What are the required
competencies of the "effective"
Comparing perspectives of service users,
service providers and
David Roe, Ph.D. Associate Professor and Chair, Department of
Community Mental Health
Faculty of Social Welfare & Health Sciences,
University of Haifa, Haifa, Israel.
Adi Telem, M.A. Graduate student, Department of Community Mental
Faculty of Social Welfare & Health Sciences, University of Haifa,
Haifa, Israel.Vered Baloush-Klienman, Ph.D.
Ministry of Health, Israel.
Marc Gelkopf, Ph.D. Associate Professor at Department of Community
Faculty of Social Welfare & Health Sciences
Haifa, Haifa, Israel.
Abraham Rudnick, M.D. Associate Professor
Departments of Psychiatry and
Philosophy and Chair
Division of Social and Rural Psychiatry, University of
Physician-Leader, Psychosis Program, Regional Mental Health
Care, London, Ontario, Canada.
Roe D, Telem A, Baloush-Klienman V, Gelkopf M & Rudnick , A.(2010).
What Are The
Of The "Effective" Psychiatric Rehabilitation Practitioner? Comparing Perspectives Of Service Users, Service
And Family Members. International
Journal of Psychosocial Rehabilitation. Vol
and objective: Research findings and conceptual developments have
generated growing optimism that with appropriate resources and
opportunities many persons with serious mental illness (SMI) can
achieve recovery and related community integration. It is essential to
identify how front line psychiatric rehabilitation service providers
(PRPs) can facilitate this process. This study aimed to identify the
skills, knowledge, attitudes, and values required from the effective
PRP. Method: During the first stage, focus groups were conducted
with a group of service users , a group of family members and a group
of PRPs. Based on these and on a review of the literature, we found
interpersonal, professional, rehabilitation, planning and evaluation
skills, and access to community resources to be the major competencies
required of the PRP. This list was developed into a questionnaire and
administered to 34 service providers, 35 service users, and 33 family
members which required a forced choice rating of each of the
competencies based on their degree of importance. Results: There were
few differences in the way service providers, service users, and family
members rated the importance of these competencies. Conclusion:
Key stakeholders (service users, service providers and family members)
appear to agree in general about the key competencies required from the
PRP, suggesting that the needed competencies may be universal and
independent of cultural context. Implications for training and
education are discussed.
Key words: competencies, practitioners, psychiatric rehabilitation, stakeholders
Historically, services for people with serious
mental illness (SMI) in Israel included mainly psychotropic medication
and limited psychotherapy often dispensed during long psychiatric
hospitalizations, some of which lasted decades. A milestone in the
development of psychiatric rehabilitation services (PSRS) was reached
with the recent legislation concerning the rehabilitation in the
community of people with psychiatric disabilities (The Rehabilitation
of Psychiatrically Disabled Persons in the Community Act., 2000). The
legislation specifies a "basket" of PSRS to be provided to service
users who meet eligibility requirements, As a result, in the last
decade more than half the psychiatric hospital patients in Israel were
discharged into the community, resulting in a decrease from 1.17 per
1,000 people hospitalized in psychiatric hospitals in 1996 to 0.45 in
2008 (Aviram, in press). Currently, approximately 14,000 persons with
psychiatric disabilities who meet eligibility requirements are
receiving PSRS in the community. The provision of adequate services in
the area of psychiatric rehabilitation requires service providers with
appropriate competencies. The importance of identifying these
competencies is manifest in reports by supervisors of rehabilitation
service providers on the need for efficiency on the job (Marrelli et
al., 2005). For example, in a survey conducted among 81 employers of
PSRS in the U.S., one third ranked their employees as "unprepared,"
lacking experience, lacking procedural knowledge in work with
consumers, having deficient interviewing skills, being unable to plan
rehabilitation programs, and deficient in group leading skills
(Fishbein & Holland, 1993). Lack of competencies among a broad
segment of service providers is perceived as a barrier to recovery and
community integration for persons with SMI (Kevin, 2007; Marrelli,
Tondora & Hoge, 2005; Morris & Stuart, 2002; Young et al.,
2005). There is thus, a clear need for identifying the competencies
required from rehabilitation service providers (note that in this
paper, as in practice, the term competencies is used both broadly, to
address various types of professional abilities, and narrowly, to
address observable abilities).
The United States Psychiatric
Rehabilitation Association (USPRA) provided a useful definition (2007)
of psychiatric rehabilitation (PSR) and of the goals of PSR services,
but far less attention has been paid to define the PRPs who provide
these services. In order to improve the training and education of PRPs,
it is important to characterize the competencies - approaches, skills,
knowledge, and values - required from them.
A small number of
empirical studies have focused on such efforts. In a study that
attempted to identify the competencies required from PRPs (Coursey,
2000), a 28-member panel of experts was assembled, with varied
backgrounds in mental health and rehabilitation. The panel found 12
sets of competencies required from psychiatric rehabilitation service
providers. In another comprehensive study (Young, Forquer, Tran,
Starzynski & Shatkin, 2000), 37 competencies were found in seven
different areas. Finally, the International Association of Psychosocial
Rehabilitation Services (IAPSRA, 2000), initiated a panel of six
experts of the Association to identify and determine the professional,
personal, and interpersonal competencies required from graduates of
psychiatric rehabilitation programs. The objective of the panel was to
initiate the first steps in determining areas of professional
responsibility for students obtaining certification in psychiatric
rehabilitation. To this end, a test was devised to examine the areas of
responsibility, knowledge, values, and competencies of psychiatric
rehabilitation service providers. Subsequently, 1,000 service providers
were asked to validate the test, its clarity, and its relevance to the
field. Following the work of the panel, several areas were specified as
defining the criteria that every person entitled to a certificate as a
psychiatric rehabilitation professional must meet (IAPSRS, 2000).
the reviewed studies emphasize the importance of competencies related
to the relationship between the rehabilitation practitioner and the
consumer; to the ability to diagnose and evaluate; to advance
rehabilitation and facilitate empowerment; to provide
therapeutic, family, and supportive interventions; and to advance
resources and coordination (Coursey et al, 2000; Young et al., 2000;
IAPSRS, 2001). Competence is also needed to emphasize the fact that the
rehabilitation process is unique and individualized, and for the
rehabilitation practitioner to shape, evaluate, and document the
interventions. Also important are skills needed for the rehabilitation
practitioner to cooperate within the organization and with other
organizations and to conduct professionalism and follow ethical norms
and toward the endeavor to expand knowledge and develop a professional
creed. Finally, important skills are related to the service providers'
ability to seek support from colleagues and remain updated regarding
the professional literature.
In order to improve the
qualification process of PSR service providers, and consequently, the
quality of the services they offer, it is necessary to define with
greater precision the competencies - approaches, skills, knowledge, and
values - required from them. This is particularly so as the previous
studies, as noted above, focused on professional experts as primary
sources of information and validation,whereas service users and their
family members should also have a say in this matter, particularly in
order to upkeep a recovery orientation (DHHS, 2003). The purpose of the
present study, therefore, was to identify the skills, knowledge,
attitudes, and values required from the effective PSR practitioner
considering multiple perspectives of key stakeholders.
design. This mixed design study combined qualitative focus group
studies and a quantitative study. Both were informed by three different
groups of stakeholders: service users, service providers and family
members (of consumers). Written informed consent was obtained from all
Qualitative Focus Group Studies
Three groups of stakeholders met separately:
service providers' group. Two groups which together included 19 service
providers (14 women and five men aged 23-40) from the field of
psychiatric rehabilitation included service providers from
various disciplines (social work, psychology, occupational therapy,
community mental health workers). They had a bachelor's degree or more
advanced education and worked in a variety of rehabilitation agencies
and organizations, such as hostels and assisted living arrangements,
and at rehabilitation centers that agreed to take part in the focus
group about the effective PSR practitioner.
group. This group was made of 11 service users with SMI (3 women and 8
men aged 28-40) receiving rehabilitation services.
members' group. This group consisted of 8 family members of service
users (7 women and 1 man, aged 45-60), actively involved in their
family member's life and in touch with the PSR service providers.
3 focus groups were convened in 2007. All participants agreed to take
part in discussions, which were based on a semi structured group
interview guide, about the effective rehabilitation practitioner in
mental health care. Participants were asked open ended questions such
as "What do you think makes for an effective psychiatric rehabilitation
practitioner" and "What knowledge, values and skills would you expect
an effective psychiatric rehabilitation practitioner to have"?.
The focus groups convened once for an hour and a half under the
guidance of the 2nd and 3rd authors.
Method of analysis
discussion of the focus groups was audiotaped and transcribed. The 3
first authors performed a cross-case content analysis (Patton, 1990),
identifying and coding themes across cases. Subsequently, they examined
their individual analyses comparatively, discussing differences and
seeking agreement on prominent recurrent elements and central themes
and assembling them into categories of skills, knowledge, attitudes and
The data obtained from the focus groups answered the
first research question: What skills, knowledge, attitudes and values
are required from effective PSRs according to the three groups of
stakeholders (service users, service providers and family members).
The study sample was divided into three groups of stakeholders:
service providers' group. This group included 34 service providers (28
women, 6 men aged 26-60), who provide front line PSRs to people with
SMI. The sample of service providers were of various disciplines
(social work, psychology, occupational therapy, community mental health
workers) and had a bachelor's degree or more advanced education. They
worked in a variety of rehabilitation agencies and organizations.
users' group. This group was made of 35 service users with SMI
(21 women and 14 men aged 24-52) receiving psychiatric rehabilitation
services. This group was sampled from a wide range of PSRs (such as
residential and employment services) and was recruited through
convenience sampling, some at an annual consumers' conference and
others through various PSRs.
Family members' group. This group
consisted of 33 family members of service users (20 women and 13 men,
aged 26-81), actively involved in the consumers' lives and in touch
with rehabilitation service providers. They were recruited by
convenience sampling through various psychiatric rehabilitation
The total number of participants in the quantitative study was 102.
Study Sample Characteristics Questionnaire
Items common to all three groups: gender, age, marital status, employment.
for Service users: education, independence (measured by degree of
independence from the point of view of living arrangements),
psychiatric diagnosis, age at onset of disorder and number of
Items for rehabilitation service providers:
Education, area of specialization, seniority.
evaluate the service providers' attitudes toward rehabilitation and
consumers, we used the Psychiatric Rehabilitation Beliefs, Goals, and
Practices Scale (PRBGP; Casper, Oursler, Schmidt & Gill, 2002).
This questionnaire has shown excellent convergent and discriminant
validity (Casper, 2005).
Evaluation of the importance of competencies
evaluate and compare the importance each stakeholder group afforded
regarding the different competencies of the rehabilitation practitioner
in mental health care in the Israeli context we generated a tool, the
Competencies of the Rehabilitation Practitioner Questionnaire (CRPQ),
based on the results of the qualitative portion of the study and the
relevant professional literature (see Appendix 1). This questionnaire
included the essential competencies of the rehabilitation practitioner
that were mentioned in the focus groups and in the literature, which we
classified into 5 dimensions: (a) interpersonal, addressing the modes
of communication of the rehabilitation practitioner with the consumer;
(b) professional, relating to knowledge skills addressing mental
illness and psychiatric disability, medications and their side effects,
and professional ethics; (c) evaluation and planning, relating to
proper resource management and documentation, and evaluation of the
consumer's situation; (d) access to social resources, relating to a
holistic approach to the human condition and wide knowledge of existing
services being offered to this population; and (e) rehabilitation (or
recovery orientation), relating to the optimism of the service
providers and their faith in the persons who they serve. The
questionnaire was administered to the 3 stakeholder groups. All
participants ranked the items of the CRPQ on a 5-point scale (from
5=most important to 1=least important). So as to avoid having
participants respond the same way on each of the items a forced choice
method was used, whereby the same rank score (e.g., 4) cannot be given
more than once to a different skill. After all the questionnaires were
completed, the competencies of the effective rehabilitation
practitioner were grouped into two categories: more important (ranking
of 4-5) and less important (ranking of 1-3).
used descriptive statistics to characterize the groups of participants.
In the quantitative study to test the relations between the various
stakeholder groups and the ranking of competencies we performed χ2
tests. In addition, we performed t-tests and χ2 tests to assess the
relationship between demographic, professional and clinical
characteristics and the rating of competencies. Significance was set at
We present here first
the results of the qualitative study, followed by the results of the
quantitative study which elaborated upon the qualitative findings.
competencies of the rehabilitation practitioner from the point of view
of the three focus groups and the professional literature is presented
hereunder. No differences were observed in the competencies presented
by the three groups, and all points could be found in the professional
literature and included the following 5 categories. Interpersonal
skills: These include a positive and empathic approach toward
service users and their wishes, their backgrounds, and their peer group
(Young et al., 2000). The focus groups also stressed the importance of
conducting an honest, clear, and structured dialogue with the
consumer (Young et al., 2000; Coursey et al.,2000; IAPSRS, 2001).
skills: These include having knowledge about disorders, various methods
of treatment, medicines and side effects (Young et al., 2000; Coursey
et al.,2000; IAPSRS, 2001). The need for professional ethics, knowledge
about consumer rights and services offered to service users (Young et
al., 2000; Coursey et al.,2000; IAPSRS, 2001) was also noted. Service
providers were also required to be able to identify difficult
situations that require intervention and to be able to take measures to
minimize deterioration (Young et al., 2000).
Evaluation and planning
skills: These include the ability to conduct bio-psychosocial
interviews, complete functional and health evaluation forms (denture,
hearing, vision) (Young et al., 2000). Evaluation of the consumer's
state at any given moment and assistance in identifying situations that
enable growth and the gaining of strength was also considered as
central (Coursey et al.,2000; IAPSRS, 2001).
Skills related to
access to community resources: These include understanding of the
effect of the socio-economic status on the rehabilitation process
(Young et al., 2000); access to information and economic, employment as
well as social services that support the rehabilitation process in the
community (Young et al., 2000; Coursey et al.,2000; IAPSRS, 2001). The
importance of assistance connecting the consumer with other sources of
support (focus groups, Young et al., 2000; Coursey et al.,2000; IAPSRS,
2001), and coordination and supervision of these sources in order to
promote the rehabilitation process (Young et al.,2000) was also noted.
Follow-up and connection of the consumer with medical resources, and
maintenance of continuous treatment (Young et al., 2000; Coursey et
al.,2000; IAPSRS, 2001) and the need for struggle against
situations that discriminate against the service users in the community
(IAPSRS, 2001)was also stressed.
Skills related to
rehabilitation (or recovery orientation): including optimism, faith in
the potential of the consumer to grow and gain strength, and help in
building hope and self-empowerment was noted, holistic approach (Young
et al.). Assistance to service users in identifying and defining their
wishes and ambitions in a wide range of domains (focus groups, Young et
al., 2000; Coursey et al.,2000; IAPSRS, 2001) was considered important.
The ability to Teach service users a range of skills related to leading
an independent life, such as management of financial resources,
identifying and coping with crisis situations, establishing social
relations and acclimating within various frameworks, as independence
from case worker develops, was also identified (Young et al. 2000) .
Analysis of stakeholder groups and characteristics of the research groups:
mentioned, the research sample was divided into 3 groups:
rehabilitation service providers, service users and family members.
Tables 1 show the main characteristics of each group separately
Table 1. Description of
the stakeholder groups
Service Users (n=35)
Service providers (n=34)
Family members (n=33)
lives in couple
Did not answer
10 years or
Bi – polar
Don’t want to
NOTE: NR= not relevant
No differences were observed between the
three stakeholder groups regarding the demographic data, except for
family stakeholder group, which was found to be scientifically
older in comparison to the two other stakeholder's groups
(service users and service providers (One-Way Anova f(2)= 62.77
Assessing the relations between demographic, clinical
and professional attributes of the stakeholder groups and the ranking
of the competencies (see table 2) of the effective rehabilitation
practitioner, no significant relation was found.
Distribution of the Competencies of the Effective Rehabilitation Practitioner
assessing the relative importance participants gave to the different
competencies, results show that interpersonal, professional, and
rehabilitation skills were ranked as more important than planning and
evaluation skills and skills for accessing social resources.
Table 2. Mean score and mean ranking of
importance of the complete sample (N=102)
Type of competence
Rated as Important
Rated as Less Important
Skills for accessing social resources
Planning and evaluation skills
Ranking of the Competencies of the Effective Rehabilitation Practitioner:
Differences Between Stakeholder Groups
test the hypothesis that there are differences in the way in which
rehabilitation service providers, consumers, and family members
evaluate the competencies of the effective rehabilitation practitioner
we performed five 3 X 2 χ2 tests assessing whether on the five
competencies the 3 stakeholder groups rated each of the competencies as
being differentially important. Results are presented in Table 3.
Relation between the Ranking of Competencies and the Attitudes of the Rehabilitation Service providers
of the service providers' group were asked to complete the PRBGP to
test whether various attitudes toward rehabilitation and service users
was related to their ranking of the competencies of the effective
rehabilitation practitioner. Using t-tests comparing those who rated
each competency as important vs. less important on the total score of
the PRBGP, we found no relation between the rating of importance of
competencies and the PRBGP total score.
In sum, analysis of
the results shows that except for rehabilitation and professional
competencies, which were assessed as more important by service
providers and service users respectively, members of the various
research groups hold more or less the same opinion regarding the
effective rehabilitation practitioner.
quality of PRS provided depends to a large extent on the person
providing them. The need for research that attempts to identify the
competencies of the PRP arose in the past decade, primarily in the US
(Young et al., 2000; Coursey et al., 2000; IAPSRS, 2001). In the
literature, the key competencies of the rehabilitation practitioner are
distributed over a wide range of areas: personal, interpersonal,
professional, legislative, and cultural. There have been only a
few empirical attempts, however, to study this topic in a systematic
The present study investigated this issue in Israel,
using mixed methods as well as exploring and assessing the perspective
of three groups of stakeholders: consumers, service providers, and
family members. Findings indicate that on the one hand there is broad
agreement about the required competencies of rehabilitation service
providers in the field of mental health care, and on the other hand
there are some differences in the ranking of the degree of importance
of these competencies. Interestingly, the uniformity among the three
groups of stakeholders regarding the importance of competencies of the
rehabilitation practitioner was greater than the differences.
This finding is somewhat surprising, given that many studies in the
literature report disagreements between service providers and service
users. Studies that compared the attitudes of service providers and
service users found differences with respect to a broad range of areas
such as matters having to do with treatment (Roe, Lereya,& Fennig,
2001), rights (Roe, Weishut, Jaglom & Rabinowit, 2002), and the
strength of the therapeutic alliance, which has far-reaching
consequences for the effectiveness of the therapy (Junghan, Leese,
Priebe & Slade, 2007).
The qualitative portion of the
present empirical study examined the competencies of the effective
rehabilitation practitioner from the points of view of three focus
groups (consumers, service providers, and family members). In this
portion of the study no differences were found in the competencies of
the effective rehabilitation practitioner. This finding may reflect the
fact that psychiatric rehabilitation strives to include as many
relevant stakeholders in all forms of planning and implementation of
services, which when successful may manifest itself in agreement, as
revealed in the current study.
At the same time, a number of
differences between groups was identified. A significant
difference was found in the ranking of rehabilitation competencies. The
service providers group ranked these competencies as more important
than did the other two groups. An additional difference between the
groups was found in the ranking of professional skills. The group of
service users ranked these skills as being more important than did the
two other groups. This finding may reveal consumers wish feel safe and
well cared by well trained service providers, emphasizing the
need for their qualification and training in the relevant professional
disciplines. These findings are supported by those of several other
studies (Gill, Bagherian & Ali, 2005; Gill & Kenneth, 2005;
McReyholds, 2002). For example, in Gill's study (2005) a correlation
was found between education in fields relevant to rehabilitation and
success on the test that entitles professional workers to a certificate
of specialization in the field of psychiatric rehabilitation. In their
encounter with consumers, service providers must develop a professional
partnership with expert skills above and beyond the basic human
Limitations and implications:
The study has several
limitations. The sample was a convenience sample and relatively small.
The collected data were based on self reports which may have been
subject to various biases. The sample represents a population and
services (in Israel) that may not fully reflect populations and
services in other countries. The small sample size has also reduced the
ability of the statistical analysis to find significant differences
between the stakeholder groups. Still, this study is the first to have
surveyed PSR competencies and their relative importance from the
perspective of non-professional stakeholders, particularly service
users, and family members, who should have a major say in relation to
the type and quality of services provided to them. Future research
should attempt to replicate our findings, preferably with larger
samples and in other countries.
U. (in press). Promises and pitfalls on the road to a mental health
reform in Israel. Israel journal of psychiatry and related Sciences
E, S., Oursler,J., Schmidt, L, T., & Gill, K, J. (2002). Measuring
practitioners' beliefs, goals, and practices in Psychiatric
Rehabilitation. Journal of Psychiatric Rehabilitation, 25(3), 223-234.
E.S. (2005). A national sample of IAPSRS Members’ responses to the
psychiatric rehabilitation beliefs, goals and practices scale.
Psychiatric Rehabilitation Journal, 28, 282-289.
D., Curtis, L., Matsh, D.T., & Campbell, J. (2000). Competencies
for direct service staff members who work with adults with severe
mental illnesses in outpatient public mental health managed care
systems. Journal of Psychiatric Rehabilitation, 23(4), 370-384.
of Health and Human Services. (2003). Achieving the promise:
Transforming mental health care in America. President’s New Freedom
Commission on Mental Health. Final Report. Rockville, MD: Substance
Abuse and Mental Health Services Administration, U.S. Department of
Health and Human Services.
Gill, K. J. & Kenneth
(2005). Experience is not always the best teacher: Lessons from the
certified psychiatric rehabilitation practitioner certification
program. Journal of American Psychiatric Rehabilitation, 8, 151-164.
K, J., Pratt, C,W., Barrett, N. (1997). Preparing Psychiatric
Rehabilitation specialists through undergraduate education. Journal of
Community Mental Health, 33(4), 323-329.
Junghan, U, M., Leese,
M., Priebe, S., & Slade, M.(2007). Staff and patient perspectives
on unmet need and therapeutic alliance services. British Jurnal of
Psychiatry, 191, 543-547.
Kevin, H. H. (2007). A better mental health workforce & 8 core elements. Journal of Psychosocial Nursing, 45(3), 24-34.
A.F., Tondora J., & Hoge, M.A.(2005). Strategies for developing
competency models. Journal of Administration and Policy in Mental
Health, 32(5-6), 533-561.
Morris, J, A., & Stuart, W. (2002).
Training and education needs of consumers, families, and front- line
staff in behavioral health practice. Journal of Administration and
Policy in Mental Health, 29(4-5), 377-402.
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.).
US, California: Sage Publications.
D., Lereya, J., & Fennig. (2001). Comparing patients' and staff
members' attitudes: Does patients' competence to disagree mean they are
not competent?. Journal of Nervous and Mental Didease, 189(5), 307-310.
D., Weishut, D, J, N., Jaglon, M., & Rabinowitz. (2002). Patients'
and staff members' attitudes about the rights of hospitalized
psychiatric patients. Journal of Psychiatric Services, 53(1),
The Rehabilitation of Psychiatrically Disabled Persons in
the Community Act. Laws of the state of Israel 1746, 2000., p. 231-238.
A.S., Forquer, S. L., Tran, A., Starzynski. M., &
Shatkin, J. (2000). Identifying clinical competencies that support
rehabilitation and empowerment in individuals with severe mental
illness. Journal of Behavioral Health Services & Research,
The Competencies of the Rehabilitation Practitioner Questionnaire (CRPQ)
skills mentioned below have been considered by many to be crucial to
the rehabilitation service provider. Many people regard all these
skills as vitally important.
We would like to know what is in your
opinion and from your experience, the most important skill, the second
most important skill and so on until the least important skill for the
rehabilitation service provider.
purpose, please rank the following skills in order of importance from 1
to 5; 5 being the highest level of importance, and 1 the lowest level
Do not repeat the same number twice. The order or
the level of importance, teaches us what skills you would expect from
the "ideal" rehabilitation service provider. Remember there is no right
or wrong answer.
Thank you for your cooperation
) Interpersonal ability – this includes positive and empathetic
attitudes towards the client and his wishes, his background and the
group he belongs to, while providing an equal dialogue, in a clear and
) Professionalism – this includes knowledge about the diseases,
different ways of treatment, medication and side effects. This also
includes professional ethics and an expertise in the rights and in the
offered services, as well as identifying crisis situations that demand
intervention and action, in order to minimize deterioration.
) Assessment and Planning – this is the ability to conduct a
bio-socio-social interview and filling out function assessment forms
(dental, hearing and sight).
Assessing the client's situation at
any given moment and providing assistance in identifying those
situations that enable growth and empowerment.
) Accessibility to social resources – this means understanding the
impact of the socioeconomic status on the rehabilitation process,
access to financial-vocational information and resources that support
the rehabilitation process in the community. Assisting and connecting
the client with additional support sources, while coordinating and
supervising these sources in order to promote this process. Following
–up and connecting the client with various medical services and
preserving the flow of treatment. Advocacy – standing up against
discriminatory situations in the community.
) Rehabilitative – this includes optimism and faith in the client's
abilities to grow and become empowered, while helping him build up hope
and self reinforcement. It is an holistic approach, including assisting
the client identify and define his wishes and aspirations in a wide
variety of areas, teaching the client skills dealing with managing an
independent lifestyle such as, managing financial resources,
identifying and coping with crisis situations, creating social
connections and assimilation in different areas (with decreasing
support from the service provider).