The International Journal of Psychosocial Rehabilitation


What are the required competencies of the "effective" 

psychiatric rehabilitation practitioner?

Comparing perspectives of service users,

service providers and family members.

 

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 Health
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 Mental Health
 Faculty of Social Welfare & Health Sciences
 University of Haifa, Haifa, Israel.  
 Abraham Rudnick, M.D.
Associate Professor
 Departments of Psychiatry and Philosophy and Chair
Division of Social and Rural Psychiatry, University of Western Ontario
Physician-Leader, Psychosis Program, Regional Mental Health Care, London, Ontario, Canada.

 




Citation:
Roe D, Telem A, Baloush-Klienman V, Gelkopf M & Rudnick , A.(2010).  What Are The Required Competencies
Of The "Effective" Psychiatric Rehabilitation Practitioner? Comparing Perspectives Of Service Users, Service Providers
And Family Members
. International Journal of Psychosocial Rehabilitation. Vol 14(2) 82-94





Abstract
Background 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


Introduction
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).

Collectively, 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.  

Method
Research 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 study participants.

Qualitative Focus Group Studies
Study sample

Three groups of stakeholders met separately:
Rehabilitation 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.

Service user group. This group was made of 11 service users with SMI (3 women and 8 men aged 28-40) receiving rehabilitation services.  
Family 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.

Study process
The 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
Qualitative study.
The 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 values.

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).  

Quantitative Study
Study sample

The study sample was divided into three groups of stakeholders:
Rehabilitation 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.

Service 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 services.

The total number of participants in the quantitative study was 102.

Research tools

Study Sample Characteristics Questionnaire
Items common to all three groups: gender, age, marital status, employment.
Items 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 hospitalizations.

Items for rehabilitation service providers:
Education, area of specialization, seniority.
To 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
To 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).

Data analysis

We 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 .05.

Results
We present here first the results of the qualitative study, followed by the results of the quantitative study which elaborated upon the qualitative findings.

Qualitative Study
The 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).

Professional 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) .
 
Quantitative Study
Analysis of stakeholder groups and characteristics of the research groups:
As 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)

 

N (%)

N (%)

N (%)

Gender

Female

 

21 (60)

 

28 (82.4)

 

20 (66)

Marital Status

Single

Married or lives in couple

Divorced

Widower

 

22 (62.9)

3 (8.6)

10 (28.6)

0 (0)

 

8 (23.5)

24 (70.6)

2 (5.9)

0 (0)

 

3 (9)

21 (64)

5 (15)

4 (12)

Employment

Employed

Unemployed

Pension

Did not answer

 

26 (75)

9 (25)

 

100 (100)

0 (0)

 

15 (45.5)

13 (39.4)

2 (6.1)

3 (9)

Employment kind

Independent

Employee

Supported employment

Sheltered factory

Hostel

Supported community

Protected work

Other

 

4 (12)

4 (12)

7 (20)

10 (29)

 

 

 

1 (2)

 

 

 

4 (11)

 

12 (35)

2 (5.9)

9 (26)

7 (23.8)

NR

Living status

Independently

With family/ friends

Hostel

Protected Living

 

12 (34)

8 (22)

4 (8)

11 (31)

NR

NR

Education

10 years or less

12 years

Professional diploma

Supported academic ed.

Academic

B.A

M.A

 

3 (7)

11 (31)

11 (31)

1 (2)

9 (24)

 

 

 

 

 

 

20 (59)

14 (41)

NR

Income

Below average

Average

Above average

 

21 (61)

9 (25)

5 (14)

NR

NR

Psychiatric diagnoses

Schizophrenia

Bi – polar

Depression

Borderline

Schizoaffective

Don’t know

Don’t want to say

 

10 (29)

6 (18)

4 (11)

4 (11)

4 (11)

3 (9)

4 (11)

NR

NR

Age, Mean (Sd)

37.79

32.43

59.4

 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  P< 0.001).
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

When 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

Score

Mean                  SD

Rated as Important

N            %

Rated as  Less Important

N            %

Interpersonal skills

3.71

1.35

66

64.7

36

35.3

Rehabilitation skills

3.48

1.39

55

53.9

47

46.1

Professional skills

3.20

1.25

46

45.1

56

54.9

Skills for accessing social resources

2.55

1.16

23

22.5

79

77.5

Planning and evaluation skills

2.10

1.28

15

14.7

87

85.3

 

Ranking of the Competencies of the Effective Rehabilitation Practitioner:
Differences Between Stakeholder Groups

To 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

Members 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.

Discussion
The 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 manner.

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 partnership.

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.



 
References
Aviram U. (in press). Promises and pitfalls on the road to a mental health reform in Israel. Israel journal of psychiatry and related Sciences

Casper, 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.

Casper, 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.

Coursey, R. 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.

Department 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.

Gill, 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.

Marrelli, 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.

Roe, 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.

Roe, 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), 87-97.

The Rehabilitation of Psychiatrically Disabled Persons in the Community Act. Laws of the state of Israel 1746, 2000., p. 231-238.

Young, 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, 27(3),  321-333.

 



Appendix 1:

The Competencies of the Rehabilitation Practitioner Questionnaire (CRPQ)
The 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.

      For this 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 of importance.

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

Rank
(        ) 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 coherent way.
   
(        ) 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).    
 





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