Relationship of rehabilitation counselors' ethnicity match and cultural competency to service provision and employment outcome for vocational rehabilitation consumers

textThe purpose of this dissertation is to explore whether rehabilitation counselor/consumer racial similarity is related to rehabilitation services provided and employment outcomes achieved. This research contributes additional information to the research base on how to educate and train practicing vocational rehabilitation counselors to support culturally and linguistically diverse (CLD) consumers more effectively. Information regarding racial dyads may help to articulate whether CLD counselors are more effective with CLD consumers. Utilizing the RSA-911 data file submitted by California for fiscal year 2006 as well as 189 Multicultural Counseling Inventory (MCI) surveys collected on practicing vocational rehabilitation counselors, ANOVA, MANOVA, ANCOVA and chi-square analysis were used to measure relationships among counselor and consumer dyads that were either similar or dissimilar in ethnicity and case service variables and outcome variables. Additional analysis focused on the influence of high versus low cultural competency of rehabilitation counselors and the same consumer case service and outcome variables. Study results revealed statistically significant differences on MCI total scores between counselor ethnic groups, with Hispanic counselors demonstrating the highest mean scores overall on the MCI. In addition, significant differences existed between counselor ethnic groups on MCI total scores, as well as all four subscale scores. Chi-square was used to investigate the effect of counselor ethnicity and cultural competency scores on the case service variables of job search, rehabilitation technology, maintenance and college training, as well as outcome variables of competitive employment. MANOVA and ANCOVA were used for the continuous outcome variables of cost of services, wages at closure and weekly earnings at closure. Significant chi-square results were found for some of the service and outcome variables for both the matched counselor/consumer dyads and the counselor competency score groups. More significant findings existed in the ANCOVA analysis for cultural competency scores than for matched ethnicity groups. Implications of the findings and suggestions for future research are discussed.Special Educatio

Retrospective analysis of screening for concussion: The neuro/psychological consequences of war and violent conflict

The objectives of this presentation are: 1. to define TBI and what research can tell us about TBI 2. Outline concussion screening and research database at Landstuhl Regional Medical Center 3. Describe the scope of the retrospective study 4. Discuss implications for supporting service members, and family members with greater awareness and education on concussion.The neuro/psychological consequences of war and violent conflict Define TBI and what research can tell us about TBI Outline concussion screening and research database at Landstuhl Regional Medical Center Describe the scope of the retrospective study Discuss implications for supporting service members, and family members with greater awareness and education on concussion A traumatically induced physiological disruption of the brain function as indicated by at least one of the following: Any period of loss of consciousness Any loss of memory for eventsimmediately before or after the accident Any alteration in mental stateat the time of the accident Focal neurological deficitsthat may or may not be transient DoD definition 2007 Landstuhl Regional Medical Center screens all service members coming from theater for potential concussion TBI has been a major cause of mortality and morbidity, with blast injury the most common cause (O’Hanlon & Campbell as reported in Elder & Cristian, 2009). Not all blows or jolts to the head result in a TBI The severity of a TBI may range from “mild” to “severe” The terms concussion and mild TBI are interchangeable www.dvbic.orgSeverity GCS AOC LOC PTA Mild 13-15 <24 hrs 0-30 min <24 hrs Moderate 9-12 >24 hrs 30 min-24 hrs >24 hrs-<7 days Severe 3-8 >24 hrs >24 hrs. >7 days GCS = Glasgow Coma Scale AOC = Alteration of consciousness/mental state LOC = Loss of consciousness PTA = Posttraumatic amnesia *Positive Neuro imaging increases the severity to at least a moderateTraumatic Brain Injury Blunt (Closed)Penetrating ExplosionFallGSWSTAB BlastFragment Motor vehicle crashes (MVC)www.dvbic.org Primary Direct organ injury resulting from blast overpressure wave Secondary Kinetic energy from blast puts objects in motion that can strike the head Tertiary Kinetic energy from blast puts the person in motion Thrown into stationary objects Quaternary Burns Inhalation injuries Least likely blast mechanism to cause CNS injury Caused by high velocity mechanism 3 actual impacts Body into stationary object Skull into stationary object Brain into skull Forward to backward (or vice versa) Side to side Up to 25% of those with a concussion do not seek medical attention (1) Many of those who receive medical attention do not have a TBI diagnosis recorded, esp. if they have multiple traumas (2) (1) Sosin DM et al. The incidence of mild and moderate brain injury in the United States 1991, Brain Inj 1996; 10 47-54 Brain Injury (2) Moss NEG et al, Admissions after a head injury: How many occur and how many are recorded. Inj 1996; 27 156-161 Single concussion increases the risk of additional concussions Slower and more difficult recovery times reported with subsequent concussion More severe symptoms Guskiewicz et al., JAMA 2003 Repeat concussions –more morbidity (Collins, et al, Neurosurgery 2002) Association of recurrent concussion and late-life cognitive impairment in retired Pro-football players (Guskiewicz et al, Neurosurgery 2005) Repetitive head injury increases the chance of Chronic Traumatic Encephalopathy(CTE) in Athletes: Progressive Tauopathy ( McKee et al, J Neuropathol 2009) Natural history is recovery within weeks/months (Levin 1987) A small percentage will have persistent symptoms (Alexander, Neurology 1995) Educational interventions effective in reducing symptoms (Ponsford, et al. 2002) Help in early identification of potential concussion; enhance awareness and education of recovery from concussion. Identify those soldiers that may need further evaluation and clinical confirmation of symptoms Database providing surveillance on population since 2007 Help to support service members and families in understanding concussion recovery• Did they have an event? • Did it cause them to have a: • Loss of Consciousness (LOC) or •Alteration of Consciousness (AOC) or • Post Traumatic Amnesia (PTA) • Are they having any symptoms? • GET THE STORY!Physical Headache Dizziness Balance Problems Nausea/Vomiting Fatigue Visual Disturbances Light Sensitivity Ringing in the Ears Sleep Disturbances Emotional Anxiety Depression Irritability MoodSwings Cognitive SlowedThinking Poor Concentration Memory Problems Difficulty Finding WordsCognitive Deficits Depression Flashbacks Re-experiencing phenomenon Anxiety PTSD Headache Nausea Vomiting Dizziness TBI Avoidance Hypervigilance Nightmares Fatigue Irritability Insomnia Vision Problems Sensitivity to light or noiseSleep Headache Irritability/ Mood Cognitive mTBI Symptom Interaction Major Research Question: What care and recovery pattern trends are evident following their screening for concussion as identified in the AHLTA record based on frequency of visits for concussion symptom complaint, specialty services consulted, and length of time of symptom complaint for those service members Service members who screen into three population groups? Three groups of patients Negative screen----positive symptoms Positive screen----positive symptoms Positive screen----negative symptoms Study year 2010 N=approximately 6,000 random sample for n=75 in each group Tracking major symptom complaint and care over 1styear post deployment • Provide information and education on symptoms and recovery • Educate about prevention of further injuries • Reassure on positive recovery expectation • Empower patient for self management - Provide sleep hygiene education -Teach relaxation technique

LRMC synapse program: Helping service members with TBI

This report defines the causes and symptoms of Traumatic Brain Injury (TBI). It also describes the Synapse program at the Landstuhl Regional Medical Center, which has been developed in order to screen and treat TBIs.March 23, 2012 Kaiserslautern American Page 23 by Dr. Kendra Wagers Landstuhl Regional Medical Center, rehabilitation psychologist/TBI research coordinator Traumatic Brain Injury has been called the signa-ture injury of the wars in Afghanistan and Iraq, and after 10 years at war, many of our service members have been repeatedly exposed to events that have the potential of causing a brain injury. More than 1 million military personnel have deployed since 2001 in support of Operation Enduring Freedom in Afghanistan or Operations Iraqi Freedom and New Dawn in Iraq. Current deployment operations have involved service mem-bers in ground combat and hazardous security duty. TBI is the most prevalent injury among warfight-ers during OND, OIF and OEF as a result of contact with enemy forces or weapon systems - mortars, improvised explosive devices, rocket-propelled gre-nades - and from head impacts from accidents, enemy action or other factors. Deployment, therefore, could include being exposed to gun shots, blast exposures and other significant potential TBI generating events. Given the significant length of the war and repeated deployments of service members to dangerous duty assignments downrange, there is an increased risk of exposure to possible TBI events as well as increased risk of increased symptoms arising from repeat exposures. Landstuhl Regional Medical Center has developed an intensive rehabilitation program to help, called Synapse, which focuses on providing care to service members who experience TBI. This interdisciplinary team approach was devel-oped as a response to the dynamic nature of poten-tial TBI events service members could experience. Service members at war are particularly at risk of TBI, resulting from combat blast injury, which is usually characterized as resulting from primary (e.g., exposure to over pressurization wave from blast), secondary (e.g., impact from blast, debris), tertiary (e.g., impact after displacement), or qua-ternary (e.g., burns, inhalation of toxins, hypoxia, psychological effects) blast effects. Such blasts effects can produce profound trau-matic injuries in the brain, including damage to the parts of the brain that make vision possible, affect auditory processing, impact balance and coordina-tion, impair cognitive functioning, and/or impede occupational performance. Our team of clinicians works to collaborate and individualize care for our service members, to educate them on the recovery from injury, and foster greater understanding of what they can do to protect themselves. LRMC’s Synapse program has a strong clinical team consisting of three TBI neurology providers, a clinical psychologist, a TBI optometrist, an audiolo-gist, two physical therapists, two speech therapists, an occupational therapist, a rehabilitation psycholo-gist and several nurse case managers. The entire team evaluates service members experiencing TBI and determines if intensive services would support the service member in their return to full duty. Providers often collaborate on care evaluating the patient in an integrated service delivery environ-ment to maximize therapeutic gain. The intensive program at Landstuhl is individually developed to meet a service’s unique symptom presentation and can be a few weeks or up to eight weeks long as appropriate. The team also works closely with command to review job function and performance and tailor treatment toward addressing specific job capacities each service member may need to function within their military occupational specialty. Follow-up ser-vices and treatment plans are developed at discharge and can often be implemented via telemedicine, home therapy programs or with local providers at the patient’s home base of record. A vital component to our discharge and follow-up plan is educating service members and their support system on engaging in their own recovery and con-sidering all the factors in their lives that influence a positive course of rehabilitation. A positive course of recovery from brain injury begins and ends with education. Education and out-reach to command is not only an integral part of the intensive program, it frames our service delivery. Every component of our intensive program empha-sizes the importance of a holistic and dynamic recovery process. As one TBI specialist has written, re-framing how we think about an issue to create a positive outlook can be a vital part of recovery. Developing awareness, understanding and educa-tion on the expected course of recovery from brain injury creates empowerment. Empowerment is how we build function, create a sense of normalcy and develop self efficacy. Efficacy powers us toward our goals. The goal of the intensive Synapse program is to offer a comprehensive intensive TBI program that complements the TBI care throughout the European theater. We also work closely with TBI providers throughout the European theater to coordinate care, disseminate educational resources and foster recov-ery. Our mission is to not ameliorate symptoms but foster understanding and recovery. If you would like to learn more about the pro-gram, call the LRMC TBI Rehab Clinic at 590-5601 or 06371-9464-5601. LRMC Synapse Program: Helping service members with TB