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CJOT Vol. 53 No.

Critical Issues in Rehabilitation Counseling. Edited by William G. Emener Ph.D., Adele Patrick, M.A. Ed. and David K. Hollingsworth Ph.D., Charles C. Thomas, Springfield, Illinois, 202 pp, $29.50 (U.S.). Nineteen distinguished American educators and practitioners share their research, academic, and clinical expertise in this review of critical issues in rehabilitation counseling In addition the three editors who compiled the information and prepared this book have extensive training and experience in the field of rehabilitation counseling. In part I of the book which is categorized as "An Historical Perspective", and which spans the past sixty years of the development of the rehabilitation counseling profession in the U.S.A., it is obvious how much further developed the whole rehabilitation counseling scene is in the U.S.A. as compared to the situation in Canada. For example: "There are presently over 100 master's degree granting programs, and approximately forty of them have received accreditation by the Council on Rehabilitation Education". Of course there are extensive undergraduate training programs which are continually being evaluated and studied for their effectiveness and relativity to field practise. In part II each of the eight chapters was co-authored by a university - based professional expert and a field - based practitioner expert. These chapters are set out to enrich the reader's understanding of the critical issues and cover: personal philosophy and vocational rehabilitation; job performance; the counseling process; education and training; the "state of being" of rehabilitation counselors; generalist versus specialist issues; evaluating rehabilitation counselor effectiveness; administration and supe rvision; and the professional work of the rehabilitation counselor. October/Octobre 1986

In part III, the "Afterword and Summary", the editors summarize and try to tie together any loose ends that may have evolved in parts I and II. The original study by Doctor Emener (1981) which prompted this book, consisted of conducting interviews with sixty-one practicing rehabilitation counselors employed by the Florida Office of Vocational Rehabilitation. It would seem that the critical concerns of rehabilitation counseling presented in this text could be said to focus upon the counselor-client interaction as the unit of analysis. Therefore in spite of the very large difference in the "State of the Art" between Canada and the U.S.A., many of the problems and issues discussed are basic to both scenes and as the book quotes "there are problems but they readily lend themselves to ultimate growth than to demise and downfall." Marge Murphy, O.T. (C)

Strained Mercy: the Economics of Canadian Health Care. Robert G. Evans, Butterworth and Company (Canada) Ltd., 2265 Midland Avenue, Scarborough, Ontario MI P 4S1, 1984, 408 p., $39.95 (Can). Strained Mercy is a textbook for those with a serious interest in health economics and a desire to gain more knowledge about the evolution of the particular health care system we find in Canada. While extremely interesting, it can hardly be described as light reading. The book is divided into three parts. Part I: The Utilization of Health Care, Part II: The Provision of Health Care and Part III: The Governance of Health Care. The author liberally uses graphs, charts, tables and numerous detailed economic formulae to support his statements particularly in Part I. This makes the section especially heavy going for this reader who

has no formal background in economics. Despite this, the material presented is addicting in that it has inspired me to reread the entire text in greater depth at a later date now that I have an overview. The text covers topics such as health insurance and it's relationship to health care utilization and costs; professional ethics, self regulation of health professions and professional ownership of health care `firms' as they also affect supply, demand and costs; provider influence on demand for health care services and QUALYs (quality adjusted life years) which looks at the issues of quality versus quantity of life. Many of the chapters and headings in the book are stated as questions. Evans addresses the questions directly and proposes many possible angles and answers. For example, "Prescribing Appropriateness: Informing or Manipulating the Physician?". In this section the role of well informed pharmaceutical representatives in keeping the all too busy physician informed of the myriad of new and improved drugs available is considered. The other side of the question deals with the fact that the pharmaceutical company is in business to sell drugs. Evans reminds us that there are several built in checks such as public regulation and legal liability that shift the balance more in favour of healing the sick than strictly profit. Despite the academic nature of this text, the author maintains a subtle sense of humour. Every so often he slips in a lighter note such as a warning in one of his many footnotes to "Beware of hobgoblins!" Many of his titles and headings reflect this humourous nature as well. In Chapter 12 he heads one section as follows: "From Lifestyle Policy to Health Care Expenditure: Long Chain, Weak Links" and in Chapter 14 "Constructive Inconsistancy: Papering Over the Cracks Can Work". 229

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Evans uses footnotes generously throughout the text. They are conveniently placed at the bottom of the pages for quick reference and se rv e to present more information which is helpful in understanding the points presented in the formal text. In most instances they represent additional insights of the author rather than references to other sources. I found this book challenging, stimulating and addicting. In other words, I will have to reread it to more completely grasp the contents but it has been successful in stimulating this urge.

more satisfaction out of the psychological and social aspects of their job than out of the economic and practical aspects. Over 60% reported work-related negative stress and that it affected their personal health and job performance. The structure and conditions of work and the quality of interpersonal relations in the job were most often a major source of negative job stress. Many people felt that their jobs interfered with their home lives and there was a higher awareness of work place supported recreational and edDonna Campbell, Dip. P&O. T., ucational resources for employees OT(C) rather than counselling assistance programs. Finally, appropriate supports and Work and Well-Being: The Changing modified work structures can be put Realities of Employment. Cross-Can- into effect to increase the psychoada Perspectives and an Emerging social benefits and decrease the posAgenda on Mental Health and The sible health threatening conseWorkplace, Canadian Mental Health quences of employment for former Association, 1984, 304 pp., $15.00 psychiatric patients. (Can). The final section in the study offers concrete suggestions to deal This report of the Canadian Menwith the following agenda: tal Health Association is a nationwide strategy to stimulate greater 1. the promotion of mental health and well-being through the work awareness and community action on place, issues of mental health and well2. the promotion of mental health being related to employment. through public policy, In depth personal interviews were the mobilization of resources in 3. conducted with 176 community and through the work place to business, labour and health profeshelp emotionally troubled emsionals in five communities across ployees, and Canada. The project's goals were 4. the creation of appropriately supthree-fold: ported real employment opportu1. to promote mental health through nities for former psychiatric pathe work place, tients. 2. to help the emotionally troubled Practical concrete suggestions and employees receive the support necessary to maintain their em- directives are made in this section concerning the outlined agenda. ployment, and This study is interesting, informa3. to help former psychiatric patients maintain real employment. tive and instructive for anyone who Survey findings dealt with such is interested in the issues surroundissues as well-being and job satisfac- ing work and well-being. More spetion, negative stress in the work- cifically, it is beneficial for those place, job home interference and occupational therapists involved in resource awareness. Major findings the integration of emotionally disturbed people into the work place. included the following: A well written summary of this Most people liked to work and it was a source of pride to almost study is also available from the Caeveryone; fewer were happy with nadian Mental Health Association. Nancy Rosenfeld their current jobs; people received

Teaching Patients with Low Literacy Skills. Ceceilia Doak, Leonard Doak and Jane Root. J.B. Lippincott Company, East Washington Square, Philadelphia, PA, 1985, p. 120, $18.00

(U.S.). Did you know that, one in every five American adults has reading skills below the fifth grade level? the instructions on a T.V. dinner require a reading skill level of eighth-grade? A bottle of aspirin, tenth-grade? In a recent study of one hundred high school graduates, most were functioning at a seventh-grade reading level? Remember these facts while thinking about how in the course of a single day an Occupational Therapist may do one-to-one patient education, teach family members how to provide a specific care, do an inservice to hospital support staff, teach an out-patient Back Protection Program and present a paper at a meeting of her local organization. Contrasting the barriers outlined in my first paragraph with the demands in the second it is hardly surprising that we are often left wondering how well the message got through. Teaching Patients with Low Literacy Skills addresses this problem of patient health care management with a forthright and dynamic approach. We all spend a great deal of time teaching; here, finally, is a book that tells how. The authors begin by outlining the serious impact that low comprehension has on an individual patient's ability to comply with important health care needs. Factors that interfere with comprehension are illustrated. "Compliance" now takes on dimensions far beyond motivation when using the authors' approach. In the first half of the book the reader is led through a concise and meaningful examination of the learning process. Simple methods to determine patient understanding of new information are presented, and standardized techniques to determine the degree of literacy difficulty
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for various types of teaching materials are discussed. The latter part of the book concentrates on practical application how to simplify oral and written materials, how to create and use appropriate audiovisual aids, important considerations in the design of visuals and graphics. Of special note are the chapters on computer-aided instruction and the methodology of pre-testing educational materials. Each chapter has a summary of key points and leads logically into the next area. I responded with consistent enthusiasm to this informative text. The material is of primary relevance and is well referenced. Potential application includes program planning and quality assurance procedures in addition to patient education. In short, Teaching Patients with Low Literacy Skills addresses the prevelant problem of compliance versus comprehension and provides the reader with practical coping tools. The authors' theme is "Make it meaningful", and their book does just that.

an open system; open system dy- and teaches us how to approach our namics of human occupation; and clients in a systemic way, based on occupational function and dysfunc- a sound theoretical basis. Even if you tion. Section two deals with occupa- do not adhere to the model or agree tional development throughout the with it, the book should be read to life span. The third provides generic substantiate your opposition. applications of the model which is Thelma Gill, MEd., BScOT., O.T.(C) described as a tool to facilitate clinical thinking and problem solving. Treatment planning, occupational analysis and program development Equipment for the Disabled; Personare the focus of this section. Section al Care, fifth edition, Compiled by four discusses specific applications of E.R. Wilshire, Oxfordshire Health the model with various disability Authority, Mary Marlborough groups. These are physical disability, Lodge, Nuffield Orthopaedic Centre, psychosocial and paediatric dys- Headington, Oxford 0X3 7LD, Engfunction, dysfunctional older adults land. 1985, 58 pp., 8. and the mentally retarded. Each of these begins with a general overview Equipment for the Disabled: Perof how the components of the model, sonal Care is one of a series of 13 volition, habituation, and perform- booklets aimed at presenting inforance relate to this population and mation on aids and equipment for then moves to a discussion of its disabled people, their helpers, and relevance to specific conditions. The those professionals concerned with first three sections must be read their care. completely, however the appropriate The series is a British one, making disability groups can be chosen from much of the equipment listed possisection four. bly difficult to obtain; however, the Each section begins with an over- booklet is excellent well organized view of the content and excellent and well written. It provides well references are provided for each thought out guidelines for the selecCary Brown, OTM chapter. Many good case examples tion of equipment and aids to assist are used throughout and these are in all areas of personal care. Areas analyzed according to the model. covered include grooming (hair, nail, Many tables are used to summarize dental and skin care), bathing (bathA Model of Human Occupation: the case discussion. seats, inserts, boards, lifts, accesTheory and Application. Gary Kielsories, rails), toileting, menstruation Following section four there is an hofner, Editor. Williams and Wiland personal aids. It is interesting kins, Baltimore, 1985. 509 p. $34. excellent workbook which provides to note that most of the equipten exercises for applying the model. (U.S.). The seven exercises in Section A ment/aids shown have been used by emphasize the application of the a disabled person and their use asThis book is an excellent compila- model to oneself, while the three in sessed by a therapist. tion of all components of the Model Section B relate to clinical applicaEach section has an introduction, of Human Occupation. There were tions of the model through the use excellent points to consider, a dethirty contributors to the text which of cases. scription and/or photograph of each gives a representative view of the Finally, an excellent appendix is piece of equipment/aid, where it is applications of the model and encourages the reader to apply it to provided which contains an instru- available, its cost at the time of ment library. Sixty-four assessments compilation and whether it is availone's own situation. listed and are catalogued accord- able for export. The purpose of the Model of are ing to title, content, reliability and Each section concludes with a refHuman Occupation is "to provide a validity, population, and source. erence list for further reading. A list representation of various structures This appendix a goldmine of re- of all the distributors' and manufacand processes that underlie occupa- sources for any is department. A glos- turers' addresses is included at the tional behaviour" and this text sary of terms concludes the text. back of the booklet. clearly speaks to this purpose. To accomplish this the book is divided This book is a must for all occupaThe suggestions highlighted in this into four sections. The first presents tional therapists. It provides an ex- booklet are very good and consethe theoretical tenets of the model. cellent, cohesive discussion of a quently may generate ideas for These include the human being as model which is gaining popularity aids/adaptations that can be easily
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