CRC - Psychosocial Issues and Cultural Diversity

  1. Biomedical Model of disability
    • disability is a pathology located within the individual and deviates from norm.  
    • -  treatment is focused on "fixing" the individual 
  2. Environmental Model of disability
    individual's environment may cause/define/exaggerate the disability 
  3. Functional Model of disability
    functions of the individual influence the definition of disability
  4. 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.
  5. 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 
  6. Economic influences on Disability
    -  the majority of PWDs live at or below the poverty level 
  7. 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 
  8. 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.
  9. 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 
  10. Factors of the Disability that Affects Attitudes 
    • -  functionality vs organicity
    • -  severity
    • - visibility
    • -  contagiousness
    • -  predictabilty 
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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. 
  16. 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 
  17. 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")
  18. 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  
  19. 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
  20. 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 
  21. 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  
  22. 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 
  23. End-of-Life Care
    • 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
  24. Psychosocial adaptation
    psychosocial adaptation:  one's capacity to manage pain and symptoms & master skills associated with functional changes. 
  25. 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 
  26. Characteristics Associated with Positive Psychosocial Adaptation
    • -  higher levels of optimism
    • -  information-seeking
    • -  active and problem-focused coping styles
    • -  internal locus of control
  27. Models of Adjustment to Disability
    • -  Wright's somatopsychological approach & acceptance of disability 
    • -  Stage/phase models
    • -  Ecological models
    • -  Quality of Life models
  28. 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.
  29. Stage/Phase Models
    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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CRC - Psychosocial Issues and Cultural Diversity
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