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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. This preliminary research was intended to help rehabilitation professionals with interventions that increase empowerment in the individuals they work with, therefore the last concept, action/participation was not measured in this study. The other four concepts and rationale for measurement are discussed below.
The concept of control is listed twice in the Bolton and Brookings taxonomy (internally controlled and self-efficacious). The concept of control is referred to more than any other concept in the empowerment literature. In general, the literature suggests that people who are empowered have self-control over decisions and decision-making power (Chamberlin, 1997; Szymanski, 1994). These concepts appear to fit best under the well-defined variable of self-efficacy which purports to measure one's perceived control and confidence in executing an action. An individual who is empowered is generally considered to have a sense of positive self-efficacy and is able to cope effectively with the problems encountered when living with a disability. Therefore, the concept of control may be best operationalized through instruments that measure self-efficacy.
The second concept derived from Bolton and Brookings taxonomy and the empowerment literature concerned an individual's assertiveness, or ability to understand and ask for what he or she wants. This general concept is identified twice in the Bolton and Brookings taxonomy (assertive and self-advocating). Various researchers have described this concept as: having authority (Szymanski, 1994), personal strength (Dart, 1992), having power (Holmes, 1993), having knowledge about resources (Zimmermann & Warschausky, 1998) and having the ability to self-advocate (Word, 1988). The concept of having acquiring knowledge in order to fight for what one wants in life appears to be best operationalized by measures that purport to measure self-advocacy.
The concept of competency has been described with many different terms. Bolton and Brookings taxonomy includes seven different concepts that have competency as a common theme (autonomous, competent, goal-directed, independent, personally responsible, self-reliant, and self-monitoring). Many other theorists have used similar concepts to describe this area of empowerment including: perceived competence and problem solving skills (Zimmermann & Warschausky, 1998), a pro-active approach to life (Cornell Empowerment Group, 1989), overall competence (Emner, 1991), critical-awareness of self (Perkins & Zimmermann, 1995) and self-initiated growth (Chamberlin, 1997). An empowered individual is one who is able to self-manage their disability. That is, they are able to learn the skills necessary to carry on an active and emotionally satisfying life in the face of a chronic condition (Lorig, 1993). For the present purpose, we measured competence through assessments that measured self-management of one's disability and one that looked at coping skills thought to be needed when experiencing life with a disability.
The final concept in this study examined the concept that individuals who feel empowered feel positive about themselves, or have high self-esteem. Bolton and Brookings taxonomy appears to have two concepts that fit this area, being proud and being disability oriented. Other theorists have described individuals possessing this area of empowerment as having: a positive self-concept (Dart, 1992), self-esteem (Emner, 1991), positive identity (Cam 2003) and as overcoming stigma (Chamberlin, 1997). Individual's...
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