Spirit breaking: When the helping professions hurt

Abstract

Too often the human services dehumanize and depersonalize those who come to receive services, as well as those professionals who provide physical disabilities and people with psychiatric disabilities are frequently hurt by helping professionals, the phenomenon of “spirit breaking” is introduced. Suggestions for re‐humanizing the human services are made, including new models for clinical interaction that serve to empower rather than disempower service recipients, and the contributions that people with disabilities are making in their own state and national movements for social justice and the right to humane treatment and rehabilitation services.     

Implications of the Social Model of Disability for Visitor Research

ABSTRACT

Museum professionals have long held the view that their institutions can play a central role in supporting learning and inclusion but evidence seems to be in sort supply in the case of visitors with disabilities. Until recently, most of the work conducted in museums relating to learning and access for this particular visitor group has been about developing products and services rather than assessing their impact. The lack of research in this area reflects the slow development of disability studies as a distinct field and the fact that anti-discrimination and human rights legislation only extended to those with disabilities in the mid to late 1990s. The author introduces one approach to negotiating a balanced design of visitor research and the principles of the emancipatory research framework. She argues that this framework has the capacity to delve into the experiences of people with disabilities and provide a deeper analysis that would not otherwise be possible. The Heritage Education For All project will be used as an example to demonstrate how this approach can be developed in practice, and to show that informal learning programs designed using an emancipatory insight have the capacity to enable people with disabilities to gain new insights into their lives and identities.     

Ethnicity and the stigma of disabilities

Abstract

Recent studies reveal significant differences in the attitudes held by people of various ethnic groups toward people with disabilities. We surveyed university students and community members on a scale of desired social distance from people with disabilities. Study 1 revealed that Asian-American participants were more likely to stigmatize and less likely to differentiate between individuals with physical and mental illness than were their African-American, Latin-American or European-American counterparts. Study 2 compared U.S. born with Asian born Asian-Americans and found that nativity was a useful predictor of attitudes toward people with disabilities. Asian born participants were more likely to stigmatize disabilities overall (except mental illness and old age) than U.S. born participants presumably because of the level of assimilation. These cultural differences may have health care and psychosocial implications for those who are disabled and for health care providers.     

Fitness vs. fatness: Implicit bias towards obesity among fitness professionals and regular exercisers

ObjectivesSuccess of supported exercise programmes to tackle obesity appear to be shaped, in part, by co-exercisers’ beliefs. This study, therefore, aimed to assess implicit attitudes towards obesity among two key groups of people in a public exercise setting: fitness professionals offering exercise advice, and regular exercisers.DesignQuestionnaire survey.MethodsIn all, 57 fitness professionals and 56 regular exercisers were recruited from gyms across Central England. Participants completed a demographic questionnaire, semantic differential measure of explicit beliefs and the implicit associations test (IAT). The IAT reveals unconscious attitudes of participants to implicit associations between target concepts (thin vs. fat) and attributes (good vs. bad). The attribute of motivated vs. lazy was adopted in the current study due to relevance in an exercise setting.ResultsEvidence of a strong anti-fat bias was found (p<.01) for both fitness professionals and regular exercisers on all implicit and explicit measures (good vs. bad; motivated vs. lazy). This bias was more pronounced for fitness professionals who themselves had never been overweight and who believed personal control dictated body weight. For regular exercisers, a higher level of anti-fat bias was found for females, younger participants and those who had never been overweight.ConclusionsThis study suggests that the guidance to support exercise, and combat obesity, may be compromised by the beliefs of those facilitating such programmes.     

A focus group study on the potential of autonomous vehicles as a viable transportation option: Perspectives from people with disabilities and public transit agencies

Autonomous vehicle (AV) technology is becoming one of the most promising alternatives to improve mobility for people with disabilities. Nevertheless, how people with disabilities perceive AV as transportation services has not been explored. Also, limited information exists about how public transit agencies comprehend and perceive autonomous vehicle transportation (AVT) services. This study discusses mobility issues for people with disabilities and explores the potential of AVT to serve that population, particularly those with visual impairments or physical disabilities. Researchers conducted six focus groups comprising people with disabilities (N = 23) and public transit service experts (N = 10) in Austin, Texas and Houston, Texas. Each session was audio-recorded and analyzed using conventional content analysis. This study identified people with disabilities’ mobility issues related to: (1) current transit services (including fixed-route and paratransit services) and (2) the quality of neighborhood built environments. Both people with disabilities and transit experts expected that AVT could mitigate current mobility issues, especially in improved built environments. However, participants with disabilities also expressed concerns and anxieties regarding AVT. Transit experts agreed that more targeted strategies would be needed to overcome possible barriers to AVT for people with disabilities. This study provides insights on shaping AVT strategies and policies relevant to improving mobility for people with disabilities.     

The direct support workforce in community supports to individuals with developmental disabilities: issues, implications, and promising practices

Difficulties in finding, keeping, and ensuring the competence of the direct support workforce in community developmental disability services has long been a challenge for individuals, families, providers, and policy makers. Direct support staff recruitment, retention, and competence are widely reported as one of the most significant barriers to the sustainability, growth, and quality of community services for people with developmental disabilities (ANCOR [2001] State of the states report. Alexandria, VA: ANCOR; Colorado Department of Human Services, [2000] Response to Footnote 106 of the FY 2001 appropriations long bill: Capacity of the community services systems for persons with developmental disabilities in Colorado; Hewitt [2000] Dynamics of the workforce crisis. Presentation at the NASDDDS Fall meeting. Alexandria, VA). While long in existence, these challenges are ones of growing concern because the number of people demanding community services is increasing and the population of people from which to recruit workers is declining (Office of the Assistant Secretary for Planning and Evaluation [2006] The supply of direct support professionals serving individuals with intellectual disabilities and other developmental disabilities: Report to Congress. Washington, DC: Office of Disability, Aging and Long-Term Care Policy, ASPE, U.S. Department of Health and Human Services). As the service system moves towards consumer direction, managed care, and more noncategorical service delivery systems, the difficulties of providing for an adequate and well-prepared workforce to support people with developmental disabilities becomes more complex and multifaceted. The solutions to those challenges are also more complex. This article reviews the literature regarding the complexity of the direct support workforce crisis, the effects of this crisis on various stakeholder groups, promising practices designed to address the challenges, and the related practice and policy implications.     

Teaching Families to Collaborate

Abstract

Families, being an essential component of a student's educational program, must feel valued and involved in any planning or discussion relating to children or siblings with disabilities. A collaborative, cooperative, and caring environment must be established in order for parents and professionals to work together. Sensitivity and understanding of ethnic and cultural values and differences is an important element in any interaction between families, caregivers, and other professionals. This article examines the roles, perceptions, and expectations of parents, families, and professionals relating to program planning for persons with disabilities. Guidelines and checklists are provided for families and service providers in order to improve participation and collaboration in conferences and program planning meetings.     

Development of an Abuse Screening Tool for Women with Disabilities

Abstract

Women with disabilities are at increased risk for violence, including forms of abuse that can be experienced by all women as well as forms unique to women with disabilities, such as abuse by personal assistants. The purpose of this study was to develop an abuse-screening tool unique to women with disabilities. The tool, which was based on previous research, was field-tested with 47 women who experienced physical and/or cognitive disabilities. Final refinement of the tool's wording and formatting was accomplished through focus groups and individual interviews. Women with disabilities were receptive to participating in screening, which facilitated the identification of abuse and risk factors. Recommendations for abuse screening and risk assessment with women who have disabilities are presented.     

First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a “gender therapist,” only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.     

A Posture of Reciprocity: A Practical Approach to Collaboration Between Professionals and Parents of Culturally Diverse Backgrounds

The current emphasis on developing culturally responsive services for families of children with disabilities from culturally diverse backgrounds informs the need for professional self-awareness whereby professionals learn to recognize not only the cultural specificity of personal values and beliefs but also of their professional practice. We describe an approach, the posture of reciprocity, that enables professionals to acquire this level of cultural awareness. Examples to illustrate applications of the posture are provided.     

Major mental illness, housing, and supports. The promise of community integration

Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facility-based community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers' own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration.     

Values and Policy: The Case of legal Services

This study examines the value systems of a sample of over three hundred respondents to determine differences between those who use the services of an attorney and those who do not. Using a modification of the Rokeach Value Survey, it is found that those people who use legal services are more apt to value "independence" more highly than do those who do not use lawyers. This finding seems to contradict the work of Phillips (1963) who found that those who value "self-reliance" are more apt to shun the services of mental health professionals. It is suggested that lawyers may function as aids to those who value independence highly and psychiatrists for those who do not. This study casts doubts on simpler models of the delivery of legal services based on traditional marketing approaches.     

Empowering Parents: The Use of the Parent as Researcher Paradigm in Early Intervention

Whilst family-focussed models of service delivery are proving more effective in early intervention, it is the parents who ultimately carry the burden of responsibility. They often evolve their own strategies for coping with difficulties and solving problems within a family context. Through case study analysis, I report on some of the key outcomes of early intervention for families of very young children with disabilities. The analysis challenges traditional definitions of the family and suggests a recontextualisation of this concept. Similarly parental perceptions of the style of early intervention services are contrasted with those models reported to be effective by professionals. In striving for optimal effectiveness in early intervention, the unique knowledge and understanding of parents is pivotal, and ways are suggested of objectively collecting and collating that knowledge to inform practice and identify important research questions. This case study analysis has led to the evolution of the parent as researcher paradigm, and the implications for the practical implementation of this model will be considered.     

Cultural Mistrust of Mental Health Professionals Among Black Males Transitioning from Foster Care

We examined cultural mistrust of mental health professionals among Black males who are transitioning from the foster care system (N = 74) and its relationship to their level of satisfaction with child welfare services and the frequency of negative social contextual experiences. Results of hierarchical regression analysis showed that the level of satisfaction with child welfare services moderated the relationship between negative social contextual experiences and cultural mistrust of mental health professionals. Specifically, more frequent negative social contextual experiences were related to greater cultural mistrust of mental health professionals for Black males reporting low satisfaction with child welfare services, but not for those reporting high satisfaction with child welfare services. Implications for service delivery are discussed.     

The School and Community Study: Characteristics of Students Who Have Emotional and Behavioral Disabilities Served in Restructuring Public Schools

We present selected initial results from a study investigating the effects of school restructuring and reform activities on outcomes for students who are identified as having serious emotional and behavioral disabilities. A review of the literature revealed six key areas of reform for investigation: accountability, governance, parent involvement, includedness, curriculum and instruction, and pro-social discipline. Ten schools (five elementary, two K-8, one middle, and two high schools) actively engaged in school restructuring and reform efforts were selected to participate in the study, and their status related to these six areas is presented. Characteristics of the students identified as having emotional and behavioral disabilities and served in these schools in special education settings (N = 116) are described. Results from the administration of standardized assessments revealed that these students have significant levels of emotional and behavioral disabilities that impair their functioning at school and at home. Further, school staff are providing the majority of counseling services to these students during the school day, with non-school professionals providing services to 25% of the students.     

INTELLECTUAL DISABILITY AND MYSTICAL UNKNOWING: CONTEMPORARY INSIGHTS FROM MEDIEVAL SOURCES

Intellectual disabilities make people vulnerable to marginalization in churches and social spaces, but theology has not sufficiently attended to the topic and promoted the flourishing of people who have cognitive impairments. This article responds to theology's inadequate attention to intellectual disability and historical resources for reflection on the topic by reading medieval sources with intellectual disability in mind. I argue that Bonaventure's Itinerarium Mentis in Deum provides a model for imagining intellectually disabled and nondisabled people sharing the journey into God and that Eckhart's view of intellect as the uncreated element in the soul includes people who are intellectually disabled among those who may be united with God.     

Expanding Community Participation by People with Disabilities: Implications for Counselors

Many people with disabilities are realizing the goal of full participation in community life. Basic beliefs and values have guided the movement from special institutions and other more restrictive settings to life and work in the community. The movement has been sustained by social, political, and technological developments. The future will involve continuing advances in the opening of communities to mainstream activities on the part of people with severe disabilities, given commitment to basic beliefs and effective services from counselors and other professionals.     

L’expérience fraternelle confrontée à la déficience intellectuelle

IntroductionThe present study aims to evaluate the influence of intellectual deficiency on the lifestyle of brothers and sisters.ObjectiveThe objective is to determine whether or not a child's intellectual deficiency has an influence on the nature of the fraternal relationship. We studied the functionality of the familial typology, the feeling of social integration, and the degree of depression in brothers and sisters of children with intellectual disability.MethodThis research was carried out with 34 brothers and sisters of children faced with intellectual disabilities, aged between 6 and 12 years old, and the results were compared with those collected from a test group of 24 children.ResultsThe comparative study shows little differences between siblings and families confronted to intellectual disability and those who are not. The nature of the fraternal relationships differ however as the modality of proximity and conflicts are less expressed by siblings of children faced with intellectual disabilities. Furthermore the correlational study stresses the importance of siblings’ rivalry, the feeling of social integration, and the degree of depression.ConclusionWith these results now uncover risk and protection factors to children confronted to intellectual disabilities among their siblings