Skills Development for
Multicultural Rehabilitation Counseling:
A Quality Of Life Perspective
Leo M. Orange
California State University http://www.dinf.ne.jp/doc/english/Us_Eu/ada_e/pres_com/pres-dd/orange.htm
This article focuses on a discussion of specific strategies usable in promoting the development of leadership capabilities in individuals with disabilities from minority groups. This paper states that rehabilita tive success in counseling such persons depends on "the counselors understanding the life factors unique to consumers whose sociocultural experiences are different." Frequently, the general population affixes action-engendering stigmas and stereotypes on entire groups of minority members with disabilities. The author states that professionals also entertain pejorative cultural assumptions about disability. Recommended and discussed in detail in this paper is the Quality of Life (QOL) approach shortly defined as an orientation towards a wellness and holistic outlook addressing both the consumer's individual development and his/her environment in the broad sense of the term.
Counseling ethnic minority persons with disabilities is a topic deserving debate and discussion in the field of counseling. If quality counseling services are to be provided to ethnic minority persons with disabilities, rehabilitation counselors and human service professionals need to examine the issues involved in interacting with this consumer group. As suggested by Herbert and Cheatham (1988), and Kunce and Vales (1984), the success of rehabilitation counseling services to persons from minority groups is dependent upon the counselor's understanding of the life factors unique to consumers whose sociocultural experiences are different. For example, the rehabilitation challenges facing African Americans with disabilities are varied and complex and require counseling approaches that are sensitive to the idiosyncrasies of the African American community. Wright (1988) and Atkins (1986) indicate that human service professionals need to be cognizant of the cultural issues involved in serving minority persons with disabilities.
Disability and Minority Status
The similarities in stigmas and inequities experienced by persons from minority groups and people with disabilities are numerous. Historically, both groups have been excluded from the mainstream of American life and share an underprivileged status. Walker (1988) gave a brief historical account of societal perception of people with disabilities. Though some societies looked upon individuals with disabilities with "awe" and "reverence," in most societies disabilities have traditionally been associated with negativism. In the most recent past, people with disabilities have been consistently relegated to economic deprivation and dependency.
Stigmas associated with the minority status reflect these experiences. Wright (1983) noted that racial minority-group members have always had to deal with non- minority individuals who insist that they "not only know their place but also keep their place, that is to feel and act less fortunate than others." Herbert and Cheatham (1988) stated that either having a disability or being a minority person can present stigmas that pose barriers to full participation in education, employment, and social opportunities. Wright (1983) asserted that an individual is appraised according to the presumed characteristics of the group in which he or she is placed. An example would be that individuals with disabilities are often stereotyped as having suffered a great misfortune, and their lives are consequently disturbed and damaged.
Stereotypes also exist for persons from minority groups in the larger society. For example, African Americans are perceived as low achievers, promiscuous, and untrustworthy (Atkins, 1988). Wright (1983) maintained that the impact of these stigmas associated with disabilities or minority status can be so intense and pervasive that it can overpower other positive personal characteristics of the individual which may run counter to these stigmas. Minority persons with disabilities are already aware of the stereotypes and negative attitudes held by the majority of Americans. These observations are significant because they suggest that minority persons with disabilities must learn to cope with what Marshall (1987) called the "double whammy" - racial discrimination and physical impairment. The double bias of being a member of both status groups can manifest itself through extreme prejudice on the part of the non-disabled, non-minority individuals who lack awareness and sensitivity to the combined effects of being a minority person and having a disability.
The disability experience is described through psychological, sociological, and economic paradigms. More recently, ecological and minority models are advocated as appropriate frameworks for analysis through inclusion of an analysis of the person-in-environment (Fine & Asch, 1988; Hahn, 1987; Liachowitz, 1988). Hahn (1988) proposes that a socio-political (minority model) provides a framework from which to examine the disabling environment rather than examining personal limitations (medical model) or functional limitations (economic model). Fine & Asch (1988) challenge the research and professional community to stop considering the environment as unalterable, and to reconsider common assumptions about the meaning of disability which helps to perpetuate cultural stereotypic responses.
Critical cultural assumptions about disability also shape professional thinking and attitudes. These assumptions also reinforce language, social beliefs, and interactions throughout the culture. Common cultural assumptions and their implications are that:
1. Disability is solely biological and outcomes of social interaction are based on disability as the independent variable.
2. Problems faced by persons with disabilities are a result of the impairment rather than the cultural, legal, economic, social, and environmental contexts.
3. Persons with disabilities are victims of biological injustice rather than social injustice; hence, interventions are directed toward changing individuals' abilities rather than social context.
4. Disability is central to the individual's self-concept, self- definition, social comparison, and reference groups.
5. Disability is synonymous with needing help and social support, reinforcing associations between disability and conditions of helplessness, incompetence, and the perpetual receipt of various forms of assistance (Fine & Asch, 1988).
Quality of Life and the Role of Rehabilitation
Rehabilitation professionals continue to disagree on what is the primary goal of rehabilitation. Some rehabilitation counselors believe that vocational placement is the final outcome of a successful plan while others promote consumer independence. Atkins (1986) indicated consumers enter a rehabilitation process with a set of beliefs, attitudes, values, and goals; they encounter rehabilitation counselors with their own set of beliefs, attitudes, values, and goals. Undeniably, the interaction between consumer and counselor attributes could be critical in determining whether they leave the program successfully rehabilitated.
A Quality of Life (QOL) perspective on rehabilitation counseling integrates competing program goals such as consumer independence or employment into a higher order, multidimensional rehabilitation outcome. Counselors committed to a QOL orientation work from a wellness and holistic position that addresses both the development of the individual and the environment in which the person lives (Roessler, 1990).
Livneh (1988) presented a hierarchical and multifaceted definition of QOL. He conceptualized QOL as comprising two domains, namely community and labor force memberships; each of these was subdivided into two parts - physical and psychosocial adjustment. Within physical and psychosocial adjustment, sequential subgoals were further identified down to the level of specific behavioral objectives for a given individual. Hence, to enhance an individual's quality of life, rehabilitation services must target a wide range of body, self, and social objectives.
Quality of Life began as a political slogan during the 1950s and was rapidly adopted by the field of medicine (Vash, 1987). Definitions of QOL in the literature view "quality" as synonymous with grade or level, which may vary from high to low. "Life" generally refers to mental life, even though environmental conditions are included in some definitions. Admittedly a complex concept, QOL is typically addressed in three ways, i.e. by user of: (1) subjective estimates of satisfaction with life in general (well being or happiness); (2) subjective estimates of satisfaction with specific life domains (work, finances, health, and relationships with others); and (3) socio-demographic data of life quality (social indicators) reflective of environmental opportunities, barriers, and resources (Baird, Adams, Ausman, & Diaz, 1985; Schuessler & Fisher, 1985). Satisfaction of life domains must also address recreation, a factor that until recently has not been discussed in regard to rehabilitation services when people with disabilities are involved.
Quality of Life (QOL) is determined by both inner and outer forces (Roessler, 1990). According to Campbell (1981), one's sense of global well-being "is always dependent on the subjective characteristics of the person and the objective characteristics of the situation." Inner (subjective) factors influencing QOL include aspiration level, past experience, personal expectations, and perception of current condition (Lehman, 1983). QOL is also affected by the level of environmental resources and stressors, as indicated by a variety of social indicators (Schalock, Keith, Hoffman, & Karan, 1989). Therefore, to enhance QOL of people with disabilities, rehabilitation practices must focus on both personal and environmental conditions.
An individual personal estimate of QOL may be registered in terms of global life satisfaction or dissatisfaction or domain-specific satisfaction or dissatisfaction. In either case, the judgment requires people to compare what they have with what they believe they deserve. Consistency between the two results in satisfaction and feelings of positive effect and pleasure. Perceiving oneself as having less than one deserves creates dissatisfaction and feelings of negative effect, which create experiences of strain and pressure (Campbell, 1981).
Global QOL may be measured by asking the person to indicate on a single dimension (terrible to delighted) his/her current satisfaction with life. For example, "How do you feel about life in general?" A semantic differential format with several different adjective pairs (boring-interesting, useless-worthwhile) for "I think my life is..." may also be used (Lehman, 1983).
By addressing global and domain issues in adopting a QOL outlook in rehabilitation, the counselor emphasizes consumer input and, more importantly, the individual affected level is directly related to personal and environment factors that may need to be addressed in counseling. Scherer (1988) identified two personal factors that, if addressed in counseling, have the potential to improve life outcomes -perceived control over QOL and the desire to assimilate into society. Other correlations for people with disabilities underscore the need for intervention that results in safer living conditions, improved health care, prevention of health problems, development of social and leisure skills, increased financial security for satisfaction of social and family relationships, and improved employment status.
Roessler (1990) stated that QOL orientation benefits rehabilitation in many ways. It: a) orients the field to a wellness model, b) stresses the multidimensional nature of rehabilitation, outcomes, c) requires intervention that addresses both the development of the individual and the environment in which that person lives, d) enables practitioners to consider the consumer's perspective without imposing their own expectations on the individual, and e) yields program evaluation data indicating the extent to which interventions and facilities have enhanced the "quality" of the individual's life.
A QOL perspective on rehabilitation counseling results in a greater commitment to a holistic approach. QOL is a wellness construct with multiple dimensions. In contrast to a more traditional disease or medical model, QOL stresses competency, wholeness, robustness in individuals and society (Kirchman, 1986). QOL encompasses not only satisfaction with regard to life's basic necessities but also with regard to less tangible values such as security and fulfillment. Rehabilitation counselors must incorporate in their work as well this commitment to tangible and less tangible values. People with disabilities tend to downplay the relationship of lost function (motoric and physiological) to QOL and stress the importance of social and interpersonal skills.
Finally, consistent with the initial premise on global and domain issues, QOL must play an important role in the evaluation of rehabilitation programs. Rehabilitation counselors need to rehabilitate the "whole person" and dedicate their efforts to the end goal of increasing QOL for people with disabilities.
Atkins, BJ (1986): Innovative approaches and research in addressing the needs of nonwhite disabled persons. In S. Walker et al. (Eds.), Equal to the challenge: Perspective, problems, and strategies in rehabilitation of non-white disabled. Proceedings of the National Conference of the Howard University model to improve rehabilitation services to minority populations with handicapping conditions. (Eric Document Reproduction Services No. ED 276 198).
Baird, A., Adams, K., Ausman, J., and Diaz, F. (1985). Medical neuropsychological, and Quality-of-Life correlations of cerebrovascular disease. Rehabilitation Psychology, 30(3), 145-155.36.
Campbell, A. (1981). The sense of well-being in America. New York: McGraw-Hill.
Fine, M. & Asch, A. (1988). Disability beyond stigma: Social interaction, discrimination, and activism. Journal of Social Issues, 44(1), 3-21.
Hahn, H. (1987). Advertising the acceptable employable image: Disability and capitalism. Policy Studies Journal, 15(3), 551-568.
Hahn, H. (1988). The politics of physical differences: Disability and discrimination. Journal of Social Issues, 44(1), 39-47.
Herbert, JT., & Cheatham, HE. (1988). Africentricity and the Black disability experience: A theoretical orientation for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 19(4), 50-54.
Kirchman, M. (1986). Measuring the quality of life. The Occupational Therapy Journal of Research, 6(1), 21-31.
Kunce, JT. & Vales, LF. (1984). The Mexican American: Implications for cross-cultural rehabilitation counseling. Rehabilitation Counseling Bulletin, 27, 97-108.
Lehman, A. (1983). The well-being of chronic mental patients. Archives of General Psychiatry, 40, 369-373.
Liachowitz, CH. (1988). Disability as a social construct: Legislative roots. Philadelphia, PS: University of Pennsylvania Press.
Livneh, H. (1988). Rehabilitation goals: Their hierarchical and multifaceted nature. Journal of Applied Rehabilitation Counseling, 19(3), 13-18.
Marshall, M. (1987, October). Fighting for their rights. Ebony, pp. 68-70.
Roessler, RT. (1990). A quality of life perspective on rehabilitation counseling. Rehabilitation Counseling Bulletin, 34(3), 82-90.
Schalock, R., Keith, K., Hoffman, K., & Karan, O. (1989). Quality of life: Measurement and use. Mental Retardation, 27(1), 25-31.
Scherer, M. (1988). Assistive device utilization and Quality of life in adults with spinal cord injuries or cerebral palsy. Journal of Applied Rehabilitation Counseling, 19(2), 21-28.
Schuessler, K. & Fisher, G. (1985). Quality of life research and sociology. Annual Review of Sociology, 11, 129-149.
Vash, C. (1987) Quality of life issues affecting people with disabilities. In W. Emener (Ed.), Public policy issues impacting the future of rehabilitation in America (pp. 2-35). Proceeding of the Second Annual Education Forum. Stillwater, OK: National Clearinghouse of Rehabilitation Training Materials.
Walker, S. (1988). Toward economic opportunity and independence: A goal for minority persons with disabilities. In S. Walker et al. (Eds.), Building Bridges to independence. Proceedings of the National Conference on Employment Successes, Problems, and Needs of Black Americans with Disabilities. (ERIC document Reproduction Service No. ED 309 588).
Wright, BA. (1983). Physical disability: A psychosocial approach (2nd ed.). New York: Harper and Row.
Wright, TJ. (1988). Enhancing the professional preparation of rehabilitation counselors for improved services to ethnic minorities with disabilities. Journal of Applied Rehabilitation Counseling, 19(4), 4-9.
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