Academic journal article The Journal of Rehabilitation

Empowerment Variables as Predictors of Outcomes in Rehabilitation

Academic journal article The Journal of Rehabilitation

Empowerment Variables as Predictors of Outcomes in Rehabilitation

Article excerpt

Outcome assessment was made a focus in rehabilitation counseling in the Rehabilitation Act Amendments of 1973, in which rehabilitation programs were required to show that they could effectively and efficiently meet service outcome goals (Rubin & Roessler, 2001). In subsequent years, this focus has grown and expanded both in legislative mandates and across rehabilitation counseling settings. Evidence based rehabilitation counseling practice involves applying interventions for which a link between the intervention and a designated outcome has been empirically shown to exist. As attention to evidence-based outcome assessment has increased, so have efforts to identify, operationalize, and organize rehabilitation outcome goals (e.g., Arokiasamy, 1993; Bolton, 2001; Livneh, 1988a,1988b) as a means of both defining the profession and improving rehabilitation counseling practice.

A number of outcomes have been identified as being important goals of the rehabilitation counseling process. Traditional outcome goals in rehabilitation counseling include employment status, functional status, or income status. These goals have frequently been unidimensional and functionally-based (Fabian, 1991; Mermis, 2005). A number of broader, more general constructs have also been proposed that may be considered superordinate, or overriding rehabilitation goals. These more abstract constructs include: enhanced quality of life (QOL; e.g., Bishop & Feist-Price, 2002), independence or autonomy, enhanced control over one's life (e.g., Olney & Salamone, 1992), adaptation or adjustment to disability (Livneh, 1988b, 2001), and empowerment. This latter construct is the focus of the present research, because empowerment, though certainly one of the most frequently discussed and pursued rehabilitation outcomes has proven perhaps the most difficult to define and, therefore, associate with rehabilitation interventions. Researchers have begun to recognize and describe empowerment as multifaceted and situational. Much like satisfaction, its meaning can vary and change contextually (e.g., systematic or individual). Empowerment has been described as both a process and an outcome (Clark & Krupa, 2002; Zimmerman & Warchausky, 1998). Empowerment is a term that has been difficult for researchers to operationalize, but one that has become part of popular culture and especially rehabilitation philosophy (e.g., Linhorst, 2006). Because the term has many meanings in public perception and professional philosophy, when an organization indicates a desire to "empower" its clients, there is no common understanding of what may be done to produce such an outcome.

Parsing Empowerment

Due to the lack of specificity of the term empowerment, researchers have frequently sought to define and give theoretical meaning to the term (e.g., Bolton & Brookings, 1998; Kosciulek, 2005; Linhorst, 2006; Zimmerman & Warschausky, 1998). Rehabilitation researchers have been at the forefront of this movement. Kosciulek (2005) used five items from a self-esteem scale that he felt represented empowerment as applied to a consumer-directed theory of empowerment. Those five items concerned control, competence, responsibility, participation and future orientation (Kosciulek). Bolton and Brookings (1998) examined the rehabilitation literature with a specific focus on the interpersonal component of empowerment. Their review provided a 20-item taxonomy of characteristics of empowered persons with disabilities.

In a similar vein, in the present study we have attempted to move empowerment

from a theoretical concept to a well-defined, multidimensional construct comprised of empirically measurable variables. Using Bolton and Brookings as an overview we investigated the empowerment literature for themes of empowerment. We concluded that the concept of empowerment may be operationalized in terms of the following variables: control, assertiveness, competence, self-esteem, and action/participation in the community. …

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