The Role Of The Educational-Vocational Counselor In An Amputee Program

Amelia Sherrets, M. S.

During the past several years, rehabilitation workers have been using the clinic team approach to coordinate the efforts of medical staff, therapists, social service workers, and psychologists in order to provide a broader program of assistance to patients.

At the Children's Rehabilitation Center of the Children's Hospital in Buffalo, New York, the clinic team includes an additional member - an educational-vocational counselor - particularly when the patient is a child or young adult. This discipline has been included because the medical director and other team members felt that the school was too important a factor in the total development of the child to be omitted from the integrated consideration of the clinic team. The service is available in all five clinics conducted at the Children's Hospital, viz. : Cerebral Palsy, Neuromuscular, Seizure, Mental Retardation and Amputee.

Liaison with Schools

The influence of the school's role in any child's life would be difficult to over-estimate, and in the life of the handicapped child its potential effect -- positive or negative -- is accentuated. For the handicapped child the varied functions of a school can be made most meaningful and positive by interaction between clinic staff and school personnel.

It has been our experience that school personnel, whether in a specialized setting or in a regular school, lean heavily on findings, interpretations and recommendations of the Children's Rehabilitation Center. In order to fulfill the Center's obligation adequately, the educational-vocational counselor, trained in education and rehabilitation, must assume a key role as a team member, educational diagnostician, and reporter. She must provide the necessary liaison between the clinic, the schools and those agencies in the community which serve the handicapped child at all levels.

This paper will focus on services rendered to children seen in the Amputee Clinic of the Center.

Formulation of the Counselor's Role

In contrast to other professional staff members serving on the team, the Educational-Vocational Counselor, in this new combined professional role, had to establish an identity, formulate a series of meaningful functions, and establish inter-and intra-agency communication. In essence she had to structure a series of services which would be provided by this new discipline to serve the educational and vocational needs of the child amputee.

In interacting with the team members before, during and after each evaluation, the dual aspects of the educational-vocational counselor's role emerged as follows:

A. Educational Function

1. School Records

School records are obtained either by personal contact or by written request. These data are required early in the evaluation and then cumulatively, so that any new information, test results or anecdotal records can be utilized by team members as needed. Detailed descriptive information is preferred to routine forms.

2. Interviews and Tests

The child and parent(s) are interviewed and where necessary special tests are administered to the patient. An important aspect of the interview is the counselor's observations concerning the child's ability to cooperate on testing, to relate to the examiner, to respond to instructions, and to maintain attention.

In the case of the pre-school or young school-age child, the interview with the parent is the prime source of information on the child's social and emotional characteristics and habits, interests and play behavior. Insights into parental attitudes and understanding of the child are obtained. Interpretation of the relationship between the child and the school personnel, and understanding of the parents' expectations of the child in a school setting are additional goals.

The type and degree of testing provided depends on the number and kinds of tests previously administered and the needs of each individual case. The tests given include readiness and achievement measurements, diagnostic assessments and the use of standardized pre-school intellectual ability scales.

3. Team Conference

The educational counselor's findings are reported to team members at the professional conference. This report includes information on school background and level of achievement and a summation of the school personnel's understanding of the child. Results of the counselor's interviews and testing are presented and help provide a foundation for school placement and future planning. School personnel attend the conference when possible. If they are unable to attend, the findings and recommendations of the team conference are sent to the school, together with a summary of the educational implications of the amputation. These implications may involve such factors as: adjustment to prosthesis, level of training and functional ability, psychological considerations, parental attitudes, or a combination of all these factors. When possible, the counselor makes individual school visits at the conclusion of the evaluation to maintain rapport, clarify findings and recommendations, or to arrange for demonstration of the prosthesis. In the case of some juvenile amputees, the occupational or physical therapist or the public health nurse may also play an active role in the school setting because of problems or questions relating to the use of the prosthesis.

4. Classroom Orientation

The importance of flexibility and caution in interacting with the school can hardly be overemphasized. School personnel are and must be treated as members of the rehabilitation team serving the child amputee. The teacher's role and attitudes are critical and must be stressed and reinforced .

At the outset, the educational counselor should assume that the teacher working with the amputee child in a regular class may have little or no awareness of the philosophy governing the use of the prosthetic device or of psychological problems specific to amputees, as self-concept, adjustment to prosthesis or emotional reactions to being "different" from other children.

In introducing the child amputee to his peers, the child's attitude and personality must be taken into account. A child who has a positive self-concept, is outgoing and independent, and has good manual skills, would readily agree to "show and tell" - demonstrating and explaining the prosthetic device and discussing it with his classmates. A withdrawn, passive child would require a more gradual approach to demonstration. The other children in the classroom should be prepared for the introduction of the child wearing a prosthesis. They have to learn not to fear it, to understand how it works and the things that can be done with it. The teacher should be asked to observe closely the amputee's reaction to the school situation and also the reactions of the other children, which are not always predictable.

5. Follow-Up

Periodic reports from the school on the child's total program and progress are necessary adjuncts to follow-up. Through the educational counselor, the school can also make contact with the team, when confronted with new problems or a resurgence of old ones. When a case is to be reopened, the educational counselor is available for a school conference or review of material.

In summary, the educational role of counselor is one of examiner (readiness, achievement and diagnostic tests), interviewer, team member, reporter, and liaison member between the clinic, school and other agencies. The role requires that the counselor perform a synthesizing function, compiling and consolidating the clinic's findings and recommendations. It is within this delicate balance of clinic, home and school that the eventual integration of the amputee child into the school and community is carried out.

B. Vocational Function

The vocational aspect of the counselor's role must be separately defined and the philosophy and function of vocational counseling interpreted to the other members of the clinic team.

In the early days of vocational counseling, the counselor's function was chiefly that of supplying information on training programs, or providing guidance leading to specific employment. More recently the recognition that psychological and social factors affect the choice of a vocation as well as the adjustment to it, and that personal and emotional problems often interfere with vocational planning, made it mandatory that the counselor be concerned with personality development. In working with the amputee, the counselor also must learn to understand and evaluate the patient's psychological adjustment to his handicap. Out of these new concepts, a different role for the vocational counselor emerged.

Vocational counseling today has become a process in which the experienced and trained person assists an individual: (1) to understand himself and his opportunities, (2) to make appropriate adjustments and decisions in light of his understanding, (3) to accept the responsibility for his choice, (4) to follow a course of action in harmony with his choice. As a member of the amputee clinic team, the vocational counselor emphasizes adjustment to the handicap throughout the treatment program.

The vocational aspect of the counselor's role emerged with the following functions :

  1. The accumulation and analysis of past school history and achievement in the cases of adolescents seen in the clinic.

  2. Administering and evaluating tests. The amount and kind of testing depends on the counselor's orientation, the demands of the clinic and the willingness of the patient to participate. In this clinic, the approach is client-centered, and tests are administered as indicated in the process of counseling.

  3. Interviewing the patient. (In vocational counseling there is little or no contact with the parent.) The plan developed can be based either on the counselor's perception of the needs of the patient or on the wishes expressed by the patient.

Counseling may be initiated at the request of the patient, or the suggestion of parents, school or counselor. In no instance, however, is counseling undertaken without the consent of the patient and his agreement to become involved in the counseling process Counseling assumes mutual respect, mutual understanding of the goals of counseling, and recognition throughout of the confidential nature of the counseling process.

The Roles Compared

In comparing the roles of the educational and vocational counselor and their functions within the Center, it is apparent that the educational counselor's role involves fact finding, recommendation, community contact and follow-up, with special emphasis on interpreting the child to teachers and other school personnel. The vocational counselor, on the other hand, interacts more directly with the patient, without the intermediary of parents or agency, using methods that are consistent with the philosophy of the Center, and the best interests of the patient.

Long-Range Planning

The educational-vocational counselor's dual role on the rehabilitation team thus involves a continuous re-evaluative process, beginning in early childhood, continuing throughout the school years, and culminating in guidance of the patient toward the ultimate goal of vocational choice and adjustment.

Amelia Sherrets is associated with the Children's Rehabilitation Center, Children's Hospital, Buffalo, New York