A validation of the rehabilitation skills inventory in four Australasian rehabilitation organisations and its relationship with occupational measures : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University

Abstract

Although relatively new to the range of human health providers, rehabilitation services and programmes have developed in response to rapidly changing societal and individual needs and in partnership with technological innovations. In identifying the key historical developments in both New Zealand and Australia arguments are made for the clear identification of rehabilitation skills. A central theme of this thesis research is to describe and document these differences in rehabilitation practitioner skills. Thomas (1990) argues that an important rationale behind this type of research is "...to reveal what practising rehabilitation [professionals] do so that they can eventually be helped to do it better"(p.75). Skills in modern rehabilitation settings cannot be studied in isolation from other occupational variables which operate in multidisciplinary organisations and due regard needs to be given to these interactions. Thus a description of the relationship between practitioner skills and other job-related stressors such as workload, job vs non-job, responsibility pressure , quality concern and role conflict and job related strains such as commitment, intention to quit and job satisfaction, is a second important theme of this thesis research. The development of skills and competency measures in the rehabilitation profession has a firm basis in the United States. The development of the Rehabilitation Skills Inventory (Leahy, Shapson and Wright, 1987a, 1987b), a 114 item self report measure, is reported in this thesis because it has potential as a research and management instrument to describe core skills. An exploratory pilot use of the RSI on a sample of New Zealand rehabilitation professionals (n=82) was undertaken and subsequently reported as RSI (Amended I) (Biggs, Rett, & Voges, 1995; Biggs, Long, Flett, and Voges, 1994), providing evidence on this sample of a possible 7 component (64 item) amended solution. These components were personal and group counselling, vocational counselling, case management, vocational assessment, job placement, professional practice, and rules and regulations. Additional investigation of this instrument on a larger and more representative group of rehabilitation professionals was argued and a subsequent administration of the RSI (Amended I) to three New Zealand groups and one Australian group of rehabilitation professionals (n=301) proceeded. The results of this administration (RSI Amended II) indicated a more parsimonious and robust 4 component (47 item) solution. The four components, accounting for 48% of variance, were labelled as vocational counselling, personal counselling, professional practice, and case management. The first three of these four were also identified by Leahy et al. (1987b) as core competencies across specialisations. Roessler and Rubin (1992) contend that skills and competencies may buffer the rigours of life as a rehabilitation professional and this assertion was examined using a conceptual model of person-environment fit and its relationship with the Minnesota Theory of Work Adjustment (Dawis & Lofquist, 1984). A series of three research goals were proposed for this thesis. The first research goal was to consider the relationships between job related stress ( here conceptualised as workload, job vs non-job conflict, responsibility pressure, quality concern and role conflict) and outcomes across a range of occupational groups of rehabilitation professionals. The second research goal was to examine the relationships between rehabilitation skills and outcomes across a range of occupational groups of rehabilitation professionals. The third research goal was to examine the potential moderating or mediating effects of rehabilitation skills (as measured by the Rehabilitation Skills Inventory - Amended II) on the relationship between occupational stress and the job related outcome measures of organisational commitment, occupational commitment, intention to quit, and job satisfaction. A survey of a sample of human service workers in the disability and rehabilitation field in Australia and New Zealand (n=301) was undertaken. Respondents were drawn from professional staff in the Accident Compensation Corporation of New Zealand, the Multiple Sclerosis Society of New Zealand, Workbridge NZ, and the Australian Commonwealth Rehabilitation Service. There are a number of differences between groups in age, hours worked per week , and levels of education. Descriptive statistics and group differences on additional variables employed in the study are then provided in sequence as follows: RSI factor scores, job stress sub-scales, and outcome measures of commitment, intention to quit, and job satisfaction. With regard to the RSI scores, there were marked group differences in all four measures (vocational counselling skills, personal counselling, professional practice, and case management) with the differences generally reflecting the professional orientations of the rehabilitation organisations. With regard to job stress variables, the ACC group scored highest on responsibility pressure and quality concern while the WB group scored lowest on job vs non-job conflict and the MS group (with its predominance of part timers) scored lowest on workload stress. There were a range of group differences on outcome measures but an overall pattern was less clear. In order to assess the contribution of independent variables (job stress measures) to outcome measures (satisfaction, commitment, intent to quit) and to evaluate the potential moderating effects of rehabilitation practitioner skills, a series of hierarchical regression analyses were undertaken. While in all cases the overall regression models were significant, there was no clear or compelling evidence to suggest that rehabilitation practitioner skills might moderate the effects of stress on outcomes. In order to address the question of whether skills might mediate the relationship between stress and outcomes a further series of hierarchical regression analyses were conducted. Here a number of significant main effects emerged (e.g. job vs non-job conflict was a significant predictor for 4 of the 9 outcome measures while quality concern was significant for 6 of the 9 outcome measures) while, among the skills variables, professional practice skills tended to be the most consistent predictor of outcomes. There was some evidence also that skills mediated the effects of stress for the outcomes of intention to quit the organisation/profession, affective occupational commitment and affective organisational commitment. The similarities in rehabilitation skills core competencies in the RSI Amended II with the RSI core competencies of the major study of Leahy et al. (1987b) in North America is encouraging and helpful in the process of validation of the scale. On the other hand the lack of differentiation and elaboration of skills evident in the local version of the scale perhaps reflects the lack of growth and specialisation of the Australasian rehabilitation environment into the various specialties and occupational settings that characterise the North American environment. The mediating effect of skills on outcomes noted in this research is important for the areas of skill and competency acquisition, professional development training, and stress reduction. Understanding more fully how this mediation effect operates is an important question for the future and highlights a need for longitudinal research to identify causal sequences. The need for ongoing research into rehabilitation skills and competencies has been argued variously as a means of ongoing definition of this professional activity (e.g. Wright et al., 1987; Leahy et al., 1987a, 1987b) and as a tool for professional certification (e.g. Leahy & Holt, 1993; Linkowski et al., 1993). Within this framework psychometric issues also arise as to whether the skill definitional process is best defined by measures of skill frequency of use (as in this research), skill attainment, skill preparedness, or a combination of such measures. The research outlines in this thesis is intended to make a positive contribution to a fuller understanding of the skills required and the operating environment of rehabilitation professionals in the Australasian region. The profession is emerging in this region and the results of this research will arguably support these developments