Case Management of Psychosocial Aspects of Disability and Chronic Illness

008 CM-Psychosocial Aspects of Disability

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Objectives
~ Define Disability
~ Review the phases of disability adjustment
~ Explore the concept of Disability Identity
~ Identify aspects of disabilities which increase stigma
~ Explore the 5 As of intervention
~ Using ecological theory, explore the psychosocial impact of the disability on the individual and family.

Define Disability
~ Any mental health, addictive or physical health issue which restrict or alter a person’s regular or desired activities.
~ Examples
~ Addiction
~ HIV
~ Paraplegia
~ Deafness
~ Visual Impairment
~ Down’s Syndrome
~ Schizophrenia
~ Autism
~ Muscular Dystrophy
~ Chron’s Disease

Adjustment to Disability
~ Many people experience more than four stages of adjustment to a physical disability:
~ Shock
~ Anxiety
~ Denial
~ Mourning/Depression
~ Withdrawal
~ Internalized anger & Externalized aggression
~ Acknowledgment
~ Acceptance
~ Adjustment

Disability Identity
~ The beneficial self-beliefs that PWDs hold regarding their disabilities, as well as any ties they possess to members of the disability community
~ People with “invisible” disabilities often have a low disability identity
~ Disability identity is negatively correlated with mood disorders
~ Identity development is a fundamentally social process, and identities are formed through mirroring, modeling, and recognition through available identity resources, and so it is imperative that professionals working with individuals with disabilities become aware of this developmental process to be able to better support individuals along this journey
Disability Identity Development
~ Key Themes
~ Communal attachment—wishes to affiliate with other PWDs
~ Affirmation of disability—Living in the And
~ Self-worth—values the self and feels equal to nondisabled people
~ Pride—feels proud of identity despite recognizing that disabled is often viewed to be a devalued quality
~ Discrimination—aware of prejudicial behavior in daily life
~ Personal meaning—finds significance in, identifies benefits with, and makes sense of disability
Stigmatizing Dimensions
~ Source/responsibility for condition—Is a stigma congenital, accidental, or self-inflicted?
~ Aesthetic—Does the stigma distress or otherwise upset other people? (Addiction, amputation, wheelchair…)
~ Apparent or concealable—Is a stigma obvious (e.g., amputation) or invisible (e.g., psychological or mood disorder, chronic pain, diabetes)?
~ Disruptiveness—Does the stigma’s presence hinder or otherwise prevent social interaction or communication? (aesthetics, cognition, verbalization)
~ Perilous—Can the stigma be seen as contagious or even dangerous to others? (HIV, addiction, psychosis, autism…)
~ Course—Is the stigma getting worse or better?
Fundamentals
~ Clients must feel empowered to make decisions regarding self-management
~ Educational and empowerment strategies must be individually tailored
~ Information and support should be consistent with current best practices
~ Collaborative relationships with patients and supporters is critical to success

5 As
~ Assess
~ The condition
~ The client’s and SO’s understanding of the condition
~ Their current coping strategies and efficacy
~ The impact of the condition on the client’s (PACER)
~ Physical Health
~ Affect
~ Cognitions
~ Environment and Economic Well-being
~ Relationships and Recreation
~ Advise/educate the client and significant others
5 As
~ Agree/collaborate to develop a workable plan
~ Short term
~ Long term
~ Assist client and supports in identifying and accessing services
~ Arrange for referrals and follow-up as needed

~ Raise awareness of their rights and of the possibilities and services available to them to
~ Enhance their mental and physical
~ Engage in social/recreational activities
~ Act to eliminate discrimination
Ecological Systems
Individual Dimensions
~ Risk/Mitigating Factors
~ Age
~ Health (concurrent conditions and health behaviors)
~ Mental Health
~ Cognitive Functioning
~ Socioeconomic Status
~ Employment
~ Education
~ Perception of Disability/ Disability Identity
~ Duration of Disability
~ Cultural Values
~ Social Support Perception

Individual Dimensions cont…
~ Cognitive Constructs
~ Courage vs. Mental Defeat
~ Knowledge (Health Literacy and Coping)
~ Commitment to Action vs. Hopelessness
~ Emotional and Cognitive Transcendence vs. Pain/Disability Catastrophizing
~ Perceived Burdensomeness
~ Disability Identity vs. Thwarted Belongingness
Microsystem
~ Family and Peers
~ Community and family response
~ Impact on their lives (occupational, financial, social, emotional)
~ The insider–outsider distinction is assuming what a disability, must be like—and frequently concluding that it is not only negative and disruptive to daily living but also defining for the individual.
~ Outsiders rarely recognize disability as one quality among many in a person’s life and presume the disability is an ongoing focus, a troubling preoccupation
Microsystem
~ School/employment
~ Ability to get jobs
~ Necessary accommodations
~ Reception at school/work
~ Health Services
~ Availability of specialized services
~ Financial impact of services/medicines
Exosystem
~ Community
~ Resources
~ Attitudes
~ Government Agencies
~ Services (health care, transportation, housing)
~ Mass Media
~ Culture
~ A disability often represents a stigma that the person has some quality that is construed as being broadly negative in a given context or cultural setting
~ When a disability is stigmatizing, it serves as a social marker so that PWDs are seen and often treated as distinctly different from nondisabled people

Specific Presenting Issues
~ Depressive symptoms
~ Anger problems
~ Harmful habits (e.g. smoking, alcohol misuse, illicit drugs)
~ Lack of healthy social support
~ Poorer perceived mental health
~ Concurrent chronic pain conditions impacting relationships and sleep
~ More frequent episodes of intermittent pain
Accommodations
~ Vocational Rehabilitation
~ Job Accommodation Network
~ JAN Searchable Online Accommodations Resource (SOAR)

Summary
~ Both visible and invisible disabilities can impact people’s
~ Physical Health
~ Affect
~ Cognitions
~ Environment and Economic Well-being
~ Relationships and Recreation
~ The degree to which a disability impacts a person psychosocially depends in large part on
~ Individual Characteristics
~ Community and Family Response
~ Cultural Attitudes