by Zanskas and Strohmer (2011). They offered that counselor education departments could consider interests more related to the Enterprising and Conventional types in the Holland Codes. These characteristics relate heavily with business and labor knowledge. Zanskas and Strohmer contended that graduate education training programs could develop programs that combine these characteristics into these programs or into a specialty within the program. Ethridge et al. (2007) similarly noted that rehabilitation counseling graduates are missing an “entrepreneurial orientation” and skills necessary to work congruently within the private sector. Finally, Chan et al. (2003) noted that the evolution of the rehabilitation counseling field and professional identity have forced graduate training programs to extend beyond the required 48 credits in a master’s degree program. The latest Annual Profile of Council on Rehabilitation Education (CORE), which included data from 2008 to 2011, explained that accredited programs require 48 to 68 credits. Potentially, graduate-training programs in clinical rehabilitation counseling will have a 60-credit requirement. According to the latest policy document regarding the Counsel for Accreditation of Counseling & Related Educational Programs (CACREP)–CORE affiliation, approximately 20% of CORE (2013) programs will be moving toward 60-credit programs with an additional clinical mental health counseling focus. An extension of the curriculum requirements could allow for more flexibility within graduate programs to incorporate skills and training specific to the private sector.

Reasons for the Current Study

The current mixed-methods study is being conducted to address the evolution and incorporation of the private for-profit sector in the rehabilitation counseling field. Dating back to the Lynch and Martin (1982) study on private rehabilitation counseling needs, there is a paucity of research regarding the training needs for this particular role in the profession. Although research on private rehabilitation counseling has grown considerably (Zanskas & Leahy, 2007; Zanskas & Strohmer, 2011), few studies have focused exclusively on the private sector. Training needs for the private sector have often been included in the overall perspective of rehabilitation counseling (Chan et al., 2003; Leahy, Chan, & Saunders, 2003) as opposed to a distinct specialty. In addition, the private sector utilizes different skills and interests that are generally more entrepreneurial. The current study is focused primarily on training needs of private rehabilitation counselors due to the markedly different nature, environment, and requirements of their practice. We intend to contribute to the growing trend of private rehabilitation counseling in research, as rehabilitation counselors are finding more employment opportunities in the private sector (Ethridge et al., 2007; Zanskas & Leahy, 2007; Zanskas & Strohmer, 2011).

Research Design and Research Questions

The convergent parallel research design for this mixed-methods study includes descriptive, qualitative, and ex post facto approaches. Qualitative and quantitative data were collected simultaneously, then compared and related, and, finally, interpreted. Training needs were derived by a discrepancy model described by Froehlich and Linkowski (2002). Precedence for using this methodology to access training needs for rehabilitation counselors was established by Szymanski, Leahy, and Linkowski (1993). The qualitative approach was utilized to explore the participant’s self-perceived training needs. At the end of the Knowledge Validation Inventory–Revised (KVI-R), three open-ended questions were utilized to explore the participant’s training needs in their own words. For example, the first open-ended question asked, “What is the most significant training need for rehabilitation counselors in the field today?” The ex post facto portion of the study includes comparisons of training need scores across a number of variables such as employment or practice settings and CRC status. The research questions as addressed in this study, and reported here, are as follows.

Quantitative Approach

Research Question 1: Which counseling component knowledge areas do private rehabilitation counselors report the highest needs for training?

Research Question 2: Do perceptions in need for training differ between CRCs and non-CRCs in this sample of private-for-profit rehabilitation counselors?

Research Question 3: Are there counselor demographic variables that are significantly related to self-reported training needs? Specifically are a counselor’s gender, age, ethnicity, years of experience, highest degree earned, CRC status, number of certifications held, and work location (rural vs. urban) significant predicators of need for training?

Qualitative Approach

Research Question 4: How do private rehabilitation counselors describe consumer populations that are significantly growing in their need for rehabilitation counseling?

Research Question 5: How do private rehabilitation counselors describe the most significant training needs for rehabilitation counselors in the field today?

Method

Participants

We recruited participants using the marketing e-mail list from the George Washington University Forensic Rehabilitation Counseling Certificate Program. The list consists of approximately 5,000 e-mail addresses of rehabilitation counselors working in the private sector of rehabilitation counseling.

The total number of rehabilitation professionals who received the e-mail invitation was not determined, making it unfeasible for us to calculate the return rate. Prior to sending the invitations and recruiting the participants, we obtained Institutional Review Board (IRB) approval from The George Washington University. The only selection criterion was that participants currently work as rehabilitation counselors in the private sector. Participation in the study consisted of providing answers to the different sections of the questionnaire.

Of the recruited professionals, 557 started and 426 completed the survey. Respondents who reported their geographic region included 118 from the south (30.5%), 96 from the midwest (24.5%), 91 from the west (23.2%), and 83 from the northeast (21.1%), with four respondents practicing from Canada. Ten respondents were eliminated from the sample due to clear acquiescence (choosing the same response for every item), and four more were excluded due to lack of response for multiple questions. The final sample of 412 participants included 277 females (67.2%), 133 males (32.3%), and 2 participants who did not include their gender. Mean age for the sample was 51.8 years, ranging from 26 to 80 years of age, with a standard deviation of 11.37 years. The large majority reported their ethnicity as Caucasian (347, 84%), followed by African American (27, 6.5%), then Hispanic/Latino (12, 2.9%), with six participants (1.5%) identified as multiracial. Respondents of other ethnicities (Asian Indian, Arab/Middle Eastern, Asian American, and Pacific Islander) each constituted less than 1% of overall sample. Participants’ years in practice ranged from 4 months to 55 years, with an average of 20 years’ experience for the entire sample (SD = 11.12). The large majority of the sample held master’s degrees (341; 82.76%), followed by doctoral degrees (49, 11.89%), then bachelor’s degrees (14, 3.4%), with 22 (5.3%) participants reporting other educational training. Participants most commonly held certification as certified rehabilitation counselors (CRCs; 383, 92.96%), followed by licensed professional counselors (LPCs; 111, 26.94%), certified case managers (CCMs; 83, 19.9%), certified disability management specialist (CDMS; 69, 16.75%), and rehabilitation providers (47, 11.4%), with 286 (69.41%) holding other forms of certification. Two thirds of participants (275, 66.01%) held multiple licensures or certifications.

Most participants reported working in an urban setting (185, 44.9%), with 124 (30.1%) working in suburban settings, 64 (15.5%) in rural, and 35 (8.5%) working in some combination of urban, suburban, and rural contexts. Regarding populations currently served by the participants, the majority indicated physical disabilities (332, 80.6%), mental health (320, 77.7%), traumatic brain injury (TBI; 286, 69.4%), cognitive disability (286, 69.4%), and non-orthopedic physical disabilities (275, 66.7%). For a full breakdown of responses, see Table 1.

Table 1.

Populations Currently Served by Study Participants (n = 412).

Population	Frequency	%
Physical disability (including amputation)	332	80.6
Mental health	320	77.7
Cognitive disability	286	69.4
Traumatic brain injury	286	69.4
Non-orthopedic physical disability	275	66.7
Learning disability	227	55.1
Substance abuse	209	50.7
Vision impairment and blindness	156	37.9
Hearing impairment and deafness	156	37.9

Data Collection and Measures

A survey link from Survey Gizmo, an Internet-based survey website, was delivered via e-mail invitation. Following the initial dissemination, we sent a follow-up e-mail 2 weeks later to potential participants in an effort to maximize the response rate. Participants needed only to click on the link provided (or copy and paste the link into a browser) to retrieve the survey. Prior to dissemination, we tested the survey to ensure that it was properly compiling data. The data collected were automatically compiled from the web survey Surveygizmo.com and then exported into SPSS for Windows.

The survey consisted of 10 demographic questions, one pre-survey question, the 92-item KVI-R (CRCC, 2011), and three post-survey open-ended questions. On the first page of the survey, respondents were provided with an informed consent document notifying them of the purpose of the study and the plan for the information they were providing; that the study was completely voluntary and anonymous; that they could withdraw at any time; and of potential risks and benefits of their participation. Participants were also informed that the survey would take approximately 15 to 20 min to complete. No identifying information was collected from respondents.

KVI-R

This study used the KVI-R, which was developed by a team of researchers in conjunction with the CRCC to measure the current training needs of rehabilitation professionals. Each of the 92 items asks respondents to rate a specific knowledge area (e.g., “Diversity and multicultural issues”) on two dimensions: importance of the rehabilitation counseling field and degree of preparedness to work in that area. Both dimensions were measured on a 5-point Likert-type scale (0 = not important to 4 = extremely important), and the preparedness scale (0 = no preparation to 4 = very high degree of preparation). Construct validity of the 2011 version of the KVI-R was established through the Delphi method, in which 10 subject-matter experts in the field of rehabilitation counseling were identified by the CRCC Examination and Research Committee and placed on a panel to evaluate the items of the instrument (Leahy, Chan, Sung, & Kim, 2012). Panelist recommendations were used to confirm and validate existing items, delete outdated or repetitive items, and to add five new items.

Leahy et al. (2012) administered the revised 2011 version of the KVI-R to a sample of 409 CRCs to further validate the instrument and empirically derive test specifications for the CRCC. Using principal components analysis, we identified four factors representing broad knowledge domains in rehabilitation counseling practice: (a) Job Placement, Consultation and Assessment (α = .97); (b) Case Management and Community Resources (α = .93); (c) Individual, Group, and Family Counseling and Evidence-Based Practice (α = .92); and (d) Medical, Functional, and Psychosocial Aspects of Disability (α = .88). High coefficient alpha values generated for each factor indicated strong internal consistency of the items comprising each factor grouping. Through a subfactoring process, each of the four broad knowledge domains was broken down into more specific knowledge subdomains. The domains and subdomains identified in this study were then used by the CRCC to inform their 2012 test specifications (Leahy et al., 2012). They established 10 broad knowledge domains consisting of KVI-R items (knowledge subdomains): (a) Assessment, Appraisal, and Vocational Evaluation; (b) Job Development, Job Placement, and Career and Lifestyle Development; (c) Vocational Consultation and Services for Employees; (d) Case Management, Professional Roles and Practices, and Utilization of Community Resources; (e) Foundations of Counseling, Professional Orientation and Ethical Practice, Theories, Social and Cultural Issues, and Human Growth and Development; (f) Group and Family Counseling; (g) Mental Health Counseling; (h) Medical, Functional, and Psychosocial Aspects of Disability; (i) Disability Management; and (j) Research, Program Evaluation, and Evidence-Based Practice.

Pre- and post-survey questions

Before beginning the KVI-R, participants were asked to rate their perception of how much they would benefit from further training in rehabilitation counseling for persons with disabilities on a 5-point Likert-type scale (0 = not at all to 4 = a great deal). At the end of the survey, three additional qualitative questions were posed to respondents:

Open-ended question: “Which consumer populations do you see as significantly growing in their need for rehabilitation counseling?”

Scaled-answer question: “How prepared do you feel to work with the population(s) you identified in the previous question?” This was rated on a 5-point Likert-type scale ranging from 0 = not at all to 4 = extremely well.

Another open-ended question: “What do you see as the most significant training need(s) for rehabilitation counselors in the field today?”

Data Analysis

Survey Gizmo generated a Microsoft Excel file with results, which we imported into SPSS 19 for further analysis. Categorical demographic variables (gender, race, education level, state of practice, location of practice) were dummy coded in preparation for the regression analyses for Research Question 3 (Are there counselor demographic variables that are significantly related to self-reported training needs? Specifically are a counselor’s gender, age, ethnicity, years of experience, highest degree earned, CRC status, number of certifications held, and work location [rural vs. urban] significant predictors of need for training?). The largest group was used as the reference group in all cases. Individual items were grouped into 10 knowledge domains identified by the CRCC as their 2012 test specifications, as described above. Each item was examined for missing data on both the importance and preparedness scales. Due to missing data rates of more than 10% on some items, mean imputation was performed on all 92 KVI-R items (Sterner, 2009).

Assumptions of linearity and homoscedasticity were verified through scatter plot and p-plot inspection, both for multivariate analysis of variance (MANOVA) and for multiple regression. Homogeneity of variance for MANOVA was tested using Box’s M, which yielded no significant values. Normality within the multiple regression analysis was examined using Durbin–Watson (all values between 1.76 and 1.88), while alpha levels for reliability of overall training need and training need by factor were all greater than .8 (see Table 2).

Table 2.

Descriptive Statistics: Training Needs by Domain and Subdomain (n = 412).

Knowledge domains	Importance	Preparation	Training needs
Knowledge domains	M (SD)	M (SD)	Training needs
Factor 1. Job Placement, Consultation, and Assessment (α = .93)	3.23 (0.53)	2.59 (0.71)	0.65
Subfactor A (Domain 2)—Job Development and Placement Services	3.32 (0.60)	2.80 (0.73)	0.52
Subfactor B (Domain 3)—Vocational Consultation and Services for Employers	3.20 (0.60)	2.51 (0.80)	0.70
Subfactor C (Domain 9)—Disability Management	3.10 (0.64)	2.39 (0.81)	0.71
Subfactor D (Domain 1)—Assessment and Evaluation	3.39 (0.58)	2.73 (0.79)	0.66
Factor 2. Case Management and Community Resources (α = .90)	3.03 (0.94)	2.34 (1.06)	0.69
Subfactor A (Domain 7)—Mental Health and Healthcare Advocacy	2.92 (0.99)	2.28 (1.09)	0.64
Subfactor B (Domain 4)—Case Management and Utilization of Community Resources	3.14 (0.88)	2.40 (1.03)	0.75
Factor 3. Individual, Group, and Family Counseling and Evidence-based Practice (α = .81)	2.86 (0.63)	2.46 (0.66)	0.41
Subfactor A (Domain 6)—Individual, Group and Family Counseling	2.81 (0.75)	2.58 (0.73)	0.23
Subfactor B (Domain 10)—Evidence-Based Practice	2.92 (0.64)	2.33 (0.74)	0.58
Factor 4 (Domain 8)—Medical, Functional, and Psychosocial Aspects of Disability (α = .85)	3.30 (0.51)	2.84 (0.63)	0.46

Qualitative data (n = 412 statements) were extracted from responses to the open-ended question. The coding process, which used three independent raters, was competed in multiple steps. Inter-rater reliability was used to assess the degree to which different raters agreed or disagreed in their assessment decisions. Where there were different responses, an agreed-upon process and discussion were used to develop consensus. These data were initially organized and coded based on the open-ended questions asked on the survey instrument (e.g., “Which consumer population(s) do you see as significantly growing in their need for rehabilitation counseling?”) and for the second open-ended question, “What do you see as the most significant training needs for rehabilitation counselors in the field today?” A second coding analysis on the data was performed to review the raw responses, and we coded the training needs by grouping them into growing population and training need categories. Descriptive analysis was used to determine which training needs were reported most frequently. No higher order qualitative analyses were conducted.

Results

Quantitative

Perceptions of general training need

The pre-survey question asked, “To what degree do you feel you would benefit from further training in rehabilitation counseling for persons with disabilities?” The mean response rating for this question was 2.49, falling between “moderately” and “significantly.” The modal response was 2 (“moderately”). Ten (2.4%) of the respondents chose “not at all,” whereas 55 (13%) selected “a little bit,” 147 (34.8%) chose “moderately,” 138 (32.6%) selected “significantly,” and 73 (17.3%) chose “a great deal.” It should be noted that 358 (82.2%) participants selected either “moderately,” “significantly,” or “a great deal,” indicating a perceived need for further professional training among this sample of rehabilitation counselors.

Training needs by knowledge area

The first research question asked, “Which counseling knowledge areas do private rehabilitation counselors report the highest need for training?” Training need (TN) scores were calculated by finding the difference between importance and preparedness ratings for each item on the KVI-R, and between mean importance and preparedness ratings for each CRCC knowledge domain. A total TN score for each respondent was calculated by subtracting his or her overall mean preparedness rating from his or her overall mean importance rating. Following prior research methodology (Froehlich & Linkowski, 2002), all TN scores were rated as follows: 0.70 and above = high; 0.40–0.69 = moderate; and 0–0.39 = low. Respondent TN scores (see Table 2) were rated as high for 32 items (34.7%), moderate for 45 items (48.9%), low for 12 items (13%), and overprepared for 3 items (3.3%).

The overall TN score for the sample was moderate, at 0.557. Training need scores for each domain are reported in Table 2. For the broader knowledge domains, respondents reported the highest mean TN scores for Domain 4 (Case Management and Utilization of Community Resources; .75), Domain 9 (Disability Management; .71), and Domain 3 (Vocational Consultation and Services for Employers; .70). Respondents reported moderate mean TN scores for Domain 1(Assessment and Evaluation; 0.66), Domain 7 (Mental Health and Healthcare Advocacy; 0.64), Domain 10 (Evidence-Based Practice; 0.58), Domain 5 (Foundations of Counseling, Professional Orientation and Ethical Practice; 0.58), Domain 2 (Job Development and Placement Services; 0.52), and Domain 8 (Medical, Functional, and Psychosocial Aspects of Disability; 0.46). Respondents reported a low training need for Domain 6 (Individual, Group, and Family Counseling, 0.23).

Mean importance and preparedness ratings as well as TN scores for each item are presented in Table 2. Only two individual knowledge items received an average TN above 1.00 (53, Marketing Strategies and Techniques for Rehabilitation Services and 71, Dual Diagnosis in the Workplace). Three items generated a negative TN score (i.e., respondents indicated that they were more prepared than necessary based on importance rating of the topic): eight (group counseling practices and interventions), seven (group counseling theories), and one (historical and philosophical foundations of rehabilitation counseling).

Training needs by certification

The second research question asked, “Do perceptions in need for training differ between CRCs and non-CRCs in our sample of private rehabilitation counselors?” MANOVA was conducted to detect differences between CRCs (376) and non-CRCs (34) in perceived training needs in the 10 CRCC-specified knowledge domains, as well as overall. Significant differences were found for Domain 1 (Assessment and Evaluation), F = 8.04, p = .01; Domain 5 (Foundations of Counseling, Professional Orientation, and Ethical Practice), F = 6.94, p = .01; and Domain 7 (Mental Health and Healthcare Advocacy), F = 4.36, p = .04; as well as for Factor 2 (Case Management and Community Resources) overall, F = 5.33, p = .02; with higher reported training needs for individuals without CRCs. These results should be treated with caution due to the differences in sample size between the two groups.

Training needs by demographics

The third research question asked, “Are there counselor demographic variables that are significantly related to self-reported training needs?” Specifically are a counselor’s gender, age, years of experience, highest degree earned, number of certifications held, and work location (rural vs. urban) significant predicators of need for training? Multiple regression analyses were conducted to determine which, if any, demographic variables were significant predictors of the overall TN score, as well as the TN scores for each of the 10 knowledge subdomains (see Table 2). Respondent’s gender predicted total TN as well as TN on all knowledge domains except Domain 1 (Assessment and Evaluation), Domain 2 (Job Development and Placement Services), Domain 6 (Individual, Group, and Family Counseling), and Domain 8 (Medical, Functional, and Psychosocial Aspects of Disability), see Table 3. These results should be interpreted with caution, however, due to unequal group sizes (278 females and 132 males). In addition, years of experience was significantly related to lower training need for Domain 6, F = 1.964, p = .05.

Table 3.

Multiple Regression: Gender and Training Need on the KVI-R (n = 412).

D variable	R	R ²	F	p
Overall training need	.136	.019	1.503	.038
Factor 1	.152	.023	1.88	.029
Factor 2	.173	.03	2.456	.002
Factor 3	.147	.022	1.767	.069
Factor 4 (Domain 8)	.119	.014	1.138	.159
Misc. factor (Domain 5)	.136	.019	1.503	.038
Domain 1	.114	.013	1.04	.172
Domain 2	.14	.019	1.58	.123
Domain 3	.138	.019	1.535	.035
Domain 4	.168	.028	2.324	.002
Domain 6	.155	.024	1.964	.351
Domain 7	.168	.028	2.322	.004
Domain 9	.163	.027	2.176	.009
Domain 10	.142	.02	1.648	.032

Note. KVI-R = Knowledge Validation Inventory–Revised.

Qualitative

Population-specific training needs

Of the 412 respondents included in the above analyses, 410 (99.5%) answered the open-ended question at the end of the survey regarding population-specific needs. The populations most frequently cited as “significantly growing in their need for rehabilitation counseling” were “mental HEALTH,” noted by 102 (24.76%) of respondents; “veterans,” 70 (16.99), “aging/elderly,” 68 (16.5%), “traumatic brain injury,” 63 (15.29%), “dual diagnosis,” 45 (10.92%), and “autism spectrum disorders,” 40 (9.71%) were also each noted by a significant number of respondents. For a full breakdown of responses, see Table 4.

Table 4.

Populations Identified by Participants as Fastest Growing in Need for Services (n = 412).

Population	Frequency	%
Mental health	102	24.76
Veterans	70	16.99
Aging/elderly	68	16.50
Traumatic brain injury	63	15.29
Dual diagnosis	45	10.92
Autism spectrum disorders	40	9.71
Substance abuse	39	9.47
Injured workers/workers’ compensation	30	7.28
Multicultural/ESL	28	6.80
Youth/transition	20	4.85
Correctional/forensic	15	3.64
PTSD	15	3.64

Note. ESL = English as a second language; PTSD = post-traumatic stress disorder.

The follow-up question, “How prepared do you feel to work with that population?” had the following responses: 3 (0.7%) rated their level of preparedness as “not at all,” 34 (8.2%) chose “only slightly,” 163 (38.4%) chose “moderately,” 159 (37.5%) selected “well,” and 56 (13.2%) selected “extremely well.” The mean preparedness rating was 2.6, between “moderately” and “well.” It should be noted that more than three quarters of respondents (376; 91.3%) reported feeling moderately, well, or extremely prepared to work with populations identified as fastest growing in their need for services.

Responses to the question, “What do you see as the most significant training needs for rehabilitation counselors in the field today?” were varied. Responses were coded by theme. Themes that were mentioned more than three times were considered significant. Significant responses included

multicultural competence (67%), private VR (52%), labor market research skills (43%), ethics (42%), forensic case management (36%), expert witness testimony techniques (35%), veterans’ issues (27%), evidence based treatments (22%), dual diagnosis (17%), emerging occupations (16%), DSM-5 (15%), counseling techniques (12%), assessment tools and healthcare providers (11%), fluidity of the job market (7%), consumer empowerment (5%), changes in the healthcare system (5%), building relationships with employers (4%) and online access to counseling (3%).

Percentages do not add up to 100% due to the fact that most participants included multiple responses, which provided a wide breadth of suggested training needs.

Discussion

The current study was conducted to examine the training needs of the private for-profit sector in the rehabilitation counseling field. In 1982, Lynch and Martin wrote about the paucity of research regarding the training needs for this particular role in the profession. In 32 years of growth, the majority of rehabilitation counseling research continues to narrowly focus on the public sector. We contend that the private sector utilizes different skills and interests that are unique to those working in the private domain.

Chan et al. (2003) and Zanskas and Strohmer (2011) wrote about the distinct differences between the public, private non-profit, and private for-profit sectors, most notably with the differences in work environment and in work identity, including roles and functions relating to disability management. Rehabilitation counselors in the private sector provide their expertise to employers, working with workers’ compensation or personal injury claims. The results of the study, both quantitative and qualitative findings, support this notion as the majority of the sample perceived a moderate to large need for further professional training in the private domain. Specifically, respondents felt the need for further training in case management and utilization of community resources, disability management, and vocational consultation and services for employers.

Zanskas and Leahy (2007) explained that knowledge about case management practices was highly relevant to private rehabilitation settings. Ethridge et al. (2007) noted that private rehabilitation is “employer driven” (p. 28), which requires an enhanced skill in case management. In addition, Ethridge et al. posited that private rehabilitation practices take a preventive approach due to the increased emphasis on disability management. In an earlier study, private rehabilitation counselors articulated a need for developing their skills for disability management, use of Internet modalities, workers’ compensation laws, benefits for employees, and work accommodations (Chan et al., 2003). Prior research and the findings of the current study suggest a focus on training that addresses case management and disability management as it relates to the private rehabilitation counseling. The provision of training in these specific areas could foster a higher level of care, improved VR outcomes, and increased competency in preventative measures in the private sector.

The research literature indicates that rehabilitation counselors have expressed a desire for a more integrative knowledge base that prepares them to work with a diversity of clients. Chan et al. (2003) identified rehabilitation counselors’ overall desire for more training in the clinical counseling domain. Specifically, we noted that knowledge, regarding multicultural counseling, substance abuse counseling, and diagnosis, should be the primary focus for rehabilitation counselor training needs. The sample of the current study indicated that the populations most frequently cited as “significantly growing in their need for rehabilitation counseling” were people with mental health disorders, veterans, the aging/elderly, people with TBI, dual diagnosis, and autism spectrum disorders. When asked how prepared the participants are to work with these populations, the majority of respondents indicated that they feel “moderately” prepared. These findings are in line with those of Accordino et al. (2009), who asserted that further knowledge of psychopathology may better prepare rehabilitation counselors to effectively manage the barriers facing reintegration into the workforce. The qualitative findings also suggested the need for further training to increase multicultural competence when working with diverse consumer populations.

When comparing the articulated training needs of CRCs versus respondents without the CRC credential, significant differences were found for Assessment and Evaluation, Mental Health and Healthcare Advocacy, Case Management, and Community Resources overall, with higher reported training needs for individuals without CRCs. This finding indicates that though there is some overlap in the identified training needs of CRCs and non-CRCs, there may be differences in training needs that warrant further study. Prior research (Froehlich & Linkowski, 2002; Szymanski et al., 1993) found that the CRC credential influenced the training needs of state-federal rehabilitation counselors. However, these studies were completed 10 to 20 years ago, before the Comprehensive System of Personnel Development (CSPD) requirements were being implemented for master’s level training and before the CRC requirements for new rehabilitation counselors. In addition, these studies were focused on state-federal rehabilitation counselors, not on private rehabilitation counselors.

Demographic variables including gender and number of years in practice were found to be the most significant predictors of respondent’s total TN. Gender predicted TN on all knowledge domains except Assessment and Evaluation, Medical, Functional, and Psychosocial Aspects of Disability, and Individual, Group, and Family Counseling. This could be due to a greater willingness among women to seek out assistance and training (Feingold, 1994) or simply be a reflection of the unequal ratio of male and female participants in the current study. These results should be interpreted with caution, however, due to unequal group sizes.

Number of years in practice predicted the need for Individual, Group, and Family Counseling with a lower TN. This finding is consistent with prior research (Leahy, Muenzen, Saunders, & Strauser, 2009) and underscores the value of hands-on, clinical experience. It makes sense that rehabilitation counselors who had several years of clinical experience working with clients who have various types of disabilities would have lower TN scores than inexperienced counselors who have worked with fewer clients. Also, the on-the-job training, staff development, and continuing education credits required for renewal of certification and licensure would presumably affect training needs, as increased exposure to continuing education and staff training would be, most likely, correlated with decreased training needs. Correlations of this nature, however, are beyond the scope of the current study.

Participants provided a variety of responses when asked to describe the training needs of private rehabilitation counselors. Of particular note, several participants indicated training needs directly related to forensic rehabilitation counseling such as “expert witness testimony techniques,” “labor market research,” and “forensic case management.” These data are in line with the current research on the need for rehabilitation counseling curricula to expand to include forensic rehabilitation counseling content. Forensic rehabilitation counseling is the largest growing subset within the practice of rehabilitation counseling (Barros-Bailey, Benshoff, & Fischer, 2008). According to Marini et al. (2003), rehabilitation counselor education programs are not adequately preparing graduates for forensic rehabilitation employment settings. The data collected in the current study illustrate a perceived need among private rehabilitation counselors to have the opportunity to engage in more in-depth forensic rehabilitation counseling training.

Study Limitations

Although every effort was taken to utilize sound methodology, including descriptive, qualitative, and ex post facto approaches for the study, several limitations should be taken into consideration. The first limitation of the current study relates to the research sample and the study’s external validity. Although the sample size of this study (N = 426) was appropriate for the analyses completed, a larger sample would increase the generalizability of the findings. A second potential limitation related to the sample is self-selection bias. Self-selection bias occurs when the group being studied has any form of control over whether to participate. Lavrakas (2008) posits, “Self-selection will lead to biased data, as the respondents who choose to participate will not well represent the entire target population” (p. 808). Participants’ decision to participate may be related to traits that could potentially affect the study, thus, the participants who completed the survey may be a non-representative sample. The data collected were obtained via self-report, which is also understood as a potential threat to validity. The final limitation is the lack of generalizability inherent in the nature of qualitative research. Merriam (2009) explored the question of validity and reliability as related to qualitative research. She wrote, “A main assumption underlying qualitative research is that reality is holistic, multidimensional, and ever-changing; it is not a single, fixed objective phenomenon waiting to be discovered, observed, and measured as in quantitative research” (p. 213). The current study is exploratory and therefore, we utilized qualitative methods as a way to delve deeper into a topic that has had only a minimal amount of prior research.

Suggestions for Future Research

Future research could be expanded to include counselors from every region in the United States and should examine self-reported ratings of private training needs to other measures such as rehabilitation and employment outcomes. An examination of the relationship between self-assessment of training needs and ratings from supervisors, clients and job performance evaluations would lend additional validity to assessing the training needs in this manner. Research that compares and contrasts the training needs of rehabilitation counselors working in the public domain and counselors practicing in the private-for-profit, proprietary, and forensic sectors should be conducted and would increase the validity of the findings. In addition, future studies could delve deeper into specific training needs that were found in the current study. For example, several participants noted in both qualitative and quantitative responses that there is a need for more extensive training on veterans’ issues and multicultural competence. Further research could provide a more narrow focus on how counselor educators can better equip rehabilitation counselors in these specific areas of training.

Conclusion

The results from this study indicate a self-reported need for additional training of private rehabilitation counselors in many of the knowledge domains considered essential for rehabilitation counseling. The findings also indicate that as the number of years in practice and clinical experience increased among this sample, the need for training decreased. Prior research found that the CRC credential influenced the training needs of rehabilitation counselors. In this sample of rehabilitation counselors, multivariate analysis detected differences between the two groups. However, due to the significant differences in sample size this result should be treated with caution. The rehabilitation counseling profession is currently at a turning point regarding the qualifications of rehabilitation personnel (i.e., ending of CSPD requirements). This study provides qualitative and quantitative evidence in support of additional education for rehabilitation counselors. Rehabilitation counselors working in the private sector require increased training as the diversity of consumers broadens to include a vast breadth of racial and ethnic identity, intellectual, mental, and physical disability and an influx of returning veterans.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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