SOCIAL WORK PRACTICE AND DISABILITY ISSUES

Chapter 9Handbook of Health Social Work, 2nd Edition

Discuss the challenges faced when attempting to define disability.

Review disability models and discuss their assumptions as well as their power to influence our perspectives as social workers.

Provide an overview of common challenges social workers encounter when working with clients who have disabilities.

Explore societal values regarding difference and disability that influence both personal and clinical approaches.

CHAPTER OBJECTIVES

Disability bridges the study of health care and the study of diversity within the social work curriculum.

People with disabilities generally have a greater number of healthcare encounters than do people without disabilities and therefore have a considerable stake in issues such access to medical care, insurance, quality of care, and the delivery of health services.

For social workers the study of disability often focuses on the psychology and the politics of difference – the stigma associated with those who fall outside the mainstream as well as the benefits found when differences are embraced and societal barriers eliminated.

SOCIAL WORK

The widely quoted World Health Organization (WHO’s) definition of disability in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) distinguishes among the three related concepts of “impairment,” “disability,” and “handicap.”

Impairments are defined as “disturbances of body structures or processes.

A disability “is any restriction of lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.”

A handicap is “the social disadvantage individuals experience as a result or impairment or disability” (WHO, 1980).

WORLD HEALTH ORGANIZATION

Throughout the 20th century in the U.S., people with disabilities, when not locked away in large poorly funded institutions, were often exploited as curiosities.

They were paraded before the public for amusement and profit in circuses and freak shows that remained popular well into the 1950s and 1960s.

Telethon and other charity fund-raisers created sympathy by manipulating the fears of their viewers in order to get them to “open their wallets”

Today in innovative times as the disability rights movement replaces the charity movement and people with disabilities claim their right to equal opportunities and full participation in all aspects of society.

HISTORY

Troubling risks for people with disabilitiesDiagnostic labels such as “de-formed, dis-eased, dis-ordered,

ab-normal, in-valid”Diagnoses such as “imbecile,” “moron,” “Mongoloid idiot”

historically used to describe people with cognitive impairments.

The desire for differential diagnosis scheme and classification systems for physical and mental diseases have never been driven by patient needs.

DIAGNOSTIC PHASE OF MEDICAL MODEL

Greatly shifted the focus to psychological and family issuesA lot of literature promotes the belief that physical disability

invariably inflicts horribly disruptive and negative psychological consequences and lead to a whole host of personality disorders.

For year mental health professionals seems to think that pathological bodied lead to pathological personalities

BIOPSYCHOSOCIAL MODEL

Helps us recognize parallel between people with disabilities and people of other recognized minority groups defined by race, gender, sexual orientation, or nationality.

SOCIAL MODEL

Initial Counseling and Framing the Disability Social workers are called upon to provide support and counseling

for individuals who are encountering disability for the first time. Professionals involved in presenting disability news must

appreciate that the words they choose, the tone they adopt, their affect, their body language, and their message intertwine solely on medical concerns.

It is imperative that social workers who engage in initial counseling closely examine their own perceptions.

One of the most valuable commodities during the framing process is access to a nonjudgmental counselor.

It is also critical that at some point during the framing process people with newly defined disabilities have an opportunity to interact with others who actually live with similar conditions.

CLINICAL PRACTICE ISSUES AND THE ROLE OF THE SOCIAL WORKER

Grief models compare reactions to disability with the process of bereavement following a death.

Mourning is often defined as the adaption to loss and can have relevance to the loss of a limb, the loss of function, or the loss of the dream of a healthy child.

The primary difference between bereavement and adaptation to disability is that the death by its very nature is finite while the disability is ongoing or chronic.

GRIEF

The presence of a disability is often only one of many factors that will prompt an individual to question the value of life and exhibit signs of depression, hopelessness, and anxiety.

The most useful of adjustment perspectives are those that can account for the paradoxical feelings and ideas that most individuals have toward disability.

Some of the most pressing ethical issues of our times involve disability on some level.

Physician-assisted suicide, stem cell research, genetic engineering, healthcare-resource allocation, and end-or-life care.

Schiavo’s feeding tube- simply a disability accommodation- tube become devoid of medical meaning and allows them to ingest food efficiently and safely.- slippery slope, people feared we might eventually wind up removing tubes from people who are profoundly disabled but not in a permanent vegetative state.

DISABILITY AND ETHICS

Income maintenance may be available from: Social Security disability insurance (SSDI) Supplemental Security income (SSI) The Veteran’s Administration Crime victims compensation Private disability insurance Worker’s compensation

Knowing both entitlement eligibility and legal protections is important for social workers.

ADVOCACY

TransportationAffordable/accessible housingAttendant care servicesPolitics that surrounds community living programs are

complex-bias toward the institutionalization of people with disabilities in

our current government programs remains- It may cost less to care for a person with a disability in a

community, they may end up in a nursing home because they cannot piece together the support systems needed for independent living.

- Attendance are difficult to find and keep, they are often paid less than other nonskilled jobs.

COMMUNITY LIVING EXPENSES

The right to free and appropriate public education for children regardless of the type or extent of their disability has been secured in the United States through the passage of Public Law 94-empowerment.

EDUCATION

Search for meaning is a journey that can take many years.People with disabilities may have some added poignancy and

importance.Many mental health professionals have noted the need to

shift our focus from examining the parameters of patients’ physical conditions or analyzing clients’ psychological make-up to helping them clarify their values in an effort to create positive meaning.

FINDING MEANING