Undergraduate rehabilitation degree programs are interdisciplinary programs of study that prepare professionals for entry-level, generalist roles in allied health careers. The focus of their work is to support people with disabilities and chronic health conditions in the pursuit of optimal levels of functioning in work, school, and all other aspects of their daily lives (World Health Organization, 2023). Rehabilitation work is inherently human service, and human services is described as an interdisciplinary field with the goal of helping people to reach optimal functioning in their daily lives (National Organization for Human Services, n.d.). Throughout the United States, there are a variety of bachelor’s degree programs in rehabilitation. For the purposes of this paper, I will focus on degree programs with rehabilitation in the degree program name – which includes rehabilitation science(s), rehabilitation studies, rehabilitation services, rehabilitation and human services, rehabilitative health sciences, rehabilitation psychology, and others. Many of these programs share a common history in that they were affiliated with or inspired by master’s and doctoral programs in rehabilitation counseling and similar disciplines. They were expected to help remediate the shortage of professionals in the rehabilitation workforce – by preparing them to go directly into the field upon graduation, or pursue graduate work in rehabilitation (Hylbert, 1963). Before its merger with the Council for Accreditation of Counseling and Related Educational Programs (CACREP), many of these undergraduate and graduate programs were first accredited by the Council on Rehabilitation Education (CORE) (Joseph et al., 2018). As of 2017, CORE has been absorbed by CACREP, which does not currently accredit undergraduate degree programs.
Most undergraduate rehabilitation programs are not currently accredited by a unifying body. Although recent efforts by some rehabilitation educators are geared toward changing this (Drake et al., 2019), a significant number don’t necessarily have a desire to pursue accreditation (Oswald et al., 2018). One URE program is accredited by the Council for Standards in Human Service Education (CSHSE), which does accredit bachelor’s degree programs (CSHSE, 2018). As of October 2023, three URE programs have achieved accreditation through the Commission on Accreditation of Allied Health Education Programs (CAAHEP), with the Inclusive Rehabilitation Sciences specification (CAAHEP, 2023). Unlike CACREP, CAAHEP accredits certificate, diploma, associate, and bachelor’s degree programs. One of the goals of accreditation is for programs to adhere to standardized principles for program development, such as curriculum expectations across degrees (Joseph et al., 2018).
While certain courses are commonly found among undergraduate rehabilitation degree programs (e.g., fieldwork, case management, psychosocial/medical aspects of disability), some are not. One example of this is a course designated to ethical principles. While many courses naturally have incorporated within them the topic of ethics, one is not guaranteed to find a course solely dedicated to ethics in undergraduate rehabilitation education (URE) programs. Ethics of confidentiality, within therapeutic relationships, for the protection of vulnerable populations, and to honor state and federal laws are a few examples of the areas in which rehabilitation educators will employ ethical principles in their courses. Though researchers have argued the importance of stand-alone ethics courses in a variety of post-secondary academic disciplines instead (Jagger & Volkman, 2014; Kheir et al., 2019; Liu et al., 2020), and even in all disciplines – generally as professional ethics (Gülcan, 2015; Safatly et al., 2020; Simmons et al., 2013). And perhaps the dedication of a full course, that is also required and not an elective, can help to emphasize among future practitioners the weightiness of this knowledge domain (Gang et al., 2022; Rabow et al., 2016).
From an internet search of URE degree programs, 10 required courses in ethics were found among the initial 26 programs that the search resulted in. And one additional URE program offered an ethics course as an elective. Examples of such courses included Professional, Ethical and Legal Issues in Rehabilitation; Ethics, Law, and Professionalism in Health Sciences; and Rehabilitation Ethics. Many aspects of URE are explored periodically in the research literature, such as program content, perspectives on accreditation, current trends, and professional identities of graduates (Joseph et al., 2018; Oswald et al., 2018; Oswald & Jenkins, 2022). Ethics education is consistently supported, yet there has been no mention of a need for a specific course related to ethics within undergraduate rehabilitation education. In 2022, Oswald and Jenkins conducted a review and identified 40 URE programs of which up to 25 required content on ethics “and/or” other topics (p. 260).
One of the curriculum requirements for CAAHEP accreditation under Inclusive Rehabilitation Sciences includes “understanding the lived experience of individuals with disabilities and/or impairment” (CAAHEP, 2019, p. 11). There are also sub-criteria here, requiring that “Students will demonstrate knowledge of: a) Community social policies and laws; b) State social policies and laws; c) National social policy and laws; d) Global social policy and laws” (CAAHEP, 2019, p. 11). Under the curricular expectations of Professional and Ethical Practices, a series of 22 concepts and sub-concepts related to ethical principles and ethical codes and decision-making are listed – such as “a) Health Insurance Portability and Accountability Act (HIPAA) Regulations and Family Educational Rights and Privacy Act (FERPA),” and “b) Difference between law and ethics and what to do when laws and ethics appear to conflict” (CAAHEP, 2019, p. 17). And according to the accreditation standards of CSHSE, number 19 indicates that curriculum should “promote understanding of human service ethics…” (CSHSE, 2020, p. 12). Accreditation standards for human services degree programs are clear in their positions on the importance of curriculum that includes training in ethics and legislation. Regardless of a URE program’s desire to seek formal accreditation, using curriculum guidelines that are based on expert standards will be beneficial to URE students, faculty, and rehabilitation employers across the United States.
Laws such as HIPAA and FERPA are just two of many relevant laws regarding health, disability, and ethics of which rehabilitation students should be knowledgeable. Matters of ethics never cease, as crises and other social phenomena affecting people with disabilities cause policy and their implications to evolve (Akande, 2023). For instance, the 2022 overturn of the Roe v. Wade decision by the Supreme court uniquely impacts the reproductive health and well-being of people with disabilities in ways that will ultimately vary from state to state (Getahun, 2022). The advent of Long COVID-19 as a new chronic health condition compelled the Biden administration to extend protections of the Americans with Disabilities Act to individuals with Long COVID (The White House, 2022). And the June 2023 decision of the Supreme Court, in favor of a wedding website designer who denied services to same-sex couples, is feared because it may be indicative of a greater threat to gay rights, such as same-sex marriage (Chung, 2023; de Vogue & Cole, 2023). The family unit and the legal and social benefits afforded to married couples (e.g., health insurance, medical decision-making), if revoked, would negatively and disproportionately impact LGBTQ couples with disabilities (Garrison & Morin, 2022). Lastly, the proliferation of artificial intelligence (AI), such as Chat Generative Pre-training Transformer (ChatGPT) expand ethical questions and political regulation needs in educational and practice settings to be addressed within administrative bodies and in future research (National Conference of State Legislatures, 2023; Skerritt & Wolstein, 2023).
Another matter to consider is the selection of the appropriate code(s) of ethics that URE students should be taught from. The National Organization for Human Services (NOHS), the American Counseling Association (ACA), the Council on Rehabilitation Counselor Certification (CRCC), and the National Association for Alcoholism and Drug Counselors (NAADC) are some examples of professional associations with applicable codes of ethics. And they all share the requirement that rehabilitation practitioners must stay abreast of local and national policies that impact their fields and the people that they serve (ACA, 2014; CRCC, 2022; NAADC, 2021; NOHS, 2015). Prior to the CORE/CACREP merger, undergraduate rehabilitation programs mostly relied on the codes of ethics provided by CORE or CRCC (Oswald et al., 2020). However, since the merger it is unclear if this is still the case. Although, a URE educator who is also likely to be a certified rehabilitation counselor, may feel inclined to default to the CRCC code (Joseph et al., 2018). But unlike graduate rehabilitation programs, the career trajectories for URE students are quite varied. Therefore, a code of ethics rooted in a professional organization for rehabilitation counselors may not wholly resonate with the professional identities of most undergraduate rehabilitation students (Oswald et al., 2020). This issue is related to an underlying lack of professional identity within undergraduate rehabilitation education, as is partially evidenced by the aforementioned range of URE program titles (Willmering, 2020). Curriculum designed to prepare generalists also broadens options for graduate studies and professions. Coincidentally, this phenomenon can create confusion for students and others seeking to understand the profession and professional options (Oswald et al., 2020).
Implications for Education, Research, and Practice
As more URE programs seek accreditation, perhaps an objective for rehabilitation professional organizations will be to establish a code of ethics for rehabilitation generalists and undergraduate rehabilitation students. In the meantime, the NOHS Code of Ethics is the only code listed that was not primarily designed for use by graduate students. This knowledge will equip undergraduate fieldwork students and future rehabilitation practitioners for service provision and advocacy among clients and patients with disabilities from diverse backgrounds. And their competencies in ethics and legislation won’t be dependent upon their pursuit of graduate study, or the requirements of their certifying and licensing organizations.
Undergraduate rehabilitation degree programs that require elective credits may recommend that students take an ethics course to fulfill some of the credits for these requirements. If an applicable ethics course is not available in one’s department, then department heads may coordinate with one another to arrange for already established courses to be shared among departments. Rehabilitation faculty may feel compelled to create ethics courses specifically for their departments, which can be initiated through independent study experiences and special topics courses. This approach would also help to gauge interest and solicit feedback for the design of a permanent course. And students at universities with satellite campuses may be able to benefit from ethics courses at other locations, through remote learning options.
The importance of ethics in URE curriculum has been established in the literature. Drake et al. (2019) also argued for knowledge of ethics and policy, as a matter of social justice for minority rehabilitation students. In this particular study, including ethics and legislation as parts of the core curriculum for URE was a likely contributor to improved outcomes for students from minority backgrounds. These outcomes were framed within the recognized need for a diverse rehabilitation workforce. Rehabilitation clients from marginalized backgrounds are more likely to experience greater barriers to rehabilitation, and a diversified rehabilitation workforce can help to meet their unique needs (Akande & Rajapaksa, 2022).
Credentialed rehabilitation educators and practitioners are required to pursue professional development on ethics topics, and continuing education opportunities related to law in human services should help to fulfill these requirements. As leaders in rehabilitation, they must be proactive, not reactive, in their preparation of students, provision of ethical treatment services, and engagement in advocacy efforts. One way that professionals can engage includes communicating with state legislators about the needs and rehabilitation barriers of people with disabilities in their state. Engagement in research that sheds light on legislative issues in rehabilitation can narrow the research-to-practice and research-to-policy gaps and also inform curriculum development. The education of clients, patients, and students about the role of legislation in rehabilitation and human services can be empowering. And personal participation in the voting process has direct implications on the rights of marginalized groups, programming, and the availability of services and human services professionals. For instance, the Violence Against Women Act (VAWA) requires reauthorization every five years. It expired in 2019 and the unfortunate coincidence of the COVID-19 pandemic led to increased rates of intimate partner violence and abuse of people with disabilities (Becker, 2022; Lund, 2020). It was finally reauthorized in 2022 with support from the Biden administration, who as a senator originally supported its progression through Congress (Becker, 2022). The VAWA has also evolved into a bit of a misnomer, because now men and non-binary individuals benefit from its protections as well – an example of the importance of education on these topics.
While ethics curriculum in undergraduate rehabilitation programs has been a standard expectation in both accreditation and practice, students and future clinicians will likely benefit from stand-alone ethics courses as required components of their degree programs. The expanded learning of a full semester course undernotes the essentialness of the topics covered. Lastly, instructors of ethics in URE should remain abreast of health and disability policy changes and needs, as they are matters of ethical practice and ethical education.