STANDARDS FOR PSYCHOLOGISTS AND SOCIAL WORKERS IN SCI REHABILITATION

Table of Contents

Statement of Purpose

Acknowledgments

Preface

• Introduction
  • Concept and Goal of SCI Rehabilitation
  • The Biopsychosocial Rehabilitation Process
  • Importance of the Treatment Team
  • Role of Psychologist and Social Worker Team Members
• Patients' Rights and Responsibilities
• Staffing Considerations
  • Definitions
    1. Psychologist
    2. Social Worker
  • Staffing Patterns
  • Education and Orientation for Staff
    1. Limits of Practice
    2. Education
    3. SCI Orientation
  • Continuing Education
  • Supervision
  • Professional Affiliations
  • Hospital Privileges
  • Professional Ethics
• Psychosocial Components of Rehabilitation
  • Basic Components of Psychosocial Programs
    1. Orientation
    2. Assessment
    3. Treatment Plan
    4. Interventions
    5. Discharge Planning
    6. Monitoring and Follow-up
  • General Guidelines for Implementing Basic Components of Psychosocial Services
  • Additional Activities of Psychologists and Social Workers
• Collaborative Activities
  • Rehabilitative Program Activities
  • Treatment Activities
  • Administrative Activities
    1. Mandated activities
    2. Non-mandated activities
  • Overlapping activities
• Glossary
• Endorsement List - First Edition

STATEMENT OF PURPOSE

The American Association of Spinal Cord Injury Psychologists* and Social Workers* (AASCIPSW) has created these Standards* to promote better outcomes for persons with spinal cord injury (SCI) through providing the highest quality of psychosocial care. These Standards are written for psychologists and social workers, although they may guide other disciplines that provide psychosocial services. It is the intention that these Standards serve as a guide for clinical practice and for advocating with legislators and policy-makers and other interested constituencies within the changing health care environment. It is our goal that persons with SCI receive comprehensive, cost effective services that meet their life-long needs.

Acknowledgments

In September, 1990 the Board of Directors of AASCIPSW appointed a ten member Standards of Care Task Force and charged that Task Force with responsibility for developing professional standards. The contributions of the members of the original Standards of Care Task Force are gratefully acknowledged. The ten members of the Task Force included: Paul B. Johnson, PhD, Chair; Craig Alexander, PhD; Stephen C. Beer, MSW; Helen Bosshart, ACSW/LCSW; Mary Bozeman, MSW; Dawn Cooke, MSW; Bruce Ellsworth, MSW; Jayne Kleinman, MS, CRC; Charles Merbitz, PhD; and Ralph Snodgrass, PhD.

In 1995 the Clinical Practice Committee was given the charge of revising the Standards to include appropriate services provided in an outpatient setting. The work of the Clinical Practice Committee in support of this second edition is also commended. Clinical Practice Committee members included: Helen Bosshart, ACSW/LCSW, Chair; Lester Butt, PhD; Laura Cushman, PhD; Marguerite David, MSW; Lise Deguire, PsyD; Jayne Kleinman, MS, CRC, Past Chair; and Charles Merbitz, PhD, CRC. It should also be noted that members of the Professional Issues Committee provided consultation on the development of the Standards.

This project was supported by a grant from the Eastern Paralyzed Veterans Association (EPVA). The contributions and support of James J. Peters, Executive Director, EPVA, Vivian Beyda, DrPH, Director of Research and Education, and Stephen Sofer, PhD, Program Manager, of EPVA are sincerely acknowledged and appreciated.

PREFACE

AASCIPSW is a not-for-profit professional membership association. Its primary membership consists of psychologists and social workers specializing in the psychosocial aspects of rehabilitation* and treatment for individuals with spinal cord injury. The organization's primary goal is to improve the quality of care for individuals with SCI. This goal is achieved by developing and promoting education and research related to their psychosocial needs. AASCIPSW advocates for the critical role played by psychologists and social workers in SCI rehabilitation.

Since 1990, AASCIPSW has pursued the development of Standards of Care to enhance the quality of care and outcomes in spinal cord injury rehabilitation provided by psychologists and social workers. The Standards for Psychologists and Social Workers in SCI Rehabilitation were drafted by professionals currently working in this field.

The need for a set of psychosocial program standards is derived from the basic right of individuals with SCI to comprehensive and effective treatment by competent professionals. The purpose of these Standards is to maintain and improve the quality and consistency of psychosocial services provided by psychologists and social workers.

The first edition of the Standards was developed by a Task Force of ten AASCIPSW members with expertise in psychosocial aspects of SCI rehabilitation. The Task Force surveyed major SCI organizations and consumers about the importance of different psychosocial services received during rehabilitation and their recommendations for current programs. The Task Force also surveyed the membership of AASCIPSW concerning essential psychosocial services in the treatment environment. Finally, a thorough review of existing standards which address psychosocial care issues in SCI rehabilitation was conducted. Utilizing this information, these Standards were developed through a consensus process. The First Edition of the Standards for Psychologists and Social Workers in SCI Rehabilitation was approved by the AASCIPSW Board of Directors and endorsed by the AASCIPSW membership in September, 1992. It was further agreed that the Standards would be reviewed at least every three years and modified as needed to be consistent with advances in professional practice.

In 1995, the Board of Directors recognized the importance of expanding the Standards to include those services provided by psychologists and social workers in the outpatient setting. It was recognized that health care had undergone numerous changes during the 1990's. It was a concern that the trend towards shorter inpatient rehabilitation and reductions in ongoing psychosocial care was neither cost-effective nor in the best interest of the individual and the community in the long term. It was in this environment that the second edition of the Standards was written.

The revision process included a comprehensive review of literature, existing standards, and current practices relevant to the lifetime psychosocial issues of persons with SCI. The membership of AASCIPSW was also surveyed concerning essential psychosocial services in the outpatient setting.

These Standards are intended to define the scope of services and function provided by psychologists and social workers throughout the continuum of SCI rehabilitation. The terms "MUST" and "SHALL" are used throughout this document to indicate what is mandatory. The term "SHOULD" is used to reflect preferred practice. The term "comprehensive" is used to reflect the wide range of psychosocial services provided in any setting, including inpatient and outpatient services. To assist with the definitions of terms used throughout this document, the term is highlighted with an asterisk (*) when first found in the document. Please refer to the Glossary for the definition.

The second edition of the Standards for Psychologists and Social Workers in SCI Rehabilitation was approved by the Board of Directors and endorsed by the membership at the annual conference in September 1997 (pending).

I. INTRODUCTION

A. Concept and Goal of SCI Rehabilitation

Biopsychosocial* theory assumes that individuals with SCI, in addition to the physical sequelae, have experienced psychological and social changes requiring accommodation and constructive resolution. Therefore, the rehabilitation of individuals with SCI is a complex process that involves biological, psychological, and social components. The psychosocial implications of spinal cord injury mandate inclusion of psychologists and social workers as integral members of the SCI rehabilitation team. Properly trained and experienced psychologists and social workers have the knowledge, skills, and expertise to positively assist both the individual and family* to respond to the many psychosocial issues. Services that address these issues are essential to the provision of quality rehabilitation and to the establishment of a satisfying lifestyle in the community.

It is the purpose of this document to address psychosocial rehabilitative issues of competent adults, adults with evidence of compromised cognitive abilities, and minor children. In the case of minor children, it is necessary to have the parent or legal guardian assume decision making responsibilities. In the case of the incompetent adult, the legal guardian must assist in all appropriate decision making. If the parent or legal guardian is not present, then the health care system must assist that child or incompetent adult in achieving such representation. Solely to facilitate ease of writing, the authors wrote the following standards from the perspective of the competent adult. However, if this is not the clinical situation presented, the SCI health care system is mandated to address and resolve these issues.

The goal of SCI rehabilitation is to assist the individual with SCI and the family in achieving optimal physical, psychological, and social functioning consistent with level of injury, personal preferences, needs, and resources. Inpatient and outpatient rehabilitation, as well as the subsequent integration of the individual and family into the community are vital components of this process. Since an individual with SCI is perpetually accommodating to varying life situations, rehabilitation is viewed as a continuous process throughout life rather than a discrete episode of treatment. As a result, psychologists and social workers are responsible for assisting the individual in comprehensive inpatient and outpatient rehabilitation from admission to the program through follow-up* in the community.

B. The Biopsychosocial Rehabilitation Process

The biopsychosocial rehabilitation process should involve a continuum of services from the onset of a spinal cord injury throughout the life span. The critical components in this rehabilitation process have many psychosocial implications. As soon as medically stable and capable of participation, the individual with a new spinal cord injury should enter a comprehensive SCI rehabilitation program. Upon entrance to the program, the individual and family should be oriented to the general philosophy of comprehensive inpatient and outpatient SCI rehabilitation.

Additionally, the individual must be included in formulating the comprehensive interdisciplinary treatment* plan. The family should be included when feasible and clinically indicated*. The plan should include treatment for inpatient rehabilitation, integration into the community, and possible outpatient rehabilitation as warranted by the individual's clinical situation.

The individual and family should participate when possible in a comprehensive patient/family education program throughout rehabilitation, commencing with the inpatient program. The educational program should focus on providing the knowledge and skills specific to spinal cord injury to insure optimal success in managing all aspects of SCI care after discharge from the facility. In many circumstances, continuation of this educational skill-building will occur within the outpatient program.

Discharge planning* should begin upon admission to the SCI rehabilitation program to insure that essential services for the individual's support are available after discharge from the facility. Discharge planning requires the participation of all team members, as well as the individual and family. Most often, primary discharge planning is within the realm of the team social worker. This discharge planning may well require specific outpatient services to further rehabilitative gains, skills-acquisition, and constructive physical and psychosocial outcomes.

To optimize successful outcomes, the individual shall have access to psychosocial rehabilitation services, in addition to physical rehabilitation. Those services provided must be specific to the individual's needs and directed toward the goal of optimal psychological and social functioning. These services may be provided in both the inpatient and outpatient programs and in individual, couple, group, and/or family formats.

Involvement in community activities is a crucial component of the individual's accommodation to spinal cord injury. The individual should be involved in community reintegration* activities on a regular basis to practice those skills acquired in physical rehabilitation. Social skills training* should teach the skills necessary to manage interpersonal relationships, individual attitudes, and societal barriers. The individual's psychosocial issues may mandate long-term interventions on an inpatient or outpatient basis.

When the goals specified in the SCI interdisciplinary treatment plan are achieved, the individual should be ready discharged. Trial home visits are recommended prior to discharge to maximize opportunities for successful community living. An aftercare plan should be developed to insure that necessary resources are available, in addition to follow-up care. Outpatient services are essential in the long-term successful accommodation to spinal cord injury, particularly as the length of inpatient stays are reduced.

Regular outpatient follow-up visits are recommended for assessment and treatment of all aspects of spinal cord injury. Periodic comprehensive re-assessments should be completed by psychologists and/or social workers to identify psychosocial needs and detect emergence of new problems. Focus on quality of life* should be an integral part of these reassessments. Respite needs for care providers should be recognized and facilitated. Lastly, the individual and family should establish linkages within the community to access specific resources and services.

C. Importance of the Treatment Team

The SCI Treatment Team is the primary decision-making body for the individual's biopsychosocial rehabilitation goals and progress. The team should include the individual with SCI, the family when feasible and clinically indicated, and a representative of each discipline the treatment team considers essential to the attainment of the comprehensive treatment goals. As needed, the team may also include professionals from other agencies. The responsibilities of each team member should be clearly defined in written policies and procedures. Team members complete individual assessments pertinent to their area of professional expertise and use the information to develop an integrated, comprehensive interdisciplinary treatment plan. There shall be regular, formal team meetings to review and document the individual's progress and to modify the treatment plan as goals are accomplished.

The individual undergoing SCI rehabilitation must be an integral part of the SCI treatment team. The individual must be included in formal as well as informal reviews with professional team members to insure that personal goals, needs, and preferences are integrated into the rehabilitation process. The family should be included when feasible and clinically indicated.

D. Role of the Psychologist and Social Worker Team Members

Psychologists and social workers are core members of the interdisciplinary team. They contribute to the treatment team by providing specialized clinical skills and perspectives to help the individual achieve optimal psychological, behavioral, social, vocational, and avocational functioning. The professional scope of practice of psychologists and social workers working with individuals with SCI is predicated upon patient needs, regardless of the clinical setting. Clinical services may be provided in the acute care setting, the rehabilitation setting, or a variety of follow-up settings, including but not limited to outpatient clinics, home health care and independent living* centers. Staffing levels in all clinical settings should be commensurate with patient needs.

Psychologists and social workers bring to the team a unique and complementary psychosocial treatment orientation. Their academic and clinical training prepares them to play particular roles in the rehabilitation process. As previously stated, their functions are complementary; however, by no means are they interchangeable within the context of the interdisciplinary team. Their unique expertise should be utilized to conduct a thorough assessment upon which a treatment plan can be devised and appropriate interventions employed. Comprehensive assessments by psychologists and social workers focus on the individual's current coping status and accommodation to the spinal cord injury in the context of person, family, and society. Psychologists and social workers also bring to the team individual and professional expertise in assessment and intervention. For the psychologist, the clinical diagnostic skills which allow the assessment of individual personality, intelligence, behavior, neuropsychological status, vocational skills and interests, and psychological functioning are unique contributions to the total psychosocial assessment. For the social worker, the training and skills to assess the key components of the individual's overall support system, (i.e. family, finances, housing, living arrangements, and community resources) are equally important in the development of a comprehensive psychosocial assessment. Predicated on the specific needs of the clinical situation, these assessment skills may be utilized in the inpatient and/or outpatient settings.

In the conduct of therapeutic interventions, both psychologists and social workers have unique expertise in a variety of psychosocial treatment skills. Clinical expertise in specific psychosocial interventions is as important as the professional identity of the psychologist are social worker. Therapeutic interventions employed by psychologists and social workers may include but are not limited to education, counseling, crisis intervention, and advocacy. Therapeutic interventions may focus on the individual, the family, social agencies, or other environmental and social systems. Psychologists and social workers are obligated by their professional ethical codes to practice within their level of training, experience, and expertise.

Adding to their multiplicity of roles, the psychologist or social worker may serve as a case manager for the individual with SCI. Furthermore, these professionals possess research skills which may be used to understand and improve clinical practice. Psychologists and social workers also provide supervision to undergraduate and graduate students who are enrolled in psychology and social work academic training.

Often, psychologists and social workers may serve as resources for the team. Their specialized training in group processes, problem solving, communication skills, and interpersonal skills may help the treatment team function more effectively and efficiently. They may facilitate communication, provide inservice education, serve as sources of support and supervision, and act as consultants on difficult, ethical or sensitive matters. Psychologists and social workers may also help members of the team understand the individual's psychosocial status and its influence upon accommodation to the spinal cord injury.

II. PATIENTS' RIGHTS AND RESPONSIBILITIES

III. STAFFING CONSIDERATIONS

A. Definitions

1. Psychologists shall have a doctoral degree in clinical or counseling psychology from a program approved by the American Psychological Association (APA) and shall be licensed in the state of practice.
2. Social Workers shallhave a master's degree in social work from an institution accredited by the Council on Social Work Education* or its Canadian equivalent and meet applicable legal requirements.

B. Staffing Patternsf

Psychologists and social workers must be core members of the interdisciplinary treatment team. AASCIPSW recognizes that staffing patterns can vary widely by institution and are affected by evolving health care system changes. The Standards describe those practices identified as essential to providing quality psychosocial care.

There should be at least one full-time psychologist and one full-time social worker for every twenty individuals in an inpatient SCI rehabilitation program.

Where outpatient services are rendered, there should be a designated psychologist and social worker who will provide at least an annual reassessment of psychosocial needs for each individual followed. For those individuals with identified psychosocial needs, a treatment plan will be developed and followed, predicated on specific individual needs.

Staffing levels need to be adequate to assess and address the individual psychosocial needs of the patient population served.

C. Education and Orientation for Staff

1. Limits of Practice

Psychologists and social workers must limit their practice to their areas of professional competence as defined by training, experience and scope of practice.

2. Education

Psychologists should be trained in SCI care, rehabilitation, and/or health psychology. Educational preparation should also include the topics listed below.

Social workers need a background in clinical practice and training and experience in SCI care or a related area of rehabilitation. Educational preparation should also include the topics listed below.

For psychologists and social workers without SCI rehabilitation training and experience the following educational and supervised experiences are recommended:

A program of education specifically including but not limited to information on the following topics:

• acute and chronic pain
• advance directives
• aging
• anatomy and physiology of SCI
• architectural barriers
• assistive technology
• bowel and bladder care
• community resources
• cultural diversity
• current SCI research
• health promotion
• independent living
• medical complications
• medications
• nutrition
• parenting and childbirth
• personal assistance services*/attendant care
• psychological, social and vocational sequelae of SCI and factors related to treatment
• respiratory care
• safety precautions
• sexuality and fertility
• skin care
• social skills
• substance abuse
• team consultation skills
• vocational issues
• wheelchair accessibility

Educational experiences pertaining to SCI topics can be arranged through local, regional, or national SCI conferences and professional meetings. It is recognized that many professionals may not be able to access formal education and/or supervision in all of these areas. Resource bibliographies, such as the AASCIPSW's Suggested Reading List, can assist in self-instruction.

3. SCI Orientation

Psychologists and social workers should receive an orientation to the philosophy and goals of the SCI program, the administrative procedures governing he SCI program, the roles and responsibilities of the different team members and any SCI-specific accreditation standards.

D. Continuing Education

Psychologists and social workers must adhere to state guidelines for continuing education. Where no guidelines exist, there should be a minimum of 20 hours for social workers and psychologists of continuing education per year, of which ten hours should be SCI-specific. Appropriate education areas may include formally organized learning events, professional meetings, and individual professional activities. Institutions should be encouraged to support continuing education.

E. Supervision

During the first three months of SCI practice, one hour per week of individual supervision by a colleague with SCI experience is essential. Throughout clinical practice ongoing consultation/supervision is strongly recommended.

F. Professional Affiliations

Psychologists and social workers are encouraged to maintain membership in national professional organizations. In addition, psychologists and social workers are encouraged to join professional organizations in specialty areas of practice related to SCI care.

G. Hospital Privileges*

Psychologists and social workers are encouraged to apply for formal hospital privileges, specifying their areas of professional competence and expertise.

H. Professional Ethics

AASCIPSW endorses the ethical standards of the American Psychological Association* (APA) and the National Association of Social Workers* (NASW). Psychologists and social workers shall "act in accordance with the highest standards of professional integrity and impartiality (NASW)," and their behavior must be "guided by the principle of promoting human welfare (APA)." Professional principles of practice should always dictate professional behavior.

Psychologists and social workers shall assure confidentiality of patient information in accordance with professional ethics and policies of the health care facility. Individuals with SCI must be advised that confidentiality is not an absolute concept and that necessary sharing of information will occur in the context of treatment planning and legal mandates.

IV. PSYCHOSOCIAL COMPONENTS OF REHABILITATION

Psychosocial services in SCI rehabilitation enhance individual and family adaptation to living with a disability from behavioral, psychological and social perspectives. Continuity of care throughout the rehabilitation process and community reintegration are emphasized. Health promotion and quality of life issues are critical in the rehabilitation process.

A. Basic Components of Psychosocial Programs

1. Orientation

Each individual shall receive an orientation to the psychological and social work components of the rehabilitation program within the first week of admission to the inpatient or outpatient SCI program, unless precluded by the individual's medical condition.

The individual's family shall be included in the orientation process when feasible and clinically indicated.

The orientation shall include a review of the individual's rights and responsibilities and a review of psychologist and social worker team members' roles and responsibilities.

2. Assessment

Each individual entering an SCI rehabilitation program shall have an assessment by a psychologist and a social worker within five working days of entry into the inpatient or outpatient program, unless precluded by the individual's medical condition. Records of previous psychosocial interventions and relevant medical treatments should be obtained. The family shall be included in the assessment process when feasible and clinically indicated. The assessment may include, but not be limited to:

• adaptive behavior* and substance abuse
• behavioral and psychological response to spinal cord injury
• current mental status, neuropsychological status, personality, and intelligence
• ethnic, cultural and spiritual factors
• family members and social support networks
• financial status
• housing and living arrangements
• individual and family expectations of treatment
• interests and vocational activities
• legal issues
• other assessments needed to develop appropriate goals and an effective treatment plan.
• potential problems for rehabilitation or community reentry
• premorbid behavioral/psychological status
• psychological or behavioral strengths and vulnerabilities
• sexual concerns
• vocational and educational status

3. Treatment Plan

The psychologist and the social worker shall establish written treatment plans for the individual within one week of the comprehensive assessment. This information should be integrated into the comprehensive interdisciplinary treatment plan to promote both efficiency and quality outcomes. Each plan shall contain the following:

• a statement of the presenting needs
• assessment findings and summary
• individual and family goals and expectations
• the specific goals of treatment, stated in behavioral, functional or performance terms
• the anticipated time frame for achievement of each goal
• anticipated barriers to achievement of treatment goals.
The individual must be involved in the treatment planning process; The family should participate when feasible and clinically indicated. After implementation, revisions shall be made to the treatment plan as warranted by progress assessment. The treatment plan should be reviewed and updated at least bi-weekly. In recognition of the specific needs of individuals with spinal cord injury, the plan shall include the following primary components:
• Individual and family education - Areas to be addressed may include but are not limited to: community resources, sexuality, adjustment issues, social skills training, personal assistance services, substance abuse, smoking cessation, problem solving, discharge planning and community reintegration.
• Individual adjustment counseling
• Family conferences - Inpatient family conferences should be held within the first two weeks of admission for orientation and the establishment of rehabilitation goals and before discharge to assess goal attainment and adequacy of discharge plans.
• Additional Inpatient conferences should be held as needed. Outpatient family conferences should be held when feasible and clinically indicated.
• Progress notes documenting the individual's progress toward attaining psychosocial rehabilitation goals should be written at least weekly in inpatient programs and after each contact in outpatient programs. All clinically significant events should be documented.
4. Interventions The individual and family should have access to the following psychosocial treatment interventions as needed to achieve their psychosocial goals:
• behavior management
• couple counseling
• family therapy
• group therapy
• individual psychotherapy
• pain management
• problem solving and coping skills training
• referral to specialized services such as: peer counseling, psychiatric consultations, hypnosis, vocational counseling, neuropsychological consultations, spiritual support.
• resource referrals
• sexuality and sexual counseling
• social skills / assertiveness training
• stress management, biofeedback, and relaxation techniques
• substance abuse prevention

Psychologists and social workers may also be responsible for the design, management, evaluation, monitoring and coordination of team-implemented psychosocial interventions.

5. Discharge Planning

Discharge planning begins at the time of the individual's admission to treatment. It is an interdisciplinary effort requiring the full participation of the individual, the family, and the treatment team. Through the discharge planning and evaluation process, the individual is encouraged to develop a plan for maintaining an optimal level of physical, psychological, and social functioning.

A written discharge plan shall be initiated with the individual at the time of the initial assessment. The final discharge plan should fully describe those services and resources needed to support the psychosocial and medical elements of the treatment plan. Essential areas for description include: family support, financial status, housing, a personal assistance services plan if indicated, and a post-discharge follow-up plan.

The individual's perception of readiness for discharge from both inpatient and outpatient programs should be formally assessed by the psychologist and social worker. Additional information, education or referrals should be provided as needed.

The individual and family when feasible and clinically indicated should attend a final discharge conference to review and finalize the individual's plan for discharge from rehabilitation services.

6. Monitoring and Follow-up

A written plan for follow-up psychosocial services shall be developed with the individual and the family when feasible and clinically indicated. The plan shall provide for ongoing community reintegration services and social support through appropriate community referrals which may include:

• chemical dependency treatment
• community mental health programs
• driver's education and training
• educational programs
• financial assistance services
• home health services
• home modification services
• independent living centers
• peer assistance/peer counseling programs
• personal assistance services programs
• psychology and/or social work services
• recreation/vocational programs
• resources for medical follow-up.
• sexuality and couple counseling
• spinal cord injury associations
• transitional living programs
• transportation services
• vocational rehabilitation services

Provision should be made for periodic psychosocial follow-up and reassessment either at the originating facility or in the geographic area in which the individual resides. Each follow-up contact or significant event should be documented with a progress note.

B. General Guidelines for Implementing Basic Components of Psychosocial Services

Psychologists and social workers should use procedures that have been shown to be effective and beneficial. Continuing research is needed to evaluate and improve the effects of treatment.

The effects of psychological and behavioral treatment for each individual shall be monitored. Treatment that does not result in demonstrable progress toward specific goals within a reasonable amount of time should be modified or discontinued. Goals shall be revised to reflect changes in an individual's condition.

C. Additional Activities of Psychologists and Social Workers

Psychologists and social workers are encouraged to participate in the following professional activities:

• community outreach/ education
• consultation to improve team effectiveness
• establishment of linkages with community agencies
• monitoring and evaluation of psychological and social work services.
• publications and presentations
• relevant system advocacy and resource development
• research
• staff inservice education
• supervision

V. COLLABORATIVE ACTIVITIES*

Social workers and psychologists in SCI rehabilitation shall foster collaboration, cooperation, and mutual support in the functioning of the interdisciplinary team to ensure integration and coordination of treatment without duplication of services. The goal of mutual cooperation recognizes that effective team functioning is essential to the provision of quality rehabilitation services. Collaborative activities should be integrated throughout the continuum of care for the individual with SCI, including inpatient, outpatient, and community based services.

A. Rehabilitative Program Activities

Psychologists and social workers shall strive to support the collaborative functions of the interdisciplinary team in all of its basic program activities:

• intake and orientation
• initial assessment
• treatment planning
• treatment reviews
• progress reviews
• discharge planning and referral
• post-discharge follow-up.

B. Treatment Activities

Social workers and psychologists shall take an active part in treatment interventions and activities which are collaborative in nature according to their expertise and interest, the needs and preferences of the individual, and current practice in the clinical setting. These collaborative activities which may involve or be led by team members from other disciplines include but are not limited to:

• community excursions
• family conferences
• family education programs
• family therapy
• group therapy or counseling
• other community integration activities.
• patient education programs
• peer counseling coordination
• skill-building groups

C. Administrative Activities

1. Mandated activities - Psychologists and social workers shall be actively involved in those collaborative activities which are or may be administratively mandated for the enhancement of program quality and program development. Examples of such activities include:

• continuous quality improvement
• program evaluation
• program and policy planning.

2. Non-mandated activities. Psychologists and social workers should be actively involved in collaborative administrative activities which may not be mandated but which serve the overall goal of health promotion and improved quality of life. These include, but are not limited to:

• community organization, advocacy, and social policy change efforts addressing issues pertinent to persons with spinal cord injury;
• consultation and collaboration with outside organizations and professionals concerning spinal cord injury;
• community outreach services, including injury prevention, health education and promotion;
• team-building;
• other pertinent psychosocial issues.

Social workers and psychologists should advocate for the accreditation of the institution in which they practice by the appropriate accreditation bodies (e.g. JCAHO, CARF).

D. Overlapping Activities*

The interdisciplinary rehabilitation treatment team often experiences an overlapping of program activities. Responsibilities for assessment, intervention, and program planning in addressing the broad areas of human functioning affected by spinal cord injury do not have precise boundaries and frequently are shared by various disciplines. Since psychologists and social workers are qualified to perform some of the same functions in the provision of psychosocial care, facility policy should define those activities which are unique to each discipline and those which are shared.

Psychologists and social workers shall work cooperatively with other disciplines to delineate responsibility for psychosocial assessment and intervention.

Psychologists and social workers shall advocate for the delivery of psychosocial services by staff members with the appropriate professional supervision, training, and credentials.

VI. GLOSSARY

Adaptive Behavior - Refers both to the ability to function as independently as possible and to the ability to meet culturally imposed demands of personal and social responsibility.

American Psychological Association (APA) - The national professional organization which represents the largest proportion of psychologists in the country. APA's stated purposes are the advancement of psychology as a "means of promoting human welfare" as well as its advancement as a profession and science.

Biopsychosocial Model - As contrasted with the medical model whose emphasis is on the physical domain, the biopsychosocial model pertains to the holistic vision of a person. Specifically, this is the interface between and among biological, behavioral, emotional, and social forces that influence health and well being.

Clinically indicated - Those individualized case determined activities or decisions rendered by the psychologist, social worker, or treatment team to abet the attainment of specified treatment goals.

Collaborative Activities - Professional functions that involve the cooperation and/or coordination of team members from a variety of professions.

Community Reintegration - The process of returning to the community after rehabilitation and adopting a meaningful, satisfying lifestyle with consideration of personality, physical, socioeconomic and employment factors.

Council on Social Work Education - A non-profit, tax-exempt, national organization which is recognized by the US Department of Education and the Council on Post-Secondary Accreditation as the sole accrediting agency for social work education in the United States.

Discharge Planning - An interdisciplinary process to assist the individual and family in the development of post-hospital plans which ensure continuity of care and services consistent with the maximal level of independence in the least restrictive environment.

Family - Relatives and/or significant others identified by the individual as constituting the primary source of emotional and social support.

Follow-up - The process of comprehensive re-evaluations of the medical, rehabilitative, and psychosocial status of the individual with SCI. Re-evaluations are scheduled on a routine basis, as well as when emergent needs arise.

Functional Performance Measures - Functional/performance measures assess an individual's observable behavior in a defined situation with respect to the construct, class of behaviors or attribute being measured.

Hospital Privileges - A formal agreement between the clinician and the health care facility which authorizes the clinician to deliver psychosocial assessment, treatment, and consultation services independently within established professional boundaries.

Independent living - The concept that persons with disabilities have the right to control their own lives and make decisions about their futures. This concept is the basis of the social and civil rights movement also known as independent living.

Interdisciplinary Treatment - In the field of SCI rehabilitation, a treatment model in which the team collaborates to complete assessments, set goals, plan and implement treatment strategies, evaluate progress and determine the discharge plan. This process occurs in a holistic fashion acknowledging that problems and solutions cross discipline boundaries.

Managed Care - a strategy developed by the health care industry to control the utilization, quality, cost, and disbursement of health care resources.

National Association of Social Workers (NASW) - The largest organization of professional social workers in the world. The Association works to enhance the professional growth and development of its members, create and maintain professional standards, and advance sound social policies.

Overlapping Activities - Professional functions which may be performed by more than one profession with varying degrees of formality and thoroughness.

Personal Assistance Services - Assistance provided by another person to assist the person with SCI to perform activities of daily living, fulfill responsibilities, and reach personal goals. This may include personal, household, communication, and mobility services.

Psychologist - A professional who has a doctoral degree in clinical or counseling psychology from a program approved by the American Psychological Association and is licensed in the state of practice.

Psychosocial - Pertaining to the psychological and social aspects of human functioning.

Quality of Life - A subjective concept by which one defines the degree of life satisfaction. It is based in the many dimensions of life experience and personal values. Critical factors include independence, social support, activity, control, and health. Common dimensions identified by Americans include physical and material well-being; relationships with other people; participation in social, community, and civic activities; personal development and fulfillment; and recreation.

Rehabilitation - The process of providing a program of coordinated services, with the full participation of the individual with SCI to achieve physical, psychological, social, economic, and vocational potential. Rehabilitation is a dynamic process of learning to live with a disability in one's own environment beginning at the moment of injury and continuing for the duration of one's life.

Social Skills Training - A component of rehabilitation in which the individual with SCI learns effective communication techniques and adaptive behaviors for a variety of social situations.

Social Worker - A professional who has a degree of Master of Social Work from an institution accredited by the Council of Social Work Education and meets applicable legal requirements.

Standards - Formal, written expectations for psychosocial rehabilitation of the individual with SCI through the establishment of realistic and achievable criteria for professional services provided by psychologists and social workers.

VII. ENDORSEMENT LIST* - First Edition

• Albuquerque, NM
• Augusta, GA
• Brockton/West Roxbury, MA
• Castle Point, NY
• Cleveland, OH
• East Orange, NJ
• Hampton, VA
• Hines, IL
• Houston, TX
• Long Beach, CA
• Memphis, TN
• Miami, FL
• Milwaukee, WI
• Palo Alto, CA
• Richmond VA
• Seattle, WA
• Sepulveda, CA
• Tampa, FL
• VA National Headquarters, Washington, DC

SCI Rehabilitation Centers

• Alfred L. duPont Institute, Wilmington, DE
• Baptist Memorial Hospital, Memphis, TN
• Capital Rehabilitation, Tallahassee, FL
• Cascade Rehabilitation Center, Leavenworth, WA
• Charlotte Rehabilitation Hospital, Inc., Charlotte, NC
• Emanuel Rehabilitation Center, Portland, OR
• Florida Hospital Rehabilitation Center, Orlando, FL
• Gaylord Hospital, Inc., Wallingford, CT
• Good Samaritan Hospital, Puyallup, WA
• Health Rehabilitation Center, Miami, FL
• Health South Rehab Center, Florence, SC
• Healthsouth Rehabilitation Center, Columbia, SC
• Kessler Institute, West Orange, NJ
• Legacy Rehabilitation Services
• Marianjoy Rehabilitation Center, Wheaton, IL
• Mary Free Bed Hospital and Rehab Center, Grand Rapids, MI
• Medical University of SC, Charleston, SC
• Memorial Regional Rehabilitation, Jacksonville, FL
• Metro Health Rehabilitation Center, Cleveland, OH
• Mt. Sinai Medical Center, New York, NY
• O'Donaghue Rehabilitation Institute, Oklahoma City, OK
• Ohio State University Hospital, Columbus, OH
• Oregon Rehabilitation Center, Eugene, OR
• Patricia Neal Rehabilitation Center, Knoxville, TN
• Rancho Los Amigos Hospital, Downey, CA
• Rehabilitation Institute of Michigan, Detroit, Ml
• Rehabilitation Institute of West Florida, Pensacola, FL
• Sacred Heart Medical Center, Spokane, WA
• Sea Pines Rehabilitation Hospital, Melbourne, FL
• Spain Rehabilitation Center, Birmingham, AL
• St. Joseph Rehabilitation Hospital, Albuquerque, NM
• St. Jude Hospital and Rehabilitation Center, Fullerton, CA
• Sunnyview Hospital and Rehabilitation Center, Schenectady, NY
• The Rehabilitation Center, Santa Clara Valley Medical Center, San Jose, CA
• Thomas Rehabilitation Hospital, Asheville, NC
• Turning Point Rehabilitation Center, Walla Walla, WA
• University of Michigan, Ann Arbor, Ml
• University of Utah Medical Center, Salt Lake City, UT
• University of Washington Rehabilitation Medical Center, Seattle, WA
• Walton Rehabilitation, Augusta, GA
• West Gables Rehabilitation Hospital, Miami, FL
• Woodrow Wilson Rehabilitation Center, Fishersville, VA

Organizations

• American Congress of Rehabilitation Medicine
• American Paraplegia Society
• Bay Area and Western Paralyzed Veterans of America
• Cal-Diego Paralyzed Veterans of America
• Central Florida Paralyzed Veterans of America
• Daniel Heumann Fund for Spinal Cord Research, Inc.
• Eastern Paralyzed Veterans Association
• Florida Gulf Coast Paralyzed Veterans of America
• Foundation for SCI Prevention
• Great Plains Paralyzed Veterans of America
• Help Them Walk Again
• Iowa Paralyzed Veterans of America
• Lone Star Paralyzed Veterans of America
• Mid-America Paralyzed Veterans of America
• Minnesota Paralyzed Veterans of America
• Mountain States Paralyzed Veterans of America
• National Organization on Disability
• North Texas National Spinal Cord Injury Association
• Northern National Spinal Cord Injury Association
• Oregon Paralyzed Veterans of America
• Paralyzed Veterans of America
• SCI Network International
• The Job Accommodation Network, W. Virginia University
• Vaughn Paralyzed Veterans of America
• Wisconsin Paralyzed Veterans of America

*The Standards have been endorsed by at least one if not all of the administrative staff, the medical director, the social work department director, the psychology department director, and/or the program administrator. Agencies were not included if any administrators did not endorse the standards.