A CLINICAL DECISION MAKING MODEL TO ASSIST PHYSICAL THERAPISTS IN MAKING APPROPRIATE REFERRALS TO REHABILITATION COUNSELORS: BUILDING ON HOAC II
Robin D. Washington*
Physical Therapy, Alabama State University
THEORY: Roles of physical therapists and rehabilitation counselors parallel one another as related to types of patient/client problems and identification of the problems. Both professions work with patients/clients to address existing and anticipated problems. Both facilitate the patient/client effective use of vocational, personal and social adjustments and resources. Both emphasize patient-centered outcomes which ultimately enhance the quality of life for individuals with disabilities. In 1986, Jules Rothstein and John Echternach introduced the Hypothesis-Oriented Algorithm for Clinicians (HOAC). HOAC was intended to serve as a conceptual model in the management of patients/clients which included recognizing when to refer patients/clients to other healthcare professionals. In 2003, Rothstein et al. presented the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II) as an enhanced model for clinical decision making. HOAC II provides a sound foundation as a guide to patient/client management through the incorporation of the Guide to Physical Therapy Practice and utilization of the disablement model.
PHENOMENON: Within the HOAC II model, physical therapists are instructed to generate a patient-identified problems (PIPs) list, formulate an examination strategy, conduct an examination, analyze data, refine hypotheses, and carry out additional examination procedures in order to confirm or deny hypotheses. Following these initial steps, the physical therapists are instructed to add non-patient-identified problems (NPIPs) to the list which are problems identified by others and not initially by the patient. NPIPs may consist of existing problems and anticipated problems which are problems that may lead to functional limitations and disabilities if not prevented. From a refined problem list that includes existing and anticipated problems identified by the patient and others, physical therapists are then required to identify problems that fall within and outside their scope of practice. Problems falling outside the physical therapy scope of practice should be eliminated from the refined problem list and addressed by others (e.g. family, caregivers, and other health care professionals). Building on HOAC II, physical therapists may appropriately refer to rehabilitation counselors. The scope of practice for rehabilitation counselors incorporates "a systematic process which assists persons with physical, mental, developmental, cognitive, and emotional disabilities achieve their personal, career, and independent living goals in the most integrated setting possible through the application of the counseling process". Physical, educational, vocational, psychosocial, and economic factors as well as personal vocational choice considerations are areas in which rehabilitation counselors focus. Primary emphasis of rehabilitation counselors is the inclusion of individuals with disabilities within employment and educational settings as well as within society as a whole. Interventions are geared toward bringing about self-advocacy, psychological, vocational, social and behavioral changes ultimately minimizing or eliminating attitudinal and architectural barriers. Rehabilitation counselors are equipped to provide quality service to infants, children and adults with disabilities. The following serves as examples of questions physical therapists may ask when considering the referral of patients/clients for rehabilitation counseling services: 1. Is the patient/client condition progressive or stable? 2. Does the disability impede the vocational skills of the patient/client? 3. Is the patient/client able to manage finances? 4. Does the patient/client have an established work history? 5. Does the disability interfere with the ability of the patient/client to financially support self and family?
PURPOSE: The purpose of this presentation is to build upon the HOAC II model to assist physical therapists in making appropriate referrals to rehabilitation counselors.
EVIDENCE: Parallel to the history of the profession of physical therapy, rehabilitation counseling gained recognition during World War I with the return of a large number of veterans with disabilities. Initially, the Smith-Hughes Act of 1917 was intended for federal dollars to support state vocational education programs in the training of unskilled rural youths moving to the city and to retrain former industrial workers. An extension of this act later included the vocational training of individuals with disabilities including veterans. Extension of this act stemmed from the realization that individuals with disabilities could be "vocationally rehabilitated around their impairments". As time progressed, significant medical advances occurred attributing to the increased number of World War II veterans returning home with disabilities, increased life expectancy for individuals with disabilities and a need for long-term medical management. The Vocational Rehabilitation Act Amendments, Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 are three of many acts and legislation highlighted in signifying the scope of practice for rehabilitation counselors.
TESTABLE HYPOTHESIS: Does the HOAC II model assist physical therapists in making appropriate referrals to rehabilitation counselors?
IMPORTANCE: Traditionally, rehabilitation counselors have integrated physical therapy services in the case management of their clients. However, nothing has been found in the literature regarding the integration of rehabilitation counseling services into the patient/client management model utilized by physical therapists. Criteria will be presented for the initiation of rehabilitation counseling services in the achievement of patient-centered outcomes.
FUNDING SOURCE: N/A
KEYWORDS: HOAC II, Rehabilitation Counselors, Clinical Decision Making Model
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