Professional Development Needs of Community Rehabilitation Program Staff: Focus Group Research

Leslie McAllan, Susan Moore, Phyllis Cowman, Charlene Kampfe, Amos Sales, and Mae Smith

Abstract

Focus groups were conducted to determine training needs of Community Rehabilitation Program (CRP) staff throughout the state of Arizona. As a research method, the use of focus groups is considered participatory action research, a method that requires collaboration among all stakeholders that allows them to actively shape the research rather than merely provide information. This study was carried out following a review of rehabilitation literature that revealed the absence of direct care staff input in areas of training and development. Themes that emerged from this study included the perceived rewards of training as well as frustrations with the work environment and how training is delivered to employed personnel.

Introduction

Participatory Action Research (PAR) was promoted in the 1980's as a user-responsive method of research that reframed research questions in alignment with the concerns of the service users (Racino, 2000). Hammel, Finlayson, and Lastowski (2003) defined PAR as a research approach that involves a "dynamic collaboration among stakeholders invested in a common social issue" (p. 99). Stakeholders are regarded as shapers and leaders of the research and as active participants in the entire process, rather than as passive providers of information. Use of focus groups as a participatory action method of conducting research has been evident in the literature for over twenty years, yet there is generally a lack of published studies in which focus groups have been used appropriately to determine professional development needs.

In this paper, results of a focus group analysis of the professional development needs of Community Rehabilitation Program (CRP) staff in Arizona are reported as one example of a PAR needs assessment process. A review of the literature was conducted in order to find data from previous studies on training needs including those needs specific to CRP staff. Although very few articles were found, the authors summarized information obtained related to examples of previous research utilizing focus group methodology, training issues in CRP's, and needs expressed by consumers with disabilities related to service delivery professionals. Finally, findings from a focus group analysis of the professional development needs of Arizona professionals are discussed.

Focus Group Research Methods

Methodologies used in the following studies include a combination of focus groups and other techniques for obtaining data. These methodologies are described here to illustrate the common use of focus groups to generate categories of needs and priorities. It should be noted that the focus groups often had steps in place to assure that recommendations made by participants were considered and implemented, if feasible.

In a recent guest editorial in an international journal, Turmusani (2004) compared "participatory research" to a newer paradigm called "emancipatory research." According to Turmusani there are four main differences between the two approaches: 1) in emancipatory paradigms people with disabilities have full control over the research, whereas in participatory models, full participation is encouraged but the researchers may continue to have control over the research; 2) in the emancipatory model the researcher remains neutral and offers his/her expertise to people with disabilities; whereas in the participatory model, the researcher remains the expert with regard to research skills and people with disabilities are considered to be experts with regard to their life situations; 3) the emancipatory model encourages people with disabilities to be the source of the research questions and design; whereas in the participatory model outside sources, including the researcher, are seen as the initiator; and 4) the emancipatory model encourages viewing a person with a disability as part of the community within which he/she lives and works and the participatory model still focuses on the individual and on "individualism" as an essential value. The distinctions between these two paradigms suggest that there are varying degrees of involvement on the part of persons with disabilities when conducting research.

Jurich, Casper and Hull (2001) conducted a five-month study to assess the needs of correctional educators using three components: a) a focus group, b) a survey based on the focus group findings, and c) classroom observations to confirm what educators said on the surveys. The focus group was the beginning point, and was used to generate educators' needs. These needs were coded and themes emerged as categories for training. A survey instrument was developed based on these themes and was then distributed to a larger sample. The second phase of this research allowed for a larger sample size than would be possible using focus groups alone.

In another study, focus groups with 60 rural health workers in Queensland, Australia were used as a strategy to develop research priorities and to collaborate on an educational resource manual (Parker, O'Connor-Fleming, Tooth & Humphries, 2002). This study began with a literature review to analyze existing manuals. Focus groups were then held to identify needs and to keep the workers informed about stages of producing the manual. Consumers were included through the use of a questionnaire that asked them to self-report their health care needs. Finally, the manual was tested and evaluated by the health care workers and specialists. Unfortunately, the study did not elaborate on the focus group process; it simply included it in the sequence of events.

Tsiboukli and Wolff (2003) conducted two focus groups with workers in community drug rehabilitation programs, each consisting of seven members. Each group lasted for two hours and met twice. There were three weeks between sessions. The facilitator worked to create a safe supportive environment and confidentiality was assured. Each group had one moderator and one observer who met after the sessions to exchange their impressions. The authors analyzed the data by first transcribing each session; and then systematically analyzing the content of each session, including the participants' behaviors, thoughts, feelings and beliefs about training. The researchers coded responses and looked for themes and common patterns. Respondents later evaluated the process and reported that it was a very good experience that allowed them to self-evaluate their training needs.

Using an interdisciplinary rehabilitation model for persons with chronic pain, Thunberg and Hallberg (2002) conducted focus groups, participant observations with field notes, and document analysis to determine service delivery needs. The researchers chose the focus group format because it "capitalizes on the interaction within a group to elicit rich experimental data" (Asbury, J.-E., 1995, p. 421). As a research strategy, a focus group approach allowed the exploration of research areas from the participants' own perspective. Thunberg and Hallberg found that the process increased team members' abilities to listen to each other and decreased their reliance on individual professional identities.

Tsiboukli and Wolff (2003) used focus groups in Greece to understand staff perceptions of their training needs in order to work with substance abusers. They indicated that the focus group interview process was a technique derived from group therapy, but was limited in time and scope and used to assess specific issues. They indicated that group dynamics must be "handled in such a way that the research aims are not lost and the group is not transformed into a therapy session or a simple chat" (p. 154). The authors confirmed the need to plan questions and to develop new questions as the focus group proceeds, so that the questions seem informal but also cover all the topics they are investigating. They suggested that focus groups can be used to generate hypotheses for subsequent quantitative surveys or to supplement data that were already obtained, basing the premise of focus groups on the concept that workers are aware of their own needs.

According to Adams and Maynard (2000), "A major benefit of the use of focus groups was an enhanced feeling of partnership, cooperation, and collaboration... a feeling of being included that was much appreciated, and a renewed commitment to continue to work together on an ongoing basis to reassess training needs" (p. 51). Jurich, Casper and Hull (2001) also reflected, "During the process, teachers felt ownership of the entire process, and enthusiasm for the training was high" (p. 26). To illustrate the application of focus group research to the assessment of training and professional development needs of CRP staff, the authors have chosen to present the results of research conducted in Arizona.

Training Needs

The professional development needs of CRP line staff without advanced degrees are not frequently addressed in the literature; however, the training needs of rehabilitation counselors have been investigated by two sets of researchers (Froehlich & Linkowski, 2002; Szymanski & Linkowski, 1993). Szymanski and Linkowski (1993) studied the human resource development needs of certified rehabilitation counselors who were renewing their certification by asking them to respond to a Likert-type scale with training categories defined by the researcher. The results indicated that counselors rated the areas of "medical and psychosocial aspects of disability," "individual counseling and development," and "assessment" as highly important training needs. They rated "vocational services;" "foundations of rehabilitation;" and "social, cultural and environmental issues" as moderately important; and they rated "case management and services," "workers' compensation," "employer services and technology," and "research" as low to moderately important. "Group and family issues" was rated as the sole area of relatively low importance (see Table 1). In this particular study, a discrepancy model was employed to allow the counselors to rate both perceived importance of the training needs and perceived preparedness in each of the competency areas.

Froehlich and Linkowski (2002) assessed the training needs of state vocational rehabilitation (VR) counselors, using the Rehabilitation Counseling Knowledge Instrument (RCKI), a self-report questionnaire. In the RCKI, the activities that counselors perform were grouped into clusters, and respondents were asked to rate each item from "high need for training" to "low need for training." Training needs were derived by using a discrepancy model, defining need for training as a difference between the perceived importance and perceived preparedness of the items on the RCKI. High need for training was identified in the following areas: "vocational services," "case management and services," "medical and psychosocial aspects of disability," "workers' compensation," "employer services," and "technology." Moderately high discrepancy ratings were obtained in the area of "social, cultural, and environmental issues." "Foundations of rehabilitation" and "individual counseling and development" elicited moderately low ratings. The lowest ratings were found to be "group and family issues" and "research." A comparison of the training priorities in both of these studies is presented in Table 1.

Table 1
Comparison of Training Needs

Across the two studies, consistently high areas of need were found in "medical and psychosocial aspects of disability" and "assessment." Areas that remained in the moderate range in both studies included "social, cultural, and environmental issues" and "foundations of rehabilitation." "Group and family issues" was considered to be a low area of need during both studies. The areas of "workers' compensation, employer services and technology" and "case management and services" were specified as a moderately low need in the earlier study and as a high need in the second study. Perhaps the much greater use of technology in the nine years between studies led to this shift in priorities. Conversely, "individual counseling and development" was rated as high in the first study and moderately low in the second one. Finally, "group and family issues" and "research" were consistently rated as a low priority in both studies.

In both studies training need categories were presented by the researchers and subjects were asked to respond to these relatively traditional pre-existing training categories that relate directly to the major content categories of the professional exam for Certified Rehabilitation Counselors. Results were fairly consistent across studies and reflected high needs for training in disability specific content and diagnostic areas. Although studies of training needs for rehabilitation counselors may have some relevance for certain CRP staff, it is important that separate studies be conducted to learn more about the training needs of and problems associated with delivering training to CRP staff.

Training Issues in CRPs

In addition to the lack of published information regarding the training needs of CRP staff, there was limited information published about the problems associated with delivering training in settings that have limited staff, lower salaries, mandated client-staff ratios, multiple shifts, and large turnover. Future studies of training needs must take into account the personnel problems faced by many CRPs. An exhaustive review of the literature resulted in the discovery of only two research articles about personnel problems in these facilities.

Shafer, Pardee and Stewart (1999) conducted a survey of 395 mental health and vocational rehabilitation professionals in six western states in the United States of America to assess their training needs. The researchers concluded that a major challenge for many programs was the distance many of these facilities were from potential training opportunities. Responses to the survey suggested a need for developing distance learning technologies. However, nearly three-quarters of the respondents reported not knowing how to use the internet, even though nearly all of them expressed an interest in receiving training on how to use it.

Racino (2000) criticized "one-shot" in-service trainings that are often held outside of agencies for either one day or for a long weekend. Racino noted that these training sessions often occur without workers' needs assessments, on-site follow-up, or hands-on instruction, support, or post-training evaluation. Follow-up support costs were considered prohibitive in terms of time and money, and arguments were made for integrating financial support into professional development plans.

The previous two studies were not conducted using a PAR model. Researchers asked the questions and designed the research methodologies rather than involving the consumers in the entire research process. Although the following research does not use a PAR methodology, it does involve consumer perspectives that can shed a practical light on the perceived training needs of professionals who deliver services and drive future research that is more participatory in nature.

Consumer Perspectives of Professional Training Needs

CRP consumer needs and concerns were examined by McCarthy and Leierer (2001), who asked 40 former rehabilitation counseling clients with spinal cord injury to describe both the "ideal" rehabilitation counselor and the minimal qualifications desired for these counselors. In the first part of the survey, respondents were asked to describe in their own words the "ideal rehabilitation counselor" and also the minimum qualifications that all rehabilitation counselors should have. For writing the responses, the participants were given a sheet with 10 numbered lines after each question. This section allowed the subjects to think up their own responses. The second part of the survey used a Likert scale to have participants rate the personal impact of rehabilitation counseling services they had received as well as rate four specific counselor factors. These four factors included "the way they behave toward me," "their education and training," "the experiences they have had in life," and "personal characteristics." Results of the survey indicated that the two most frequent characteristics of an "ideal" counselor were "consumer-first attitudes and advocacy" and "nurturing traits that promote the counselor-client relationship." The next three most frequently mentioned characteristics were "knowledge about disability and rehabilitation," "professional standards of practice," and "efficient case management." The remaining characteristics were mentioned by very few respondents: "facilitative counseling and communication skills," "disability experience in personal life," "educational background," and "maturity and professional experience."

Regarding rehabilitation counselors' minimal qualifications, the researchers found the clients to be less descriptive than with the traits of "ideal" counselors (McCarthy & Leierer, 2001). "Commitment to advocacy" was the most desired characteristic identified, followed by "nurturing traits." "Factual knowledge," including the counselor's education and credentials, was rated as less important. These results suggest that consumer priorities regarding training and qualifications are directly opposite to the results of surveys of professionals. These data support the notion that participatory action research methods, including focus groups, could provide important data for planning and programming in CRPs.

Methodology

The focus group process used to illustrate the participatory action research model was conducted initially to obtain data on training needs for the purposes of applying for grant funds to provide training to CRP staff in Arizona. The research was conducted with the support of the Community Rehabilitation Advisory Council (CRAC) to the Arizona Rehabilitation Services Administration. The CRAC is made up of managers of the primary CRPs in the state. However, the researchers decided that it was important to communicate directly with CRP staff to obtain information about training needs, rather than rely solely on supervisors for a management perspective. A focus group research design was selected.

After reviewing the two research models presented by Turmusani (2004), it is clear that the focus group model discussed in this paper represents more of a participatory paradigm applied to mostly non-disabled people working with persons with disabilities than an emancipatory model. The researchers had full control of the study with assistance and guidance provided by the CRAC, the researchers were the experts on the research design and CRP staff were considered to be the experts on their needs, and the research was initiated by the researchers for the specific purpose of obtaining information to include in a grant. However, the researchers chose a more emancipatory approach with regard to the location and focus of the research by studying the needs of CRP staff within the context of their work environments. Earlier in this paper, it was noted that McCarthy and Leierer (2001) studied the perceptions persons with disabilities had regarding the "ideal" rehabilitation counselor. A similar approach, asking persons with disabilities who are served by CRP staff to identify training needs of staff, might have provided another useful consumer perspective. Of course, making this choice might depend on how one defined the "consumer" in this study. Is the "consumer" of training activities the person being trained, the person or persons served by the person being trained, the organization (i.e. management) of the person being trained, and/or all of the above? Participatory research certainly is appropriate in all of these scenarios, however emancipatory research implies that the research must be controlled by people who are in some way or another oppressed.

Participants

The researchers decided that it would be important to travel to the employment sites of CRP workers in a wide variety of locations, rather than mail survey instruments, require that staff travel to other locations to participate, and/or conduct telephone interviews. It was thought that there would be important opportunities for the researchers to observe the working conditions, identify key staff, and encourage participation through separate meetings with agency management. There were a total of 104 participants from 14 locations across the state of Arizona and the Navajo Nation. The locations represented a variety of services, service populations, agency sizes, and community sizes and included nine community-based agencies from Phoenix, Tucson, Prescott, Douglas, Flagstaff, and Casa Grande and five community-based agencies from the Navajo Nation. Participation reflected all levels of program staff from management to direct care.

Focus Group Questions

The focus group questions were developed by the researchers with input from the CRP Advisory Committee because of the need to obtain data specific to the development of a grant proposal regarding the provision of training services to CRP staff. A potentially more effective participatory action research model would have been to choose the research design and develop the questions with input from the CRP staff to be studied; however, time and cost factors limited this option in this case. The focus group questions were:

1. What are your personal or professional goals and hopes for the future?

2. What challenges do you face to doing your job well? Fears?

3. What sustains you and keeps you motivated to do your job well?

4. What are your thoughts about training?

5. What format for training would you prefer?

Procedures

As noted previously, the researchers scheduled meetings at specific sites and traveled to those sites to conduct one and a half to two hour focus groups. Each group session was tape recorded for later transcription. The final transcripts were reviewed by a panel of experts, including CRP staff, to determine important and consistent themes. The researchers attempted to use the words of the participants to express the essence of the themes. It was important to accurately capture what was expressed so that participants could assist in the process of determining creative solutions to meeting training needs in Arizona.

Results

Several themes emerged from the group responses to all of the focus group questions. One theme emerged related to the "rewards" of training. CRP employees reported wanting the training they received to count toward certification or advancement in the field. Many mentioned wanting to earn master's degrees, especially in rehabilitation, administration, or social work. One supervisor noted, however, that upon gaining a higher level of education, "We can't compensate them well. We can't pay them market value." Employees concurred that there were few opportunities for advancement in their agencies. They also indicated that two specific barriers toward pursuing an advanced degree were excessive cost and lack of educational opportunities near their home and work locations.

A second theme emerged in which participants were less concerned about the rewards of training and more interested in simply building their skills to do a more effective job. These employees indicated that they would like to have training that did not lead to a degree but would enhance their performance. Grant writing skills, systems advocacy, assessment skills, and leadership development were specific aspects of professional development for which they asked. Participants also noted an increasing need to advocate for persons with disabilities, but there was a general fear of public speaking. This need was reflected in the following comment made by one participant, "One thing we're thinking of doing is starting a Toastmaster's organization here so we can learn presentation and speaking skillsÉ.. We need to build our skill level and confidence."

A third theme emerged related to the nature of the work environment. CRP employees discussed feelings of being underpaid and undervalued, and talked of low morale and job frustration. One worker described the frustrating nature of the work in terms of its repetitive aspects, "Sometimes you do the same thing every day and it's hard to get through [to consumers]. It's frustrating, especially when you have seen a little glimmer where someone has been able to do something and they come in on Monday and act like they have never seen a broom before." Employees asked for stress management training to alleviate the frustration.

Participants identified gaps between legislative direction, actual practices in CRPs, and strategies for best practices. One employee conceded, "We don't use RSA [Rehabilitation Services Administration] because the individuals or clients don't want to fail. The same goes for the direct care staff that goes with them, so we don't use this approach." Another participant stated, "Well, the state supports what I do in theory, but then they ask you to use work adjustment funds to do something that is high cost." Other participants noted that there were too many demands and too few resources and this appeared to limit opportunities for professional development. In residential centers, staff members reported that they were required to cover shifts all day; and funding to pay workers for overtime accrued during training was limited. One worker summarized this by saying, "Transportation and hours of employment are barriers, both due to money. Can't get to work or have to leave early because that's the only time that transportation people come."

The fourth and final theme that emerged emphasized the nature of the delivery of training. Workers concurred that training opportunities need to be offered at several times for all shifts. Some of the participants preferred the use of video formats. In this study, very few workers inquired about the use of computer technology and web-delivered courses. However, these options are rapidly becoming more widespread and commonplace. A participant who sought this format stated, "We have computersÉ.we're all hooked together. We're not on the Internet, but that would be helpful. We need to upgrade." One employee liked the idea of using teleconferencing, and another said, "We didn't like that with the ADA [Americans with Disabilities Act] training. You could call in. It was very impersonal. You had to think of a question and wait on the phone a long time. We didn't get much out of it, especially compared to the technology training that was face to face." In general, participants preferred an interactive training model rather than training that involves being "talked at" (i.e., technical aspects of their jobs).

Finally, with regard to the question of specific training needs, participants identified a whole range of possibilities. These training and skill building needs included (in no particular order):

• Skills for improving communication within the agency;
• Skills needed to motivate and get consumers ready;
• Techniques for increasing consumer and family involvement;
• Team building skills;
• Skills for building coalitions and networks in the community;
• Working with parents to allow consumers to become independent;
• Working with the community to help them understand disability;
• Management and leadership skills;
• Communication and advocacy skills;
• Grant writing skills;
• Skills for recruiting, training, and working with volunteers;
• Computer skills;
• Skills for effectively and efficiently communicating current practices among professionals.

When participants responded to the question regarding preferred training formats, most indicated that university credit was an attractive option but that it was more important to them to be able to learn skills to do their jobs better. They indicated in general that they wanted brief, local, hands-on, skill building offered at various times for people who work shifts.

Practical Outcomes of the Research

The selection of a focus group design with a participatory action research approach allowed the researchers to create systems change at the state level. The researchers were successful in obtaining a long-term training grant that has supported customer-responsive educational programs for CRP staff for many years. The researchers learned, over time, that it was impossible to meet all of the training needs for all of the CRP staff all of the time. The researchers eventually developed annual institutes that are repeated in three different areas of the state and offer continuing education credits for all learning opportunities. The content of these institutes varies from year to year and is based on the needs expressed by CRP staff who attend the institutes each year. The researchers also developed the opportunity for individualized training, as needed in response to specific requests; produced a quarterly newsletter; and routinely evaluated the impact of the training activities on service provision. Finally, the researchers were also successful in obtaining several "career ladder" grants to deliver university degrees utilizing a work-study model to persons working in CRPs.

The data obtained through this PAR model provided a rich context upon which to build a flexible and uniquely responsive system of learning opportunities for CRP staff in Arizona. The focus group process was both enlightening and stimulating. Participants were very clear about their working conditions, their training needs, and their desire to improve their ability to work with consumers. Although training needs and working conditions did not seem to vary a great deal across agencies and cultures, the individual responses and personal visits to specific programs allowed the researchers to take into account unique cultural needs related to delivery of training. The researchers strongly recommend the use of focus groups as an integral part of assessing training needs and implementing systems change within the health care field.

Discussion

Because of the inclusion of a participatory research model in the grant application for the state-federal vocational rehabilitation program, the overall objective of the needs assessment described in this paper was "to create optimal employment opportunities for all persons with disabilities in Arizona." It was assumed that the availability of well trained and qualified personnel could have a major impact on this objective. As an immediate response to the focus group activities, the researchers planned a community intervention phase that included the delivery of two workshops that addressed some of the needs expressed by the participants. These workshops were titled "Practical strategies for building functional skills for persons with severe multiple disabilities" and "How to maximize your potential: Getting your ideas across to people who matter." Both workshops were delivered in nine locations across the state and attracted over 100 participants each.

As part of the evaluation process for these training activities, participants were asked to comment further on training needs and issues. Their responses continued to reinforce the issues that surfaced during the focus group process. Following are some of the themes that emerged from the evaluations conducted during this community intervention phase related to training, feelings and the work environment.

With regard to training, staff noted that training should count toward certification or career ladder opportunities, there should be more training on personal futures planning, there should be more training on and experience with functional assessment and programming, there is a need for clear communication to better serve consumer needs, training should be individualized and extended over longer periods of time in order to teach new strategies, and there was a preference for an interactive training model rather than training that involves being talked at.

With regard to feelings about their work, staff reported that they felt underpaid and underappreciated, that there was a general frustration among staff, that there was a general fear of public speaking, that there was a general fear of self-advocacy and communication with management, and that morale seemed consistently low.

With regard to the structure of their work environment, staff reported that there were few opportunities for advancement within community programs, there was a gap between state of the art strategies and CRP practices, that there was a gap between legislative direction and practice within CRPs, that there were too many demands and too few resources that limit opportunities for people to attend training, and that there was an increasing need to advocate for persons with disabilities. Finally, it is important to reiterate that participants seemed dedicated and willing to take risks to learn.

References

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Asbury, J.-E. (1995). Overview of focus group research. Qualitative Health Research, 5 (4), 414-421.

Froelich, R. J., & Linkowski, D. C. (2002). An assessment of the training needs of state vocational rehabilitation counselors. Rehabilitation Counseling Bulletin, 46 (1), 42-50.

Hammel, J., Finlayson, M., & Lastowski, S. (2003). Using participatory action research to examine outcomes and effect systems change in assistive technology financing. Journal of Disability Policy Studies, 14 (2), 98-108.

Jurich, S., Casper, M., & Hull, K. A. (2001). Training correctional educators: a needs assessment survey. Journal of Correctional Education, 52 (1), 23-27.

McCarthy, H., & Leierer (2001). Consumer concepts of ideal characteristics and minimum qualifications for rehabilitation counselors. Rehabilitation Counseling Bulletin, 45 (1), 12-23.

Parker, E., O'Connor-Fleming, M., Tooth, L., & Humphries, R. J. (2002). Developing a cardiac rehabilitation education resource for rural health workers in Queensland: reviewing the process and outcomes. Australian Journal of Rural Health,10 (1), 15-19.

Racino, J. A. (2000). Personnel Preparation in Disability and Community Life: Toward Universal Approaches to Support. Springfield, IL: Charles C. Thomas.

Shafer, M. S., Pardee, R., & Stewart, M. (1999). An assessment of the training needs of rehabilitation and community mental health workers in a six-state region. Psychiatric Rehabilitation Journal, 23 (2), 161-170.

Szymanski, E. M., & Linkowski, D. C. (1993). Human resource development: an examination of perceived training needs of certified rehabilitation counselors. Rehabilitation Counseling Bulletin, 37 (2), 163-176.

Thunberg, K. A., & Hallberg, L. R. M. (2002). The need for organizational development in pain clinics: a case study. Disability and Rehabilitation, 24 (14), 755-762.

Tsiboukli, A., & Wolff, K. (2003). Using focus group interviews to understand staff perceptions from training in the therapeutic community model. Journal of Drug Education, 33 (2), 143-157.

Turmusani, M. (2004). An eclectic approach to disability research: A majority world perspective. Asia Pacific Disability Rehabilitation Journal,1(15), 3-11.

Contact for correspondence

Dr. Les McAllan

Email: lmcallan@email.arizona.edu

Keywords

Focus groups, participatory action research, professional training needs, community rehabilitation programs, rehabilitation counseling, rehabilitation, human resource development, program management, research paradigms, assessment

International Journal of Disability, Community & Rehabilitation
Volume 4, No. 2 Canada
www.ijdcr.ca
ISSN 1703-3381