CRC - Psychosocial Issues and Cultural Diversity
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Biomedical Model of disability
- disability is a pathology located within the individual and deviates from norm.
- - treatment is focused on "fixing" the individual
Environmental Model of disability
individual's environment may cause/define/exaggerate the disability
Functional Model of disability
functions of the individual influence the definition of disability
Sociopolitical Model of disability
- disability isn't a personal attirbute, but is caused by society
- - therfore, society should be responsible for dealing with the disability.
World Health Organization International Classification of Functioning (WHO-ICF)
- conceptualizes disability based on 5 major areas:
- - body functions and structure
- - activities
- - participation
- - personal factors
- - environmental factors
Economic influences on Disability
- the majority of PWDs live at or below the poverty level
Social Support and Disability
- - PWDs are shown to have smaller social support systems
- - higher levels of social support are linked to more positive rehab outcomes
Attitudes and Disability
- Attitudes: observable consequences of customs, practices, ideologies, values, norms, facual beliefs, and religious beliefs.
- Attitude: evaluative affect, cognitions, or behaviors related to a person, object, or event.
- Stereotype: exaggerated belief associated with a category of people.
- Prejudice: negative generalization toward a group of people and hte assumption that na individual belonging to that group has characteristics based on the generalization.
- Discrimination: action carried out based on prejudice.
- Stigma: chain of events resulting from negative attitudes and beliefs, resulting in discrimination.
Livneh's Sources of Attitudes Towards Disabilities
- - sociocultural conditions
- - childhood influences that lead to fear/anxiety of disability
- - psychodynamic mechnaisms that preserve the value of a full functioning "normal" body by negatively responding to disability
- - view of disability as a punishment for a sin
- - discomfort from lack of exposure
- - aesthetic diversion
- - disability experienced as an unconscious threat to body image integrity
Factors of the Disability that Affects Attitudes
- - functionality vs organicity
- - severity
- - visibility
- - contagiousness
- - predictabilty
Marshak & Seligman's Conscious/Unconscious Reactions to Disability
- inaccurate perceptions: client characteristics obscured by the disability
- fatalistic/passive stance: responses to client problems as if they can't be significantly alleviated
- exaggeration of psychopathology: client's psychological adjustment underestimaged and adaptive strategies are seen as maladaptive
- psychological distance: due to characteristics associated with the disability
- exclusion focus on client's disability: disability becomes the reason for all of the client's issues, even those unrelated to the disability
Adjustment to Disability
- adaptation - dynamic process a PWD experiences to achieve adjustment to a disability
- adjustment - optimal person-environment congruence
- acceptance - disability incorporated as a part of the individual's self-concept and accepted as nondevaluing.
- coping - drawing on personal/environmental resources to decrease the negative impact of a stressor
Coping versus Succumbing
- coping - focusing on individual assets and orienting toward what can be done
- succumbing: emphasizing hte negative effects of the disability and neglecting the challenge for change and meaningful adaptation
Wright's 4 Major Value Changes of Acceptance
- enlargement of the scope of values: suscribe to values not in conflict with the disability
- subordination of the physique: individual doesn't think of the body as a symbol of worth
- containment of disability effects: individual doesn't deny the disability, but contians/limits the effects of the disability
- transformation from comparative status to asset values: individual doesn't compare the self to those without disabilities, but focuses attention on his/her assets
Common Stereotypes towards PWDs
- safety threat: PWDs perceived to be a threat to the physical safety of people without disabilities.
- ambiguity of disability: ascribing negative aspects/greater limitations to the disability
- salience of the disability: considers the disability the most important aspect of the individual
- spread or overgeneralization: discounting/underrating all the abilities of the PWD
- moral accountability for the cause & management of the disability: blaming the PWD for the cause and how they deal with the disability
- inferred emotional conseqeunces of the disability: assumption that all PWDs are experiencing negative emotions due to their disability.
- fear of acquiring a disability: fear that by interacting with a PWD, one will "catch" the disability.
Stage Models to Disability
- initial impact: shock & anxiety
- defense mobilization: bargaining and denial
- initial reaction: mourning, depression, internalized anger
- retaliation: externalized anger/aggression
- reintegration/reorganization: acknowledgement, acceptance, and adjustment
Culture and Worldview
- - culture - beliefs, customs, practices, social behaviors, and set of attitudes of a particular nation or group of people.
- - worldview - framework of ideas and beliefs through which an individual interprets the world and interacts with it.
- - there are a disproportionate # of PWDs from minority backgrounds (at risk for "double discrimination")
Women and Disability
- - VR services were originally developed for WWI veterans (males)
- - women may experience double discrimination
- - women may experience higher rates of depression and grief
- - women usually have more favorable attittudes towards PWDs
- - there are social restrictions on the range of careers traditionally held by woman
- - women may question their ability to balance family, home, and career
Men and Disability
- - society values physical capacity --> loss of functioning can be significantly challenging for men
- - men often define themselves through their careers --> loss of career means loss of identity
- - sadness/grief often coped with through distractions like physical activity --> those unable to use physical coping mechanisms may be at greater risk for depression
- - men equate masculinity with the ability to have intercourse
- - men are often seen as the primary caregiver --> inability to work may be interpreted as a disappointment to the family
LGBTQQIA and Disability
- - higher rates of mood/anxiety/substance abuse disorders
- - societal oppression and greater risk if internalized homophobia/biphobia/transphobia
- - 3x higher adolescent suicide rates
- - low self-esteem and poor development of self-identity
Aging and Disability
- - chance of disability increases with age
- - older adults face multiple life transitions
- - the most common stresstors for older adults are health-related issues and loss of independence
- - high rates of psychological problems in older adults
Working with Older Adults
- - work to limit/minimize/reverse the effects of aging via lifestyle changes
- - older adults don't completely understand the impact of aging on medications
- - look for signs of adult abuse
- - be prepared to discuss mortality
- With terminally ill clients, must work to enable client to:
- - obtain high-quality end-of-life care
- - exercise highest degree of self-determination possible
- - be given eery opportunity to make informed decisions
- - receive complete/adequate assessment of their ability to make competent, rational decisions on their own behalf
- - If the client wishes to hasten their own death, you have the option of breaking confidentiality
psychosocial adaptation: one's capacity to manage pain and symptoms & master skills associated with functional changes.
Research on Psychosocial Adaptation
- - there's no personality type associated with a specific disability
- - there's not simple/direct relationship between adjustment and severity of disability
- - similar people with similar disabilities react differently
- - high distress often initially experienced with chronic illness and disability, but generally diminishes over time
Characteristics Associated with Positive Psychosocial Adaptation
- - higher levels of optimism
- - information-seeking
- - active and problem-focused coping styles
- - internal locus of control
Models of Adjustment to Disability
- - Wright's somatopsychological approach & acceptance of disability
- - Stage/phase models
- - Ecological models
- - Quality of Life models
Wright's Somatopsychological Approach
- Key factors:
- - influences of the environment
- - distinction between insider and outsider
- - transformation of values following chronic illness/disability
- transformation of values:
- 1. enlargening scope of values: person realizes values other than those affected by the chronic illness/disability
- 2. containing disability effects: limiting impact of the condition
- 3. subordinating physique: seeing body image as something other than a symbol of worht/desirability & reconceptualizig physical attributes
- 4. transforming comparative status values into asset values: focusing on one's assets rather than comparing self to others.
stage phase models - adjustment is the gradual assimilation of body image, self-concept, and person-environment interaction
the individual goes through a series of stages/phases in response to disability/chronic illness:
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