Rehabilitation process

The goal in rehabilitating the handicapped is to reverse or control handicapping problems. Unlike the medical model, which assumes specific treatment, rehabilitation is predicated on a set of factors—adaptation, coping, and adjustment—rather than cure. Poor health, injury, and illness become more critical when cure is impossible, as is often true with rehabilitation patients. This set of circumstances can be approached only through the rehabilitation process, which requires a problem-solving, goal-focused, and coordinated approach to improving the condition of the patient. The process also requires the patient to change his or her life-style, react to the problem, and change his or her physical environment. The team must address the optimal possible adjustment through counseling, concrete resources, medical care, orthotic adaptations, and modifications. The social workers responsibilities include being familiar with the availability of community resources, offering counseling to patients and significant others about the preventing problem, and explaining the rehabilitation process. The following are specific areas with which social work must be involved (always-in conjunction with the relevant earn members):

1. Early assessment of the medical, psychosocial, and educational impairment and initial management of conditions that led to the handicap.

2. Assessment of the actual and potential capabilities of the patient and of the team members serving him or her in a responsive, coordinated psychosocial system that includes the patient as part of the planning. Planning focuses on the reduction of social and physical barriers and enabling the patient to participate as fully as possible in appropriate community activities.

3. Involvement in a dynamic plan of care that includes evaluation, diagnosis, prognosis, and ultimate discharge. The plan should also include guidelines for achieving goals.

4. Inclusion of patient and significant others throughout the entire plan of care with arrangements for follow-up as indicated or referral to another facility, for example, one nearer the patient's home.

5. Helping the patient move from dependent to more independent functioning, particularly with respect to goals for education, training, social adjustment, and interpersonal relationships.

Rehabilitation services are being increasingly developed see "Quality Assurance and Evaluation" through careful planning. The initial process of diagnosis involves identifying specific functional problems (how feasible or desirable is their resolution) and the ultimate prognosis that accounts for temporary, chronic, or unchangeable impairments and complications. The 'social worker's assessment of strengths of the patient and significant others is a serious component of this prognosis. Careful and sensitive analysis of these data helps to justify the goals of care and to determine priorities and, above all, assists in establishing realistic expectations so neither the patient nor the team members become frustrated, angry, disappointed, and bitter about the experience.