Abstract
Rehabilitation counselling for disabled is a type of therapy that involves assisting people who are experiencing disability to encounter with the impact of disability, health conditions and disadvantage on individuals’ lives. This can be done by providing advice or counselling on personal matters, medical conditions, education, social, vocation, and assistive technologies. Rehabilitation counselling for disabled aims to help people with disability and others gain better understanding of the impact of disability and accept it. Moreover, it helps disabled people in achieving a sense of confidence to find their own solutions to problems as well as building up their decision-making skills in order to make appropriate decision on the way they live their lives. Objectives: to study 1) the scope and standard practice guideline of rehabilitation counselling in other countries 2) the access to rehabilitation counselling in hospitals 3) an appropriate service provision model and feasibility of rehabilitation counselling in hospital setting Methods: This study used both quantitative and qualitative approaches. The quantitative approach included a hospital survey on availability of rehabilitation counselling for disabled people, patient satisfaction survey, secondary analysis of quantitative data derived from National Health Security Office (NHSO) database. A mail survey was used to gather data from all public hospitals in Thailand. This was done in order to explore the availability of rehabilitation and counselling services for disabled people. Patient satisfactions survey were conducted with 150 patients who have received rehabilitation counselling in 10 hospitals as well as Sirindhorn National Medical Rehabilitation Institute (SNMRI). Quantitative data derived from NHSO database was analyzed to explore the number of patients who have received each type of rehabilitation service from fiscal year 2015 (B.E.2558) to 2017 (B.E. 2560) The qualitative approach included narrative literature review, an in-depth interview, and focus group discussion with services providers involved in providing rehabilitation services in hospital at all levels which also included medical schools and SNMRI. Results: There were rehabilitation counselling services available in most public hospitals (about 80.0% of tertiary hospitals, 69.7% of secondary hospitals, and 60.7% of primary hospitals being surveyed). Yet, most of rehabilitation counselling service reported was merely simple advice given along with usual rehabilitation activities rather than in-depth counselling. Most rehabilitation counsellors were physiatrists, physiotherapist and occupational therapist. However, necessary skills and knowledge including education and career advice, and psychological counselling techniques still find lacking in these professionals. Meanwhile, SNMRI appointed a public health technical officer who has a degree in rehabilitation counselling to act as a rehabilitation counsellor. Taking the shortage of personnel with appropriate qualification into account, this study suggests that physiotherapist and registered nurse should take up a rehabilitation counsellor role. However, additional capacity building on counselling is required. Also, additional workload for those professionals, especially in tertiary and secondary hospitals should be seriously taken into consideration. Most key informants agreed that rehabilitation counselling should be separated from usual rehabilitation activities and should be reimbursable according to NHSO reimbursement criteria. They further concurred that in order to make this service reimbursable, standard practice guideline, qualifications of service providers, and reimbursement data entry guidance should be established. Unfortunately, Thailand has no standard practice guideline for rehabilitation counselling in the present time. At patient end, most of disabled people being surveyed reported to have good satisfaction level and a medium quality of life. Conclusion: Rehabilitation counselling is essential for both disabled people and caregivers. Specific counselling technique and standard practice guideline are prerequisite conditions for providing rehabilitation counselling services. Currently, there are problems related to readiness of health facilities for rehabilitation counselling service, particularly those involved personnel and standard practice guideline matters. If this service will be fully implemented in all public hospitals or be separated from usual rehabilitation service according to the NHSO reimbursement criteria, all agencies and stakeholders involved should jointly develop standard practice guideline and code of conduct as well as support capacity building in rehabilitation counselling in order to provide such in more efficient and sustainable manners.
