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Evaluation Of Short-Term Training For Rehabilitation Counselors: Effectiveness Of An Institute On Epilepsy

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Evaluation Of Short-Term Training For Rehabilitation Counselors: Effectiveness Of An Institute On Epilepsy

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Content EVALUATION OF SHORT-TERM TRAINING FOR REHABILITATION
COUNSELORS: EFFECTIVENESS OF
AN INSTITUTE ON EPILEPSY
A Dissertation
Presented to
the Faculty of the School of Education
University of Southern California
In Partial Fulfillment of
the Requirements for the Degree
Doctor of Education
by
Everett Wilson Stude, Jr.
January 1972
72-17,517
STUDE,.Jr., Everett Wilson, 19 39-
EVALUATION OF SHORT-TERM TRAINING FOR
REHABILITATION COUNSELORS: EFFECTIVENESS
OF AN INSTITUTE ON EPILEPSY.
University of Southern California, Ed.D., 1972
Education, guidance and counseling
University Microfilms, A X ERO X Com pany, Ann Arbor, Michigan
©Copyright by
EVERETT WILSON STUDE, JR.
1972
THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED
This dissertation, written under the direction
of the Chairman of the candidate’s Guidance
Committee and approved by all members of the
Committee, has been presented to and accepted
by the Faculty of the School of Education in
partial fulfillment of the requirements for the
degree of D octor of Education.
Date... ................ Z Z Z i ........
PLEASE NOTE:
Some pages may have
indistinct print.
Filmed as received.
University Microfilms, A Xerox Education Company
ACKNOWLEDGMENTS
As is the case in most research projects, the
finished product is a result of many individuals' efforts
in addition to that of the author. Consequently, the
author is deeply indebted to the following individuals:
The administration and staff of the California
State Department of Rehabilitation, including: Paul
Mueller, Ph.D. and Linda Culy for their assistance in the
caseload review; and Robert Howard, Stan Merrill, Harry
Lucas and Morgan Vail for their cooperation in allowing
and making it possible for the Department's counselors to
participate in the study;
Members of the Dissertation Committee: Professors
Donald Schrader, Chairman; Earl Carnes; and C. Edward Myers
for their suggestions and guidance;
The Veterans Administration Center in West Los
Angeles and Frank Risch, Ph.D., Director of Epilepsy
Rehabilitation and Founder of Epi-Hab USA Incorporated,
for providing valuable assistance and cooperation in
developing and presenting the Institute on Epilepsy;
The staff of the University of Southern California
Medical School's Division for Research and Training in
Rehabilitation, including: Arthur Johnson for his
ii
assistance in presenting the institutes; and Janice Woo
and Virgel Hampton for typing the preliminary draft;
And especially my wife, Mary-Ann, for her encourage
ment and support, as well as proofreading all drafts; and
my daughters, Susan and Sandra, for their patience and
understanding in sharing their father with this endeavor.
TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS..................................... ii
LIST OF T A B L E S ..................................... vi
Chapter
I. INTRODUCTION ............................... 1
Statement of the Problem
Institute Selection and Description
Selection of Criteria to Measure
Effectiveness
Research Hypotheses
Significance of the Study
Definition of Terms
II. REVIEW OF RELATED LITERATURE............. 19
Introduction
Evaluation of Short-Term Training--
Theoretical Concepts
Evaluation of Short-Term Training
for Rehabilitation Counselors
Evaluation of Short-Term Training
for Counselors in General
Evaluation of Short-Term Training
for Medical Students
Evaluation of Short-Term Training--
General Education
Evaluation of Short-Term Human Relations
Training in Business and Business
Administration and Management
Cone1us ion
III. RESEARCH DESIGN............................ 54
Population Sample
Experimental and Control Groups
Evaluation Procedures
Operational Testing of Hypotheses
Statistical Treatment
iv
Chapter Page
IV. RESULTS..................................... 71
Description of Sample
Criterion I: Epilepsy Information
Examination
Criterion II: Semantic Differential
Epilepsy Attitude Survey
Criterion III: Caseload Case Status
Review
V. DISCUSSION OF RESULTS....................... 93
Introduction
Research Hypothesis I
Research Hypothesis II
Research Hypothesis III
Research Hypothesis IV
VI. SUMMARY, CONCLUSIONS AND IMPLICATIONS
FOR FURTHER STUDY........................... 100
Summary
Conclusions
Implications for Further Study
REFERENCES.......................................... 117
APPENDIXES......................................... 127
A. Epilepsy Institute Program
B. Rheumatic and Coronary Heart Disease
Institute Program
C. E,pilepsy Information Examination
D. Semantic Differential Epilepsy Attitude
Survey
E0 Biographical Data Sheet
F. Correspondence with Subjects
v
LIST OF TABLES
Table Page
1. Description of Sample: Age, Number of
Years in Field and Number of Years
Employed..................................... 72
2. Description of Sample: Sex, Highest
Educational Level, and Epileptic
Friend or Relative.......................... 73
3. Description of Sample: Non-M.S. in
Rehabilitation Counseling, College
and Graduate School Majors .................. 74
4. Mean, Range and Standard Deviation for
Criterion I: Epilepsy Information
Examination................................ 77
5. One-Way Analysis of Variance for
Criterion I: Epilepsy Information
Examination................................ 78
6. Tukey's HSD Test for Difference among
Means in Criterion I: Epilepsy
Information Examination ................... 79
7. Group Means, Ranges and Standard
Deviations for each Concept's Total
Score in Criterion II: Semantic
Differential Epilepsy Attitude Survey . . 81
8. One-Way Analysis of Variance between
Experimental and Control Groups for
each Concept in Criterion II: Semantic
Differential Epilepsy Attitude Survey . . 82
9. Standard Score Significance of the
Difference between Group Means and an
Indifferent or Neutral Rating in
Criterion II: Semantic Differential
Epilepsy Attitude Survey ................. 83
vi
Table
10.
11.
12.
13.
14.
15.
Page
Mean, Range and Standard Deviation of
Positive and Negative Epileptic Case
Status Changes by Month per Counselor
by Groups in Criterion III: Caseload
Case Status Review....................... 85
Two-Way Analysis of Variance of Positive
Epileptic Case Status Changes per
Counselor across Ten Months between
Groups for Criterion III: Caseload
Case Status Review........................ 87
Two-Way Analysis of Variance of Negative
Epileptic Case Status Changes per
Counselor across Ten Months between
Groups for Criterion III: Caseload
Case Status Review........................ 88
Mean, Range and Standard Deviation of
Positive and Negative Epileptic Case
Status Changes for the Five Months
Pre Institute and Five Months Post
Institute per Counselor between
Groups in Criterion III: Caseload
Case Status Review........................ 89
Two-Way Analysis of Variance of Positive
Epileptic Case Status Changes for the
Five Months Pre Institute and Five
Months Post Institute per Counselor
between Groups in Criterion III:
Caseload Case Status Review ............. 90
Two-Way Analysis of Variance of Negative
Epileptic Case Status Changes for the
Five Months Pre Institute and Five
Months Post Institute per Counselor
between Groups in Criterion III:
Caseload Case Status Review ............. 91
vii
CHAPTER I
INTRODUCTION
Statement of the Problem
One of the goals of the University of Southern
California School of Medicine's Division for Research and
Training in Rehabilitation^- is to "Facilitate the teaching
of the principles of comprehensive health care within the
associated health professions" (R.T. #18, 1970, p. 26).
In an attempt to partially fulfill this goal, the Division
annually presents a series of Institutes for Rehabilita
tion Counselors on Rehabilitation of the Physically Dis
abled. This series includes the presentation of nine,
two-day institutes covering the topics of alcoholism,
spinal cord injury, cerebrovascular disease, rheumatic and
coronary heart disease, drug abuse and addiction, chronic
respiratory diseases, epilepsy, arthritis and hemophilia.
Participants include rehabilitation counselors employed by
state and non-state vocational rehabilitation agencies and
^Supported in part by grant #16-P-56816/9-05 to the
University of Southern California Rehabilitation Research
and Training Center from the Social and Rehabilitation
Services Department of Health, Education and Welfare,
Washington, D.C.
1
master's degree rehabilitation counseling students from
the University of Southern California and California State
College at Los Angeles.
The objectives of the series of institutes are:
A. To familiarize rehabilitation counselors with
the medical, psychological, social and voca
tional aspects of these disabilities;
B. To provide them with information regarding
evaluating the functional limitations of these
conditions; and
C. To encourage them to apply the above informa
tion to the vocational rehabilitation of
individuals handicapped by these disabilities.
The Division's basic assumption and rationale for
presenting the institutes is a feeling that rehabilitation
counselors have less positive attitudes toward and are
therefore less likely to accept individuals with the above
mentioned disabilities for vocational rehabilitation
services because of two reasons: the severity of these
disabilities in terms of their effects on the functional
life of the disabled person; and prejudices and misconcep
tions on the part of rehabilitation counselors about these
disabilities due to lack of information and experience
regarding the underlying medical, psychological, social
and vocational dynamics of the condition, new concepts of
treatment and real vocational potential. Rehabilitation
counselors attending the institutes are exposed to factual
information regarding these disabilities and their
rehabilitation potential. This information is believed to
lead to a better understanding of the underlying dynamics
of the disabilities, more positive attitudes toward
individuals handicapped by these disabilities, a greater
willingness to accept individuals with these disabilities
for vocational rehabilitation services, and greater success
in helping these individuals return to their community and
obtain employment.
To meet these assumptions and objectives, the
institutes were designed to demonstrate an interdiscipli
nary approach to comprehensive health care while exposing
counselors to the environment of the acute, in-hospital
phase of the disabled person's return to productivity.
Methods of presentation include: lectures, panel presenta
tions and discussions by physicians, nurses, therapists,
social workers, psychologists, rehabilitation counselors,
etc. specializing in working with these particular dis
abilities; films; slides; patient presentations; the use
of programmed patients (actors who simulate disability);
demonstration of evaluative equipment; and tours of
treatment facilities.
To date, evaluation of the effectiveness of the
institutes has been limited to utilizing a pre-post test
4
of information and an evaluation rating form completed by
counselors attending the institutes. While both of these
measures, as well as informal feedback following the
institutes, have indicated that the series fulfilled a
need on the part of rehabilitation counselors for informa
tion regarding the more severe physical disabilities and
their rehabilitation potential, whether the information
obtained actually had any effect on the attitudes or
behavior of the counselor has yet to be determined,
The purpose of this study, therefore, will be to
attempt to develop a method for evaluating the effective
ness of short-term training of the nature described above
and to apply this method to a particular institute in the
series.
Institute Selection and Description
In thinking about which institute would be most
appropriate to evaluate for the purposes of this study,
several things were taken into consideration. First, the
disability topic covered during the institute should be
one that is easily identifiable as the major disabling
condition. Second, the disability would need to be one
that it would be reasonable to expect would be referred to
rehabilitation counselors. Third, the institute should be
one in the series that had not been presented numerous
times in the past. And fourth, the disability topic
covered during the institute should be one that would lend
itself to being compared with another institute utilized
as a control.
The Institute for Rehabilitation Counselors on
Epilepsy met the above criteria of selection. This Insti
tute covered a disability that was readily identifiable,
likely to be referred to rehabilitation counselors,
presented only once in the past and one that would lend
itself to comparison with another institute, such as the
Institute on Rheumatic and Coronary Heart Disease. Per
sonal coversations with the Research and Statistics section
of the California State Department of Rehabilitation
revealed that during the 1968-69 fiscal year there were
approximately two hundred and fifty clients with the
diagnosis of epilepsy successfully rehabilitated and
approximately seven hundred and fifty clients with this
diagnosis still on the rolls at the close of the year.
These figures did not include the number of clients with
epilepsy that were closed short of successful rehabilita
tion for one reason or another during the year. Conse
quently, it seemed reasonable to expect that a sizeable
population sample of rehabilitation counselors could be
obtained for the purposes of this study.
The objectives of the Institute on Epilepsy are
similar to the objectives of the series of institutes in
general:
A. To familiarize rehabilitation counselors with
the medical, psychological, social and voca
tional aspects of epilepsy;
B. To provide them with specific information
regarding methods of evaluating the effects
and functional limitations of this condition;
and
C. To encourage them to apply the above informa
tion to the vocational rehabilitation of
individuals handicapped by this disability.
The Institute was held at the Veterans Administra
tion Center in West Los Angeles, an institution with a
neurology ward containing a number of patients with a
diagnosis of epilepsy and a special Epilepsy Rehabilitation
Program. Faculty included Center staff and individuals
from the community who had specialized or were currently
specializing in working with epileptics. The faculty
represented the disciplines of medicine, psychology,
social work, sheltered workshop administration, rehabili
tation counseling and engineering. The Institute took
O
place over a two-day period with presentations'1 including:
lecture-slide-discussion presentations on The History of
9
See appendix A for a more detailed description of
the Institute.
7
Epilepsy, The Neurological Deficits and Educational Im
plications of Epilepsy, The Causes and Treatment of
Epilepsy, Research and Prevention of Epilepsy, Epilepsy--
A Universal Stigma, The Social Implications of Epilepsy,
The Psychological Implications of Epilepsy, Vocational
Implications of Epilepsy, The Role of the Rehabilitation
Counselor in Epilepsy Rehabilitation Transition, and A
Community Resource for the Epileptic— The California
Epilepsy Society. In addition, two films entitled
"Modern Concepts of Epilepsy" and "Blueprint for Epilepsy"
were shown; a tour of the Industrial Workshop at the
Veterans Administration Center was conducted; The Transi
tion of Epilepsy from Forced Idleness to Productive
Employment--A Case Presentation was presented; electro-
encephalographic recording requipment was demonstrated;
and a panel of Institute faculty responded to questions
from participants.
Selection of Criteria to Measure Effectiveness
Several authors have indicated that adequate
evaluation of training requires the use of multiple
criteria to measure success (Bellman and Remmers, 1959;
Fryer, 1951; Michael and Metfessel, 1967; Knutson, 1952;
Miller, Oberman, et al., 1969; Arbuckle, 1968; and
Hamerlynck, 1970). The general consensus of these
authors is that the most suitable criteria short of
actual job production is change in job behavior. In
addition, several of these authors (Bellman and Remmers,
1959; Fryer, 1951; and Kropp and Hankin, 1962) suggest
that information and attitudes should be measured to
determine what effect, if any, the training had in these
areas.
Consequently, it seemed appropriate in attempting
to evaluate the effectiveness of the Institute on Epilepsy
to select three criterion measures: (1) accumulation of
information regarding rehabilitation of the epileptic
individual as the criterion measure for the effectiveness
of achieving the goals of familiarizing rehabilitation
counselors with the medical, psychological, social and
vocational aspects of epilepsy, and providing them with
specific information regarding methods of evaluating the
effects and functional limitations of the condition;
(2) change in attitudes as well as (3) change in the job
behavior toward the epileptic individual as the criterion
measure of effectiveness for achieving the goal of
encouraging rehabilitation counselors to apply the informa
tion to the vocational rehabilitation of individuals
handicapped by this disability.
Research Hypotheses
As indicated previously, it was anticipated that if
the Institute on Epilepsy was successful in achieving its
objectives, rehabilitation counselors attending the
Institute would be exposed to and accumulate factual
information regarding the rehabilitation of epileptics;
this information would lead to a better understanding of
the underlying dynamics of epilepsy; more positive atti
tudes toward epileptics as vocational rehabilitation
clients; and, ultimately, more positive behavior on the
job toward epileptic individuals, resulting in a greater
willingness to accept them as clients and greater success
in helping these individuals return to productive roles
in their community.
More specifically, it was anticipated that:
1. Counselors attending the Institute on Epilepsy
would obtain a greater amount of information
regarding the rehabilitation of epileptics
as compared with counselors attending another
institute or not attending any institutes;
2. Counselors attending the Institute on Epilepsy
would demonstrate more positive attitudes
toward epileptic individuals as compared with
counselors attending another institute or not
attending any institute;
3. Counselors attending the Institute on Epilepsy
would demonstrate more positive job behavior
toward epileptic individuals than they
demonstrated prior to the Institute or as
compared with counselors attending another
institute or not attending any institutes;
and
4. Counselors attending the Institute on Epilepsy
and obtaining factual information would demon
strate more positive attitudes and job behavior
toward epileptic individuals as compared with
counselors attending another institute or not
attending any institutes.
Significance of the Study
The significance of this study is seen in three
areas: the training of rehabilitation counselors in
general; the in-service training program of the California
State Department of Rehabilitation; and the rehabilitation
counselor training program of the University of Southern
California School of Medicine's Division for Research and
Training in Rehabilitation.
As will be indicated in Chapter II, while there
have been a great number of short-term training programs
developed for rehabilitation counselors due to the large
need for additional counselors, lack of properly trained
counselors and trend toward specialization, little has
been reported in the way of evaluating the effectiveness
11
of the training, especially in terms of attitudes, effect
on job behavior and job performance. This study developed
a method for evaluating the effectiveness of short-term
training for rehabilitation counselors (measurement of
information, attitudes and job behavior using experimental
and control groups) and applied it to a specific training
program. Regardless of the results of the study in rela
tion to whether this particular training session is
effective or not, the method of evaluation is one that
could be duplicated in evaluating the effectiveness of
other types of short-term training in the field of re
habilitation counseling. In addition, master's programs
in rehabilitation counseling have long assumed the im
portance of training in the medical-social-psychological
aspects of disability. Almost all, if not all, rehabilita
tion counselor training programs at the master's degree
level contain one or more courses in these areas. An
unpublished survey by the California State Department of
Rehabilitation reveals that employed rehabilitation coun
selors with master's level training rate training in the
medical-social-psychological aspects of disability as
number two and three in terms of usefulness and priority
on a list of training needs (Mueller, 1969). The results
of this study will tend to support or not support the
effectiveness of short-term training for rehabilitation
counselors in the medical-social-psychological area as
12
indicated by increase or lack of increase in information
about the disability and a corresponding increase or de
crease in positive attitudes and job behavior toward the
disabled client.
The California State Department of Rehabilitation
annually spends a considerable sum of money to provide in-
service training for their professional staff. Because of
the limited nature of their training budget, much of the
in-service training is conducted by agencies and institu
tions outside of the Department. Even in the latter case,
the Department usually must pay for transportation and per
diem costs to send counselors to the training programs and
experience the loss of the productivity of the staff mem
ber during the training program itself. Consequently, the
results of a study such as the one herein reported will
have considerable import for the Department's in-service
training program, both in terms of the advisability of
continuing to send their counselors to short-term training
of this nature and applying a similar method of evaluation
themselves to other short-term training programs they
either sponsor themselves or utilize as a part of their
overall in-service program.
Finally, the results of the study will have an
impact on the rehabilitation counselor portion of the
Division for Research and Training's overall training
program. Negative results will necessitate deletion,
13
revision or modification of this type of short-term
training while positive results will possibly lead to an
expansion of such training. The method of evaluation
proposed in this study will also have considerable
applicability to other training programs for other dis
ciplines now sponsored by the Division.
Definition of Terms
Although most of the phrases and terms used in this
paper may have a specific meaning to the reader, this
meaning may vary from reader to reader, depending on his
particular frame of reference. Consequently, several of
the critical terms and phrases will be defined in relation
to this particular study for the purpose of clarification.
Rehabilitation Counselor (Vocational Rehabilitation
Counselor).— The rehabilitation counselor
is concerned with helping each of his (disabled)
clients identify and understand his vocational
and related problems, select a suitable voca
tional goal, plan an effective way to reach it,
and pursue the plan to its full realization in
gainful employment . . . [he has] a deep knowl
edge of the dynamics of individual and inter
personal behavior . . . understands the handi
capping effects of disabilities . . . has a wide
knowledge of jobs and occupational information
. . . knows the extent to which restoration is
possible or knows how to acquire such knowledge
. . . is aware of and knows how to use community
resources . . . knows how to utilize [other
professional persons'] knowledge and skills in
serving his clients. (Rehabilitation Services
Manual, 1968, p. 1.1300.)
14
Epilepsy.--"An episodic disturbance of conscious
ness during which convulsions may occur" (Taber, 1961,
p. E-40) .
A condition characterized by recurrent parox
ysms in which an impairment of consciousness
occurs, and which may or may not be accompanied
by convulsive movements of the body. There are
three major forms: grand mal, in which the in
dividual has major convulsions; petit mal, in
which he is subject to lapses of consciousness
with either slight or no convulsive movements;
and psychomotor, in which there are seizures
not of convulsion but of psychic phenomena and
abnormal behavior. (Travis, 1961, p. 117).
"A disorder of the central nervous system character
ized by recurring explosive nerve cell discharged and
manifested by transient episodes of unconsciousness of
psychic dysfunction, with or without convulsive movements"
(Bollo, 1961, p. 233).
Short-Term Training.--
Training that is of shorter duration than
a quarter or a semester of a regular academic
year is generally regarded as short-term
training. It is intended to precede or sup
plement basic or advanced professional educa
tion on an academic or calendar year basis.
Short-term training courses generally range
in length from 2 or 3 days to 6 weeks, ac
cording to their specific purpose. They
include institutes, workshops, seminars, and
other training courses. ("Support of Short-
Term Training," 1966, p. 48).
Institute.--Two sessions held on two concurrent days
for the purpose of presenting material regarding a specific
15
disability.
Disability.--nA condition of impairment, physical
or mental, having an objective aspect that can usually be
described by a physician (essentially a medical thing)1 1
(Hamilton, 1950, p. 17).
Handicap.--"The cumulative result of the obstacles
which disability interposes between the individual and his
maximum functional level (an individual thing composed of
the barriers which the handicapped person must surmount)"
(Hamilton, 1950, p. 17).
Referral.--
Any individual who has applied by personal
contact with any Vocational Rehabilitation
employee, by telephone, or by letter; or who
has been referred to any Vocational Rehabilita
tion employee by letter, by telephone, by client
contact, or by any other means, and for whom the
following minimum information has been formu
lated: name and address, disability, age, sex,
date of referral, and source of referral.
(Rehabilitation Services Manual, 1968, p. 5.2000).
Acceptance.--An individual is accepted for evalu
ation when he has met the basic requirements for eligi
bility:
The presence of a physical or mental disability;
the existence of a substantive handicap to employ
ment (as a result of the disability); and a reason
able expectation that vocational rehabilitation
services may render the individual fit to engage
in a gainful occupation. (Rehabilitation Services
Manual, 1968, p. 8.0000).
16
Employability.--"The capacity of the individual to
prepare for, enter into, and progress within occupations
in which he can find economic and personal satisfactions"
(Hamilton, 1950, p. 23).
Vocational Rehabilitation Potential.--"Reasonable
expectation that vocational rehabilitation services may
render the individual fit to engage in a gainful occupa
tion" (Rehabilitation Services Manual, 1968, p. 8.0000).
Gainful Occupation.—
Includes employment in the competitive labor
market; practice of a profession; self-employment;
homemaking, family or family work (including work
for which payment is in kind rather than in cash);
sheltered employment; and home industries or other
homebound work of a gainful nature. (Rehabilita
tion Services Manual, 1968, p. 8.3330).
Rehabilitation Plan.—
A statement of the ways and means by which the
client is to overcome his handicap and regain his
competitive capacity. The plan contains a state
ment of the goals sought in each of the three
major components of the client's handicap--medi-
cal, psychosocial and vocational. It contains a
survey of the services needed. It indicates by
whom they shall be rendered, and in what sequence.
It gives a valid estimate of the time involved
and of the costs anticipated. It contains a
statement of the vocational direction of the
client, if not his job objective. It is sub
stantially a statement of the functional inter
relationship of agencies as they relate to the
needs of the client. It contains the probable
job placement plan through which the level of
restored employability will actually be demon
strated. (Hamilton, 1950, pp. 139, 141).
17
Closed Rehabilitated.— Cases closed rehabilitated
must as a minimum:
1) have been declared eligible, 2) have re
ceived appropriate diagnostic and related
services, 3) have had a plan of vocational
rehabilitation services formulated, 4) have
completed the plan insofar as possible, 5) have
been provided counseling and one or more other
rehabilitation services (placement, assistance,
etc.), an<^ 6) have been determined to be suit
ably employed at the time of closure and for a
minimum of thirty days prior to closure.
(Rehabilitation Services Manual, 1968, p.
14.3100).
Definition of Statuses.--Major statuses include the
following:
Referred--Status 00-referral (entrance into the
vocational rehabilitation process);
Status 02-applicant (receipt of docu-
ment signed by the individual re
quest ing vocational rehabilitation
services); Status 04-six-month evalu-
ation and Status Ob-eighteen-month
evaluation (used for further deter
mination of eligibility).
Accepted--Status 10-plan development (used after
eligibility has been certified and
while the case study and diagnosis is
being completed to provide a basis for
the formulation of the individual's
plan of vocational rehabilitation).
Plan Completed— Status 12-plan completed (plan
written and approved); Status 14-
counseling and guidance only (coun
seling, guidance and placement are
the only services required to prepare
the client for employment); Status 16-
physical restoration (client receiving
medical, surgical, psychiatric, or
therapeutic treatment or is being
fitted with an appliance); Status 18-
training (client receiving school
training, employment training, or
training at some other facility by an
individual or by correspondence).
Employment--Status 20-ready for employment
(client has completed preparation for
employment but has not been placed);
Status 22-in employment (client has
begun employment.
Rehabilitated--Status 26-closed rehabilitated
(client successfully employed as
defined under "closed rehabilitated"
above).
Closed Not Rehabilitated— Status 08-closed
after referral or" extended evaluation
(not accepted for services due to
lack of eligibility or loss of con
tact); Status 24-service interrupted
(rehabilitation services interrupted
while client is implementing his voca
tional rehabilitation plan); Status 28-
closed unemployed after rehabilitation"
plan initiated; and Status 30-closed for
other reasons before rehabilitation plan
initiated. (Rehabilitation Services
Manual, 1968, pp. 25510.01-.30).
CHAPTER II
REVIEW OF RELATED LITERATURE
Introduction
Unlike many professions, the profession of rehabili
tation counseling traces its beginning to federal
legislation. In 1920, Congress passed the Vocational
Rehabilitation Act, which provided rehabilitation services
to disabled civilians, designed to return them to pro
ductive employment. These programs were developed by the
several states on a federal-state financial matching
basis, with a vocational adviser or rehabilitation officer
serving as the principal contact with and resource person
for the disabled client. In 1942, the Vocational
Rehabilitation Act was amended to include the mentally
retarded and emotionally disturbed as well as the
physically disabled. In addition, the need for qualified
counseling was stressed. However, from 1920 to 1942, and
in fact until 1954, no graduate program existed to train
individuals to become rehabilitation counselors in spite
of the tremendous expansion of the state-federal programs
(Allan, 1958). Individuals entering the profession came
primarily from the fields of psychology, sociology, and
19
20
education, with bachelor's degrees or less, and learned
the techniques of rehabilitation counseling on the job.
In 1954, Congress again amended the Vocational Rehabilita
tion Act, providing for federal support of formal educa
tion at the master's degree level for professional
workers, in-service training, and research and demonstra
tion. This led to the development of two-year Master of
Science degree university programs in rehabilitation
counseling, and in-service, short-term training for
employed rehabilitation counselors by universities and
private organizations, as well as state vocational
rehabilitation agencies.
Indications are that the need for professionally
trained rehabilitation counselors will continue to grow
in the next decade. According to the most recent Public
Affairs pamphlet, 500 to 600 new rehabilitation counselors
are needed just to fill vacant positions each year (Ogg,
1970). As a result of substantial increases in federal
aid to state vocational rehabilitation agencies, the
pamphlet indicates that many states plan to double, triple
or quadruple their staffs by 1975. As a result, there
will be a need for 25,000 rehabilitation counselors by
1975, as compared with 8,300 in 1969.
In addition to the increasing numbers of counselors
needed, enlightened social concepts expanding legislation
have greatly increased the types of physical, mental and
21
social disabilities accepted for vocational rehabilitation
services and have led to increasing specialization on the
part of counselors with a particular type of disabled
client— alcoholic, mentally ill, severely disabled, public
offender, mentally retarded, deaf, blind, etc.
This increase in numbers and specialization has led
to a great need for short-term training. There are con
siderable numbers of counselors working for both private
and public vocational rehabilitation agencies who have not
had graduate training in rehabilitation counseling. In
addition, completion of a two-year master's degree program
gives sufficient time for only broad education in rehabili
tation counseling and is not able to prepare one for
specialization in a specific disability area. To meet this
need, a large number of short-term training sessions have
been held throughout the country, covering such topics as
job placement, group counseling, caseload management
training and specific disability areas. Unfortunately,
very little has been done in terms of evaluating the
effectiveness of these short-term training sessions.
Consequently, the scope of this literature review
will include attempts to evaluate short-term training in
fields closely related to rehabilitation counseling as well
as evaluation of short-term training for rehabilitation
counselors themselves. After presenting some theoretical
concepts regarding evaluating short-term training, specific
22
studies will be cited related to evaluating short-term
training for rehabilitation counselors, counselors in
general, short-term training for medical students and
short-term training in human relations in the field of
business administration and management.
Evaluation of Short-Term Training--
Theoretical Concepts
In 1957, Warren and Sanford surveyed, by means of
questionnaires and personal interviews, six short-term
training institutes for rehabilitation personnel in New
York City to determine of what value these institutes were
in the eyes of the organizers. They concluded the fol
lowing :
(1) The short-term institute varies widely in
program, objective and organization;
(2) It is popular and appeals to a wide audience;
(3) The flexibility of the institute enables ready
adaptation to the needs of participants and
community;
(4) The short-term institute as an aid in rehabili
tation is suited to expanding needs; and
(5) The total contribution of the short-term
institute has yet to be fully explored.
(Warren and Sanford, 1957).
23
At the conclusion of this article, James Garrett, a
member of the staff of the Social and Rehabilitation
services, United States Department of Health, Education
and Welfare, raised some interesting questions regarding
the last point and the process of evaluating the effec
tiveness of the short-term training institute.
It is not a question of final exams or some
similar academic procedure. How does one
develop the effectiveness of a training program
in the "team work" process? By the extent to
which one worker expresses himself in a case
conference? Or by someone saying they felt
they profited from course work? In what period
of time after completion of the institute do we
judge our results? On the last day of class?
Six months? Years? . . . we must face the fact
that we have to date evaluated our training by
the most rudimentary means rather than in depth.
(P. 32).
Just what is evaluation? Bellman and Remmers
define it as "the process by which we try to determine the
worth of what we do or develop as a result of some action
. . . expressed in numerical terms, less tangible terms or
more or less vague value judgments" (Bellman and Remmers,
1958, p. 29). They further indicate that the evaluation
process can usually be applied to three broad areas of
training: skills, knowledge, and attitudes.
Douglas Fryer (1951) reported an attempt to measure
these three areas. The short-term training he developed
was designed to identify the behavior necessary to job
accomplishment--attitude, knowledge, skill patterns of the
24
job. To evaluate whether they accomplished this goal, he
suggested interviewing and observing students, securing an
item description of the training process and scoring it on
its goodness, and rating both on the attitude-knowledge-
skill pattern dimensions.
While there is general agreement on the use of
skills as a criterion in evaluation, there is not complete
agreement on the benefits of measuring effectiveness in
terms of either attitudes or information. Lundberg (1962)
suggests that the measurement of attitudes may be a
barrier because it implies evaluating people in ways
difficult to determine beforehand. "The fewer attitudes
a person has and the less intense the retained ones are
held, the more likely he is to perceive and/or interpret
stimuli as they exist in reality" (p. 41).
The usual method of measuring the amount of infor
mation gained as a result of short-term training is to
administer some kind of an information test, usually of a
30 to 50 multiple choice variety. The result is, of
course, only as good as is the instrument. As most
teachers know, developing a good multiple choice test is
a very difficult thing to do. Consequently, evaluation
utilizing this method is often subject to questionable
validity. Kropp and Hankin (1962) have given several
suggestions that are designed to minimize the unsatisfac
toriness of using multiple choice item information tests
25
in evaluation:
(1) Avoid heavy language that clouds the question;
(2) Avoid item linkages;
(3) Avoid repetition of alternatives;
(4) Avoid heterogeneous or overlapping alterna
tives ;
(5) Order alternatives to enable easy search for
the correct response;
(6) Do not write more than five alternatives for
each item;
(7) Do not consistently make the correct response
longer than other responses;
(8) Do not use patterns for deciding the position
of the correct responses; and
(9) Avoid personally inventing all the incorrect
responses for an item.
In terms of the criterion used to measure the
effectiveness of short-term training, there have been at
least two historical stages. During the first stage, the
criteria for criterion included reliability, accessibili
ty and cost, and acceptability to the sponsor. The
current stage has seen the addition of two criteria for
criterion: predictability and agreement with other
criteria. Future studies to determine the ultimate
26
criterion should continue emphasizing clarification of
purpose, improving measuring methods, increased criterion
equivalents, improvement in the methods of job and situa
tional analysis techniques, studies to empirically validate
rational approaches, and attention to how to select proper
criteria to accomplish the specific task at hand (Wherry,
1957).
MacKinney (1957) indicates that the best evaluation
of short-term training is the controlled experimental
study which includes pre-post measures on experimental and
controlled groups. Second best is evaluation of training,
utilizing a trained group only. He relegates to lowest,
utilizing criterion measures after training only. He
further indicates that the highest, in terms of criterion
relevance, is objective performance scores determined by
trainees and subordinates.
A slightly different criterion measure is suggested
by Weislord (1966). He proposed designing a controlled
experiment evaluating the effectiveness of training by
eliciting meaningful and operationally feasible data on
the employment and income effect of training. As men
tioned above, randomly selected members of a well-defined
group would be provided with training while others are not.
Their subsequent experience could be compared and statis
tical conclusions within stated competences drawn.
Several authors have stated what they felt to be
27
the major steps necessary in order to realistically evalu
ate the effectiveness of short-term training (Bellman and
Remmers, 1958; Michael and Metfessel, 1967; and Knutson,
1952). These major steps are summarized as follows:
(1) Statement of broad goals and purposes;
(2) Development of specific behavioral objectives
(broad purposes must be broken down into
specific, concrete, definable goals);
(3) Transformation of specific behavioral attitudes
into a form applicable to training;
(4) Selection or construction of a variety of
measures or instruments to furnish data
allowing inferences to be made concerning the
extent to which specific behaviorally stated
objectives have been obtained;
(5) Control groups should be established;
(6) Periodic observation of behavior changes
relative to specific objectives should be
made for both experimental and control groups;
(7) Evaluative data should be interpreted in terms
of both the behaviorally stated objectives and
broad goals of training; and, finally,
(8) Results of the evaluation should lead to
28
modification and further implementation of
the educational program itself.
Finally, in terms of evaluating the effectiveness
of short-term training for rehabilitation counselors,
Dugald Arbuckle (1968) has said that "... it would seem
that behavior is a more valid measure of change, at least
if counseling effectiveness is thought of as being in any
way related to behavior with others and the results of
that behavior" (p. 435).
Learning is inferred from changes in the behavior
of the person studied. Expected behavior changes can be
grouped into the areas of greater information or concept
development; greater skill or proficiency in performing a
task; and greater awareness or change in personal attitudes
or dispositions. Although these are admittedly inter
mediate and immediate criteria when you are speaking of
measuring the effectiveness of training for individuals
who work in an agency whose ultimate product is the pro
vision of services to people (a very complex criterion in
itself), they are often necessary because the use of
ultimate criteria is unfeasible due to cost, time, con
fidentiality, etc. (Miller, Oberman, et al., 1969).
Evaluation of Short-Term Training
for Rehabilitation Counselors
As mentioned previously, while some attempts on the
29
part of state vocational rehabilitation agencies and
universities has been made to evaluate the effectiveness
of the two-year master's degree program in rehabilitation
counseling, very little has been reported in relation to
the evaluation of the effectiveness of short-term training
(Anthony and Carkhuff, 1971). As a review of the attempts
that have been made and to illustrate the wide variety of
these evaluative attempts in terms of the theoretical con
cepts mentioned above, the author would like to cite five
evaluative studies.
Smith, et al. (1963) attempted to evaluate the
effectiveness of a five-day workshop for rehabilitation
counselors on "Resolving Problems of Dependency through
Motivation." Twenty-six participants were encouraged to
use alternative approaches to problem solving by means of
lectures, small groups, sensitivity training, hand-out
cases and material. Evaluation took place at the close of
each evening session in relation to the participants'
feelings about the effectiveness of the training. On the
last day, participants were again asked to evaluate the
experience. The remarks were summarized and compared.
Razik (1969) reported on the evaluation of the
effectiveness of a film, "Will It Be You," developed to
interest individuals (undergraduates) in careers in reha
bilitation counseling and to inform the general public of
the goals and services of rehabilitation counseling as a
profession. Three assessment phases were conducted to
evaluate the effectiveness of the film.
(1) Thirty-nine professional rehabilitation
counselors and 35 graduate students in
rehabilitation counseling rated the film
as to technical excellence, informative
medium for the general public, and as a
recruitment tool for the profession;
(2) Cognitive and affective aspects were
evaluated by means of a 20-item test
to measure knowledge conveyed by the
film and semantic differential type
attitude inventories to assess feelings
toward rehabilitation counseling and
disabled persons. These were given to
61 high school students and 507 college
students (321 students were shown the
film, and 247 students served as a
control group);
(3) The film's affect on vocational choice
was measured by having experimental and
control groups rank a list of occupations
in order of their preference for the
occupation.
31
Results indicated: professionals and students felt
the film was technically sound and served as a useful
medium to convey information about the profession to the
public; students seeing the film had higher scores on
cognitive and affect tests; and little consistent affect
on vocational choice.
Miller, Oberman, et al. (1969) developed a series
of 30 learning units, with each unit including a tape
recorded auditory components. State vocational rehabili
tation offices in three states were used, with 17 offices
serving as an experimental group receiving the training
and 14 as a control group.
Evaluation instruments used included: Minnesota
Importance Questionnaire, Wonderlic Personnel Test,
Adjective Checklist and Counseling Questionnaires, all of
which were given to counselors in both groups to determine
selection choice traits. The SCERC Information Test and
Supervisory Rating were given to all counselors when
entering the program, at the end of six months, and at
the end of the project year. Learning Unit Evaluation
Forms were given to all counselors. And, Supervisory
Questionnaires were given to all supervisors when entering
the study. Results will be reported upon the completion
of the total study in another monograph.
Tipton and Wenger (1970) attempted to evaluate the
effectiveness of a short-term intensive orientation
32
program for rehabilitation counselors at a state mental
hospital rehabilitation unit. Twenty-four counselors were
divided into groups of five, with each group spending two
and one-half days in the unit. Evaluation was accomplished
by administering a semantic differential type instrument
measuring the Connative meaning of concepts under the
general headings of Evaluation, Potency, and Activity.
The instrument was administered to each counselor in the
experimental groups and an equal number of counselors in
the control groups at the beginning of the training session
and two and one-half days later at its conclusion. The
Mann-Whitney U Test was used to determine the significance
of any difference between groups. Results included a
significant change in the counselors' competency for
dealing with the emotionally disturbed client, understand
ing of mental patients and ex-mental patients, and greater
ability to relate to the physically handicapped client.
No change was found in the counselors1 ability to relate
with emotionally disturbed clients, or in the physically
handicapped and emotionally disturbed clients' chances for
successful rehabilitation. The authors concluded that
short-term training of this type is of value in increasing
the rehabilitation counselors' desire to serve the mental
hospital population.
Finally, Moriarty (1971) reported on an attempt to
evaluate the effects of intensive, short-term training on
the attitudes of newly employed rehabilitation counselors.
The study attempted to evaluate the effects of intensive,
short-term training on the attitudes of newly employed
rehabilitation counselors. The study attempted to evaluate
the effects of regional rehabilitation in-service training
on counselor attitudes and to define the personality
attributes associated with positive attitudes toward the
disabled. Attitude measures were administered to five
groups of rehabilitation counselor trainees before and
after participation in a regional counselor training
course. A t-test of significance of the difference between
correlated means before and after group results was per
formed, and counselor attitudes were correlated with
various personality measures. Findings showed statis
tically significant improvement in group attitudes.
Evaluation of Short-Term Training
for Counselors in General
Studies reported in this section will include evalu
ation of short-term group experience as an adjunct to
counselor practicum experience, short-term training for
counselor preparation, and evaluation of NDEA Counseling
and Guidance Institutes.
Demos and Zuwaylif (1963) attempted to ascertain
significant changes in counselor attitudes resulting from
an intensive, six-week program in counseling which
34
included course work in psychological testing, mental
health and behavior dynamics, counseling and interviewing,
and supervised counseling with critique of counseling
tapes. Forty secondary school counselors participated in
the study with each student previously being rated by
supervisors as above average, average, or below average.
Movement was then measured from evaluative attitudes to
understanding attitudes from beginning to end of the six-
week session. Porter Pre-Post Tests were used to measure
movement and analysis of variance to determine signifi
cance. Results indicated a significant difference for all
five categories of the Porter (less evaluative, supportive
and probing and more understanding and interpretative). In
relation to supervisors' ratings, above average counselors
made a significantly greater decline in the use of evalu
ative responses and chose more understanding responses than
average or below average counselors. The authors concluded
with some statements regarding the need for screening and
selecting counselor trainees.
Munger and Johnson (1960) studied changes in atti
tudes in counselor trainees over an eight-week summer
session, assuming that the acquisition of skill should be
accompanied by change in attitudes. Thirty-two experienced
secondary teachers with an interest in guidance made up the
experimental group, while 31 secondary school teachers with
no formalized guidance experience made up the control
35
group. The course included six weeks of formalized course
work and two weeks of supervised practicum training.
Porter's Ten Question Test of Counseling Attitudes was
administered to both groups on the first day of the insti
tute, on the last day of the first phase of training, and
on the day after the practicum experiences. Significant
attitude changes were seen in three out of five categories
measured by the Attitude test as compared with the control
group. The authors concluded that the principal change
took place during the formal course work of phase one.
Gazda and Ohlsen (1961) and Betz (1969) all evalu
ated the effectiveness of short-term group counseling on
prospective counselors and as an adjunct to practicum
experiences. Gazda and Ohlsen randomly placed 34 students
in four groups for one-hour sessions twice a week for
seven weeks. A control group was established utilizing
regular students enrolled in the regular term. Effective
ness of the group experience was measured by a pre-post
and six months follow-up administration of the Picture
Story Test, Self-Rating Scale, Behavior Rating Scale, and
Edwards Personal Preference. Betz programmed two types of
group counseling experiences (affective and cognitive) for
30 NDEA counselors undergoing supervised practicum experi
ences. Comparisons were made pre-treatment, during
treatment, and post-treatment, by means of rating content
analysis of transcribed tapes in relation to ability to
36
respond to feeling or content, degree of lead, and vari
ability of counselor response pattern. While Gazda and
Ohlsen found short-term group counseling ineffective in
improving the mental health of emotionally normal individu
als immediately at the conclusion of therapy, a trend
toward better adjustment was evident in a twelve-month and
fourteen-month follow-up. Betz, on the other hand, found
a significant increase in the "affective" group's ability
to respond to their counselees1 affect, but no significant
change in "degree of lead" or variability in response
patterns.
Hountras and Redding (1969) and Ivey, et al. (1968)
evaluated the affects of two different types of short-term
training on practicum performance. Hountras and Redding
gave 15 beginning practicum students training in verbal
interaction analysis and compared their practicum per
formance with 15 students who did not receive the training.
The first and final counseling session was taped prior to
and after verbal interaction analysis training. The Verbal
Interaction Analysis Scale and the Amidon Method were used
to evaluate excerpts from the interviews for both groups.
Analysis of variance revealed no significant difference
between experimental and control groups on either client
initiated to client response talk ratio or the indirect
to direct counselor influence ratio. There was a trend for
the experimental group to change toward more counselor
37
indirect influence. Ivey utilized "Microcounseling"
(a videotape method of training counselors in the basic
skills of counseling within a short period of time) and
studied the affect of this type of training on three
groups of beginning counselors. Three different skills--
attending behavior, reflection of feeling, and summariza
tion of feeling--were evaluated by the development and
application of a scale to assess attending behavior,
rating of type script interviews and semantic differential
of Counseling Effectiveness Scale during initial practicum
experiences. Results indicate that Microcounseling was a
successful means of teaching attending behavior.
Glenn (1971) reported a study which attempted to
evaluate short-term training programs designed to change
interpersonal skills and assess changes in empathy,
warmth, and genuineness after training. Methodology in
cluded "controlled" interviews of individuals trained un
der the program and assessment of pre and post ratings to
see if additional skills are learned. Results are yet to
be reported.
In the midst of these attempts to evaluate the
effectiveness of short-term training for counselors, two
rather alarming notes in terms of their import for train
ing of counselors were sounded by Robert Carkhuff (1966,
1969). He found that;
38
The few instances of systematic training re
search yield negative or highly questionable
results. Only lay counselor training programs
geared principally to assisting trainees to
become their most facilitative selves have
demonstrated their effective outcomes, sug
gesting that lay trainees can accomplish in
counseling and therapy anything that the
supervisor can accomplish. (p. 366)
In addition, he found that three critical classes
of variables emerge from research on 16 programs involved
in counselor training:
(1) Level of trainer functioning;
(2) Level of trainee functioning; and
(3) Type of program.
Trainer level of functioning appears most critical with
trainees moving in their functioning in the direction of
their trainers. Both of these statements should cause
counselor trainers to reassess their methods and goals of
short-term as well as long-term training programs for
counselors.
Evaluation of Short-Term Training
for Medical Students
Since the author proposes to evaluate the effective
ness of short-term training in a specific disability area
for rehabilitation counselors, the following two studies
evaluating short-term training and training techniques for
39
medical students are included in this literature review.
Charles Lewis (1966) conducted an evaluative study
of second-year medical students to determine the endurance
of effect on attitudes toward patient care of experience
in an interdisciplinary, home-care program they were in
volved in during their first year of medical school. Forty
per cent of the class of 100 students participated in a
13-week program, spending one-half day per week with five
patients and other professionals working with them to try
to understand the patients' total needs. The remainder of
the class served as a control group. An instrument was
devised to describe doctor-patient interaction designed to
evoke responses which would indicate whether concern was
disease or patient-centered, biological or social, and
measure degree of hostility. One year after the experi
ence, students in the experimental group evidenced highly
significant (.08 level of confidence) more psychological
orientation, primarily patient-centered concern, and
concern with social factors. Significantly more hostile
statements were made by the control group.
Manning, Abrahamson and Dennis (1968) compared the
effectiveness of four short-term teaching techniques—
programmed text, textbook, lecture-demonstration, and
lecture-workshop. Programs were developed regarding
plotting of mean cardiac vectors in the horizontal frontal
plane from the standard twelve lead electrocardiogram.
40
Four groups, totaling 148 practicing physicians, partici
pated with learning gain measured by means of a pre-post
administered multiple choice test. Analysis of variance
indicated no significant differences between means of post
tests for all groups and no significant gain in learning
from pre to post-test among the groups.
Evaluation of Short-Term Training--
General Education
In reviewing the literature, the author came across
four additional studies evaluating short-term training
that, while they do not exactly fit under any of the
previous headings, seem appropriate to report.
Balinsky and Dispenzieri (1961) attempted to deter
mine the relative effectiveness of lecture and role
playing methods in interviewing training. The cumulative
affect of different training methods was analyzed by using
three groups of students: students in a general psychology
class; students in a vocational psychology class who had
previously taken the general psychology class; and
students in an interviewing course who had previously
completed the first two courses. During the first and
fifteenth weeks of the semester, each student listened to
part of a recorded interview where only the counselee's
statement was recorded. Students wrote responses to
counselee statements as if they were the interviewer.
41
The authors read student protocols, rating them on previ
ously determined categories, such as reflecting of
feeling, probing, reassurance, and ego-defensive. Results
indicated that students exposed to lecture and discussion
in the general psychology class were less able to reflect
feelings than those who experienced lecture-interviewing.
Students exposed to lecture, interviewing and role playing
were most able to reflect feelings.
John Hampton (1967) measured the relative effective
ness of linear and branching programmed textbooks compared
with each other and a conventional textbook when utilized
with six groups of 82 airmen. Student achievement was
measured by multiple choice and constructed response
tests. Analysis of variance indicated both programmed
texts resulted in significantly superior achievement and
retention; neither programmed text was superior to the
other; and the branching programming was completed in
significantly less time than linear.
Ausubel (1960) used advanced organizers in the
learning and retention of meaningful verbal material. He
hypothesized that learning and retention of unfamiliar but
meaningful material would be facilitated by advanced in
troduction of relevant subsuming concepts. Forty experi
mental subjects equated with forty control subjects on
the basis of sex, field of specialty, and ability to learn
unfamiliar material, were given 500 words of
42
substantiation background conceptual nature but much
broader than the actual task 48 hours before reading a
2,500-word passage dealing with steel production. Reten
tion of learning tested three days later in terms of both
groups supported the author’s hypothesis.
Finally, David Castle (1966) conducted an inter
esting study assessing the affect of participation training
(a group procedure developed at Indiana University), on
two local church groups. Changes were measured at both
the content and process level after the experimental
groups were given 24 hours of participation training in
two 12-hour sessions. Content (measure of meaning) was
gathered by a semantic differential technique measuring
selected concepts on nine bipolar, adjective scales, pre
post for both groups. Process (forces which described the
how of an act as contrasted with the what of an act) was
measured by Journal Questionnaire in relation to aware
ness, acceptance, and affirmation. Results revealed an
improved sense of worth and improved communication
capacity for the experimental group as measured by the
semantic differential. The experimental group also:
increased in participation; became less fearful of contro
versy, irritableness, etc.; increased in degree of
acceptance; remained constant in terms of awareness; and
developed affirmation according to the emotional climate
in the group.
Evaluation of Short-Term Human Relations
Training in Business and Business
Administration and Management
While a relatively small number of studies evalu
ating the effectiveness of short-term training for
rehabilitation counselors and counselors in general have
been reported, the field of Business Administration and
Management has been much more concerned with this problem,
especially in relation to human relations training for
supervisory and management personnel. This section will
include a review of a number of attempts to evaluate the
effectiveness of short-term training, both for supervisors
and workers, in various manufacturing and service companies
throughout the country.
Lindholm (1953) evaluated the effects of a super
visory training program in human relations by utilizing
pre-post measures of employee attitudes. Alternate forms
of "How to Supervise?" were administered at the first and
final training meetings for 50 first-line supervisors and
management personnel of an insurance company. In addition,
an attitude survey, including 13 incomplete statements to
be completed by checking one of five categories developed
by IRC at the University of Minnesota, was administered to
employees supervised by the trainees, one week before the
start of training and three months after training was
44
completed. The attitude survey measured attitudes toward
the company in terms of commitment, co-workers, hours, pay,
supervision, type of work, and working conditions. Results
indicated a significant increase in the mean score obtained
on the "How to Supervise?" test after training by trainees;
and significantly more favorable attitudes by employees
after training on all scales except pay, hours, and working
conditions. The authors acknowledged a weakness in the
results due to lack of a control group, but concluded the
supervisory training was successful as measured by employee
attitudes.
Blocker (1955) evaluated the effectiveness of a
course in human relations as indicated by trainees'
behavior on the job after training. His criterion was
that success would be seen in terms of supervisors using
a more democratic and permissive approach to problems of
employees. Fifteen insurance company supervisors were
randomly selected for the training and classified into two
groups--democratic and authoritarian— based on two years
of prior observation. The supervisors' behavior and atti
tudes toward subordinates, over a three-month period
immediately following completion of training, were deter
mined by analyzing supervisor-employee interview records
and rating them as either democratic or authoritarian. No
significant difference in their original classification
was seen in the supervisors' interview records after ten
45
two-hour training meetings over a period of eight months.
Buchanan (1957a, 1957b) reported an original study
and follow-up study of a 60-hour (one full week and three
one-day sessions each month thereafter) course, designed
to increase supervision performance and job satisfaction
by increasing trainee appreciation for the job of super
visors, increasing understanding of the job station, and
increasing skills for handling problems. Supervisors and
subordinates of the 154 supervisors who participated in
the training session were asked to complete a question
naire two months after the training session, requiring
them to make two judgments: did they observe any behavior
change; and whether the change occurred as a result of
training. Results indicated that 49 per cent of all
participants 1 behavior changed as rated by supervisors and
subordinates. These changes were examined in light of
goals of the sessions. A follow-up study was conducted
several months later to see if evaluation of training by
having subordinates and supervisors rate trainees was
valid. A questionnaire listing 15 types of learning
related to the goals of the original training program was
sent to all trainees. Each trainee was asked to check
the extent to which his learning had been important in his
job performance. Out of 153 sent, 48 returned the ques
tionnaire, with 35 judged to have benefited and 11 judged
to have not benefited from training. These results were
46
compared with the ratings of behavior by supervisors and
subordinates and the conclusion drawn that trainees judged
by supervisors and subordinates to have benefited from
training indicated they learned more and their job per
formance was positively affected. Baum, Sorensen and
Place (1966) reported a similar study utilizing training
participants' ratings of level of influence for clerical
and supervisory personnel before and after training.
Goodacre (1957) suggested that in terms of cri
terion, there are three general categories possible:
immediate (grades made in a supervision training program);
intermediate (ratings of performance on the job); and
ultimate criterion (success on the floor). He further
suggested that realistically speaking, immediate and
intermediate criterion are the only two feasible criteria.
With this in mind he evaluated a training program in
leadership by randomly assigning 800 eligible persons to
two groups--an experimental group which received training,
and a control group which did not. Both groups were
tested pre and post by an attitude scale, achievement test
and ratings by immediate supervisors. Results, using a
t-test to measure significant differences between groups,
indicated no measurable improvement in job performance.
Significant improvement was found in: self-confidence and
understanding personnel policy; knowledge of how to train
subjects in decision-making; knowledge of job evaluation
47
planning; and ability to develop and improve employees.
In relation to the intermediate criterion of attitudes,
Randall (1960) reported that the follow-up studies of
attitude change indicated the change was not permanent.
Nile Soik (1958) administered the Supervisory
Inventory on Human Relations, Comment Sheets, and the
Human Relations Questionnaire to 56 first-level supervisors
prior to nine one and one-half hour sessions, held every
two weeks, on techniques of supervision. These same tests
were administered following the training program and
correlated with personal characteristics (I.Q., occupa
tional interests, personality factors), contribution of
program, relationship of participation to increased
knowledge, and need for additional training. Six months
later, the SIHR and the HR questionnaires were readminis
tered. Results indicated that; I.QC and interest in work
were trainee characteristics contributing to human rela
tions knowledge; the amount of class participation did not
correlate to the amount learned; and increased knowledge
was observed.
Moon and Hariton (1958) studied the effectiveness
of a personnel development program providing training and
feedback of appraisal to subordinates to stimulate growth
and development. Two years after training, a questionnaire
designed to obtain subordinates' views about changes in
their managers' behavior since the program and a
48
questionnaire regarding the training were administered to
trainees and their subordinates. Results indicated that
while managers felt very positive toward the training
program, subordinates from engineering (the department in
which managers were trained) felt their managers had
generally improved in employee relations, as compared with
the feelings of subordinates in manufacturing (where
managers received no training). Least improvement was
seen in frequency of performance discussions, something
stressed during the training program itself.
Lawske and his associates evaluated the use of role
playing as a tool in management human relations training
by giving three groups one session in which they were
presented with a problem situation and asked to complete
the scene, and by involving two groups in four weekly
role-playing sessions (Lawske, Bolda and Brume, 1959).
Evaluative criteria consisted of scaled responses to a
standard human relations training case with two dimensions:
sensitivity and employee-orientation. Criterion responses
were obtained before and after training for four groups,
and after training for the fifth group. It was found that
changes in criterion case response were effected in only
those instances where impact occurred in connection with
training experience. Repeated exposure to role playing
showed little advantages over single, impact experience.
Sensitivity and employee-orientation improvement were
differentially effected.
Mahoney (1960) reported a study to evaluate the re
sults of one week of full-time participation in training
in management techniques by middle-level managers. Im
provement was measured by administration of a pre-post
information test, case problem test, and attitude scale.
An experimental (receiving training) group and a control
(no training) group were used, with the results showing
significant improvement by the experimental group in
applying a special analytical method of problem solving
and in appreciation and sense of responsibility for self
development. However, no significant difference was
found in terms of attitude change or increase in informa
tion. In fact, instructors1 scores on the information
test were about equal to the average control group member.
Neel and Dunn (1960) investigated the possibility
of predicting success in supervisory training through
better selection techniques. Participants in a 15-week
evening course were given the Wonderlic Personnel Test,
the "How to Supervise?" scale, and the F Scale (a measure
of authoritarian personality). Criterion for success in
training was the numerical grade the student received at
the end of the course. Results revealed that psycholog
ical tests were relatively independent of each other, with
the "How to Supervise?" scale being the best predictor in
terms of the success criterion. The F Scale was second
50
in prediction and scores from the two tests correctly pre
dicted success for 14 out of 15 people attending the
training sessions.
Several studies evaluating the effectiveness of
short-term training for workers in various companies have
utilized actual job performance or ability to perform job
skills as the major criterion of success (Baxter, Taaffe
and Hughes, 1953; Kirkpatrick, 1960; and Schultz and
Siegel, 1962). Baxter, et al. utilized production records,
job satisfaction, termination rate, life insurance knowl
edge, and supervisory ratings in measuring training for
the position of debit insurance agent. Kirkpatrick
reported five studies which utilized safety records,
reports of negligent accidents, missed deliveries, mis
handling of valuable mail, late reporting, abuse of sick
leave, adverse probational reports, etc.; separations,
initial visits to dispensary for occupational reasons,
actions incurring disciplinary suspension, work stoppage,
etc.; and productivity, loyalty, interest and attitudes.
Schultz and Siegel developed for each job task the average
proficiency on a job task for a group of training program
graduates and the task's importance to the total job. A
matrix was developed and applied to the several job tasks
included in the goals of the training program.
Alexander and his associates and Schlesinger have
both evaluated the effectiveness of short-term training
51
for military personnel (Alexander, Kepner and Tregre,
1962; and Schlesinger, 1958). The former utilized pre-post
tests exercises in simulated air defense operations to
evaluate the value of using knowledge of results debriefing
sessions on performance. The latter used trainee self
rating of job performance, comparison of time distribution
of training topics and training emphasis with skills and
knowledge required on the job as indicated by job descrip
tions, and a small number of critically important job
activities selected and studied in terms of required
behavior and content of curriculum material estimated to
be most relevant to performance of these activities in a
training program for psychological warfare officers.
Hunergager (1960) attempted to evaluate the ef
fectiveness of university-sponsored, short-term training
for executives by sending a detailed questionnaire to the
60 firms who had sent trainees to the university. Broad
ening or making a technical specialist more generalized in
his approach and group association (learning a result of
informal bull sessions) were rated as the greatest value
of training.
And, finally, Cox (1964) evaluated training with the
Ward Edwards formulation of the value of training, which
includes estimates of cost efficiency level attained,
worth of a training man in dollars, and training costs in
dollars. When applied to a 21-week electrical equipment
52
maintenance coarse, he found that each man would produce
from minus $19.10 to plus $31.00 gain over a two to four-
year period. However, he indicated difficulty in measuring
the worth of a man.
Conclusion
While there are some notable exceptions, attempts
to evaluate the effectiveness of short-term training over
the past 10 to 15 years have been characterized by a wide
variety of approaches and a lack of rigorous adherence to
the principles of good evaluation mentioned in the section
on theoretical concepts— adequate experimental design, the
use of control groups and the correlation of research
design with the enunciated program goals and objectives.
In future studies, more emphasis should be placed on the
use of ultimate criteria (job behavior, production outcome,
results of services, etc.) as a measure of training
success. Where this is not feasible, immediate and inter
mediate criteria should be correlated with ultimate
criteria in pilot studies. These results could then be
generalized to larger studies which use immediate and
intermediate criteria only. Finally, the concept of
evaluating the effectiveness of short-term training is a
concept that should be emphasized as being as important
as putting on the training program itself. This is es
pecially true in the field of rehabilitation counseling
53
and counseling in general, in view of the relatively small
number of attempts to evaluate short-term training re
ported in the literature. In addition to more effective
short-term training, emphasis on evaluation should result
in a greater awareness of the value of short-term training
in helping to implement an agency's program objectives by
agency administrators, whether these objectives be im
provement of service to people, increased opportunity for
individuals in our society to maximize their potential,
improvement in production of materials, or increased
selling of merchandise.
CHAPTER III
RESEARCH DESIGN
Population Sample
The population studied was rehabilitation counselors
employed by the California State Department of Rehabilita
tion. In conjunction with the Department of Rehabilita
tion, all of the rehabilitation counselors who worked with
epileptics during the fiscal year 1969-70 were identified.
This was done by obtaining a Department computer print-out
listing all the clients and former clients of the Depart
ment during 1969-70 whose major disabling condition was
epilepsy, along with the name or names of the counselors
who worked with them. This list of counselors was checked,
and those counselors who attended the Institute on Epilepsy
held during the Spring of 1970 were eliminated. As a
result of this procedure, 292 counselors were identified
as having worked with clients whose major disabling condi
tion was epilepsy during the above mentioned time period.
In an attempt to insure selection of counselors for the
study who would be most likely to be referred epileptic
clients, the list was further pared down by eliminating
all counselors who did not handle one of the following
54
55
types of caseloads: general caseload (all disabilities);
trust fund caseload (clients receiving social security
disability insurance payments); welfare caseload (clients
receiving some form of public assistance); industrially
injured caseload (clients injured on the job); severely
disabled caseload (clients with more severe disabilities,
such as paraplegia, quadriplegia, stroke, etc.); and
public offender caseload (clients who were on probation or
parole). From the group of 198 counselors remaining (172
of which handled general caseloads as described above),
180 counselors were randomly selected, using Kirk's table
of random numbers (1969), to participate in the study.
These 180 counselors were then randomly assigned to three
groups. Of this number, 145 returned completed informa
tion tests and attitude surveys, and 25 were eliminated
after the follow-up caseload survey information was ob
tained, because of termination, promotion or change of
assignment. Thus 120 counselors, 40 in each group, were
used in the study.
Experimental and Control Groups
The experimental design employed in this study
resembles the Post-Test Only Control Group Design, as
described by Campbell and Stanley (1963). Their design
includes two groups, randomly assigned, with the experi
mental group undergoing the treatment and then being post
56
tested, and a control group not undergoing the treatment
but being post tested. The experimental group attended
the Institute on Epilepsy, held on January 28 and 29, 1971,
and was post tested in relation to information, attitudes
and job behavior regarding epilepsy and epileptic clients.
Control group number one attended the Institute on
Rheumatic and Coronary Heart Disease,^" held on January 21
and 22, 1971, but was post tested in relation to informa
tion, attitudes and job behavior regarding epilepsy. This
control group was set up in an attempt to control for the
"Hawthorne Effect," which suggests that mere attendance
at any institute might account for any observed change
because it is a break in an individual's routine or just
something different and novel (Ruch, 1958). A second
control group did not attend any institute and was post
tested in relation to the same three variables. Compari
sons were made in terms of post tests between groups to
determine if there was any significance in the difference
between the experimental group and the two control groups.
Evaluation Procedures
As previously stated, three criteria were utilized
to evaluate the effectiveness of training--information,
attitudes, and job behavior. Accumulation of more factual
^See appendix B for a description of the program.
57
information regarding epilepsy is not necessarily accom
panied by a more positive attitude toward epileptics; and
more positive attitudes toward epileptics are not necessar
ily accompanied by a change in job behavior toward
epileptic clients. Multiple observations of a different
nature are necessary to adequately evaluate and generalize
change (Campbell and Stanley, 1963). The degree of change
in one criterion will be important only as related to the
degree of change in the other two, with change in job
behavior being the ultimate criterion of success. Conse
quently, this section will be devoted to describing the
measures used in this study and a statement regarding
their administration and techniques of data collection.
Information Test.--The Information Test on
o
Epilepsy was developed in an attempt to ascertain whether
the information presented during the Institute was
assimilated by the participants. The test consists of 46
multiple choice items obtained by asking each Institute
faculty member to develop four questions that would cover
the important content he would be presenting during the
Institute. Items covered the medical, social, psycho
logical and vocational aspects of epilepsy; its historical
development; treatment concepts; and community resources
2
See appendix C.
58
for epileptics. This test was used in a pre-post test
fashion in conjunction with the 1970 Institute on Epilepsy.
It was scored, analyzed item by item in relation to the
suitability of the question and its choices, and revised
by modifying, substituting or eliminating those questions
where choices were confusing or where wording was inade
quate .
Attitude Survey.— Several attitude scales were
reviewed in searching for an instrument appropriate for
this study. In addition to the Attitudes Toward Disabled
Persons Scale, a general attitudes toward disability
survey developed by Yuker, Block and Young, a number of
additional instruments to measure attitudes toward dis
ability were reviewed by these authors (1966). These
included: non-scored instruments such as an unstructured
questionnaire, interview schedule, two-point response
categories, ranking procedures, adjective or personality
check list, and the sociometric choice technique; simple
scored scales which resemble Thurstone or Likert attitude
scales in format but were not developed in accord with the
methodology associated with these techniques and are
usually intended for specific investigative purposes
directed toward specific attitudes; attitude scales such
as those developed by Bogardus, Thurstone and Likert that
have been adapted and modified for measuring attitudes
59
toward the disabled; and other scoreable techniques such
as a semantic differential rating scale, paired-antonyms
in a trait check list, projective techniques and pictorial
projectives. Siller, et al. (1967) have reported the use
of a Feeling Check List, Social Distance Scale and Dis
ability Factor Scales to measure attitudes toward the
disabilities of amputation, skin disorders, deafness,
paralysis, cerebral palsy, blindness, and muscular dys
trophy. Razik reported the use of a series of bipolar
scales pertinent to subject's attitudes toward disabled
persons to evaluate the effectiveness of a film developed
for the recruitment of rehabilitation counselors and a
public education program in rehabilitation counseling
(1969). Campbell, Burwen and Meer (1964) developed a
Photo Preference Test, consisting of one hundred facial
photographs standardized for like and dislike. Meer and
Amon (1963) utilized this test to determine whether
deviant responses to the photographs were related to
psychological disturbance of newly admitted patients to a
state hospital, and retested four months later. Paul
Mueller, Ph.D., Chief of Research and Statistics, Cali
fornia State Department of Rehabilitation, adapted the
Photo Preference Test as a pilot test with three subjects,
asking them to identify pictures of people who they
thought had epilepsy (1970). Each selected picture was
given its likeability weight, as previously determined by
60
Meers, et al., and the likeability weights were summed and
divided by the number of epilepsy selections to get the
average likeability score.
Finally, the Adjective Check List, developed by
Harrison Gough (Gough and Heilburn, 1965) and consisting
of 300 adjectives commonly used to describe attributes of
a person, which may be administered to an individual to
elicit his self-evaluation or his characterization of
anyone he knows, has been used by Hammond and Kern to
measure attitudes in a psychological study of a change in
medical education (1959). The procedure was devised to
discover whether the student undergoing a particular type
of curriculum experience changed his conception of him
self as a medical person. Students were asked to fill out
a modified version of the Adjective Check List in four
ways: checking those adjectives describing 1) the typical
surgeon, 2) the typical internist/pediatrician, 3) the
typical psychiatrist, and 4) himself. A post test was
administered in the same manner. Each student obtained a
Self-Surgeon Similarity Score (the proportion of all
adjectives checked which was common to both surgeon check
list and self checklist), a Self-Internist/Pediatrician
Similarity Score, and a Self-Psychiatrist Similarity
Score. The student's pre and post test scores were then
correlated to determine any change in the two scores.
In the same study, the Favorable and Unfavorable scales
61
were used as measures of change in self-acceptance and
self-criticality. The Adjective Check List Self-Acceptance
score was the ratio of the number of favorable adjectives
check to the total number of adjectives checked, and the
ACL Self-Criticality score was the ratio of the number of
unfavorable adjectives checked to the total number of
adjectives checked.
After reviewing the above, all of them were
rejected as measures suitable for this study for one or
more of the following reasons: 1) the attitude scale was
developed to measure attitudes toward disability in
general; 2) they did not include specific attitude
measures for epilepsy; 3) the items were too readily
fakable due to the high degree of visibility of socially
acceptable "right1 1 answers, especially when used with
professionals in the field of vocational rehabilitation
who have had a considerable amount of education regarding
and exposure to disabled persons; and 4) the need for
extensive validation and reliability studies to justify
adopting the instrument to the measurement of attitudes
toward epilepsy, something beyond the scope of this
dissertation.
Consequently, the instrument used in this study was
a semantic differential technique,^ as originally
3
See appendix D.
62
developed by Osgood (Osgood, Suci and Tannenbaum, 1957).
This instrument was selected because it has and can be
readily adapted to measure specific concepts with reason
able validity and reliability, and its items are not
readily fakable due to being able to tell which adjective
is "right."
The semantic differential is an instrument that
allows individuals to describe the meaning of a variety
of signs by means of patterns of scaled judgments made to
pairs of contrasting adjectives (Snider and Osgood, 1969).
It usually consists of a number of bipolar adjectives,
such as good-bad, fair-unfair, masculine-feminine, black-
white, bitter-sweet, clear-hazy, etc., each rated on a
seven-point scale from one to seven, with four indicating
neutrality, one and seven extremely, two and six quite,
and three and five slightly. Tannenbaum, Williams,
Friedman and Gladden, and Snider all reported studies in
which a semantic differential technique was used to
measure attitudes (Snider and Osgood, 1969). Test-retest
reliability as reported by Snider was .60. In relation
to this study, the meanings of four concepts--epilepsy,
seizures, heart disease, and illness— were measured by
selecting those adjective pairs found by Osgood to have
high loadings of the evaluative factor (Osgood and Suci in
Osgood and Snider, 1969), and asking individuals to indi
cate their feeling toward these concepts by marking one
63
point on a seven-point scale for each bipolar adjective
listed. The total concept score for an individual was the
sum of the scales checked. In addition, a mean group
score for each concept was computed. A low score indicates
more positive feeling toward epileptics, while a high score
would indicate less positive attitudes (Brinton in Snider
and Osgood, 1969). Strauch, Chester and Rucker (1970)
reported use of a similar procedure to measure change in
attitudes of teacher aides toward the mentally retarded
involved in a six-week summer program at a residential
institution for the retarded. The concepts State Training
School, Children I Work With, Normal Children, and Insti
tutionalized Retarded Children were measured by the
semantic differencial technique pre and post program.
Analysis of variance on pre-post test attitude scores
revealed the teacher aides1.attitudes became more positive
on all four concepts (p.^1.05).
A study of stability characteristics of the
semantic differential conducted by Norman (Snider and
Osgood, 1969) revealed the following: In relation to
consistency of individual ratings, 40 per cent remained
the same, 35 per cent shifted one unit, and 25 per cent
changed two or more, with the average shift slightly
greater than one position on a seven-point bipolar scale
with no evidence of marked sex difference in overall con
sistency; use of factor scores rather than single-scale
64
values increase stability slightly; correlation of D’s
reveal a rather high degree of time-lapse and sampling
stability for the semantic differential for groups of
subjects from an undergraduate population; and a high
stability of group-mean ratings and D's over time in
absence of any systematic intervening treatment. Staats
and Staats, Howe, Deese, Solley and Messick, Flavell, and
Solarz have all reported studies relating various aspects
of validity of the semantic differential (Snider and
Osgood, 1969). Staats and Staats concluded that the
correlation between intensity, meaning and verbal associ
ates is a result of the fact that the more often a word
is paired with its word associates, the stronger the con
nections between them, and the meaning of the associates
is conditioned to the word. Consequently, semantic
generalization is a function of similarity of meaning
between words, similarity of word associates elicited by
words, and similarity of meaning responses elicited by
word associates of words. Howe dealt with whether
Osgood's D4 (multidimensional distance from the origin) of
verbal stimuli facilitates prediction of several quantita
tive associative properties of such stimuli. He found
that Bad word/Good word differences have their psychologi
cal roots in a different affect-arousing potential for Bad
versus Good words which are otherwise "equal" in measured
polarization. Evaluative Scores and Activity factor
65
scores independently yield about the same degree of
correlation with associative variables as does the D4
measure, but while Evaluation and D's are highly corre
lated, Activity and D4 are not. Deese presents an analysis
of the relations among the associative distribution of 278
English adjectives. The analysis shows 40 pairs of polar
opposites that are nearly completely orthogonal. He also
finds evidence for the general linguistic validity of the
results of factor analysis of associative meaning. Solley
and Messick used the semantic differential as a measure of
meaning, and demonstrated that the instrument adequately
reflects at least one statistical aspect of a concept's
referents (scale-intervals are at least not markedly
unequal). Flavell found that the correlations between
judgments of meaning similarity between words and a
measure of co-variance were quite high (.95 and .94),
making it difficult for the multiple prediction of meaning
similarity between words from the semantic differential
D score and the probability of co-variance to improve on
them substantially. This was particularly true for
adjective-adjective and adjective-concrete noun pairs.
Meaning similarity between words and semantic differential
D scores were also quite high but lower than meaning
similarity and co-variance. Solarz related a pencil-
tapping response to the Semantic Differential Factor III
(activity) values. The high correlation found in his
66
study of two groups (.96 and .95) provided a behavioral
validation for this particular semantic differential
factor.
Caseload Review.--Change in counselors' job be
havior toward epileptic individuals was measured by
conducting a statistical caseload review both before and
after the Institute for all three groups of counselors
participating in the study. From the time an individual
makes contact with the Department of Rehabilitation until
he successfully completes the vocational rehabilitation
process, he is placed in a number of different statuses
for the purpose of statistical reporting. These statuses
denote his movement through the various steps in the
rehabilitation process--referral, acceptance, evaluation,
vocational plan, implementation of the plan, employment
and case closure. Consequently, the caseload review
included the number of epileptic individuals: referred to
each counselor (status 00, 02, 04 and 06); accepted into
the active caseload for vocational rehabilitation
services (status 10); with whom a vocational plan is
developed (status 12, 14, 16 and 18); ready for employment
or in employment (status 20 and 22); and closed rehabili
tated (status 26). In addition, the number of epileptic
individuals not completing the vocational rehabilitation
process successfully, where services are interrupted or
67
they drop out at some stage for one reason or another, were
tabulated (status 08, 24, 28 and 30). In general, larger
numbers in statuses 00, 02, 04, 06, 10, 12, 14, 16, 18, 20,
22, and 26 and smaller numbers in statuses 08, 24, 28, and
30 after the institute was an indication of more positive
counselor job behavior toward the epileptic individual.
Administration Schedule and Data Collection.--Both
the information test and the attitude survey were adminis
tered to all three groups by mail, approximately one week
after the Institutes. The statistical case load review
covered the five months prior to the Institutes (September,
1970, through January, 1971), and the five months follow
ing the Institute (February, 1972, through June, 1972) for
all groups. This was accomplished in cooperation with the
California State Department of Rehabilitation by obtaining
a computer print-out on each counselor which indicated
case status movement of his or her epileptic referrals and
clients as described above during that ten-month time
period.
Operational Testing of Hypotheses
Null hypothesis I (no difference in information
about epilepsy) was tested by comparing the group means
on the post information test between groups. Null
hypothesis II (no difference in attitudes toward epileptic
68
individuals) was tested by comparing the group means on
the post attitude survey between groups. Null hypothesis
III (no difference in job behavior toward epileptic in
dividuals) was tested by comparing pre caseload review
statistics with post review between groups. Null hypothe
sis IV (no interaction between information, attitudes and
job behavior regarding epilepsy and epileptic individuals)
was tested by comparing all three post measures between
groups.
Statistical Treatment
The significance level for rejecting the null
hypotheses was set at ,10. This level was selected instead
of the more traditional levels of .05 or .01 because of
the newness of this particular type of training evaluation
and the difficulty in detecting the effect of short-term
training reported previously. However, all of the differ
ences were tested for significance and their level reported
for the purpose of letting the reader draw his own con
clusions in light of the conclusions drawn by the author.
Statistical significance of the difference between
post information test group means was measured by using
Tukey's HSD Test (Kirk, 1969). This procedure, which
utilizes a range statistic, was designed for making all
pairwise comparisons among means. In addition, the
reliability of the measurement was determined, utilizing
69
the Hoyt Analysis of Variance Method (Hoyt, 1941).
Statistical significance of the difference between
means on the post attitude survey was measured by using a
One-way Analysis of Variance (Guilford, 1965). This
statistic is used to determine whether there are any sig
nificant differences among the means of several samples of
the same general character. The group mean for each con
cept was calculated, and the significance of the difference
between groups compared; and the significance of the group
mean for each concept and 4 (the indifferent or neutral
choice) was calculated utilizing Z scores.
The statistical caseload review was conducted on a
descriptive basis, utilizing the Time Series Experimental
Design as described by Campbell and Stanley (1963). The
essence of the Time Series Design is "a periodic measure
ment process on some group or individual and the introduc
tion of an experimental change into this time series of
measurements, the results of which are indicated by a
discontinuity in the measurements recorded in the time
series" (Campbell and Stanley, 1963, p. 37). Case status
statistics for all epileptic individuals in counselors'
caseloads in all three groups were tabulated and statis
tically compared for each month, five months prior to the
Institute and five months following the Institute. This
comparison was accomplished by using two methods: the
group mean for positive and negative statuses by month was
70
determined; and the group mean of the positive and nega
tive statuses for the first five months and the second
five months was computed. Statistical significance of
the difference between groups was determined by utilizing
a Two-way Analysis of Variance for repeated measures and
new variables (Guilford, 1965). This procedure included
two distinct bases of classification (pre-post and
between groups).
CHAPTER IV
RESULTS
Description of Sample
Tables 1, 2 and 3 contain a biographical descrip-
tion^ of the three groups that make up the population
sample. The average experimental group counselor is a
male (67.5 per cent) or a female (32.5 per cent), 38.3
years of age, who has been in the field of vocational
rehabilitation counseling for 5.1 years and has been
employed by the California Department of Rehabilitation
for 4.6 years. Approximately 47 per cent of this group
hold a Master of Science Degree in Rehabilitation Counsel
ing, with the remainder (40 per cent) holding a Bachelor’s
Degree or a Master's Degree in another field (12.5 per
cent). The largest percentage (47.5 per cent) of those
counselors in the experimental group without a Master of
Science Degree in Rehabilitation Counseling majored in
sociology during their undergraduate or graduate school
years. Only 10 per cent of this group indicated they have
a close friend or relative who is epileptic.
■^See appendix E, Biographical Data Sheet.
71
TABLE 1
DESCRIPTION OF SAMPLE: AGE, NUMBER OF YEARS
IN FIELD AND NUMBER OF YEARS EMPLOYED
Number of years in the Number of years employed
Age field of vocational re- by the California Depart-
habilitation counseling ment of Rehabilitation
M Range SD M Range SD M Range SD
Experimental 40 38.3 25.63 10.3 5.1 1-22 4.8 4.6 1-17 3.7
Control #1 40 38.8 24.62 10.2 5.9 1-26 5.0 5.2 1-26 4.5
Control #2 40 40.9 24.64 11.4 6.3 1-24 6.5 5.7 1-24 5.1
TABLE 2
DESCRIPTION OF SAMPLE: SEX, HIGHEST EDUCATIONAL
LEVEL, AND EPILEPTIC FRIEND OR RELATIVE
Percentage of Counselors
Group
Sex
Highest educational
level completed
Do you have
or relative
epileptic?
a friend
who is
Male Female Total B.A.
M.S. M.A.or
Rehab. M.S.
Coun. Other
Total Yes No Total
Experimental 40 67.5 32.5 100.0 40.0 47.5 12.5 100.0 10.0 90.0 100.0
Control #1 40 67.5 32.5 100.0 57.5 32.5 10.0 100.0 12.5 87.5 100.0
Control #2 40 55.0 45.0 100.0 50.0 35.0 15.0 100.0 7.5 92.5 100.0
TABLE 3
DESCRIPTION OF SAMPLE: NON-M.S. IN REHABILITATION
COUNSELING, COLLEGE AND GRADUATE SCHOOL MAJORS
Major
Percentage of Counselors
Groups
Experimental
n = 19
Control #1
n = 13
Control #2
n = 14
Counseling and Guidance 7.5 2.5 5.0
Psychology- 15.0 17.5 22.5
Social Sciences 7.5 20.0 5.0
Sociology 47.5 32.5 35.0
Other 22.5 27.5 32.5
75
The average counselor profile for both control
groups is quite similar to that of the experimental group,
with the mean age being 38.8 and 40.9 years; in the field
of vocational rehabilitation counseling, 5.9 and 6.3
years; and employed by the California Department of
Rehabilitation for 5.2 and 5.7 years, respectively.
While the distribution of males and females in control
group 1 is the same as the experimental group (67.5 per
cent males and 32.5 per cent females), the male-female
ratio of control group 2 is 55 per cent to 45 per cent.
Thirty-two and a half per cent and 35 per cent of the
counselors in each control group hold a Master of Science
Degree in Rehabilitation Counseling, with 57.5 per cent
and 50 per cent holding a Bachelor's Degree and 10 per
cent to 15 per cent holding a Master's Degree in another
field.
Of those not holding a Master of Science Degree
in Rehabilitation Counseling, the largest number in
each group majored in sociology during their undergraduate
and graduate years.
While 12.5 per cent of control group 1 indicated
they have a close friend or relative who is epileptic,
only 7.5 per cent of control group 2 replied in the
affirmative to this question.
76
Criterion I: Epilepsy Information Examination
Table 4 contains the mean, ranges and standard devi
ations for the Epilepsy Information Examination by group.
Examination of this table reveals the experimental group
obtained a higher mean score (28.3 out of 46 possible
points) than either control group 1 (21.5) or control
group 2 (22.2). A One-Way Analysis of Variance (Table 5)
indicated these differences were significant at the .01
level of confidence. Application of Tukey's HSD test for
difference among means (Table 6) further revealed that the
difference between the experimental group mean and either
the means for control group one or control group two were
significant at the .01 level.
The Hoyt Analysis of Variance Method of Ascertaining
Test Reliability revealed a reliability of .59 for the
total group of 120 subjects and .54 for the experimental
group. However, the reliability for control groups 1 and
2 was .04 and .15, respectively.
Criterion II: Semantic Differential
Epilepsy Attitude Survey
As indicated previously, attitudes toward epilepsy
were measured by asking subjects to rate each of four
concepts on 15 bi-polar adjectives 7-point semantic
TABLE 4
MEAN, RANGE AND STANDARD DEVIATION FOR CRITERION I:
EPILEPSY INFORMATION EXAMINATION
Group
Points
Possible M Range SD
Experimental 46 28.3 19-37 4.1
Control #1 46 21.5 15-28 2.9
Control #2 46 22.2 14-30 3.1
TABLE 5
ONE-WAY ANALYSIS OF VARIANCE FOR CRITERION I:
EPILEPSY INFORMATION EXAMINATION
Source of
Variation
df SS MS F
Between Groups 2 1108.55 554.27 47.70*
Within Groups 117 1359.44 11.62
Total
119 2467.99
*p. .01.
oo
TABLE 6
TUKEY'S HSD TEST FOR DIFFERENCE AMONG MEANS IN CRITERION I:
EPILEPSY INFORMATION EXAMINATION
Group Means M Exp. M C#1 M C #2
M Exp. = 28.28 -
6.80*
(q = 12.63)
6.02*
(q = 11.19)
M C#1 = 21.48 - .78
M C#2 = 22.25 -
*p.<.01.
•vj
VO
80
differential type scales. Tables 7 and 8 reveal that
while the experimental group achieved a slightly lower
mean score (70.9 and 72.6 out of 105 possible) on the
concepts of epilepsy and seizures than either control
groups 1 (72.2 and 74.9) or (72.3 and 75.4), none of the
differences for any of the concepts were statistically
significant.
Since a mean rating of 4.0 could indicate a more
positive attitude for a particular group, but would in
fact mean that the group had neutral or indifferent
feelings about the concept, a standard score significance
of the difference between group means and an indifferent
or neutral range of 4.0 was performed (Table 9). Results
of this procedure indicated that the difference between
group means and a mean rating of 4.0 was significant at
the .01 level of confidence for each of the four concepts.
Criterion III; Caseload Case
Status Review
The Caseload Case Status Review was conducted
during the five months preceding the Institute (September
to January) and the five months after the Institute
(February to June), for all three groups. The means,
ranges, and standard deviations for positive and negative
epileptic case status changes per counselor by month for
TABLE 7
GROUP MEANS, RANGES AND STANDARD DEVIATIONS FOR EACH
CONCEPT'S TOTAL SCORE IN CRITERION II: SEMANTIC
DIFFERENTIAL EPILEPSY ATTITUDE SURVEY
Concept
Group
Epilepsy
(105 possible)
Seizures
(105 possible)
Heart Disease
(105 possible)
Illness
(105 possible)
M Range SD M Range SD M Range SD M Range SD
Experi
mental
70.9 48-86 8.0 72.6 58-93 9.6 70.2 60-87 7.4 71.7 60-96 8.9
Control
#1 72.2 42-105 11.7 74.9 60-105 10.7 70.1 27-105 12.3 73.9 60-105 10.6
Control
#2 72.3 55-90 8.8 75.4 53-96 10.6 71.2 58-90 8.8 72.7 55-93 9.8
TABLE 8
ONE-WAY ANALYSIS OF VARIANCE BETWEEN EXPERIMENTAL AND
CONTROL GROUPS FOR EACH CONCEPT IN CRITERION II:
SEMANTIC DIFFERENTIAL EPILEPSY ATTITUDE SURVEY
Concepts df SS MS F
Epilepsy
Between Groups
Within Groups
2
117
48.80
10838.50
24.40
92.64
0.26 (ns)
Total 119 10887.30
Seizures
Between Groups
Within Groups
2
117
174.07
12492.25
87.03
106.77
0.82 (ns)
Total
119 12666.32
Heart Disease
Between Groups
Within Groups
2
117
28.72
11081.23
14.36
94.71
0.15 (ns)
Total
119 11109.95
Illness
Between Groups
Within Groups
2
117
97.40
11159.49
48.70
95.38
0.51 (ns)
Total
119 11256.89
o o
to
TABLE 9
STANDARD SCORE SIGNIFICANCE OF THE DIFFERENCE BETWEEN GROUP MEANS
AND AN INDIFFERENT OR NEUTRAL RATING3 IN CRITERION II:
SEMANTIC DIFFERENTIAL EPILEPSY ATTITUDE SURVEY
Concept
Epilepsy
Seizures Heart Disease
Illness
M SD Z M SD Z M SD Z M SD Z
Experimental 4.7 .5
*
r - '
•
00
4.8 . 6 8.3* 4.7 .5 8.6* 4.8 .6 8.4*
Control #1 4.8 .8 6.6* 5.0 .7 8.8* 4.7 .8 5.2* 4.9 .7 8.3*
Control #2 4.8 .6 8.9* 5.0 .7 9.2* 4.8 .6 00
.
( —*
*
4.8 .7 8.2*
a
Neutral rating = 4.0 on a 1-7 rating scale.
*p.£.01.
00
LO
84
each group are presented in Table 10. A Two-way Analysis
of Variance for Repeated Measures for positive statuses
(Table 11) revealed no significant difference among means
across months between groups or in the interaction of
months and groups. The same procedure applied to the
negative statuses (Table 12), revealed no significant
differences across months, a difference significant at
.05 level of confidence between groups, and no significant
difference in the interaction of months and groups. The
statistical significance found between groups was not
interpreted as significant for this study, since it was
the interaction of months and groups where true signifi
cance would have to be located.
The means, ranges, and standard deviation for posi
tive and negative epileptic case status changes per
counselor for the five months pre-Institute and the five
months post-Institute for each group are presented in
Table 13. In a manner similar to results reported above,
a Two-way Analysis of Variance for Repeated Measures for
Positive Statuses (Table 14) revealed no significant dif
ference among means pre-post Institute, a significant dif
ference at .10 level of confidence between groups, and no
significant difference in the interaction of pre-post
Institute and groups. Table 15, negative statuses,
indicates no significant difference pre-post Institute,
between groups or in the interaction of pre-post Institute
TABLE 10
MEAN, RANGE AND STANDARD DEVIATION OF POSITIVE AND NEGATIVE
EPILEPTIC CASE STATUS CHANGES BY MONTH PER COUNSELOR BY
GROUPS IN CRITERION III: CASELOAD CASE STATUS REVIEW
Pre Institute
September October November December January
M Range SD
M Range SD M Range SD M Range SD M Range SD
Experimental
(n = 40)
Positive .9 0-4 1.0 .9 0-4 1.1 .5 0-3 .8 .8 0-5 1.3 .8 0-3 .9
Negative .4 0-3 .7 .4 0-3 .7 .2 0-2 .5 . 6 0-4 .9 .5 0-3 .7
Control #1
(n = 40)
Positive .9 0-6 1.3 .8 0-4 1.0 1.0 0-6 1.4 .8 0-3 .9 . 6 0-3 .8
Negative .3 0-3 . 6 .5 0-3 .8 . 6 0-2 .8 .3 0-2 . 6 .4 0-2 .7
Control #2
(n = 40)
Positive . 6 0-5 1.2 .7 0-3 1.0 .6 0-3 .9 .7 0-3 .9 .9 0-4 1.1
Negative .2 0-1 .4 .4 0-2 . 6 .2 0-1 .4 .4 0-2 .6 .5 0-4 .8
00
Cn
TABLE 10--Continaed
Post Institute
Groups February March April May June
M Range SD M Range SD M Range SD M Range SD M Range SD
Experimental
(n = 40)
Positive .9 0-4 1.1 .7 0-3 .9 .8 0-4 1.1 .5 0-3 .7 .4 0-3 .7
Negative .3 0-3 .7 .4 0-2 . 6 .5 0-3 .7 .4 0-3 .7 .2 0-2 .5
Control #1
(n = 40)
Positive .6 0-6 1.1 .9 0-5 1.1 .7 0-4 1.0 .5 0-5 1.0 .5 0-5 .9
Negative .4 0-3 .7 .6 0-4 .9 . 6 0-4 .8 .4 0-4 .9 .3 0-2 .5
Control #2
(n = 40)
Positive .5 0-3 .9 .8 0-2 .8 .7 0-5 1.1 . 6 0-3 .8 . 6 0-2 .8
Negative .1 0-2 .4 . 6 0-2 .7 .4 0-3 .7 .2 0-2 .6 .3 0-2 . 6
oo
TABLE 11
TWO-WAY ANALYSIS OF VARIANCE OF POSITIVE EPILEPTIC CASE STATUS
CHANGES PER COUNSELOR ACROSS TEN MONTHS BETWEEN GROUPS FOR
CRITERION III: CASELOAD CASE STATUS REVIEW
Source of Variation df SS MS F
Between Subjects 119 216.59
A (Across Months) 2 .76 .38 .21 (ns)
Subjects within Groups 117 215.83 1.84
Within Groups 1080 996.37
B (Between Groups) 9 14.75 1.64 1.78 (ns)
AB 18 14.94 .83 .90 (ns)
BX Subjects within Groups 1053 966.68 .92
Total 1199 1212.96
oo
TABLE 12
TWO-WAY ANALYSIS OF VARIANCE OF NEGATIVE EPILEPTIC CASE STATUS
CHANGES PER COUNSELOR ACROSS TEN MONTHS BETWEEN GROUPS FOR
CRITERION III: CASELOAD CASE STATUS REVIEW
Source of Variation df SS MS F
Between Subjects 119 72.06
A (Across Months) 2 1.76 .88 1.47 (ns)
Subjects within Groups 117 70.30 .60
Within Groups 1080 480.71
B (Between Groups) 9 9.75 1.08 2.47*
AB 18 8.47 .47 1.07 (ns)
BX Subjects within Groups 1053 462.49 .44
Total
1199 552.77
*p.^ .05.
oo
00
TABLE 13
MEAN, RANGE AND STANDARD DEVIATION OF POSITIVE AND NEGATIVE EPILEPTIC
CASE STATUS CHANGES FOR THE FIVE MONTHS PRE INSTITUTE AND
FIVE MONTHS POST INSTITUTE PER COUNSELOR BY GROUP
IN CRITERION III: CASELOAD CASE STATUS REVIEW
Groups
Pre Institute Post Institute
M Range SD M Range SD
Experimental
(n = 40)
Positive 3.9 0-9 2.7 3.2 0-8 2.4
Negative 2.0 0-8 1.7 1.9 0-8 1.6
Control #1
(n = 40)
Positive 4.1 0-11 3.0 3.2 0-11 3.1
Negative 2.0 0-6 1.6 2.2 0-7 1.7
Control #2
(n = 40)
Positive 3.5 0-12 2.9 3.2 0-7 2.3
Negative 1.6 0-5 1.4 1.7 0-6 1.6
oo
vO
TABLE 14
TWO-WAY ANALYSIS OF VARIANCE OF POSITIVE EPILEPTIC CASE STATUS
CHANGES FOR THE FIVE MONTHS PRE INSTITUTE AND FIVE MONTHS
POST INSTITUTE PER COUNSELOR BETWEEN GROUPS IN
CRITERION III: CASELOAD CASE STATUS REVIEW
Source of Variation df SS MS F
Between Subjects 119 1082.98
A (Pre-Post Institute) 2 3.81 1.90 .21 (ns)
Subjects within Groups 117 1079.17 9.22
Within Groups 120 712.95
B (Between Groups) 1 21.60 21.60 3.67*
AB 2 2.02 1.01 .17 (ns)
BX Subjects within Groups 117 689.33 5.89
Total 239 1795.93
*p.< .10.
VO
o
TABLE 15
TWO-WAY ANALYSIS OF VARIANCE OF NEGATIVE EPILEPTIC CASE STATUS
CHANGES FOR THE FIVE MONTHS PRE INSTITUTE AND FIVE MONTHS
POST INSTITUTE PER COUNSELOR BETWEEN GROUPS IN
CRITERION III: CASELOAD CASE STATUS REVIEW
Source of Variation df SS MS F
Between Subjects 119 360.29
A (Pre-Post Institute) 2 8.81 4.40 1.47 (ns)
Subjects within Groups 117 351.48 3.00
Within Groups 120 252.47
B (Between Groups) 1 .20 .20 .10 (ns)
AB 2 .81 .40 .19 (ns)
BX Subjects within Groups 117 251.46 2.15
Total 239 612.76
92
and groups. Again, the statistical significance reported
for the positive statuses between groups was discounted
for this study since, to be applicable, significance would
have had to occur in the interaction.
Summary
To summarize: The experimental and control groups
were found to be essentially equivalent in age, sex,
experience, academic degrees, majors and pre-Institute
close contact with epileptics; the experimental group was
found to achieve significantly higher scores on Criterion
I, the Epilepsy Information Examination, with the instru
ment proving reasonably reliable for the total group and
the experimental group, but quite low in reliability for
the control groups; and no significant difference was
found between the experimental and control groups on
Criteria II and III, Semantic Differential Epilepsy
Attitude Survey and Caseload Case Status Review.
CHAPTER V
DISCUSSION OF RESULTS
Introduction
In this chapter, the author will attempt to relate
each result of the study to the appropriate research
hypothesis. In addition, the support or lack of support
for the hypothesis will be discussed in terms of the
objective or objectives of the Institute on Epilepsy to
which it is related.
Research Hypothesis I
The first research hypothesis of this study was
that rehabilitation counselors attending the Institute on
Epilepsy would obtain a greater amount of information
regarding the rehabilitation of epileptics, as compared
with counselors attending another institute or not
attending any institutes. This hypothesis, as measured by
criterion I: the Epilepsy Information Examination, was
supported at the .01 level of confidence. The experi
mental group attending the Institute on Epilepsy obtained
significantly higher scores on the Examination than either
of the control groups. The Null Hypothesis of no differ
ence between groups was rejected.
93
94
Research hypothesis I was related to the first two
goals or objectives of the Institute: familiarizing re
habilitation counselors with the medical, psychological,
social and vocational aspects of epilepsy; and providing
them with specific information regarding methods of
evaluating the effects and functional limitations of the
condition. As measured by criterion I: the Epilepsy
Information Examination, these two essentially information
giving Institute objectives were achieved. However, these
results must be interpreted in light of the reliability
of the measurement, which was a little low (.54 and .59),
but consistent for the experimental group and the three
groups as a whole, but very low (.04 and .15) and incon
sistent for control groups 1 and 2. Consequently, a more
reliable examination in terms of control groups could have
had an effect on this difference and its significance.
Research Hypothesis II
The second research hypothesis was that rehabilita
tion counselors attending the Institute on Epilepsy would
demonstrate more positive attitudes toward epileptic
individuals, as compared with counselors attending another
institute or not attending any institutes. This hypothe
sis was tested by criterion II: The Semantic Differential
Epilepsy Attitude Survey, which indicated that while the
experimental group attending the Institute had slightly
95
lower mean scores toward the concepts of epilepsy and
seizures, this difference was not statistically signifi
cant. Consequently, while there was a slight tendency
for the experimental group to demonstrate more positive
attitudes toward epilepsy, as indicated by the lower
scores on the Survey, the hypothesis was not supported.
The Null hypothesis of no difference between groups was
not rejected.
The ratings of all three groups toward the concept
of heart disease and the more general concept of illness
were essentially the same for each group. However, the
ratings of all three groups on all four concepts tended
to be more negative than positive. This was further
substantiated by the fact that the rated means for each
group (4.7 to 5.0), in relation to each of the four
concepts, were significantly different at the .01 level
of confidence than a neutral or indifferent rating of 4.0.
Had this not been the case, what initially would have
looked like a more positive attitude in terms of lowness
of the mean, would have actually been due to the lack of
any feeling, negative or positive.
Research hypothesis II was related to the third
objective of the Institute: encouraging rehabilitation
counselors to apply the information to the vocational re
habilitation of individuals handicapped by the disability
of epilepsy. The partial achievement of this goal was
96
expected to be reflected in more positive attitudes toward
the concepts of epilepsy and seizures, as indicated by
adjective-pair ratings on the part of the experimental
groups as compared to the control groups. However, the
lack of support for research hypothesis II indicates this
objective was not achieved as far as attitudes are con
cerned .
Research Hypothesis III
The third hypothesis of the study was that rehabili
tation counselors attending the Institute on Epilepsy would
demonstrate more positive job behavior toward epileptic
individuals than they demonstrated prior to the Institute,
or as compared with the counselors attending another
institute or not attending any institutes. This hypothesis
was measured by criterion III: Caseload Case Status Review.
As indicated earlier, movement of a client through the
rehabilitation process is accompanied by a series of case
status changes which denote positive movements, such as
referral, acceptance for services, vocational plan
developed, ready for employment, employed successfully,
and negative movement, such as closed after referral,
services interrupted, closed unemployed, or closed before
rehabilitation plan could be initiated. A change in
status indicates a change in relationship between coun
selor and client. The Caseload Case Status Review
97
included a tallying of the positive and negative epileptic
case status changes for all three groups of counselors
during the five months preceding and the five months fol
lowing the Institute on Epilepsy. The results of this
case status review indicated no statistically significant
differences in positive or negative epileptic case status
changes between groups before or after the Institute,
when examined by month or by combining the first five
months and the last five months. Consequently, the
research hypothesis was not supported and the Null hypoth
esis was not rejected as measured by the Caseload Case
Status Review.
Although there was a statistically significant
difference between groups in both the month by month nega
tive status review and the combined months' positive
status review, as revealed by a Two-Way Analysis Variance,
the difference was not examined further or considered
important to this study. To be applicable to this study,
the significant difference would have had to occur in the
interaction of months, pre-post Institute, and between
groups.
Research hypothesis III was also related to the
third objective of the Institute on Epilepsy: encouraging
rehabilitation counselors to apply the information to the
vocational rehabilitation of individuals handicapped by
epilepsy. The lack of support for research hypothesis III
98
indicates that this objective was not achieved, as
reflected in counselor behavior on the job, to the extent
that this behavior is revealed by an increase in positive
and a decrease in negative case status changes for their
epileptic clients.
Research Hypothesis IV
The fourth research hypothesis proposed that
rehabilitation counselors attending the Institute on
Epilepsy and obtaining factual information would demon
strate more positive attitudes in job behavior toward
epileptic individuals, compared with counselors attending
another institute or not attending any institutes. This,
of course, was the underlying assumption and rationale
for presenting the Institute on Epilepsy.
Research hypothesis IV was not subjected to
specific statistical treatment. It would be necessary
for research hypotheses I, II, and III to have been sup
ported in order for such a comparison to be statistically
meaningful. However, the support of research hypothesis I
and the lack of support for research hypotheses II and III
indicate lack of support for research hypothesis IV.
More factual information on epilepsy, as measured by
criterion I (Epilepsy Information Examination) was not
accompanied by more positive attitudes and more positive
job behavior toward epileptics, as measured by criteria
II and III (Semantic Differential Epilepsy Attitude
Survey and Caseload Case Status Review).
CHAPTER VI
SUMMARY, CONCLUSIONS AND IMPLICATIONS
FOR FURTHER STUDY
Summary
Purpose
The purpose of this study was two-fold. First, a
method for evaluating the effectiveness of short-term
training for rehabilitation counselors was developed.
The method included evaluation of information gained,
change in attitudes and change in job behavior after
training. The second purpose of the study was to apply
this method of evaluation to a particular institute in a
series of two-day Institutes for Rehabilitation Counselors
on Rehabilitation of the Physically Disabled.
Methodology
The two-day Institute for Rehabilitation Coun
selors on Epilepsy was selected as the Institute to be
evaluated. The objectives of this Institute were:
A. To familiarize rehabilitation counselors
with the medical, psychological, social
and vocational aspects of epilepsy;
100
101
B. To provide them with specific information
regarding methods of evaluating the effects
and functional limitations of this condition;
C. To encourage them to apply the above informa
tion to the vocational rehabilitation of
individuals handicapped by this disability.
The Institute was presented at the Veterans Administration
Center in West Los Angeles on January 28 and 29, 1971, to
a group of rehabilitation counselors by an interdiscip
linary health team whose methods of presentation included:
lectures, panel discussions, slides and films, patient
presentations, demonstration of evaluation equipment, and
a tour of treatment facilities.
In cooperation with the California State Department
of Rehabilitation, 180 counselors employed by that Depart
ment were randomly selected to participate in the study
out of 198 counselors handling general, trust fund, wel
fare, severely disabled, public offender, or industrially
injured caseloads. Each of these counselors had worked
during 1969 and 1970 with clients and former clients of
the Department whose major disabling condition was
epilepsy. These 180 counselors were randomly assigned to
an experimental group and two control groups, with 120
(40 counselors in each group) being utilized as subjects
in the final study as a result of attrition caused by
102
illness, promotion, change of assignment, or termination.
Experimental and control groups were found to be equiva
lent in age, sex distribution, number of years in the
field of vocational rehabilitation counseling, number of
years employed by the Department of Rehabilitation, high
est educational level completed, college and graduate
school majors, and pre Institute close contact with
epileptics.
The criteria selected to measure effectiveness were
information, attitudes, and job behavior. The criterion
of information gained was measured by an Epilepsy Informa
tion Examination, which was developed by compiling and
refining 46 multiple choice questions submitted by Insti
tute faculty covering the material to be presented during
the Institute itself. The criterion of change in atti
tudes was measured by a Semantic Differential Epilepsy
Attitude Survey using Osgood's seven-point evaluative
scale of bipolar adjectives. Participants were asked to
rate the concepts of epilepsy, seizures, heart disease
and illness, using this scale. The criterion of change
in job behavior was measured by conducting a Caseload
Case Status Review of positive and negative epileptic case
status changes during the five months preceding and
following the Institute. The positive case status
changes included referral, acceptance for services,
vocational plan developed, ready for employment and
103
closed employed successfully; while negative statuses
included closed after referral, services interrupted,
closed unemployed, or closed before rehabilitation plan
could be initiated.
The experimental group attended the Institute on
Epilepsy, while control group one attended the Institute
on Rheumatic and Coronary Heart Disease, presented
January 21 and 22, 1971, and control group two did not
attend any Institutes. Control group one was used to
control for the Hawthorne effect of a change in routine
accounting for a difference in the criteria measured,
rather than change resulting from the Institute itself.
All three groups were administered the Epilepsy Informa
tion Examination and the Semantic Differential Epilepsy
Attitude Survey by mail, approximately four days after
the Institutes were held. The Caseload Case Status
Review was conducted for the months of September, 1970
through June, 1971, by the Department's computer facility
in Sacramento.
Research hypotheses were as follows:
1. Rehabilitation counselors attending the
Institute on Epilepsy would obtain a
greater amount of information regarding
the rehabilitation of epileptics, as
compared with counselors attending another
104
institute or not attending any institutes;
2. Rehabilitation counselors attending the
Institute on Epilepsy would demonstrate
more positive attitudes toward epileptic
individuals, as compared with counselors
attending another institute or not at
tending any institutes;
3. Rehabilitation counselors attending the
Institute on Epilepsy would demonstrate
more positive job behavior toward epileptic
individuals than they demonstrated prior to
the Institute, or as compared with coun
selors attending another institute or not
attending any institute; and
4. Rehabilitation counselors attending the
Institute on Epilepsy and obtaining factual
information would demonstrate more positive
attitudes in job behavior toward epileptic
individuals, as compared with counselors
attending another institute or not attending
any institutes.
Statistical significance of the difference between
post information examination group means was measured by
a One-Way Analysis of Variance and Tukey's HSD test, with
105
reliability of the measurement determined by the Hoyt
Analysis of Variance Method; statistical significance of
the difference between post attitude survey group means
was tested by a One-Way Analysis of Variance and Standard
Score-Normal Curve Comparison; and statistical signifi
cance of the difference between positive and negative
epileptic case status changes, month by month, and for the
pre-post five months combined between groups was tested by
a Two-Way Analysis of Variance for repeated measures and
new variables.
Findings
1. Research hypothesis 1, increase in informa
tion, was supported at the .01 level of
confidence, with the experimental group
obtaining a higher mean examination score
(28.3 out of 46 possible points) than
either control group one (21.5) or control
group two (22.2). However, while the
reliability of the measurement for the
experimental group and the entire group
of 120 counselors was .54 and .59 res
pectively, reliability for the control
groups was only .04 and .15.
2. Research hypothesis II, more positive
attitudes, was not supported even though
the experimental group demonstrated slightly
more positive mean ratings of the concepts
of epilepsy and seizures (70.9 and 72.6 out
of 105 possible) than either control group
one (72.2 and 74.9) or control group two
(72.3 and 75.4). Attitudes for all three
groups were similar on the concepts of
heart disease and illness; more negative
than positive on all concepts; and sig
nificantly different at the .01 level of
confidence than a neutral or indifferent
rate of 4.0 on all concepts.
Research hypothesis III, more positive job
behavior, was not supported as measured by
positive and negative epileptic case status
changes month by month, or combined pre and
post months between groups.
Research hypothesis IV, a gain in information
leads to more positive attitudes in job be
havior toward epileptic individuals, was not
supported. While the experimental group did
obtain more information than the control
groups, there was no significant difference
between groups in the criteria of attitudes
107
or job behavior.
Conclusions
In light of the results of this study, the follow
ing conclusions seem reasonable:
1. A two-day Institute for Rehabilitation
Counselors on Epilepsy, utilizing the
presentation format used in this study,
does have the potential for imparting
information regarding the condition
itself and important aspects in the
rehabilitation process of individuals
diagnosed as epileptics, as measured
by an Examination developed to cover
the information presented during the
Institute.
2. The two-day Institute on Epilepsy, as
presently constituted, does not have
any significant effect on rehabilitation
counselor attitudes toward epilepsy or
epileptic clients, as measured by a
Semantic Differential Epilepsy Attitude
Survey, approximately four days after
the Institute. A change in Institute
format, which would allow for more
108
emotional involvement of the Institute
participants with the topic and epileptic
individuals over a longer period of time,
might have a more profound effect on
attitudes.
3. The two-day Institute on Epilepsy, as
presently constituted, does not have any
significant effect on the job behavior
of rehabilitation counselors toward their
epileptic clients, as measured by changes
in positive and negative case statuses of
these clients during the five-month period
following the Institute. A change in
Institute format, content, length or
degree of participant involvement seems
to be necessary to achieve a change in
behavior.
4. The acquiring of more factual information
about epilepsy and its rehabilitation
aspects by rehabilitation counselors
attending such an Institute is not accom
panied by a corresponding increase in
positive attitudes and positive job
behavior toward epilepsy and epileptic
clients.
Two out of the three objectives of
presenting the Institute on Epilepsy
appear to have been achieved. Rehabili
tation counselors were familiarized with
the medical, psychological, social and
vocational aspects of epilepsy and did
gain specific information regarding the
methods of evaluating the effects and
functional limitations of this condition.
However, the crucial objective of en
couraging them to apply this information
to the vocational rehabilitation of
individuals handicapped by epilepsy was
not achieved, as measured by change in
attitudes and job behavior.
The method of evaluation used in this
study, comparing gain in information,
change in attitudes and change in job
behavior between experimental and control
groups, appears to be a viable method for
measuring the effectiveness of short-term
training. As was indicated in the review
of the literature, evaluating the presenta
tion of information without also looking
at its effect on attitudes in job behavior
is merely scratching the surface of
measuring effectiveness or lack of
effectiveness. Valuable information
that can indicate the need for program
modification, deletion or expansion
can be obtained by this method that
would otherwise be lost to the program
developer. The results will be more
effective training cost wise and more
effective short-term training in terms
of its quality.
Implications for Further Study
Although the Institute objective of
providing information was supported,
it might be assumed that the hypothesis
would have been supported if only a one-
day Institute was held, set up in a
similar manner. In other words, are two
days necessary for imparting such
information?
A change in the Institute presentation
and activity format might produce more
impact on attitudes and behavior while
still imparting information. For
example, a study of the- effects of peer
contact on attitudes toward disabled
college students conducted by Urie and
Smith (1971), revealed that eleven weeks'
contact with handicapped college students
in a residential setting had a signifi
cant effect on the attitudes of female
college students whether or not they
had previous contact with handicapped
students. Applying these results to the
Institute on Epilepsy might include a
presentation format which, in addition
to providing basic information, also
allows a considerable amount of time for
participant contact and individual dis
cussion with epileptic individuals
similar in age to the counselors attend
ing the Institute. To enhance this
increased client contact, the Institute
might be held for three days instead of
two days.
The quality of participation and the
quantity of emotional involvement of
the counselors attending the Institute
could be improved. Sands (1970), in a
study directed toward changing employment
policies and attitudes toward persons with
epilepsy, comes to the conclusion that:
Since the public education campaign
directed at policy-level executives
did not engage them in any of the
community activities associated with
the campaign, it is suggested that
perhaps by emotionally involving
these executives in the activities
of an education program their atti
tudes toward hiring persons with
epilepsy could be changed to be
consistent with modern medical and
rehabilitation concepts of epilepsy,
(p. iii)
By involving counselors attending the
Institute in accepting some responsibility
for planning and conducting a portion of
the Institute, their emotional involvement
with the subject could be increased. This
emotional involvement might then initiate
a significant change in behavior as well
as attitudes toward epileptic clients.
Such involvement might range all the way
from asking counselors to bring epileptic
case profiles selected from their own
caseloads to the Institute sessions for
group and individual discussion, to hold
ing planning meetings with counselors
selected to attend the Institute well in
advance of its presentation, for the
purpose of developing an Institute format
that would meet counselors1 felt needs
for training.
A controlled experiment, designed to create
a positive shift in community attitudes
regarding epilepsy by a year of intensive
education through the media, resulted in
a surfacing of negative rather than posi
tive attitudes toward epilepsy (Towne,
1970). This result suggests that bringing
concepts and issues which are initially
repulsive to one's awareness might result
in an immediate or first reaction more
negative in terms of attitudes and behavior
than originally expected. This might occur
especially in situations where little is
known intellectually or visually about the
condition prior to the focusing of atten
tion on the condition. Although the post
Institute attitudes of the experimental
group toward the concepts of epilepsy and
seizures tended to be more positive than
those of the control groups, there was no
significant difference in attitudes or
behavior between the groups pre or post
Institute. As pointed out by Siller in a
research brief on the structure of atti
tudes toward the disabled, even pro
fessionals, such as rehabilitation
counselors, who spend a great deal of
time with the disabled, can have hidden
prejudices which can greatly damage their
rehabilitation process (Siller, 1970).
Downes (1967), Yuker, Block and Young
(1966), and others have indicated that
positive change in attitudes toward the
disabled may vary with age, educational
level, professional experience, previous
contact and sex. Consequently, it might
prove beneficial to look at the results
of this study in relation to subgroups
divided according to the biographical
data collected on each counselor by group.
For example, information, attitudes and
job behavior might be compared between
groups for those over and under 40 years
of age, male-female, five years or more
experience versus five years or less
experience. The information gained
could prove to be helpful in terms of
participant selection for certain types
of training programs. For instance,
younger, less experienced counselors
without a Master of Science degree in
rehabilitation counseling may benefit
to a greater extent from the type of
training format used in the Institute
of Epilepsy, while older, more experi
enced counselors with rehabilitation
counseling degrees may need another
format to achieve effectiveness.
The reliability of the Epilepsy Informa
tion Examination should be strengthened
to provide for a more reliable measure
ment of information gained as a result
of training.
The Semantic Differential Epilepsy Atti
tude Survey might be given several times
during the follow-up period after the
presentation of the Institute, to ascer
tain increase or decrease in the attitudes
of the experimental and control groups in
view of the slightly more positive attitude
mean score demonstrated by the experimental
group on the concepts of epilepsy and
seizures.
In order to allow for enough time to
elapse so that more of the rehabilitation
process could be completed in individual
cases, the period of time over which the
pre-post Caseload Case Status Survey was
conducted might be lengthened. This
could lead to more valid results, since
the average time for successful voca
tional rehabilitation to occur in a case
is often referred to by the Department
of Rehabilitation as being 18 months.
The method of evaluation utilized in this
study should be applied to all of the two-
day institutes in the series to determine
the effectiveness of an institute format
and objectives similar to the Institute
on Epilepsy but directed toward a different
disability topic. Certain disabilities
might prove to be more suited to a particu
lar type of institute presentation format
in terms of meeting its objectives, as
measured by change in information, atti
tudes and job behavior, than others.
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117
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AP PE ND IX ES
127
Appendix A
Epilepsy Institute Program
University of Southern California
School of Medicine
Division for Research and Training in Rehabilitation
Institute for Rehabilitation Counselors
on
Epilepsy
Veterans Administration Resocialization Center
Wilshire at Sawtelle Boulevards
Los Angeles, California 90073
Administration Building 218
Room 14 A
January 28-29, 1971
128
129
Division for Research and Training in Rehabilitation
University of Southern California School of Medicine
Institute for Rehabilitation Counselors
on
Epilepsy
Veterans Administration Resocialization Center
Administration Building 218
Room 14 A
January 28-29, 1971
Objectives:
A. To familiarize rehabilitation counselors with the
medical, psychological and social aspects of
epilepsy;
B. To provide them with specific information regard
ing methods of evaluating the effects and
functional limitations of this condition; and
C. To encourage them to apply the above information
to the vocational rehabilitation of individuals
handicapped by this condition.
Participants:
Employed rehabilitation counselors, private and public
vocational rehabilitation agencies; and
Rehabilitation counseling students from CSCLA and USC.
FIRST DAY
January 28, 1971
9:00 A.M. Registration and Introduction
E. W. Stude, Vocational Rehabilitation
Coordinator
Arthur W. Johnson, Assistant Vocational
Rehabilitation Coordinator
USC Division for Research and Training in
Rehabilitation
130
9:25 A.M. Welcome
Gale N. Wagener, Director
Veterans Administration Resocialization
Center
9:30 A.M. The History of Epilepsy
Richard D. Walter, M.D.
Professor of Medicine (Neurology)
UCLA Center for Health Sciences
10:00 A.M. The Neurological Deficits and Educational
Implications of Epilepsy
Leon Oettinger, Jr., M.D.
Clinical Professor of Medicine
USC School of Medicine
I. Epilepsy is not just convulsions. The
learning and behavioral abnormalities
associated with epilepsy are probably
more damaging both socially and to the
ego than are the seizures themselves.
II. It should be noted that the primary
causes for these changes are the
abnormalities of the brain, and not
the rejection of individuals by
society. In many instances the
epileptic is quite similar to that
group of children who are now known
as minimally brain damaged.
III. Medical care should be directed not
only to the control of convulsions but
also the control of the learning and
behavioral disorders. Some drugs may
control convulsions but worsen behav
ior, therefore being of little value.
IV. The function of the epileptologist is
to aid the epileptic to function as a
member of his society, and treatment
is directed to the epileptic and not
to epilepsy.
10:30 A.M. COFFEE
131
10:45 A.M. The Causes and Treatment of Epilepsy
Elinor R. Ives, M.D.
Clinical Professor of Neurology
USC School of Medicine
I. Etiology of Epilepsy
A. Chief categories which may cause
seizure disorders.
B. Age at onset.
C. Various types of seizure disorders.
II. Treatment of Epilepsy
A. Medications
1. Problems in administration.
2. Patient response.
B. The "do's" and "don't's" which may
precipitate seizures.
C. The influence of the patient's per
sonality and environment on the
control of seizures.
11:30 A.M. Modern Concepts of Epilepsy (Film)
12:00 Noon Diagnosis and Research on Epilepsy
Adam Wechsler, M.D.
Ass is tant Chief, Neurology
Wadsworth Hospital
I. Diagnosis of Epilepsy
A. History and Physical Examination.
B. Laboratory Examinations.
C. Radiological Procedures.
D. The EEG.
II. Research on Epilepsy
A. Depth Electrode Studies
12:30
1:30
2:00
2:15
2:45
132
B. Neurochemical Studies.
C. Physiological Mechanisms of Epilepsy.
D. Investigations with Anticonvulsant Drugs.
P.M. LUNCH
P.M. Epilepsy--A Universal Stigma
William H. Oldendorf, M.D.
Medical Investigator, Wadsworth V.A. Hospital
Clinical Professor of Medicine, UCLA Medical
School
’ .M. COFFEE
P.M. The Social Implications of Epilepsy
Mrs. Betty Ticho, ACSW, Executive Director
Los Angeles County Epilepsy Society
I. The epileptic as viewed by his many publics.
II. The epileptic's view of himself.
III. The epileptic as he appears to his family.
IV. Implications of these viewpoints for the
professional working with epileptic persons.
P.M. The Psychological Implications of Epilepsy
Vladimir A. Ordon, Ph.D.
Research Senior Scientist
Astropower Laboratories
McDonnell Douglas Company
I. Psychological questions associated with
epilepsy.
II. Psychological disorders observable among
epileptic patients.
III. Epilepsy as a formative factor in development
of personality in conjunction with:
A. Age
B. Sex
133
C. Seizure experience.
D. Adjustive reactions.
E. Ego defense mechanisms.
F. Social aspects.
G. Secrecy and isolation patterns.
H. Compensation and decompensation.
I. Prospects for "normal" life.
IV. Methods for psychological testing and the
role of the psychologist in epilepsy
counseling.
A. Examples of current research.
3:30 P.M. END OF FIRST DAY
SECOND DAY
January 29, 1971
9:00 A.M. Vocational Implications of Epilepsy
Frank Risch, Ph.D., Chief
Epilepsy Rehabilitation, V.A. Center,
and Director, Epi-Hab Organizations
This presentation deals with the epileptic
in a competitive labor market and delineates
his trials and tribulations in establishing an
anchor in the job arena. The veto forces are
many. A few of them are outlined in this
presentation. It is important to know how
employers, unions and licensing agencies look
upon epilepsy and who the resisting powers are
in industry, and in organized labor. Experi
ences with industry, labor and government show
a variety of inconsistencies in hiring, train
ing, workmen's compensation, driver's licensing,
etc. To raise the epileptic to a competitive
level, archaic beliefs and stigma must be
dispelled.
134
During the past 20 years, epilepsy has
made some inroads into the realm of education,
economics and social living. The western part
of the United States is generally less tradi
tional and more innovated. The Gallup Poll
taken every five years since 1949, to check
the attitudes of the general public toward
epilepsy, has come up with some encouraging
signs. It found that progress has been made
in a variety of geographic areas, with the
greatest acceptance of the epileptic in the
western part of the United States.
9:30 A.M. A Manufacturer's Experience with Epilepsy
Charles Barron, M.D.
Medical Director
Lockheed Aircraft Company
I. Historical Review.
II. Employment Considerations
A. Medical; Hazard to Self and Others.
B. Economic: Industrial and Group Insurance.
C. Operational; Flexibility, Productivity,
and Morale.
III. Experiences to Date
A. Increasing Identification and Utilization.
B. Work, Absenteeism, and Safety Experience.
C. Changing Attitudes: Management, Industrial
Physician, and Insurance Carrier.
IV. Suggestions to Enhance Employment of
Epileptics
A. Proper Training for Job Opportunities.
B. Education of Employers.
C. Improvement of Medical Treatment.
D. Education and Self-Discipline of
Epileptics.
135
E. Continued Research in Medical Control
of Disease.
10:00 A.M. COFFEE
10:15 A.M. The Role of the Rehabilitation Counselor in
the Epilepsy Rehabilitation Transition
Arthur W. Johnson, M.S.
Assistant Vocational Rehabilitation Co
ordinator
USC Division for Research and Training in
Rehabilitation
I. Videotaped Interview of Epi-Hab L.A. Inc.
Employee (Interviewee is a full-time, com
petitively paid epileptic working in
Epi-Hab's machine shop.)
II. Role of the Rehabilitation Counselor in a
Sheltered Workshop Serving a Predominately
Epileptic Population
A. Referral Screening.
1. Development of medical, educational,
social, and psychological information.
2. Appropriateness of referral— attitude
toward accepting workshop level
involvement.
B. Program Selection.
1. Work evaluation.
2. Trade training.
III. Counseling the Epileptic.
A. Individual Counseling.
B. Family Counseling.
C. Group Counseling.
IV. Placement.
A. Assessing Job Readiness.
B. Need for Counselor Intercession in
Placement.
C. Job Saving.
10:45 A.M. Blueprint for Epilepsy (film).
136
11:15 A.M. The Transition of Epilepsy from Forced
Idleness to Productive Employment--
A Case Presentation
Calvin M. Williams, General Manager
Epi-Hab L.A., Inc.
The presentation will cover the entry and
transition of epileptics that have partici
pated in the Epi-Hab L.A. program.
1. What are some of the identifiable
problems the epileptic must consider
without any immediate expectation of
relief?
2. What are some of the factors that
influence these decisions?
3. How, with assistance, some epileptics
have merged into the general population,
12:00 Noon A Community Resource for the Epileptic—
The California Epilepsy Society
Mrs. Betts Jensen, Executive Director
California Epilepsy Society
I. Epilepsy Foundation of America
A. Government grants and research funds.
B. Literature and case referrals.
C. Educational materials.
II. California Epilepsy Society
A. Structure.
B. Functions.
1. Expans ion.
2. Advice and counseling to chapters.
3. Seeking out of sponsoring groups.
III.
12:30 P.M.
1:15 P.M.
I.
II.
137
4. Legislation.
a. Services of the Crippled
Children's Services program.
b. Immigration.
5. Participation in State and Federal
Programs.
Services Offered by an "Ideal" Local Chapter
A. Medical referrals.
B. Employment referrals.
1. 1969 Gallup Poll.
2. Civil Service.
c. Emergency drug funds.
D. Counseling Services.
E. Social groups for epileptics.
F. Parents groups.
G. Speakers Bureaus.
H. School Alert Program.
LUNCH
The Industrial Workshop in the V.A. Hospital
(tour)
Joseph J. Henry, Administrative Officer
Epilepsy Rehabilitation, V.A. Center
Brief History of Epilepsy Rehabilitation
Workshop
Description of Physical Plant
A. Machine Shop, Building T-63.
B. Earphone Processing Shop, Building T-68.
C. Woodworking Shop, Building T-66.
138
D. Sandblasting Shop, Building 82.
E. Heavy Packaging Shop, Building 181.
F. Light Assembly Shop, Building T-54.
G. Neuropsychiatric Evaluation Shop,
Building 259.
Tour of Shops--Questions will be invited during
Tour.
2:15 P.M. Electroencephalographic Recording Demonstra
tion
Samuel S. Viglione, M.S.
Manager, Pattern Recognition Research
Astropower Laboratories
McDonnell Douglas Company
In recent years esearchers have shown an
increasing interest in monitoring subjects with
physical and mental handicaps in natural dynamic
situations. Under the sponsorship of the Social
and Rehabilitation Service of the U.S. Department
of Health, Education and Welfare, a program has
been undertaken to study epileptics who are
ambulatory, able to work, but still vulnerable
to seizures. The objective of this program is
to investigate the development of a method, or
a device, to predict an imminent epileptic
seizure.
The results obtained during the initial
phases of this program will be discussed.
These efforts have been directed toward col
lection of data from a limited number of
subjects (primarily those experiencing
generalized seizure attacks), formulation of
procedures suitable for medical, visual and
computer analysis, and, finally, preliminary
system evaluation for detecting and classify
ing pre-seizure activity. Instrumentation has
been developed and tested allowing collection
of EEG and other correlated data from physically
active epileptic subjects. Numerous recordings
have been made (including seizures), and anal
yses performed (clinical and computer-aided)
giving credence to the hypothesis that de
finable pre-seizure activity can be noted.
139
2:45 P.M. Panel - Responding to questions from
participants.
Panel Members:
Frank Risch, Ph.D., Chief, Veterans
Administration Epilepsy Rehabilitation
Service
Charles Barron, M.D., Medical Director,
Lockheed Aircraft Co.
Harold Brand, Recipient of the Epilepsy
Foundation of America "Epileptic of
the Year Award 1970"
Mrs. Betts Jensen, Executive Director
of the California Epilepsy Society
3:45 P.M. Evaluation Form
E. W. Stude, M.S., Vocational Rehabilitation
Coordinator
Arthur Johnson, M.S., Assistant Vocational
Rehabilitation Coordinator
USC Division for Research and Training in
Rehabilitation
4:00 P.M„ END OF INSTITUTE
Appendix B
Rheumatic and Coronary Heart Disease
Institute Program
University of Southern California
School of Medicine
Division for Research and Training in Rehabilitation
Institute for Rehabilitation Counselors
on
Rheumatic and Coronary Heart Disease
USC School of Medicine
Hoffman Building
2025 Zonal Avenue
Los Angeles, California 90033
Hastings Auditorium
January 21-22, 1971
140
Division for Research and Training in Rehabilitation
University of Southern California School of Medicine
Institute for Rehabilitation Counselors
on
Rheumatic and Coronary Heart Disease
USC School of Medicine
Hoffman Building
Hastings Auditorium
January 21-22, 1971
Objectives:
A. To familiarize rehabilitation counselors with the
medical, psychological and social aspects of
Rheumatic and Coronary Heart Disease;
B. To provide them with specific information regard
ing methods of evaluating the effects and
functional limitations of these conditions; and
C. To encourage them to apply the above information
to the vocational rehabilitation of individuals
handicapped by these conditions.
Participants:
Employed rehabilitation counselors, private and
public vocational rehabilitation agencies; and
Rehabilitation counseling students from California
State College at Los Angeles and the University of
Southern California.
142
FIRST DAY
January 21, 1971
9:00 A.M. Registration, Introduction and Pre-test
E. W. Stude, Vocational Rehabilitation
Coordinator
Art Johnson, Assistant Vocational Rehabilita
tion Coordinator
USC Division for Research and Training in
Rehabilitation
9:30 A.M. Rheumatic Heart Disease— Etiology and
Pathogenesis
Masayoshi Matsuno, M.D., Instructor in
Med ic ine
USC School of Medicine
A. Etiology - Hypersensitivity Tissue Reaction
to Group "A" Streptococcus Infection
B. Pa thogene s is
1. Sensitizing infection due to strep
tococci usually with sore throat
(and maybe with scarlet fever)
2. Repeat attacks of sore throat (Strept.
Infection) result in tissue injury with
acutely inflammed joints (rheumatic
fever)
3. Inflammation of the heart may occur
during the acute attack and subside
or permanent damage to heart valves
and muscle may occur
4. Damages valves and muscle, may cause
secondary compensatory changes in
structure and function of the heart
C. Causes of Death
1. Severe acute inflammation with heart
failure
2. Chronic heart disease with failure
3. Embolic phenomenon
143
D. Survival increased by:
1. Prophylactic therapy against strept.
infections
2. Adequate medical care
10:00 A.M. Rheumatic Heart Disease - Classification
and Types of Disability
Robert Barndt, M.D., Instructor-Medicine
LAC-USC Medical Center
A. The clinical diagnosis of rheumatic fever
is dependent on the Jones Criteria;
1. Major manifestations
a. Carditis
b. Polyarthritis
c. Chorea
d. Erythema Marginatum
e. Subcutaneous nodules
2. Minor manifestations
a. Clinical
1- Previous rheumatic fever or
rheumatic heart disease
2- Arthalgia
3- Fever
3. Laboratory
a. Acute Phase Reactions
1- Erythrocyte sedimentation rate
2- C-Reactive Protein
3- Leukocytosis
b. Prolonged P-R Interval
144
4. Plus - Supporting Evidence of Pre
ceding Streptococcal Infections
(increased ASO or other streptococcal
antibodies; positive throat culture
for Group A Streptococci; recent
scarlet fever).
5. The presence of two negative criteria,
or of one major and two minor cri
teria, indicates a high probability
of the presence of rheumatic fever if
supported by evidence of a preceding
streptococcal infection. The absence
of the latter should make the diag
nosis doubtful, except in situations
in which rheumatic fever is first
discovered after a long, latent
period from the antecedent infection
(e.g., Sydenham's chorea or low grade
carditis).
B. Rheumatic heart disease may be divided
into pericardial, myocardial, and endo
cardial lesions. For the most part, the
pericardial lesions are but a transient
phase without permanent sequelae, whereas
myocardial and endocardial lesions result
in permanent disabled cardiac pump. The
endocardial valvular lesions may be on
the input or output valves and occur most
frequently in the following order:
1- Mitral
2- Aortic
3- Tricuspid
4- Pulmonic
These valve lesions are amenable to heart
surgery in selected cases.
C. The classification and clinical manifesta
tion of the rheumatic heart disease and
arteriosclerotic heart disease meet on
common grounds in that both etiological
diseases cause impaired cardiac output and
therefore physical disability. This
secondary effect on physical disability
is classified by the American Heart
145
Association as follows:
Functional Capacity
Class I Patients with cardiac disease
but without resulting limitation
of physical activity. Ordinary
physical activity does not cause
undue fatigue, palpitation,
dyspnea or anginal pain.
Class II Patients with cardiac disease
resulting in slight limitation
of physical activity. They are
comfortable at rest. Ordinary
physical activity results in
fatigue, palpitation, dyspnea
or anginal pain.
Class III Patients with cardiac disease
resulting in marked limitation
of physical activity. They are
comfortable at rest. Less than
ordinary activity causes
fatigue, palpitation, dyspnea
or anginal pain.
Class IV Patients with cardiac disease
resulting in inability to carry
on any physical activity with
out discomfort. Symptoms of
cardiac insufficiency or of the
anginal syndrome are present
even at rest. If any physical
activity is undertaken discom
fort is increased.
Therapeutic Classification
Class A Patients with a cardiac disease
whose ordinary physical activity
need not be restricted.
Class B Patients with cardiac disease
whose ordinary physical activity
need not be restricted, but who
should be advised against severe
or competitive physical efforts.
146
Class C Patients with cardiac disease
whose ordinary physical activity
should be moderately restricted,
and where more strenuous efforts
should be discontinued.
Class D Patients with cardiac disease
whose ordinary physical activity
should be markedly restricted.
Class E Patients with cardiac disease
who should be at complete rest,
confined to bed or chair.
10:30 A.M0 COFFEE
10:45 A.M. Case Presentation - Rheumatic Heart Disease
Mohammed Mohsenin, M.D., Fellow in
Cardiology
LAC-USC Medical Center
11:30 A.Mo LUNCH
12:30 P.M. Coronary Heart Disease - Etiology and
Pathogenesis
L. Julian Haywood, M.D., Director
Coronary Care Unit
LAC-USC Medical Center
A. Definition
B. Etiology - cause unknown
C. Factors thought to be important in
pathogenesis:
1. Age
2. Heredity
3. Hypercholesterolemia
4. Obesity
5. Diabetes
6. Hyper tens ion
7. Smoking
147
D. Anatomical Factors:
1. Localized disease of coronary vessels
a. Sclerosis
b. Plague Formation
c. Clot Formation
2. Myocardial infarction - localized
heart muscle death due to occlusion
or insufficiency
E. Causes of Death:
1. Arrhythmias - sudden death
2. Congestive heart failure
3. Shock
4. Other less frequent complications
F. Potential for survival increased by:
1. Immediate attention during attack
if "sudden death" occurs
2. Intensive monitoring during acute
phase (coronary care unit)
3. Adequate care during convalescence
and recovery
4. Control of contributing factors as
noted under "B" above
1:00 P.M. Coronary Heart Disease - Classification and
Types of Disability
Maria De Guzman, M.D., Staff Physician in
Cardiology
LAC-USC Medical Center
A. Clinical manifestations of arterio
sclerotic heart disease are dependent on:
1. Myocardial infarction
2. Angina Pectoris
148
3. Heart failure, etc.
4. Laboratory findings
a. ECG changes of myocardial
infarction
b. ECG changes with exercise
c. Acute myocardial infarct phase
reaction - sedimentation rate,
SGOT, SGPT, CPK
d. X-ray evidence of post myocardial
infarct. Myocardial aneurysm
e. Angiographic techniques visualizing
the coronary artery disease
B. Clinical Course
This type of heart disease is of a de
generative nature which is usually
progressive and eventually death-dealing.
The available medical and surgical care
for this disease is directed toward
alleviation of his symptoms and improving
cardiac reserve without jeopardizing his
survival.
C. Management
1. Medical
2. Social - economic
3. Work evaluation
1:30 P.M. Film - "The Problems of Chest Pain"
2:00 P.M. COFFEE
2:15 P.M. Case Presentation - Coronary Heart Disease
Hafitz Kahn, M.D., Fellow in Cardiology
LAC-USC Medical Center
149
3:00 P.M. The Psychological Implications of Heart
Disease
William F. Kiely, M.D., Associate Director
Consultation Liaison Service, Department of
Psychiatry
LAC-USC Medical Center
A. Any person will experience and respond to
a given episode of somatic illness in
manner characteristic of him rather than
of the illness per se.
This "style" of reaction reflects four
variables:
1. patient's personality and specific
life history
2. patient's current social and economic
situation
3. characteristics of the hospital or
"sick room" environment
4. the nature of the illness particularly
as perceived and evaluated by the
patient
B. Psychological response to the illness may
vary over a spectrum, depending upon the
acuteness and severity from:
1. anxiety: often reflects lack of
sufficient factual under
standing of the illness
2. panic: often reactive to physical
pain and associated fear
of death
3. denial: a reaction against the
reality posed by the
illness
4. depression: masked or overt - reflec
tive of the "loss" com
ponent of the illness
150
C. Seven basic personality types and
associated attitudes:
1. dependent, overdemanding = oral
2. orderly, controlled = compulsive
3. dramatizing, emotionally seductive =
hysterical
4. long-suffering, self-sacrificing =
masochistic
5. guarded, questioning = paranoid
6. superior-feeling, expansive =
narcissistic
7. uninvolved, aloof = schizoid
3:45 P.M. END OF FIRST DAY
SECOND DAY
January 22, 1971
9:00 A.M. Community Resources
Barbara Thies, ACSW, Executive Director
Los Angeles County Welfare Information
Service
A. Describe WIS services as resources
consultant to rehabilitation counselors
and as referral source for patients.
B. Review resource directory sources, dis
tribution of Key Community Resources
published by WIS.
C. Highlight legal requirements for special
services for handicapped.
D. Discuss major sources for auxiliary
services in L.A. County, such as:
financial assistance, homemaker, meals
on wheels, transportation, diet coun
seling, family counseling, recreation,
loan funds.
151
9:30 A0M. The Sociological Implications and Public
Health Aspects of Heart Disease
Kathleen Obier, ACSW, Medical Social Worker
Linda MacIntyre, R.N., Public Health Nurse
Coronary Care Unit - LAC-USC Medical Center
Sociological Implications of Heart Disease
A. Impact of hospitalization
1. Potential psychosocial crises
2. Organization of new self
3. Reality problem
B. Heart disease as a type of chronic illness
1. Misconceptions regarding heart disease
2. Changes in patient's life style, real
and perceived
3. Changes in family's life style, real
and perceived
C. Rehabilitation in the acute hospital
1. Affect of hospital milieu on early
perception
2. Prevention of patient regression and
family disintegration
3. Health team goals
Heart Disease and the Role of the Public
Health Nurse
A. In the Hospital
1. Discharge planning with the patient
and his family
2. Interpretation, to the patient and
his family, about heart disease and
the physicians' recommendations
regarding his care
152
B. In the Community
1. Assisting the patient with his care
at home
2. Resource person for other community
agencies, i.e., vocational rehabili
tation
3. Education
C. Experience of this Public Health Nurse
with the Post-MI Patient from the
Coronary Care Unit
1. Job description
2. Findings from a study done over a
one-year period.
10:15 A.M. COFFEE
10:30 A.M. Vocational Rehabilitation Counseling Problems
Beverly Marshall, Rehabilitation Counselor
California Department of Rehabilitation
A. Medical Background for the Counselor
1. Familiarity with the rheumatic and
coronary artery disease entities
2. Obtaining and reviewing detailed
medical records on each patient
3. Need for on-going medical supervision
B. Pre-Vocational Assessment of the Cardiac
Patient
1. Detailed analysis of patient's work
background
2. Evaluation of psycho-social aspects
of work history
C. The Counseling Process
1. Nature and scope of the counseling
relationship
153
2. Assisting client in handling and
accepting his problem
3. Necessity for the active involvement
of the patient in the counseling re
lationship
D. Use of a Workshop
1. Further evaluation of patient's work
capacity
2. The workshop as a diagnostic aid
3. The workshop from the standpoint of
physical and emotional adjustment
E. Employment
1. The on-going counseling relationship
and its importance in job seeking
2. The counselor as a liaison person
between the patient and the community
3. Barriers to employment of cardiac
patients
F. Case Study - Mr. W.
11:00 A.M. The Role of the Workshop in the Rehabilitation
of Heart Disease Patients
Howard Moes, Director
Handcraft Industries
A. Coronary Patient as Seen from the Eyes
of the Employer
1. Is a sheltered workshop director
representative of industry?
2. Description of handcraft
3. Function of program (group counseling
vs. individual counseling)
4. Clients served
154
B. Work Activity
1. Skill level
2. Psychological work atmosphere
C. Cardiac Patients
1. Background of Cedar's Project
2. Background of patients - clients
3. Attitude of disability group
4. Case histories
D. Evaluation of Program
1. Extension of work level and skill
2. Extension of facility
E. Transference of Shop Experience to Indus
try
1. After the workshop - what?
11:30 A.M. LUNCH
12:30 P.M. Film - "Pulse of Life"
1:15 P.M. Methods of Evaluating Rheumatic and Coronary
Heart Disease
Donald Crawford, M.D., Staff Physician in
Cardiology
LAC-USC Medical Center
(1/2 group observe cardiac catheterization
demonstration, then switch to:
Robert Brandt, M.D., Instructor of Medicine
LAC-USC Medical Center
1/2 group observe bicycle ergometer and
electrocardiogram demonstration, then switch
to above.)
155
A. The Work Tolerance Test
1. General Purposes:
a. Non-specific diagnosis; The
ability to do work of increasing
severity depends in part on the
ability of the heart to increase
proportionally the amount of blood
pumped, heart rate, etc. There
fore, work tolerance tests can be
used for determination of heart
function in patients with known
heart disease in order to establidi
functional classification or re
sults of treatment.
b. Specific diagnosis: Work tests can
be used clinically for the demon
stration of symptoms and signs of
certain diseases, notably coronary
artery disease and abnormalities
of cardiac rate, which may only ap
pear during exercise when the heart
is stressed.
2. Methods of Testing:
a. Most testing is done on stationary
apparatus so that the subject can
be observed closely and measure
ments made, i.e., treadmill and
bicycle ergometer.
b. When the patient has suspected
condition such as a recurrent ab
normality of cardiac rhythm which
cannot always be reproduced in the
laboratory, equipment for tele
metry or tape recording of heart
signals may be used.
3. Methods of Evaluation:
a. Rheumatic heart disease: Measure-
ment of work tolerancedepends on
evaluation of the patient s symp
toms, correlated with abnormali
ties in heart rate and respiration
during work (too high) which are
presumptive evidence of abnormal
156
cardiac stress. In certain cases
this may be documented by blood
or other special tests during ex
ercise .
b. Coronary artery disease: Since
resting examination and electro
cardiography are often normal, the
diagnosis may be confirmed by the
appearance of typical abnormali
ties of the electrocardiogram
during exercise.
B. Cardiac Catheterization
1. General Purposes:
a. Rheumatic Heart Disease: To con-
flrm the presence and/or to define
the severity of heart valve ab
normalities and related effects.
b. Coronary artery disease: To
demonstrate the extentand loca
tion of obstruction of the
coronary artery and the effect
of this on the function of the
heart.
2. Methods of Testing:
a. Using local anesthesia, small
plastic tubes of special design
can be passed into any location
in the heart under x-ray visuali
zation to measure the amount and
direction of blood pumped, pres
sures in the various heart cham
bers, and to record pictures of
heart chambers or of coronary
arteries.
3. Methods of Evaluation:
a. An abnormal leak or obstruction
of a heart valve leads to
measurable abnormalities in the
pressures and blood flow within
the heart.
b. Obstructions in the coronary
157
arteries can be visualized and
evaluated on still and cine x-ray
pictures.
2:45 P.M. COFFEE
3:00 P.M. Panel - discussing and answering questions from
the participants.
Panel Members: Julian Haywood, M.D.;
Kathleen Obier, ACSW;
Beverly Marshall;
Linda MacIntyre, R.N.; and
William Kiely, M.D.
3:45 P.M. Post-test and Evaluation Form
Art Johnson, Assistant Vocational Rehabilita
tion Coordinator
USC Division for Research and Training in
Rehabilitation
4:15 P.M. END OF INSTITUTE
Appendix C
Epilepsy Information Examination
Division for Research and Training in Rehabilitation
University of Southern California School of Medicine
Institute for Rehabilitation Counselors
on Epilepsy
Examination
Circle the Correct Answer
1. Special hospitals or "Colonies" for epileptics in the
country are:
1. quite common at the present time.
2. began disappearing in the 1940's.
3. are anticipated to increase in the future.
4. have never existed in this country.
2. The first major effective drug treatment for epilepsy
was:
1. Phenobarbital.
2. Dilantin.
3. Bromides.
3. The "epileptic personality"
1. can be identified by modern psychological
testing.
2. can be recognized clinically.
3. may have been induced by drugs.
4. none of the above.
158
159
4. The modern concept is that epilepsy is a separate
disease rather than a symptom.
True False
5. The behavior and learning disorders associated with
epilepsy are primarily due to:
1. rejection by society.
2. emotional problems.
3. abnormalities of the brain.
6. Drugs which control convulsions:
1. aid cognition.
2. make cognition worse.
3. sometimes worsen cognition.
4. have no effect on cognition.
7. Psychologic and psychometric testing of epileptics is:
1. of no value
2. of medium value.
3. of great value.
8. Care of the epileptic is primarily concerned with:
1. control of seizures.
2. stabilizing the individual neurologically
and emotionally.
3. quieting the patient down.
Check the statement that is correct in the two following
questions.
9. 1. Epilepsy is inherited in 50% - 757. of cases.
2. Epilepsy is inherited in over 75% of cases.
3. Epilepsy is due to disease.
4. Epilepsy is a syndrome due to a variety of causes.
10. 1. Patients will stop having seizures if they take
medicine regularly, and follow the doctor's
orders.
2. Some patients will continue to have seizures
regardless of their taking medicine regularly,
and obeying the doctor's orders.
3. If a patient under medical care continues to have
seizures, it indicates he doesn't want to get
well.
4. If a patient under medical care continues to have
160
seizures, it indicates he'iL. probably drinking
liquor.
11. Seizures may be precipitated by:
1. drinking over four cups of coffee a day.
2. eating too much fried or fatty food.
3. not taking medicine at certain specific hours.
4. physical exercise.
12. Treatment of epilepsy should include:
1. rest.
2. recreation.
3. protection from responsibility.
4. plenty of drinking water.
13. An initial evaluation of a patient with seizures
should include all but which of the following:
1. x-rays of the skull.
2. electroencephalogram.
3. pneumoencephalogram.
4. brain scan.
14. Seizures which begin with rotation of the eyes to the
right, followed by rotation of the head to the right,
suggest a lesion in the:
1. right parietal lobe.
2. left frontal lobe.
3. left parietal lobe.
4. right frontal lobe.
5. left temporal lobe.
15. The EEG would be of particular value in the localiza
tion of:
1. an ependymoma of the fourth ventricle.
2. an abscess of the frontal lobe.
3. an astrocytoma of the cerebellum.
4. a cyst of the third ventricle.
5. a pinealoma.
16. A focus of epileptic discharge is likely to be
produced by:
1. electrical activity from tumor cells.
2. pathological alterations in the physiochemical
161
state of neuronal membranes.
3. alteration of the blood-brain barriers.
4. decreased serum bicarbonate.
5. elevated serum calcium.
17. "Adult epileptics have learned to feel shame. They
feel keenly the stigma that the attitude of society
and its laws has placed upon them." This statement
was made by one of the following:
1. Mary Switzer.
2. Sigmund Freud.
3. Plato.
4. Hippocrates.
5. Samuel W. Livingston, M.D.
18. In general, the person who develops epilepsy as an
adult has:
1. less of a chance to succeed "socially."
2. the same chance to succeed "socially."
3. a better chance to succeed "socially."
19. Children with epilepsy should have:
1. the same kind of parental discipline as a
non-epileptic child.
2. little or no discipline.
3. individualized discipline.
20. If he is otherwise competent to drive, the adult with
epilepsy can secure a driver's permit in California
if:
1. his seizures occur only at night.
2. his seizures are completely controlled for
two years.
3. he always has a "warning" or "aura" of a
seizure and has sufficient time to move
to a safe place.
4. he is completely controlled for a period
considered adequate by the Department of
Motor Vehicles.
21. The Workmen's Compensation Insurance Carrier:
1. penalizes an employer for hiring an epileptic.
2. increases the insurance rate of a company if
it employs epileptics.
3. does not impose any restrictions on a company
162
for hiring epileptics.
4. discourages hiring people with epilepsy.
5. concerns itself with rating both accidents
and disabilities.
22. People with epilepsy should not be allowed to work at
machinery.
1. Dangerous to have an epileptic standing near
a machine.
2. The epileptic will generally fall into the
moving parts of a machine.
3. It depends on the kind of machine that he is
us ing.
4. No restrictions whatever are necessary.
5. The usual safeguards should be the rule.
23. The person with epilepsy should not be allowed to
operate motor vehicles unless:
1. he is under medical supervision, regardless
of the number of seizures he has.
2. he has been seizure-free for three years but
still uses alcoholic beverages.
3. he has been seizure-free for a year and is a
respons ible individual.
4. the cause of his epilepsy is known.
5. never allowed to drive again.
24. Most epileptics are generally considered slow and
marginal workers:
1. because they have epileptic personalities
which bring them into conflict with others.
2. because they can have seizures and it can
upset everybody.
3. because research and demonstration indicates
this.
4. because the public is misinformed and
prejudiced, which conceals the true facts.
5. because overmedication affects their
production.
25. The primary reason for rejection of epileptics for
employment is:
1. excessive absenteeism.
2. group insurance costs.
3. poor work performance.
4. possible economic risk relating to industrial
accidents.
163
26. Actual work experience at Lockheed has resulted in
the following observation:
1. Epileptics have a significantly higher
accident rate.
2. Turnover rates are higher for epileptics.
3. Epileptics seldom achieve managerial
positions.
4. When properly placed, epileptics perform
as efficiently as other employees.
27. The best way of assuring employment of epileptics is:
1. deny existence of disease.
2. training them adequately for jobs which are
or will be in demand.
3. file with appropriate State and Federal
agencies for discriminatory practices.
4. write to the president of the company.
28. The key to job retention is:
1. offer to work overtime without compensation.
2. minimize frequency of attacks during working
hours.
3. self-regulation of medication to avoid
drowsiness.
4. skip regular appointments with the doctor in
order to avoid excessive absenteeism.
29. The Vocational Counselor in assisting the epileptic
choose an appropriate vocational goal should auto
matically rule out which of the following work
situations:
1. work around or with moving machinery such
as in a machine shop.
2. work requiring the operation of a motor
vehicle.
3. work where a person is required to climb
ladders, work on scaffolding, etc.
4. all of the above.
5. none of the above.
30. Which of the following statements is not true con
cerning the hiring practices of epileptics:
1. Few companies have hiring guidelines for
epileptics; for most companies epilepsy
is a carte blanche reason for not hiring.
2. Epileptics are just as likely to be dismissed
164
from employment when they have their first
seizure on the job regardless of their
disclosure or non-disclosure of their
condition at point of hiring.
3. A company's workmen's compensation insurance
rates will automatically go up when an
epileptic is hired.
4. Studies have shown that most epileptics with
good medical control and no other disabling
condition merge with the general population
and do not reveal their condition to an
employer.
31. When an employee has a seizure on the job typically
the greatest problem that he faces is:
1. physical injury.
2. inability to return to work immediately
after the seizure.
3. his fear of the reactions of co-workers and
supervisors.
4. his ability to assure the employer that there
will be no greater hazard, in the future,
than the incident that has just occurred.
32. For the individual rehabilitation counselor, the most
important service of a workshop for his epileptic
client is:
1. development of diagnostic tools to assess
the capabilities and potentials of
epileptics.
2. development of statistics to refute employer
objections for hiring epileptics; safety
records, insurance costs, time loss due
to seizures, etc.
3. development of a real but therapeutic work
environment to reverse years of negative
conditioning and enhance job readiness.
4. demonstrate to industry and the public what
the epileptic can do in a work situation
with the willingness of management to
assume "reasonable risks."
5. training and placement.
33. The medical profession can best influence general
acceptance of the epileptic by:
1. familiarizing themselves with the latest
developments in convulsive medicine.
165
2. working with lay organizations to keep the
public informed of recent medical advances.
3. influencing legislation.
4. speaking to and advising industrial firms
regarding the employability of epileptics.
34. Idleness is imposed upon the epileptic because:
1. he is afraid of getting injured.
2. he is ashamed of seizures.
3. he, as well as others, does not know what he
can safely do.
4. lack of employment opportunity for epileptics
35. In deciding whether the epileptic should conceal his
seizures in seeking employment, he should consider:
1. can he honestly do the job.
2. can he safely do the job.
3. if it is a matter of survival.
4. will he be rejected if his condition is
disclosed.
5. truth at all cost.
36. How many states have no epilepsy societies?
1. 7
2. 13
3. 18
4. 23
37. How many states have a "state" epilepsy society, with
local chapters?
1. 2
2. 11
3. 15
4. 23
38. In what year did children with epilepsy as their only
handicap become eligible for care under the Crippled
Children's Services program in California?
1. 1950
2. 1957
3. 1962
4. 1970
166
39. In what year were persons with epilepsy permitted to
become citizens of the United States?
40. What protective devices are required in a shop where
epileptics are employed?
41. Epileptics employed in Workshops compare in efficiency
to non-handicapped workers in general in the following
manner:
42. Average time lost in Workshops due to a seizure is:
43. The surface potentials that are measured on the scalp
and referred to as the EEG can be measured in the
following ways:
1. Through the use of electrodes mounted to
the surface of the scalp and connected
to an appropriate recorder.
2. By attaching the scalp-mounted electrodes
to a specially designed radio transmitter
and utilizing a remote receiver and tape
recorder to obtain the recording.
3. Either or both of the above.
4. Neither of the above.
44. Frequency analysis of the EEG is particularly useful
for which of the following indications.
1. localizing isolated spikes.
2. detecting spike and wave activity.
3. highlighting changes in the EEG rhythm that
1. 1900
2. 1930
3. 1950
4. 1965
1
2
3
4
none.
those normally found in any shop
many special devices,
few special devices.
1. less efficient.
2. more efficient.
3. approximately the same
1. 2 hours.
2. 5 minutes.
3. 15 minutes.
4. 4 hours.
167
may be partially obscured by artifact or
background activity.
4. detecting brain scars or lesions.
45. Pattern recognition can be more readily associated
with which of the following methods of analysis:
1. numerical averaging.
2. statistical analysis based upon a knowledge
of the underlying parameters of the data.
3. a nonparametric, mathematical analysis
technique based upon adaptive learning
procedures.
4. computer data processing.
46. The objective of the program discussed is to:
1. show that the computers can be used to
process the EEG.
2. develop bio-telemetry for remote recording
of epileptic seizures.
3. determine the feasibility of detecting
physiologic changes occurring prior to
the onset of a seizure.
4. categorize seizures by computer analysis.
Appendix D
Semantic Differential Epilepsy
Attitude Survey
Division for Research and Training in Rehabilitation
University of Southern California School of Medicine
Institute for Rehabilitation Counselors
on Epilepsy
Attitude Survey
INSTRUCTIONS: The purpose of this study is to measure the
meanings of certain words to various people by having them
judge each word against a series of descriptive scales.
In taking this test, please judge the words on the basis
of what they mean to you. Each numbered item presents a
CONCEPT (such as DICTATOR), and a scale (such as high-low).
You are to rate the concept on the 7-point scale indicated.
If you felt that the concept was "very closely associated"
with one end of the scale, you might place your check mark
as follows:
DICTATOR
up_______: ______: ______: _____ : ______: ______: X down
If you felt that the concept was "quite closely related"
to one side of the scale, you might check as follows:
HOUSE:
straight : X : ______: _____ : ______: ______: _____crooked
168
169
If the concept seemed "only slightly related" to one side
as opposed to the other, you might check as follows:
CLOUD:
easy ______: ______ : X ; ______: ______: ______: _____difficult
If you considered the scale "completely irrelevant, or
both sides equally associate," you would check the middle
space on the scale:
TREE
idealistic : : : X : ______: ______: _____realistic
Sometimes you may feel as though you have had the same
item before on the test. This will not be the case; every
item is different from every other item. "So do not look
back and forth throughout the test." Also, do not try to
remember how you marked similar items earlier in the test.
Make each item a separate and independent judgment. Work
at fairly high speed, without worrying or puzzling over
the individual items for long periods. It is your first
impressions that we want.
Of course, some of the items will seem highly irrelevant
to you. It was necessary, in the design of this test, to
match every concept with every scale at some place, and
this is why some items seem irrelevant— so give the best
judgment you can and move along.
170
1. EPILEPSY:
good__
beautiful__
sour__
clean__
distasteful
valuable__
kind
pleasant__
bitter__
happy__
profane__
awful__
fragrant__
honest__
fair
bad
.ugly
_swee t
_dirty
tasty
_worthless
cruel
_unpleasant
sweet
sad
sacred
__nice
foul
dishonest
unfair
171
2. SEIZURE
bad_
beautiful
sweet
dirty__
distasteful
valuable__
kind__
pleasant__
bitter__
happy__
profane__
nice
fragrant_
dishonest-
fair
_good
.ugly
sour
_c lean
tasty
_worthless
cruel
^unpleasant
sweet
sad
sacred
_awf ul
foul
.honest
unfair
172
3. HEART DISEASE:
good__
ugly__
sweet__
dirty__
distasteful
valuable__
cruel__
pleasant__
bitter__
happy__
sacred__
awful__
fragrant__
honest__
unfair
_bad
_beautif ul
_sour
_clean
tasty
_worthless
kind
janpleasant
sweet
_sad
profane
nice
foul
dishonest
fair
173
4. ILLNESS:
good_
beautiful_
sweet
dirty_
tasty_
worthless_
kind_
unpleasant_
bitter_
happy_
sacred_
nice_
foul_
honest_
fair
bad
.ugly
_sour
clean
distasteful
valuable
cruel
pleasant
sweet
sad
pro fane
_awful
_fragrant
_dishonest
unfair
Appendix E
Biographical Data Sheet
Division for Research and Training in Rehabilitation
University of Southern California School of Medicine
Biographical Data Sheet
Please complete the following questions by checking the
appropriate space and/or filling in the appropriate blank.
1. Age:_____ 2. Sex: _____ Male Female
3. Highest Educational Level Completed; _____ College
(Major ______ )
M.S. in Rehabilitation Counseling
M.So or M.A. in another field
(Ma j or__________________________)
4. Number of years in the field of vocational
rehabilitation counseling: ______
5. Number of years employed by the California
Department of Rehabilitation:
6. Do you have a close friend or relative who
is epileptic?
______ yes no
174
Appendix F
Correspondence with Subjects
State of California
MEMORANDUM
To:
Department of Rehabilitation
Date: December 22, 1970
File No.:
From: Harry J. Lucas
Subject: Evaluation of Short-Term Training
As most of you are aware, the University of Southern Cali
fornia Medical School's Division for Research and Training
in Rehabilitation has presented a series of Institutes for
Rehabilitation Counselors on Rehabilitation of the Phys
ically Disabled for the past three years. A sizeable
number of our counselors have attended this series and the
initial reaction has been favorable.
In an attempt to more adequately ascertain the real ef
fectiveness of this kind of training, the Department is
cooperating with the University in conducting a controlled
study of Institute Training designed to measure the
achievement of training goals. The results of this study
will supply valuable information for both the University
and the Department in terms of their future presentation
of and our participation in this type of training.
With the Department's cooperation and assistance, you have
been selected to participate in this project. This will
involve your attending the Institute on Epilepsy to be
held at the Veterans Administration Resocialization Center
in Los Angeles on January 28-29, 1971, and completing and
returning two types of data gathering instruments.
Please mark these dates on your calendar so you can plan
for your attendance and cooperation.
You will receive more specific instructions regarding time,
place, and parking approximately two weeks prior to the
Institute directly from the University.
HJL:dm
cc: S. M. Merrill
Regional Administrators
District Administrators
Bud Stude
175
176
State of California
MEMORANDUM
To:
Department of Rehabilitation
Date: December 22, 1970
File No.:
From Harry J. Lucas
Subject: Evaluation of Short-Term Training
As most of you are aware, the University of Southern Cali
fornia Medical School's Division for Research and Training
in Rehabilitation has presented a series of Institutes
for Rehabilitation Counselors on Rehabilitation of the
Physically Disabled for the past three years. A sizeable
number of our counselors have attended this series and
the initial reaction has been favorable.
In an attempt to more adequately ascertain the real
effectiveness of this kind of training, the Department
is cooperating with the University in conducting a con
trolled study of Institute Training design to measure the
achievement of training goals. The results of this study
will supply valuable information for both the University
and the Department in terms of their future presentation
of and our participation in this type of training.
With the Department's cooperation and assistance, you have
been selected to participate in this project. This will
involve your attending the Institute on Rheumatic and
Coronary Heart Disease to be held at the USC School of
Medicine in Los Angeles on January 21 and 22, 1971, and
completing and returning two types of data gathering
instruments.
Please mark these dates on your calendar so you can plan
for your attendance and cooperation.
You will receive more specific instructions regarding time,
place and parking approximately two weeks prior to the
Institute directly from the University.
HJL:dm
cc: S. M. Merrill
Regional Administrators
District Administrators
Bud Stude
177
State of California
MEMORANDUM
Department of Rehabilitation
To: Date: December 23, 1970
File No.:
From: Harry J. Lucas
Subject: Evaluation of Short-Term Training
As most of you are aware, the University of Southern Cali
fornia Medical School's Division for Research and Training
in Rehabilitation has presented a series of Institutes for
Rehabilitation Counselors on Rehabilitation of the Physi
cally Disabled for the past three years. A sizeable
number of our counselors have attended this series and the
initial reaction has been favorable.
In an attempt to more adequately ascertain the real effec
tiveness of this kind of training, the Department is
cooperating with the University in conducting a controlled
study of Institute Training designed to measure the
achievement of training goals. The results of this study
will supply valuable information for both the University
and the Department in terms of their future presentation
of and our participation in this type of training.
With the Department's cooperation and assistance, you have
been selected to participate in this project. This will
involve your completing and returning two types of data
gathering instruments during the week of February 1, 1971.
Please mark this date on your calendar for your coopera
tion .
You will receive more specific instructions regarding the
data gathering instruments directly from the university
at that time.
HJL:dm
cc: S. M. Merrill
Regional Administrators
District Administrators
Bud Stude
178
DIVISION FOR RESEARCH AND TRAINING IN REHABILITATION
UNIVERSITY OF SOUTHERN CALIFORNIA
SCHOOL OF MEDICINE
1739 GRIFFIN AVENUE, LOS ANGELES, CALIFORNIA 90031
(213) 225-3115— Ext. 73874
M E M O R A N D U M
January 22, 1971
TO:
FROM: E. W. Stude, Vocational Rehabilitation
Coordinator
SUBJECT: Evaluation of Short-Term Training
You recently attended an Institute for Rehabili
tation Counselors on Rheumatic and Coronary Heart Disease
in relation to a study being conducted by the University
in cooperation with the Department of Rehabilitation
designed to evaluate the effectiveness of this type of
short-term training.
In order to complete the study, please fill out
the enclosed biographical data sheet, multiple choice test
and attitude survey. You will notice that these instru
ments are designed to measure information and attitudes
regarding epilepsy. This is not a mistake, but pertains
to the institute we are evaluating. You do not need to
write your name on either the biographical data sheet or
evaluation instruments as these have been coded so your
identity will remain anonymous.
Place the completed data sheet, test and atti
tude survey in the enclosed self-addressed, stamped
envelope and return them by January 29. 1971.
On behalf of myself and the USC Division for
Research and Training in Rehabilitation, I would like to
express our appreciation for your cooperation in this
study. Its results should supply valuable information for
both the University and the Department of Rehabilitation
in relation to future presentation of and participation
in this type of training.
EWS:jw
encl.
179
DIVISION FOR RESEARCH AND TRAINING IN REHABILITATION
UNIVERSITY OF SOUTHERN CALIFORNIA
SCHOOL OF MEDICINE
1739 GRIFFIN AVENUE, LOS ANGELES, CALIFORNIA 90031
(213) 225-3115— Ext. 73874
M E M O R A N D U M
January 29, 1971
TO:
FROM: E. W. Stude, Vocational Rehabilitation
Coordinator
SUBJECT: Evaluation of Short-Term Training
You recently attended an Institute for Rehabili
tation Counselors on Epilepsy in relation to a study being
conducted by the University in cooperation with the
Department of Rehabilitation designed to evaluate the
effectiveness of this type of short-term training.
In order to complete the study, please fill out
the enclosed biographical data sheet, multiple choice test
and attitude survey. You do not need to write your name
on either the biographical data sheet or evaluation in
struments as these have been coded so your identity will
remain anonymous.
Place the completed data sheet, test and atti
tude survey in the enclosed self-addressed, stamped
envelope and return them by February 5. 1971.
On behalf of myself and the USC Division for
Research and Training in Rehabilitation, I would like to
express our appreciation for your cooperation in this
study. Its results should supply valuable information
for both the University and the Department of Rehabilita
tion in relation to future presentations of and participa
tion in this type of training.
EWS:jw
encl.
180
DIVISION FOR RESEARCH AND TRAINING IN REHABILITATION
UNIVERSITY OF SOUTHERN CALIFORNIA
SCHOOL OF MEDICINE
1739 GRIFFIN AVENUE, LOS ANGELES, CALIFORNIA 90031
(213) 225-3115— Ext. 73874
M E M O R A N D U M
January 29, 1971
TO:
FROM: E. W. Stude, Vocational Rehabilitation
Coordinator
SUBJECT: Evaluation of Short-Term Training
A little over a month ago you were asked to
participate in a study being conducted by the University
in cooperation with the Department of Rehabilitation
designed to evaluate the effectiveness of short-term
training for rehabilitation counselors.
In order to complete the study, please fill
out the enclosed biographical data sheet, multiple choice
test and attitude survey. You do not need to write your
name on either the biographical data sheet or evaluation
instruments as these have been coded so your identity
will remain anonymous.
Place the completed data sheet, test and
attitude survey in the enclosed self-addressed, stamped
envelope and return them by February 5, 1971.
On behalf of myself and the USC Division for
Research and Training in Rehabilitation, I would like to
express our appreciation for your cooperation in this
study. Its results should supply valuable information
for both the University and the Department of Rehabilita
tion in relation to future presentation of and partici
pation in this type of training.
EWS:jw
encl.

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Asset Metadata

Creator Stude, Everett Wilson, Jr. (author)

Core Title Evaluation Of Short-Term Training For Rehabilitation Counselors: Effectiveness Of An Institute On Epilepsy

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Education

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, guidance and counseling,OAI-PMH Harvest

Language English

Advisor Schrader, Don R. (committee chair), Carnes, Earl F. (committee member), Meyers, Charles Edward (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-480604

Unique identifier UC11362363

Identifier 7217517.pdf (filename),usctheses-c18-480604 (legacy record id)

Legacy Identifier 7217517

Dmrecord 480604

Document Type Dissertation

Rights Stude, Everett Wilson, Jr.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA