Assessing Changes in Life Skills and Quality of Life Resulting from Rehabilitation Services. (Assessing Rehabilitation Outcomes)

In addressing the goals of the rehabilitation process, Murphy and Williams (1999) state: The rehabilitation process is seen as a systematic approach to assessing and addressing the total needs of a person with disabilities. Each person is seen as a unique individual with assets that can be developed. The ultimate goal of the rehabilitation process is to promote functional independence where the individual is capable of economic self-sufficiency and integration into society. (p. 29) A major accountability mandate for rehabilitation services to achieve those goals dates back to the passage of the Rehabilitation Act of 1973. That mandate required rehabilitation service programs to demonstrate that they have met expected service outcome goals and have done so in an efficient manner (Rubin & Roessler, 2001). Meeting and exceeding expected service outcome goals is one method of demonstrating the success and effectiveness of services provided and of justifying the continued funding of rehabilitation services. Historically, the evaluation of the effectiveness of rehabilitation services has been heavily focused on short-term employment outcomes (Gilbride, Stensrud, & Johnson, 1994; Gilbride, Thomas, & Stensrud, 1998). However, limiting the assessment of service effectiveness to short term employment outcome data may provide an insufficient and sometimes misleading picture of the benefits to consumers from rehabilitation services (General Accounting Office, 1993). It is difficult to determine the meaning of short-term employment outcome data as an index of service effectiveness without also having a clear picture of how the competencies of the individual and the individual's perception of the desirability of his/her life situation has changed following rehabilitation services. Unless the post-services employment status of the individual can be explained as resulting from the changes produced in the individual or his/her life situation by the rehabilitation services provided, there is little reason to believe that either the current employment will be sustained for any meaningful period of time or that the current job could not have been acquired without the rehabilitation services provided. To acquire a valid picture of desired benefits from complex packages of services, measurement tools for the comprehensive assessment of client outcomes are needed (Johnston, Stineman, & Velozo, 1997; Schalock, Keith, Hoffman, & Karan, 1989). It can be argued that in addition to assessing changes in vocational status, changes in areas of life skills and areas of sense of well being (i.e., self perceived quality of life) in consumers who have received vocational rehabilitation services would be valid measures of the impact of services received. Several health care and rehabilitation researchers have been advocating for the inclusion of quality of life in the framework for assessing rehabilitation health outcomes (Murphy & Williams, 1999; Renwick & Friefeld, 1996). For example, the Medical Outcomes Study (MOS) project has underscored the concept of measuring well being, as well as functioning in order to examine the relationship between improvement in functioning and changes in patients' well-being as indicators of successful outcomes (Stewart & Ware, 1992). The purpose of this paper is to discuss the relevance of addressing both life skills and quality of life when attempting to assess the effects of rehabilitation services. The purpose of such measures is to provide the service provider with (a) a clear over-all pre vs post picture of the level of functioning of the individual, (b) clear evidence of the effects of services on the sense of well being of the consumer and, (c) a means with which to monitor his or her own effectiveness (Ware, 1992). Moreover, such measures can be used to generate service outcome data for a large group of counselors as well as for the individual counselor (Keith, 1999). …