Psychology of Rehabilitation

Psychology of Rehabilitation
DPSY696
Edited by:
Dr. Vijendra Nath Pathak
Psychology of Rehabilitation
Edited By
Dr. Vijendra Nath Pathak
Content
Unit 1: Introduction: Overview of the Profession of Rehabilitation 1

Psychology and Practice, History, Growth and Scope, Role of
Psychologist in Rehabilitation
Unit 2: Disabilities: Definition, Nature, Types and Characteristics 13

of Various Disabilities as per Person with Disabilities, Mental
Retardation, Learning Disabilities and Visual Disabilities
Unit 3: Models of Disability: Theories and Models of Adaptation 24

to Disability, Adaptation Processes, Ways of Coping with
Disability
Unit 4: Psychological Assessment-Assessment of Cognition, 34

Aptitudes, Psychopathology, Work/Vocational and Daily
Functioning
Unit 5: Models of Disability and Rehabilitation: Biological Model 40
Unit6: Sociological Model of Rehabilitation Psychology 50
Unit 7: Support System: Group Dynamics, Self Help groups, Self

advocacy 69
movement, Community awareness, Community based
rehabilitation
Unit 8: Disability Dealing with Families 77
Unit 9: Models of Rehabilitation 89
Unit 10: Community Based Rehabilitation 99
Unit 11: Health Behavior 110
Unit 12: Caregivers 121
Unit 13: Quality of Life 131
Unit 14: Adjustment & Well Being 141

Unit 01: Introduction: Overview of the Profession of Rehabilitation Psychology and Practice, Notes
History, Growth and Scope, Role of Psychologist in Rehabilitation
Unit 1: Introduction: Overview of the Profession of Rehabilitation

Psychology and Practice, History, Growth and Scope, Role of
Psychologist in Rehabilitation
CONTENTS
Objectives
1.1 Overview and Practice:
1.2 Historical Perspectives in Rehabilitation Psychology
1.3 What is Rehabilitation Psychology?
1.4 Definition
1.5 Scope of Rehabilitation Psychology
1.6 Goals and Objectives of Rehabilitation
1.7 Methods of Rehabilitation Psychology
1.8 Functions/ Role of Rehabilitation Psychologists
1.9 Role of Psychologist in Disability Rehabilitation
Keywords
Self-Assessment
Answers for Self Assessment
Review Questions
Further Readings
Objectives
This unit will enable you to:
 Understand the history of rehabilitation psychology

 Elucidate the meaning and definition of rehabilitation psychology
 Evaluate the various goals, scope and methods of rehabilitation psychology
 Discuss the role of rehabilitation psychologists
1.1 Overview and Practice:

Around 2.68 crore population of India is facing the brunt of disability according to the 2011 Census.
But they lack support. And the next census (2021) is likely to include all 21 categories of disabilities
as per RPWD Act (2016). The number as a result is likely to rise significantly as many new disability
conditions have been added since previous PWD Act (1995) which included seven disability
conditions.
The demand of trained licensed Rehabilitation Psychologists is quite high and will go on increasing
as we get the figure in the next census. But as per the current estimates the number of
Rehabilitation Psychologists is very low. Institutions offering courses in Rehabilitation Psychology
need to be increased for developing trained manpower for the country. We need to spread
awareness on the variety of specialty disability conditions among all stakeholders, namely the
general public, affected individuals, their families and the government. Acceptance and action on
part the affected individuals and their families complete the process that we as Rehabilitation
Psychologists look forward to.
LOVELY PROFESSIONAL UNIVERSITY 1

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The role of a rehabilitation psychologist is not merely testing, evaluation and intervention but also
to focus on the quality of life for a child and his family, where welfare is a significant criterion for
treatment goals and rehabilitation to facilitate community integration. If the family needs help, they
may look for the following resources and contact-
1. ARPP (India) (Association of Rehabilitation Psychologists & Professionals), India website:
www.rehabilitationpsychologistsindia.org
2. Kiran- Mental Health Rehabilitation helpline - 24x7 Toll-free Number 1800 599 0019
For many years, rehabilitation counselling has struggled with development and identity issues that
have both excited constructive development and diminished energy and resources that could have
better defined its practice. The authors have had the good fortune entering the field, experiencing
the practice of rehabilitation counselling, and providing leadership for some of its
professionalization efforts during many fascinating and crucial junctures in the last few decades.
We have also had the good fortune of both deeply loving the philosophy and practice of
rehabilitation counselling and of forming a productive partnership in our work as rehabilitation
counsellor, educators at the University of Iowa over the last two decades. The idea of re-structuring
of rehabilitation counselling around a clear point of view on its nature and future is necessary. The
time worn debate about whether rehabilitation counselling at its core is essentially counselling or
case management. It defines an exciting and transcendent view of the potential future for
rehabilitation counsellors by firmly focusing on the unique and important partnership its
practitioners have with persons with disabilities and yet mindful of the critical grounding we must
maintain with the profession of counselling and its standards. Future clients and students seeking
to enter the field can derive greater benefit from such clarity of perspective and commitment to one
vision that seeks to integrate rehabilitation counselling’s practitioners with the strongest potential
for excellence in practice and best opportunities in future years.
1.2 Historical Perspectives in Rehabilitation Psychology

Amongst the first charitable organization which contributed to the field of rehabilitation
psychology were hospitals. Hospitals were established by the Church during the early Middle
Ages, to provide care to the sick and disabled who had no families to care for them. The needs of
persons with disability were first addressed by the Red Cross, The National Tuberculosis
Foundation, Goodwill Industries and the Easter Seal Society, during the nineteenth and twentieth
century. Governmental organizations were set up during the beginning of the nineteenth century
for people who had special needs, mental retardation, illness and children.
The definition of disability emphasized the return to work as a goal, from the very beginning.
Persons disabled the statute defined as ‘any person by reason of a defect or infirmity whether
congenital or acquired by accident, injury or disease is, or may be expected to be, totally or partially
incapacitated for remunerative occupation.’ The primary mission of the agency of each state is to
help people with special needs reach their potential for employment or independent living. From a
historical perspective, rehabilitation psychology can be seen as a field that is interested in studying
and dealing with problems of physical and mental impairments and is committed to deal with
these people to enable them to lead a healthy, fuller and a more meaningful life. Both from the
inside and outside the profession, psychologists, have been viewed as mental health professionals.
As the older mind-body dualism gives way to a more holistic integration of the physical and
psychological aspects of life, rehabilitation psychology is gaining increasing interest and relevancy.
Period of growth has been stimulated by war, which has led to growth in rehabilitation psychology
as a result of the increased need to care for large numbers of disabled veterans returning from war.
Following the Civil War, efforts to care for the American veterans took place. Several agencies, in
1921, were consolidated into the Veterans Bureau, which later became the Veterans Administration
and now the Department of Veterans Affairs. This agency played an important role in developing
clinical psychology as a profession and in placing psychologists in rehabilitation settings.
Two events that had a great impact on the growth of the field of rehabilitation psychology were a
set of domestic programs that were launched by Democratic President Lyndon B. Johnson in 1964-
65 and the establishment of the Rehabilitation Act of 1973.
The National Council on the Psychological Aspects of Disability (NCPAD) marked the
organizational beginning of Division 22. Psychologists, Jane Shover and Phyllis convened this
group, who between 1949 and 1951, called psychologists working with persons with disabilities at
several American Psychological Association (APA) annual meetings. During this year, the group
formally organized as a special interest group within the APA. By the next year, it had become The
2 LOVELY PROFESSIONAL UNIVERSITY

National Council on the Psychological Aspects of Physical Disability (NCPAPD). The change of
name reflects the tension between those whose work was primarily with physical disabilities and
those who saw rehabilitation in a broader perspective that included mental disabilities. The early
role of NCPAD during the annual meetings of the APA was primarily as a focus of activity, but
with the course of time there was a greater perceived need for organizational structure to manage
the business between annual meetings. The members of NCPAD were ambivalent about making
the next step, seeking divisional status within the APA, despite its growth divisional status. It was
recommended by the APA board of directors, to grant divisional status to the Council of
Representatives, who then voted at the APA annual meeting in August 1958 and thus, Division 22
was officially born.
In a conference held in Princeton, New Jersey, February 3 to 7, 1958 on the role of psychology and
psychologists in rehabilitation, the origin of rehabilitation psychology was defined. APA and the
US Department of Health, Education and Welfare, were the co-sponsors of the conference. Beatrice
Wright (1959) recorded the proceedings of the Princeton Conference and it was published by the
APA as ‘Psychology and Rehabilitation’. This is an excellent reflection of the thoughts at the time
concerning the professionalization of rehabilitation psychology and helps us to understand the
goals, viewpoints and methods of this emerging specialty. The scope and nature of rehabilitation
were discussed there. The main issue was the degree to which rehabilitation should include mental
disorders or remain focused on physical disorders. The tension concerning the name of the
National Council reflects this debate.
The multidisciplinary character of rehabilitation resulted in the debate on the scope of
rehabilitation. As a medical specialty emerged rehabilitation medicine or psychiatry, at the same
time. The role of physical therapists, nurses, and social workers, among others was also important.
More than most professional’s specialties, rehabilitation psychology involved extensive day to day
contact with other professionals from a very wide range of training with very different vantage
points on the problems of disability. In the proceeding, an entire chapter was devoted to ‘Inter-
professional Relations’. It was noted by psychologist, Wright that rehabilitation ‘is not the sole
province of any one profession. It is rather an expression of a system of values and attitudes toward
the person with a disability and his or her place in society.’ A key value was a belief that
‘purposeful activity’ should replace the idleness of mere ‘convalescence’.
Vocational focus was another major characteristic of rehabilitation psychology. To provide
vocational rehabilitation services to disabled veterans and non-veterans, there were statutory
mandates. Vocational counsellors and psychologists were brought into the forefront of
rehabilitation by agencies that were created to fulfil these mandates. In the year 1958, the concept of
vocational rehabilitation had been broadened to include ‘sheltered and homebound employment as
well as homemaking.’ The discussion also included the roles and functions of psychology in a
rehabilitation setting.
At the conference, the training of rehabilitation psychologists was discussed. The doctoral level of
training was seen as the most appropriate, followed by the earlier decisions in clinical and
counseling psychology. Covering ‘soma to psychology’, a term which was earlier coined by
researchers to describe the study of impact of physique and visible disability on psychological
functioning was necessary.
Another conference sponsored by the Office of Vocational Rehabilitation (OVR) was held at Clark
University, a year after the Princeton Conference. As starting points, a more formal set of
presentations and papers were used. The paper which aimed at guiding the direction of research
efforts was considered the most interesting paper and was sponsored by the OVR as the major
federal granting agency. Myerson’s call for more ‘comprehensive theories of illness, disability and
rehabilitation’ was another salient point. He observed after reviewing the extant theories that an
integrated theory would have to integrate facts about the person, the disability, the social setting,
the rehabilitation process itself and the ‘flexibility or amenability to change of each characteristic’.
The three founding members of Division 22 conducted one of the pioneering studies on the
psychological aspects of disability. Psychologists, Dembo, Leviton and Wright sought out veterans
and others who had lost limbs in the war or were otherwise visibly different. These veterans were
then interviewed and sometimes significant others concerning their adaptation to the changes in
physical appearance and function and the reactions of others to their visible disability. Soma to
psychology was a term which was coined by Dembo and her colleagues, which refers to the ways
in which apparent and obvious physical difference has a psychosocial impact on self and others.
Throughout the history of rehabilitation psychology, this social psychological framework has been
a major theme.

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During this period another important work has summarized the history of literature on
psychological adjustment to physical disability. Kurt Lewin, a German-American psychologist
played an important role in the psychology and social psychology of disability. The holistic
interaction between the individual and the environment was emphasized by his field theory
approach to psychology, a concept which was of great relevance to studying how the visible
physical differences of amputees led to changed reactions of self and others.
The Lewinian emphasis on the person-environment interaction is reflected in several ways. The
individual disability is understood in terms of the impact that the disability has on that individual
himself or herself and that individual’s opportunity to integrate into the community at large. In this
early period, another significant development was the close association between rehabilitation
psychologists and Division 17. The distinguishing features of counseling psychology have been its
emphasis on working with people who are psychologically normal and who are undergoing
significant life-stage transitions. Rehabilitation psychology and counseling psychology share an
emphasis on the vocational role and its importance in not only economic but psychological
independence. Like counseling psychology, rehabilitation psychology has also been more sensitive
to the differences between normalcy and pathology. The field has attempted to identify what
factors influence an individual who has a disability to react in an adaptive or maladaptive manner
to the circumstances imposed by his or her situation.
Rehabilitation psychology emerged as a distinct specialty within professional psychology, by the
1960’s. This year included the intensifying struggle for civil rights and racial justice as well as
President Lyndon Johnson’s Great Society and the beginning of the Medicare program as a means
of providing health care to elderly and disabled individuals.
A disability rights movement gained momentum, in the 1970’s, with an emphasis on the
psychological issue of normalization and the social challenge against paternalism. This led to the
passage of the Rehabilitation Act of 1973. Empowerment is the ethic behind this movement. This
movement viewed the people as socially disadvantaged by physical and psychological barriers and
changing those environmental features is the major goal.
The Americans with Disabilities Act (ADA) in 1990, was an important development for persons
with disabilities. The NCPAD published a newsletter, which kept division members up to date on
organizational matters, as well as the Bulletin, which presented more formal scientific and scholarly
articles. The first editor of the Bulletin was Lee Myerson. He recognized the need to further
improve the quality of the journal and the research contained in it if the division was to truly
emerge as an important source of knowledge and assistance to practitioners. The editorship has
now been passed to Bruce Caplan, and the American Psychological Association is currently the
publisher. Two papers addressed both poverty and the impact of race and ethnicity on
rehabilitation and reflecting the growing sensitivity to minority group issues were published
during the same time.
The role of self-help groups in the rehabilitation process was provided by Wright (1971). By 1978,
the division had matured enough to begin honoring its members who had distinguished
themselves through research or service. James Garrett was the first recipient of the Distinguished
Service Award for research contribution. He was a key person in arranging sponsorship of the early
conferences defining the field of rehabilitation psychology. One of the early handbooks on the
psychological aspects of disability was also edited by him. Tamara Dembo and Beatrice Wright,
who were part of the early Lewinian tradition in rehabilitation psychology, were the other
members to receive this award.
Dembo focused her attention on the importance of practical considerations of actual life problems
and advocated actively involving the persons with disability in the rehabilitation process. Wright
has contributed to social psychology and has extensively written in the field of rehabilitation
psychology.
Psychologist, Wilber Fordyce pioneered behavioral approaches to chronic pain and has contributed
more than 20 articles expanding on this theme. Nancy Kerr and Lee Myerson are the two main
recipients of the Distinguished Service Award; they collaborated on articles concerning the
importance of independence for persons with disability and research methodologies for
rehabilitation. Numerous papers on aspects of rehabilitation of persons with mental retardation
and sensory disabilities were contributed by Myerson. George Wright was the recipient of the
Distinguished Service Award 1988. He wrote extensively on the topic of the competencies of
rehabilitation professional and how to train and enhance them.
To honor a senior colleague who had a distinguished career in research in rehabilitation
psychology, the Roger Baker Award was initiated in 1988. The first recipient of this award was

Brian Bolton. He has contributed and collaborated on more than 120 articles, books, and chapters in
the field of rehabilitation. Recipient of the 1989 Baker Award was William Anthony, who had
published nearly 80 articles in the field of psychosocial rehabilitation of mental disabilities.
For his long career interest in attitudes toward disability was received by Bob Yuker in 1991. The
Attitudes toward Persons with Disability Scale (ATDP) was developed by him, which has been
among the most widely used instruments in assessing such attitudes.
Marcus Fuhrer along with Margaret Nosek, were the recipients of the Barker, who were the 1995
winner of the Garret award, took up the theme of independence for persons with disabilities.
In 1958, American Psychological Association (APA) established the division of rehabilitation
psychology as an organization for psychologists concerned with the psychological and social
consequences of disability but it got implemented only in August 2015 when, the APA Council of
Representatives approved Rehabilitation Psychology as an area of professional psychological
practice which had a distinguishing feature of aiding to specified problems in a particular
population. Since its genesis, there have been some major developments in the field of
rehabilitation psychology. Let us recapitulate it in the following section.
 In 1994 Division 22 of APA (established in 1958) which focused on Rehabilitation psychology

along with Professional Issues Committee was given more importance and a leadership role
and Division 22 in the same year organized APA Conference on Health Care Reform.
 In 1995, establishment of The American Board of Rehabilitation Psychology (ABRP) occurred.
 In 1996, Division 22 played an important role in developing the APA Interdivisional Health
Care Committee whose purpose is to establish a common agenda for promoting the
professional, educational, and scientific goals of health care psychology.
 In 2010, establishment of the Foundation for Rehabilitation Psychology occurred.
Over the years, people with physical and mental disabilities have witnessed a wide variety of
attitude, some more welcoming and the others less welcoming, in terms of social expectations and
participation. Social stigma, lack of knowledge and discrimination has, in the past and to some
degree in the present too, left people with disability with few employment opportunities. In order
to bring about a shift in the attitude and develop more acceptance towards people with disability, a
comprehensive civil rights law called The Americans with Disabilities Act (ADA), was established
that prohibits, discrimination on the basis of disability and provides protection in the areas of
employment and public services to such people.
The interests of many rehabilitation psychologists became increasingly focused toward the
specialty of neuropsychology, with the advent of ‘neuropsychological rehabilitation’, which is the
use of psychological principles and techniques to address the needs of persons with neurological
disabilities.
Neuropsychology began primarily as an aid to diagnosis and much work has been done by
members of both Division 22 and Division 41 to enhance the use of psychological assessment data
to diagnose brain damage. Relationship between the environment and the patient has been one of
the themes of neuropsychological rehabilitation. More emphasis was given on the correlation
between test performance and the presence or localization of a lesion, by classical neuropsychology.
The founding members of the division were involved in working with children, but in 1987, a
special interest group was created for psychologists involved in pediatric rehabilitation. Pediatric
rehabilitation has been but one of several special interest groups that have emerged as the field of
rehabilitation psychology has grown in complexity and specialization.
In the 1970’s and 1980’s there was a dramatic growth in rehabilitation and its diversification into
subspecialties including but not limited to psycho-social rehabilitation of the chronically mentally
ill, neuro rehabilitation of traumatic head injury and stroke survivors. Medicare and Medicaid are
some government benefit programs which have begun to encourage beneficiaries to use health
maintenance organization (HMO’S) and other types of managed care. Rehabilitation Psychologists
felt the impact of private credentials bodies, in addition to managed care, with which all
psychologists who are health care providers have to deal with.
The major private credentialing body in this specialty area is the Commission for Accreditation of
Rehabilitation Facilities (CARF) and its standard mandating inclusion of psychologists on the
inpatient rehabilitation team has aided growth in the job market for rehabilitation psychologists.

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The accreditation standards promulgated by the CARF, has been one of the major source for the
increased job market for rehabilitation psychologists.
Primarily all health care is rooted in a medical model, for better or worse and that invariably
implies a diagnostic system. For most of the health care concerns, psychology uses the Diagnostic
and Statistical Manual of Mental Disorders (DSMIV), American Psychiatric Association 1994). The
chronic problems resulting in disability and requiring rehabilitation is covered by the International
Classification of Impairments, Handicaps and Disabilities (ICIHD), which come under the WHO
(1980).
Impairment refers to the medical condition itself on the other hand; disability refers to ‘any
restriction or lack of ability to perform an activity within what is considered normal for a human
being.’ Handicap refers to the disadvantages encountered by individuals because of impairment or
handicap and reflects the interaction between the physical level, the functional capacity level and
the level of social structures, support and attitudes.
The passage of the Americans with Disabilities Act (ADA, 1990), has been a major milestone in the
movement for civil rights of persons with disabilities. Rehabilitation psychologists have been
actively involved in providing testimony for passage of this legislation, as well as being involved
after its passage in providing interpretative services to business and community groups regarding
disabilities. In pediatric rehabilitation, the division has developed special interest sections. There
are special centers for deafness as well. To bring together interests in rehabilitation, wellness,
psycho-spirituality, and alternative healing, new committees on integrated health and living have
been added. The division has also moved into the computer era, with a website through the
American Psychological Association (APA). On professional psychology in general and
rehabilitation in particular, the impact of managed care and health care cost containment continues.
1.3 What is Rehabilitation Psychology?

Rehabilitation has been described as a program that uses a combination of interventions to
empower individuals with disabilities and chronic health conditions with the aim to help them
achieve socially meaningful, personally fulfilling, and functionally effective interaction in their
daily lives. Rehabilitation psychology is a branch of psychology that is related to the study and
application of psychological knowledge, social principles and skills development for persons with
disabilities and chronic health conditions. Another definition of rehabilitation psychology is it is the
study and application of psychological principles on behalf of persons who have disability due to
illness or injury. The aim of Rehabilitation Psychology is to maximize mental health, independent
functional abilities, and social role participation across the life span of individuals with disabilities
and chronic health conditions.
Rehabilitation psychologists, often within teams, assess and treat cognitive, emotional, and
functional difficulties. They help people to overcome barriers to participation in life activities. They
are involved in practice and research with the broad goal of fostering independence and
opportunity for people with disabilities.
1.4 Definition
According to renowned psychologists, Maki and Riggar (2004), the term ‘rehabilitation’ refers to an
integrated program of interventions that empower individuals with disabilities and chronic health
conditions to achieve ‘personally fulfilling, socially meaningful and functionally effective
interaction’ in their daily context.
American Psychological Association defined rehabilitation psychology as, ‘rehabilitation
psychology is the study and application of psychological principles on behalf of persons with
physical, sensory, cognitive, developmental or emotional disabilities.’
Rehabilitation psychology is a specialty area within psychology that focuses on the study and
application of psychological knowledge on individuals with disability and chronic health
conditions with an aim of maximizing health and welfare, improving quality of life and social
participation across lifespan. In other words, rehabilitation psychology can be seen as an important
part of treating and preventing chronic health problems. It also involves practice, research and
advocacy which aim at promoting independence and opportunity for people with disabilities.
Rehabilitation psychologists are trained and specialized to engage in a broad range of activities
including clinical practice, consultation, program development, research, teaching and training,

administration, development of public policy and advocacy related to people with disability and
chronic health conditions. As a result, rehabilitation psychology services are spread across variety
of settings including in acute care hospitals and medical centers, inpatient and outpatient physical
rehabilitation unit, nursing homes and assisted living centers, and specialty clinic (for example,
vision loss and low vision, cerebral palsy, multiple sclerosis, or deafness). Some of these facilities
are operated privately while others are aided by the government (such as for war veterans).
1.5 Scope of Rehabilitation Psychology

The scope and application of rehabilitation psychologist is wide, as rehabilitation psychologist
address various domains of one’s everyday functioning, as per the World Health Organization
(WHO)’s International Classification of Functioning, Disability and Health (ICF). Some of these are
as follows:
 Assessment of an individual’s physical, personal, psychological, cognitive, and behavioral

factors and followed by developing an intervention plan accordingly.
 Assessment of an individual’s neuro-cognitive status, sensory difficulties, mood and
emotions, desired level of independence and interdependence, mobility and freedom of
movement, self-esteem and self-determination, behavioral control and coping skills,
individual’s capabilities and quality of life to understand the client’s perspective efficiently.
 It assesses the influence of culture, ethnicity, language, gender, age, developmental level,
sexual orientation, geographical location, socioeconomic status and assumptions of difficulty
on attitudes and the services which are given to the client.
 It explores the environmental barriers in participation and performance in day to day
activities including accommodations and adaptation in the existing social structure.
 It includes research and teaching of psychology students and other health trainees about the
requirements of people with special needs. It also focuses on development of policies for
health promotion, and advocacy for persons with disabilities and chronic health conditions.
 It provides services within existing networks of biological, psychological, social,
environmental, and political environments such as attorneys, courts, government agencies,
educational institutions, corporate facilities, or insurance companies.
1.6 Goals and Objectives of Rehabilitation

It aims at helping individuals achieve an optimal level of physical, psychological and interpersonal
functioning. In order words, rehabilitation psychology can be seen as an important part of treating
and preventing chronic and disabling health problems. It also involves practice, research and
advocacy with a broader goal of promoting independence and opportunity for people with
disabilities.
The following are the main objectives of rehabilitation:
 Develop services for meeting psychological and social needs

 Improve social, emotional relationships between handicapped
 Enlarge free movement in the physical and social environments of the disabled and deprived.
 Study the social and psychological network of rehabilitation services centers with regards to
disability and the laws and regulations.
 Goals need to be achievable and based on regular patient assessment of physical and non-
physical consequences of the critical illness throughout their recovery.
To meet these objectives and goals, rehabilitation psychologists require intensive and extensive
training in the following areas:
 Unique aspects of rehabilitation psychology

Notes
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 Psychological assessment of persons with disability
 Impact of the environment on the people who are disabled
 Intervention and remediation procedures
 Rehabilitation practices and management strategies
Rehabilitation psychologists can be trained in the several ways. The following are the main ways in
which they can be trained:
 In-service training
 Formal academic generic courses
 Short term courses
 Continuing education
1.7 Methods of Rehabilitation Psychology

A rehabilitation psychologist uses various methods to perform his or her own tasks. These are:
 Administration of standardized and non-standardized tests to assess cognitive and

psychological functioning of the client, and use of behavioral observation and interviewing
skills to get detailed information about the client.
 Evaluation and treatment of both individual and family members for improving coping and
adaptation skills in both the client and the family members.
 Providing individual and group intervention by using counseling and psychotherapy,
cognitive remediation, behavioral management and enhancing use of assistive technology for
enhancing day to day functioning of the client.
1.8 Functions/ Role of Rehabilitation Psychologists

A rehabilitation psychologist performs several functions. Some being specific and some being
general functions in general. The functions are enlisted as follows:
 He or she provides a holistic development to the client by working on his or her biological,
psychological, social, environmental and even political environment of the client to assist the
client through optimal rehabilitation goals via intervention, therapeutic support, education,
consultation with other specializations, and advocacy.
 He or she focuses on improving functioning and quality of life of persons with special needs
by restoring patient’s physical functions and modifying the patient’s physical and social
environment.
 He or she provides clinical guidance and counseling services to both the individual in need as
well as his or her family, primary caregivers and other significant people in the individual’s
social life and community to help the patient achieve optimal physical, psychological and
interpersonal functioning.
 Rehabilitation psychology involves rehabilitation program development which includes
educating the public, developing policies for injury prevention and health promotion,
advocacy for persons with disabilities and chronic health conditions, research and teaching of
psychology students and other health trainees about the requirements of people with special
needs.
 Rehabilitation psychology involves case management which includes obtaining written
reports regarding client’s progress, developing rapport with physicians and other

rehabilitation health professionals and caseload management-which refers to the ability to
manage a number of clients, within a given amount of time and provide optimum services.
 It focuses on providing a community-based rehabilitation service activity for integration and
equalizing of opportunities in all aspects of the society.
 It involves vocational counseling and consultation which include services such as job
development and placement, career counseling, vocational planning and assessment.
Another important function or key role of rehabilitation psychologist is to conduct research in the
following areas:
 Development of new services patterns

 Short term counseling approaches and methods
 Construction of evaluation instruments
 Development of new rehabilitation techniques
 Conduct studies on attitudes measurements
 Multifaceted aspects of disability
 Psychological impact of disability
 Cognitive behavioral strategies in rehabilitation.
 Behaviorally oriented skills training
 Sexual issues of disabled individuals
 Barrier-free environment
 Community based rehabilitation
There are some unique functions which a rehabilitation psychologist performs:
 Identification of co-morbidities in the client which can affect his or her functioning.
 Use of efficient assessment tools for developing effective intervention strategies.
 Identifying client’s strengths and abilities and developing on it and also identifying the risk
factors which need to be taken into consideration while providing an intervention.
 The psychologist should also take into consideration cost and availability of resources for the
client.
Rehabilitation psychologist serves a wider range of population which includes:
 Individuals with brain injuries

 Individuals with spinal cord injuries
 Geriatric population
 Individuals with neuromuscular disorder
 Individual with chronic pain disorder
 People with medical condition such as, Cancer, Multiple sclerosis, Developmental disorder,
Psychiatric disability, Substance abuse, Deafness or hearing loss, Intellectual disability,
Blindness and vision loss, Impairment by educational or other disadvantages.
Moreover, rehabilitation psychologist addresses behavioral and mental health issues faced by
individuals affected by injury or any chronic condition that can lead to disability across lifespan. It
includes issues such as:
 Emotional coping, mental and psychological status.

 Behavior that promotes positive adaptation to disability.
 Minor adjustment issues as well as severe psychopathology.

Notes
Course Name
1.9 Role of Psychologist in Disability Rehabilitation
Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain
their optimal physical, sensory, intellectual, psychological and social functional levels.
Rehabilitation provides disabled people with the tools they need to attain independence and self-
determination. Rehabilitation psychologists support individuals as they cope with the mental and
physical challenges their conditions present. They often teach their patients how to adapt and make
lifestyle choices that promote good health. Rehabilitation psychologists are concerned with all of
the factors in people’s lives that contribute to their wellness and recovery, from the support they
receive from family and friends to the relationships they have with their team of treatment
providers.
The following are the main areas in which a psychologist works:
 Rehabilitation psychologist study and work with individuals with disabilities and chronic
health conditions to help them overcome challenges and improve their quality of life.
 Rehabilitation psychologists support individuals as they cope with the mental and physical
challenges their conditions present. They often teach their patients how to adapt and make
lifestyle choices that promote good health.
 Intervening to reduce stress in the lives of vulnerable individuals, thus reducing the risk of
mental illness and preventing re-hospitalization. Psychologists can do this by teaching stress
management skills (for example, to identify stressors, manage stress, and solve problems),
environmental management skills, and the social skills necessary to build their social
networks.
 Researching the effects and managements of stress.
 Developing and applying measures to assess both the stress experienced by individuals and
the internal and external resources available to cope with that stress.
 Rehabilitation psychologists are concerned with all of the factors in people’s lives that
contribute to their wellness and recovery, from the support they receive from family and
friends to the relationships they have with their team of treatment providers.
 Rehabilitation psychologists assist individuals who have disabilities and chronic illnesses; the
disability may be congenital or acquired — for example, an accident or stroke.
 Psychologists provide psychotherapy and administer assessments.
 It is also work at the societal level to make the lives of the disabled better.
 Psychologists treat might be physical, such as addiction or chronic pain
 Psychologists might work in a number of different health facilities. This can include hospitals,
physical therapy centers, long-term care centers, drug and alcohol rehabilitation centers,
psychiatric hospitals, and mental health clinics.
Keywords
Rehabilitation, centres, psychologist, APA, Therapy, Disability, Psychology
Self-Assessment
1. ‘Psychology and Rehabilitation’ was published by
A. NCPAD
B. ABRP
C. ADA
D. APA
2. When did Division 22 come into existence?

A. August 1958
B. August 1985
C. October 1958
D. October 1968
3. What is the full form of NCPAPD?

A. National Council on the Psychological Areas of Physical Disability
B. National Council on the Psychological Aspects of Disability.
C. National Council on the Psychological Aspects of Physical Disability
D. National Council on the Psychiatric Aspects of Physical Disability
4. The American Board of Rehabilitation Psychology (ABRP) was established in which year?
A. 1992
B. 1994
C. 1995
D. 1998
5. Name the recipient of the Distinguished Service Award 1988.

A. Brian Bolton
B. Leviton
C. Lyndon Johnson
D. George Wright
6. Who coined the term ‘Soma to psychology’?

A. Lee Myerson
B. Nancy Kerr
C. Dembo
D. Kurt Lewin
7. The NCPAD published a newsletter, which kept division members up to date on

organizational matters, as well as the Bulletin. Who was the first editor of the Bulletin?
A. Wilber Fordyce
B. Lee Myerson
C. George Wright
D. Brian Bolton
8. Who among the following is not the founding members of Division 22?
A. Dembo
B. Beatrice Wright
C. James Garrett
D. Leviton
9. Name the first recipient of the Distinguished Service Award for his research contribution
who was also considered as a key person in arranging sponsorship of the early
conferences defining the field of rehabilitation psychology.
A. James Garrett

Notes
Course Name
B. Bob Yuker
C. George Wright
D. William Anthony
10. Who developed the Attitudes toward Persons with Disability Scale (ATDP)?
A. Brian Bolton, 1991
B. Bob Yuker, 1991.
C. James Garrett, 1992
D. Nancy Kerr, 1995
11. When was the Roger Baker Award initiated?

A. 1998
B. 1988
C. 1982
D. 1992

1. D 2. A 3. C 4. C 5. D
6. C 7. B 8. B 9. A 10. B
11. B
Review Questions
1. Define Rehabilitation Psychology.
2. What do you understand by the Scope of Rehabilitation Psychology?
3. Describe the Goals and Objectives of Rehabilitation.
4. Mention the Functions/ Role of Rehabilitation Psychologists.
Further Readings
 Elliott, Timothy R. & Frank, Robert G.- Handbook of rehabilitation psychology, 3rd
edition, Oxford University Press

Unit 02: Disabilites: Definition, Nature, Types and Characteristics of Various Disabilities as per Notes
Person with Disabilities, Mental Retardation, Learning Disabilities and Visual Disabilities
Dr. RubinaFakhr, Lovely Professional University
Unit 02: Disabilities: Definition, Nature, Types and Characteristics

of Various Disabilities as per Person with Disabilities, Mental
Retardation, Learning Disabilities and Visual Disabilities
CONTENTS
Objectives
Introduction
2.1 General Causes of Disability
2.2 Dimension of Disability
2.3 Types of Disability
2.4 Physical Disabilities
2.5 Intellectual/Cognitive Disability
2.6 Types of Intellectual Disability
2.7 Autism Spectrum Disorder
2.8 Classification of Autism Spectrum Disorder
2.9 Learning Disability
2.10 Signs and Symptoms of Learning Disabilities and Disorders
2.11 Types of Problems in Learning Disability
2.12 Diagnosis of Intellectual Disability
2.13 Treatment and management of Intellectual Disability
2.14 Sensory Disability
2.15 Visual Disabilities
2.16 Causes of Vision Impairment
2.17 Management and Treatment
2.18 Mental Disability
2.19 Classification of Mental Disorder
2.20 Types of Mental Disorders
2.21 Causes of Mental Disorder
2.22 Assessments of Mental Disorder
2.23 Treatment and Management of Mental Disorder
Keywords
Self Assessments
Review Questions
Further Readings
Objectives
After completion of this unit, the students will be able to:
 Understand the meaning and definition of disability

Notes
Course Name
 Know different types of disabilities
 Familiarize with the classification and characteristics of various disabilities
Introduction
Kazou (2017) Disability is any condition or impairments socially, cognitive, developmental,
intellectual, mental, physical, sensory or combination of multiple factors that makes it difficult for a
person to do certain activities or interact effectively with the surrounding world.
People with disability experience discrimination and social disadvantage. Social perceptions of
disability explained social disadvantage in terms of individual impairment such as family
circumstances, income and financial support, education, employment, housing, transport and
environment (Barnes et al., 2012). Management of Persons with disability require a combination
and continuous care from specialized medical, social, psychological personnel, vocational, and
rehabilitation (Kurland, 2003).
According to WHO reports, 15% of the world’s population lives with certain types of disability, of
whom 2-4% experience substantial difficulties in functioning (Bickenbach, 2011). Based on 2010
population estimates, worldwide, 785-795 million people aged 15 years and older are disabled
(WHO, 2010). World Health Survey estimates that 110 million people of which 2.2% have
significant difficulties in functioning, in which the Global Burden of Disease Survey estimates 190
million 3.8% have severe disability, including children, over a billion people about 15% of the
world's population (WHO, 2011). Lack of education among disabled is a barrier, whereby 54.7%
belonged to illiterate category (NSSO, 2002). Hence, severe disability is significantly longer in
women than in men (Courtney-Long, et al., 2015).
2.1 General Causes of Disability

Maxwell et al. (2007) explain different causes of disability as: Poisons and pesticides: chemicals can
cause health problem; Poverty and Malnutrition: poverty people are most vulnerable to harm;
Inherited disabilities: Spinal Muscular Atrophy and Muscular Dystrophy is some inherited
disability; Nuclear Accidents: Survived people suffered from cancers especially in the thyroid
gland; War: Explosions cause people to become deaf, blind, and lose their body parts; Poor Access
to Health Care: Difficult labor cause damage; Illness: can cause disability; Medicines and Injections:
Unnecessary and overuse of injected medicines; Use of needle or syringe without sterilizing can
cause serious diseases, paralysis or spinal cord injury; Dangerous Working Conditions: Violence,
and threats; and Accidents: Burns, falls, road accidents, and breathing or drinking toxic chemicals
are a common those are among the source of disability.
In general term, disability may be associated with different conditions at birth that may affect
functions later in life, including Cognition, Mobility and Other areas including disorders in single
genes; and result of the mother’s exposure during pregnancy to infections; Developmental
conditions such as Autism; Injury, for example, traumatic brain injury; Long-standing condition, for
example, diabetes; and progressive for example, muscular dystrophy.
2.2 Dimension of Disability

According to WHO (2011) There are three dimensions of disability: Impairment in a person’s body
structure or function, or mental functioning for examples loss of a limb, loss of vision or memory;
Activity limitation: such as difficulty seeing, hearing, walking, or problem-solving; and
Participation restrictions: such as working, engaging in social and recreational activities, obtaining
health care and preventive services.
2.3 Types of Disability

There are different types of disabilities such as Physical, Intellectual, Sensory, and Mental illness the
following are among them.

2.4 Physical Disabilities
It is the disability that affect a person’s physical capacity and mobility ether in temporarily or
permanently.
Types of Physical Disabilities

Acquired brain injury: Damage to the brain including: stroke, alcohol or drugs, infection, disease, or
a lack of oxygen and cause trouble in processing information, planning, solving problems and
experience changes in their behavior and personality.
Spinal Cord Injury (SCI):Accidents, cancer, arthritis, infections, blood clots, and degenerative
spinal conditions can affect the ability to move through paralysis, it may affect many areas of a
person’s body and results in paraplegia, loss of function below the chest, or quadriplegia, loss of
function below the neck.
Spinal Bifida:It can be mild to severe including paralysis or weakness in the legs, bowel and
bladder incontinence, hydrocephalus that is too much fluid in the brain cavities, deformities of the
spine, and learning difficulties, and it is likely caused by genetic and environmental factors.
Cerebral Palsy:People experience weakness, difficulty walking, lack of muscle control, problems
with coordination and, involuntary movements in this type. Hence, lack of oxygen to the brain;
Illnesses during pregnancy; Accidental injury to the brain, meningitis in young children, and
premature birth are among the causes.
Cystic Fibrosis (CF):Is an inherited genetic condition affects body’s respiratory, digestive, and
reproductive systems and cause mucus to be thick and sticky hence, causing lung damage and
recurrent infections. Symptoms are sinus infections, liver damage, diabetes, poor growth,
diarrhoea, infertility, and low salt levels in the body, which causes problems such as fatigue,
cramps, and dehydration.
Epilepsy:A neurological condition where a person has a tendency of recurring seizures due to a
sudden burst of electrical activity in the brain and cause unusual movements, odd feelings or
sensations and change a person’s behavior to unconsciousness. Brain injuries, strokes, cancer,
structural abnormalities of the brain, and other genetic factors can all cause disability.
Multiple Sclerosis (MS):It occurs when the myelin sheath becomes damaged, causing random
patches or scars which interfere with messages sent through the central nervous system, affecting
the brain, optic nerves, and spinal cord. Symptoms include fatigue, loss of motor control, tingling,
numbness, visual disturbances, memory loss, depression, and cognitive difficulties.
Muscular Dystrophy:It is a group of genetic disorders that lead to progressive and irreversible
weakness and loss of muscle mass. Signs and symptoms can include difficulty walking, trouble
breathing or swallowing, restriction in joint motion, heart and other organ problems.
Tourette Syndrome:Is a neurological disorder involves involuntary and repetitive vocalizations,
sounds, and movements called tics. Vocal tics can include sniffing, throat clearing, tongue clicking
and grunting; Motor tics can include eye blinking, shrugging, nose twitching, head jerking, facial
expressions, touching objects or people, spinning around. It is diagnosed between the ages of 2 and
21. A combination of genetic, environmental, and neurochemical are among the factors.
Dwarfism: It defined as an adult height of 4 feet 10 inches or less with the average height of
someone with dwarfism being 4 feet (Mayo Clinic). There are two categories for dwarfism:
Disproportionate dwarfism, some parts of the body are smaller, whilst other parts are average or
above-average; and Proportionate Dwarfism, the body is averagely proportioned, and all parts of
the body are small to the same degree. Children may experience a delay in developing motor skills,
however, dwarfism does not have a link to any intellectual disability.
2.5 Intellectual/Cognitive Disability

It is the disabilities that are limited in how people are able to learn or function, have very low
Intelligence Quotient (IQ) score, fewer limits and are able to lead independent lives in the future.
Whereby, others have severe limits that make them dependent on others for care.
Intellectual disability occurs when a person has difficulty with general mental abilities. This may
impact there: Intellectual functioning in learning, judgment, problem-solving, reasoning, and
academic skills; Practical functioning, the ability to function and take care of oneself independently,

Notes
Course Name
such as performing personal care tasks; and Social functioning, the ability to function normally in
society. According to the American Psychiatric Association, 1% of the population have intellectual
disability. Around 85% of these people have mild case, whereby males are more likely to receive a
diagnosis of intellectual disability.
Causes of Intellectual Disability:The condition develops due to disease; certain brain
conditions; certain genetic conditions; fetal alcohol syndrome; brain malformations; infections;
exposure to toxins; serious head injury; stroke; maternal disease; problems at birth; extreme
malnutrition; insufficient medical care and any condition that impacts the brain and begins before
the age of 18 years, or before birth. However, intellectual disability can also develop later in
childhood or adolescence due to brain damage.
Symptoms of Intellectual:Some common symptoms include: significantly delayed motor skills,
delayed speech or difficulty speaking, difficulty learning at grade/age-appropriate level, Poor
memory, inability to understand consequences of actions, poor problem-solving skills, thinking
logically and understanding of social rules, difficulty planning, remembering things, letting others
know their needs, limited functioning in one or more daily activities, and difficulty regulating
emotions and behaviors.
2.6 Types of Intellectual Disability

Mental retardation (MR)
is a generalized disorder appearing before adulthood, characterized by significantly impaired
cognitive functioning and deficits in two or more adaptive behaviors with Intelligence Quotient
score under 70? Syndromic mental retardation is intellectual deficits associated with other medical
and behavioral signs and symptoms. Non-Syndromic mental retardation refers to intellectual
deficits that appear without other abnormalities.
Classifying Abilities
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text version (DSM-IV-
TR), classifies four different degrees of mental retardation as described below:
Mild Mental Retardation:Approximately 85% is in the mildly retarded. Their IQ score ranges
from 50-70, can acquire academic skills up to about the sixth-grade level, and become fairly self-
sufficient and in some cases live independently, with community and social support.
Moderate mental Retardation: About 10% are moderately retarded, have IQ scores ranging
from 35-55, can carry out work and self-care tasks, acquire communication skills in childhood, able
to live and function successfully within the community in supervised environments as group
homes
Severe mental Retardation:About 3-4% are severely retarded, having IQ scores of 20-40, master
very basic self-care skills and some communication skills and are able to live in a group home.
Profound mental retardation: Only 1-2% is profoundly retarded, with IQ score under 20-25, be
able to develop basic self-care and communication skills, and often caused by an accompanying
neurological disorder that need a high-level of structure with appropriate support and training.
2.7 Autism Spectrum Disorder

This is a range of conditions classified as pervasive developmental disorders in the Diagnostic and
Statistical Manual of Mental Disorders (DSM). These disorders are typically characterized by social
deficits, communication difficulties, stereotyped or repetitive behaviors and interests, and cognitive
delays.
2.8 Classification of Autism Spectrum Disorder

Autism:It is used to describe disorders that are classified as pervasive developmental disorders
that include autism, Asperger syndrome, Childhood dis-integrative disorder, Rett syndrome and
Pervasive Developmental Disorder Not Otherwise Specified. These disorders are typically
characterized by social deficits, communication difficulties, stereotyped or repetitive behaviors and
interests, and/or cognitive delays.

Asperger Syndrome:It is characterized by significant difficulties in social interaction, alongside
restricted and repetitive patterns of behavior and interests. It differs from other autism due to
preservation of linguistic and cognitive development. Physical clumsiness and atypical use of
language are frequently reported. Genetic basis is estimated cause.
Heller's Syndrome:It is a rare, has some similarity to autism, and sometimes considered a low
functioning form of it, noted before a regression in skills or a series of regressions in skills, occurs
from age 2-10, it can be very sudden, reacting to hallucinations.
Pervasive Development Disorder (PDD):The diagnostic of this refer to a group of five
disorders characterized by delays in the development of multiple basic functions, including
socialization and communication.
Retts Syndrome:Is a neurodevelopmental disorder that affects females. The clinical features
include small hands, feet and a deceleration of head growth, repetitive hand movements, scoliosis,
and constipation are also noted. They are prone to gastrointestinal disorders and up to 80% have
seizures, no verbal skills, and about 50% of individuals affected are not ambulatory.
2.9 Learning Disability

The brains are wired differently and affects how they receive and process information, see, hear,
and understand things differently; can lead to trouble with learning new information and skills.
2.10 Signs and Symptoms of Learning Disabilities and Disorders

The following are some warning sign: Preschool, have problems pronouncing words; Trouble in
alphabet, numbers, colors, shapes, days of the week, buttons, zippers, snaps, learning to tie shoes;
Difficulty rhyming, directions or routines, crayons, pencils, and scissors or coloring within the lines;
Grades K-4 Trouble connecting letters and sounds, blend sounds to make words, confuses basic
words consistently misspells words and makes frequent reading errors, trouble learning basic
math, difficulty telling time, remembering sequences and to learning new skills; and Grades 5-8
signs have difficulty with reading comprehension or math skills, trouble with open-ended test
questions and word problems, dislikes reading and writing, spells the same word differently in a
single document, poor organizational skills, trouble following classroom discussions, and Poor
handwriting.
2.11 Types of Problems in Learning Disability

Learning Disabilities in Reading (Dyslexia):There are two types of learning disabilities in
reading. Basic reading problems occur when there is difficulty understanding the relationship
between sounds, letters and words. Reading comprehension problems occur when there is an
inability to grasp the meaning of words, phrases, and paragraphs. Symptoms include problems
with: Letter and word recognition; Understanding words and ideas; Reading speed and fluency;
and General vocabulary skills.
Learning Disabilities in Math (Dyscalculia): Ability to do math will be affected differently by
a language learning disability, or a visual disorder or a difficulty with sequencing, memory or
organization. May struggle with memorization and organization of numbers, operation signs, and
number facts; and have trouble with counting principles or have difficulty telling time.
Learning Disabilities in Writing (Dysgraphia):It involves the physical act of writing or the
mental activity of comprehending and synthesizing information. Basic writing disorder refers to
physical difficulty forming words and letters. Expressive writing disability indicates a struggle to
organize thoughts on paper. Neatness and consistency of writing, accurately copying letters and
words, spelling consistency, and writing organization and coherence are among the symptoms.
2.12 Diagnosis of Intellectual Disability

Several tests are done to assess adaptive functioning such as IQ test, a score of 70–75 indicate
intellectual disability; Interviews assess adaptive functioning in conceptual, social, and practical

Notes
Course Name
functioning; general medical tests; neurological tests; psychological tests; special education tests;
hearing, speech, vision; and physical therapy evaluation.
2.13 Treatment and management of Intellectual Disability

Intellectual disability is a lifelong condition. Currently, there is no cure, people can learn to
improve their functioning over time. Receiving early, ongoing interventions can often improve
functioning and allowing someone to thrive. Most treatment plans focus on the person’s: strengths;
Needs; and support needed to function, such as receives proper care; psychological or psychiatric
services; speech and language pathology or audiology service; therapeutic recreation; and
rehabilitation counseling; adapted equipment or assistive technology. Accurate and early
diagnosis, a child can make better due to resources available in the community.
2.14 Sensory Disability

According to WHO, Sensory disability usually refers to the impairment of the senses such as sight,
hearing, taste, touch, smell, and/or spatial awareness. It covers conditions of visual impairment,
blindness, hearing loss, and deafness. Visual Impairment and/or Blindness: Decrease or severe
reduction in vision that cannot be corrected with standard glasses or contact lenses and reduces an
individual’s ability to function at specific or all tasks; Blindness: Profound inability to distinguish
light from dark, or the total inability to see; Hearing loss: Decrease in hearing sensitivity of any
level; and Deafness: Profound or total loss of hearing in both the ears (Crews, & Campbell, 2004).
2.15 Visual Disabilities

Globally, 2.2 billion people have a near or distance vision impairment, in 1 billion or half of these
cases. Vision loss can affect people of all ages. The International Classification of Diseases 11 (2018)
classifies vision impairment into two groups:
Distance vision impairment:It includes: Mild visual acuity worse than 6/12 to 6/18; Moderate
visual acuity worse than 6/18 to 6/60; Severe visual acuity worse than 6/60 to 3/60; and Blindness
visual acuity worse than 3/60.
Near vision impairment:Near visual acuity worse than N6 or M.08 at 40 cm. The availability of
prevention and treatment interventions, access to vision rehabilitation including assistive products
such as glasses or white canes, and whether the person experiences problems with inaccessible
buildings, transport and information (Fricke et al., 2018).
2.16 Causes of Vision Impairment

Globally, the leading causes of vision impairment are: uncorrected refractive errors; Cataract; age-
related muscular degeneration; glaucoma; diabetic retinopathy; corneal opacity; and trachoma. In
low-income countries, congenital cataract is a leading cause, whereas in middle-income countries it
is more likely to be retinopathy of prematurity. Uncorrected refractive error remains a leading
cause of vision impairment in all countries amongst adult and children (Steinmetzet al., 2021).
2.17 Management and Treatment

There are effective interventions covering promotion, prevention, treatment and rehabilitation
which address the needs associated with eye conditions and vision impairment. WHO world report
on vision (2019) identifies key areas of work and activities in the prevention of blindness, including
working with Member States and other partners to provide recommendations on feasible global
targets for 2030; Observing and promoting World Sight Day; Ongoing development of technical
tools to support the implementation of the World report on vision: and assess the provision of eye
care services.

2.18 Mental Disability
According to DSM-IV, a mental disorder is a psychological syndrome associated with distress such
as painful symptoms, impairment in one or more important areas of functioning, increased risk of
death, or causes a significant loss of autonomy.
The American Psychiatric Association (2013) (APA) redefined mental disorders in the DSM-5 as "a
syndrome characterized by clinically significant disturbance in an individual's cognition, emotion
regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental
processes underlying mental functioning’.
In 2019, common mental disorders include depression which affects about 264 million, bipolar,
which affects about 45 million, dementia, which affects about 50 million, schizophrenia and other
psychoses, which affects about 20 million people, Neurodevelopmental disorders. Hence, stigma
and discrimination add the suffering.
2.19 Classification of Mental Disorder

Currently, there are two systems that classify mental disorders: International Classification of
Diseases (ICD-10) Chapter V: Mental and behavioral disorders, since 1949 by WHO; and Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) produced by the APA since 1952.
2.20 Types of Mental Disorders

Anxiety Disorder:Is a fear that interferes with normal functioning, which include specific phobia,
generalized anxiety, social anxiety, panic, agoraphobia, obsessive compulsive and post-traumatic
stress disorder.
Mood Disorder:It is an unusually intense and sustained sadness, including melancholia, or
despair, which is known as major depression or unipolar or clinical depression; Prolonged
depression; and bipolar disorder which is known as manic depression.
Psychotic Disorder:Patterns of belief, language use and perception of reality such as delusion,
hallucination, and thought disorder. It includes schizophrenia and delusion disorder.
Personality Disorder:it is the fundamental characteristics of a person that influence thoughts and
behaviors across situations and time and it includes eccentric, such as paranoid, schizoid, and
schizotypal personality disorders; types that have described as dramatic or emotional, such as
antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed
as fear-related, such as anxious-avoidant, dependent, or obsessive-compulsive personality
disorders.
Eating disorder:It is a disproportionate concern in matters of food and weight that include
anorexia nervosa, bulimia nervosa, excessive bulimia or binge eating disorder.
Sleep disorders: are associated with disruption to normal sleep patterns. A common sleep
disorder is insomnia, which is described as difficulty falling and/or staying asleep, narcolepsy,
sleep apnea, REM sleep behavior, chronic sleep deprivation and restless leg syndrome.
Sexual disordersinclude dyspareunia and various kinds of paraphilia that is sexual arousal to
objects, situations, or individuals that are considered abnormal or harmful to the person or others.
Substance use disorder:It refers to the use of drugs, legal or illegal, including alcohol that
persists significant problems or harm related to its use and includes substance dependence and
substance abuse.
Dissociative disorder:It is a severe disturbance of self-identity, memory, and general awareness
of self and surroundings including depersonalization or dissociative identity disorder, which was
previously referred to as multiple personality disorder.
2.21 Causes of Mental Disorder

genetic, psychological, and environmental factors all contribute to the development or progression
of mental disorders. Different risk factors may be present at different ages, with risk occurring as

Notes
Course Name
early as during the prenatal period such as unwanted pregnancy, lack of adaptation to pregnancy
or substance use during pregnancy, maternal stress and birth complications including prematurity
and infections; and infants neglected or not provided optimal nutrition; Social influences including
abuse, neglect, bullying, social stress, traumatic events and negative or overwhelming life
experiences, socioeconomic inequality, lack of social cohesion, features of societies and cultures,
nutrition, drug use, chronic deceases and personality trait.
2.22 Assessments of Mental Disorder

It is carried out by mental health professionals such as psychiatrists, psychologists, psychiatric
nurses and clinical social workers, by psychometric test and by observation and questioning.
Treatments are provided by various mental health professionals. Psychotherapy and psychiatric
medication is two major treatment options. Other treatments include lifestyle changes, social
interventions, peer support and self-help.
2.23 Treatment and Management of Mental Disorder

Treatment and support for mental disorders are provided in psychiatric clinics or community
mental health services and may include placebo effect; Lifestyle strategies, including dietary
changes, exercise and quitting smoking may be of benefit; counselling and psychotherapy including
family, counselor, public health professionals, peer support. A major option for many mental
disorders is psychotherapy including Cognitive Behavioral Therapy (CBT); Dialectic Behavioral
Therapy (DBT) and Interpersonal Psychotherapy (IPT); psychoanalysis; family therapy; humanistic
approach; and eclectic or integrative approach; medication such as antidepressant, antianxiety
including sedatives, mood stabilizers; antipsychotic; and stimulant; and Electroconvulsive therapy
(ECT).
Keywords
 Disability
 Disorders
 Mental retardation
 ASD
 Classification
 Assessments and treatments
SelfAssessments
1. What do you mean by disability?
A. Physical condition that affects person's mobility, physical capacity, stamina, or dexterity.
B. A physical disability is a physical weakness.
C. A Person who physically disable to perform certain task.
D. All the above
2. Which among the following is not the type of disability?

A. Physical disability
B. Mental disability
C. Learning disability
D. Climb disability
3. What is the most common type of cognitive disability?

A. Mild
B. Moderate

C. Severe
D. Average
4. What type of cognitive disability has IQ scores that range from 30-55?
A. Mild
B. Moderate
C. Severe
D. Average
5. What is the range of IQ scores for a mild cognitive disability?

A. 85-100
B. 65-85
C. 40-65
D. 55-70
6. Which of the following is an example of a Specific Learning Disability?

A. Mental
B. Retardation Dyslexia
C. ADHD
D. Autistic spectrum disorders
7. Which of the following is an example of intellectual disability

A. Dyslexia
B. ADHD
C. Mental Retardation
8. An example of a Developmental Disorder is:

A. ADHD
B. Dyslexia
C. Mental Retardation
9. Intellectual disability characterized by

A. Significant impairment in cognitive and adaptive behavior
B. Condition gone under constant change over years due to social and political compulsion
C. A and B Wrong
D. A and B Correct
10. The following is the characteristic of disability.
A. Intellectual
B. Physical
C. Sensory
D. All the above
11. Which of the following criteria can be used to define Intellectual disabilities?
A. Significantly below averages intellectual functioning

Notes
Course Name
B. Impairments in adaptive functioning generally
C. These deficits should be manifest before the age of 18-years
D. All the above
12. What is intellectual disability?

A. Intellectual disabilities are disorders that originate before 18 years of age
B. Resulting from physical causes or non-physical causes such as lack of stimulation
C. Characterized by a limited mental capacity and difficulty with adaptive behaviors
D. ABC is correct
13. Which is not considered as a physical disability?

A. Spinal cord injury
B. Cerebral palsy
C. Toothache
D. Multiple sclerosis
14. What are the problem of disabled?

A. Education
B. Health
C. Finance
D. All the above
15. Identify the eating disorders.

A. Anorexia Nervosa
B. Bulimia Nervosa
C. Both
D. None
Review Questions
1. What is dysgraphia?
2. What are general causes of disability?
3. What are the different types of learning disabilities?
4. What are the intellectual disabilities? Discuss its treatment.
5. What do you understand by mental retardation?
6. Briefly discuss sensory disabilities.

1. D 2. D 3. A 4. B 5. D
6. D 7. A 8. D 9. D 10. D
11. D 12. D 13. C 14. D 15. D

Further Readings
 Frontera, W. R., Silver, J. K., & Rizzo, T. D. (2018). Essentials of Physical Medicine and
Rehabilitation e-book. (4th ed.) Elsevier Health Sciences.
 Kirk, S., Gallagher, J. J., & Coleman, M. R. (2014). Educating Exceptional Children.
(11th ed.) Cengage Learning.
 Livneh, H., & Parker, R. M. (2005). Psychological adaptation to disability:
Perspectives from chaos and complexity theory. Rehabilitation Counseling Bulletin,
49(1), 17-28.

Unit 03: Models of Disability: Theories and Models of Adaptation to Disability, Adaptation Notes
Processes, Ways of Coping with Disability
Unit 03: Models of Disability: Theories and Models of Adaptation

to Disability, Adaptation Processes, Ways of Coping with
Disability
CONTENTS
Objectives
Introduction
3.1 Adaptation Models
3.2 Adaptation Process
3.3 Intervention Strategies For Individuals & Families Of Disabled
Keywords
Self- Assessment
Review Questions
Further Readings
Objectives
After completion of this unit, the students will be able to:
 Understand the diverse models of disability

 Know different interventions for disability
 Familiarize with the adaptation and coping processes
Introduction
A disability is any condition of the body or mind that makes it more difficult for the person with
the condition to do certain activities and interact with the world around them. Although people
with disabilities sometimes refer to a single population, this is actually a diverse group of people
with a wide range of needs. According to the World Health Organization, disability has three
dimensions:
 Impairment in a person’s body structure or function, or mental functioning such as loss of a

limb, loss of vision or memory loss.
 Activity limitation such as difficulty seeing, hearing, walking or problem solving.
 Participation restrictions in normal daily activities such as working, engaging in social and
recreational activities and obtaining health care and preventive services.
3.1 Adaptation Models

Adaptation is a term referring to the ability to adjust to new information and experiences. Learning
is essentially adapting to our constantly changing environment. Through adaptation, we are able to
adopt new behaviours that allow us to cope with change.
Adaptation models include

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Course Name
 Somatopsychology
 Stage models
 Ecological models
 Somatopsychology
Somatopsychologyprovides a framework to understand the influence chronic illness and disability
(CID) on the psychological adjustment of the individual. It is rooted in Kurt Lewin’s (1935, 1936)
field theory, concerned with the influence of social factors on individual behaviour.
1) Wright’s model (1960,1983) of adjustment to Chronic Illness and Disability

This model is based on the principles of somatopsychology and disability acceptance. He used the
term acceptance instead of adaptation and adjustment. Acceptance is an outcome in which the CID
is incorporated as part of the individual’s self-concept and it is accepted as non-devaluing. CID is
perceived as misfortune or value loss (Dembo, et al 1956). Wright developed a framework of coping
versus succumbing to CID.
Succumbing: According to this framework, a person who is succumbing to CID emphasis its
negative effects and neglects the challenge for change and meaningful adaptation. They deny or
cover up CID and idolize normal standards and strive to reach unattainable standards of normal
performance. Their behaviour focusses more on deficit behaviour rather than asset behaviour.
Coping:People who focus on their individual intrinsic and asset values and are oriented to what
they can do is described as coping. People who are coping with CID experience changes in their
value system that limits devaluation.
2) Schilder(1950), Livneh&Antonach(2005) Model

According to this model, self-concept & body image has roots in somatopsychological principles.
These concepts can be seen to follow somatopsychological principles as they arise from the
presence and resulting influence of CID on the psychological adjustment of the individual. Self-
Concept and Body images are schemas or mental representations by which human perceive and
identify themselves (Schilder, 1950). When these schemas are disrupted by the onset of CID, the
person must reconstruct new or revised schemas by which they will perceive themselves. If the
individual is able to successfully integrate changes caused by the CID into his/her self-perception
successful adaptation is said to be reached (Livneh&Antonach 2005).
 Stage Model
The process of psychosocial adaptation to Chronic Illness and Disability has also been viewed as a
sequence of stages similar to those experienced during grief. Stage model describes the process of
adaptation to CID as a linear series of psychological stages through which one has to progress
before finally reaching the stages of adjustment. According to this linear developmental approach
to adaptation, the appearance of later stages is predicated on the resolution of earlier stages. Several
theoretical models have been proposed to describe the psychosocial stages of adaptation to physical
disability.
1) Unified model of adaptation to physical disability

Liveneh(1986) conducted an extensive literature review of more than 40 stage models and created a
unified model of adaptation to physical disability, based on a synthesis of these models. He
concluded that there are 5 broad categories
1. Initial impact: This is the first stage in the process of adaptation to a physical disability consisting
of 2 separate sub stages a) shock: involves individual’s initial or emergency reaction to the sudden
onset of the disability or news of a disease diagnosis b) Anxiety: panic-stricken reaction on initially
understanding the magnitude of the injury, diagnosis or psychologically traumatic event.
2. Defensemobilization: Encompasses the somewhat overlapping substage of bargaining and

denial. Bargaining and Denial are similar because they both involve the expectation of recovery.
Bargaining involves the person’s expectation of recovery through restitution agreement or protest
and Denial involves the expectation of recovery but without the deal making proposals and

protests. Bargaining is of shorter duration than denying reaction, involves a moderate level of
suppression of CID and its consequences, in contrast to denial, which is more extensive level of
suppression. Unnecessary risk taking and resisting help efforts are examples of behaviours
observed during this stage. The individual makes effort to act as if nothing has happened and no
physical limitations have affected their functioning level (Wright, 1960).
3. Initial realization: this is a period of great emotional turmoil, during which the reality of
traumatic event and its consequences are being processed or realized for the first time. It includes
subcategories of mourning, depression and internalized anger. Mourning and depression are
similar reactions, mourning is of shorter duration and depression is of longer duration and of a
more general and diffuses nature. Internalized anger is a manifestation of self-directed resentment
and bitterness, associated with feelings of self-blame. Suicidal ideation, self-abuse or self-injurious
behaviours can occur, particularly in those individuals who perceive themselves as the cause of the
traumatic event along with passive-aggressive, uncommunicative and withdrawn behaviours.
4. Retaliation/rebellion stage: It is referred as expressed anger/aggression, in which anger and

bitterness are projected outward. It is viewed as an attempt to retaliate against the functional
limitations of CID. This stage is marked by the hostility toward other people, object or aspects of
environment that are associated with the onset of disability. Overt modes of hostility such as
verbally or physically abusive behaviours and passive aggressive behaviours uncooperativeness
may be observed during this stage.
5. Reintegration/ Reorganization: This is the final stage of adjustment and is further categorized
according to cognitive (acknowledgement), affective (acceptance) and behavioural (final
adjustment) components. Acknowledgement is the first indication that the person has cognitively
reconciled the permanence of the condition and its future implications. Acceptance and final
adjustment are the final stages in adaptation process. The individual internalizes the functional
limitation of CID into their self-concept and demonstrate self-approval and self-acceptance. During
this stage individual implements his/her goals and mastery of new behaviours and social roles.
 Ecological Models
1) Liveneh&Antonak’s Model (1997)

Liveneh and Antonak provided the review of some of the more influential ecological models of
adaptation and found them to share certain conceptual and structural components. They found that
there were 4 primary classes of variables that were important in the process of adaptation. The first
three variables are interpersonal variables and the fourth is external variable.
1. Variables associated with CID,
2. Variables associated with sociodemographic or organismic characteristics of the individual
3. Variables associated with personality and behavioural attributes of the individual,
4. Variables associated with physical and social (external) environment.
1. CID related variables: Include characteristics that are directly CID related. They are cause of the
condition, type CID, type of onset, extend of condition, degree of functional involvement, body
areas affected, extend of brain and central nervous system involvement, age at diagnosis, age of
symptom onset, chronicity, stability of condition, lethality and visibility.
2. Socio-demographic Variables: Include gender and gender-role identification, chronological age,

life or developmental stage, ethnicity, socioeconomic status, state of general health, level of
education, marital status, occupational attainment, job history, and existing vocational skills.
3. Variables associated with personality and behavioural attributes of the individual: Include
coping strategies used, defence mechanism used, locus of control, perceived control, personal
meaning of the condition, attitude towards health and sickness, personal values and beliefs, self-
concept and ego strength, body image, cognitive competence of intellectual ability, acceptance of
CID, premorbid psychosocial adaptation, previous experience of crisis of a similar nature.

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4. Variables associated with physical and social (external) environment: Include social support
systems, economic and institutional support, physical settings, attitudinal barriers or supports.
Specific variables in the first three classes interact with specific variables in the fourth class to
determine the degree and speed of psychosocial adaptation to chronic illness and disabling
conditions. Within ecological model, psychosocial adaptation is classified into
a) Earlier reactions: shock, anxiety, denial
b) Intermediate reactions: depression, internalized anger, externalized hostility
c) Later reactions: acknowledgement, acceptance, adjustment
2) Disability Centrality Model (Bishop,2005)

In his model, Bishop elaborated on the relationship between quality of life and psychosocial
adaptation to CID. This model is an extension of Denvin’s illness intrusiveness approach, in which
CID serve as a disruption in individual’s life, and can be interpreted by its impact on psychosocial
wellbeing or quality of life (Denvins, 1994). Four components of the model include satisfaction,
perceived control, impact of CID and its treatment and the importance of each domain to the
individual. Bishop suggested that this model help the clinicians to gain a comprehensive picture of
individual’s adaptation and helps in rehabilitation planning and prioritizing interventions.
3.2 Adaptation Process

Hornby, 1982 explained adaptation process as categorized into seven stages
 Shock: The initial reaction of parents on being informed of their child’s disability it is typically
one of shock. Parents report feeling, confusion, numbness, disorganization and helplessness
 Denial: Shock is typically followed by a phase characterized by denial or disbelief of the
reality of the situation. They may think that there must have been a mistake. It is
understandable that they want a second opinion and this option should be made available to
them
 Anger: When parents are beginning to accept the reality of the situation, they tend to
experience anger about the fact that their child has a disability. They may search for cause of
disability for someone to blame
 Sadness: Sadness may follow anger and is a reaction which more than any other, is reported to
pervade the whole adaptation process. This sadness can be due to parent’s grieving for the
loss of the healthy child which they expected or it can be due to sadness about the loss of
opportunities and ambitions which their children will not be able to fulfil.
 Detachment: Following sadness, parents experience a sort of detachment, when they feel
empty and nothing seems to matter. Life goes on from day to day but it has lost its meaning.
The appearance of this reaction is considered to indicate that the parent has begun to
reluctantly accept the reality of the disability. It is therefore thought to be a turning point in
the adaptation process
 Reorganization: It is reaction which follows detachment. It is characterized by realism about
the situation and hope for the future. Parents begin to focus more on what their children may
achieve and less on what they may miss out on
 Adaptation: Finally, they reach a point when they have come to terms with the situation and
exhibit a mature emotional acceptance of their child’s disability. They are fully aware of
child’s special needs and strive to provide for these.

3.3 Intervention Strategies For Individuals & Families Of Disabled
Disabilities are classified as acquired or congenital. There is a need to intervene so the person as
well as families receives quality care and support. The ultimate aim of any intervention program is
to improve the quality of life of persons with disability and their families. Also it should ultimately
lead to reintegration of person into community living like any other normal individuals (social
inclusion). So, interventions need to be holistic in nature helping the person and family to adapt
and to adopt healthy way of living leading to the growth of person and family. In order to achieve
this goal, the intervention strategies need to cover the following domains:
 Medical Based Interventions

Medical based interventions are intended to: find out the medical causes, provide a clear diagnosis,
find out associated conditions, to provide appropriate treatment, and taking means to limit the
extent of disability. The various interventions that come under this domain are as follows:
1. Early detection:
It involves identifying babies who are at risk of developing disability and having developmental
delay. Early intervention refers to the introduction of planned programming deliberately timed and
arranged in order to alter the anticipated or projected course of development. (Siegal, 1972). Babies
who are at risk & with developmental delay will be the target group of this mode of intervention. It
provides comprehensive interventions in the domains of physical, cognition, communication,
social, emotional, sensory and adaptive behaviour.
2. Therapeutics:
 Physiotherapy: It employs physical methods to restore healing, including massage,

hydrotherapy, remedial exercise etc. It helps the patient in movement restoration.
 Occupational therapy: It involves restoring, reinforcing & enhancing the function/ decreasing
the impact of disability and thus promoting health through activities. Its primary goal is to
help the individuals with compromised physical functioning to adapt to their impairments to
regain their optimal function.
 Speech therapy: It is a therapeutic treatment to correct defects in speaking. Such defects may
originate in the brain, ear, or anywhere along the vocal tract and may affect the voice,
articulation, language development, or ability to speak after language is learned.
3. Pharmacotherapy:
It is given to reduce the impact of associated conditions & secondary complications of disability
E.g.: fits, spasticity, hyperactivity, excessive cry, nutritional deficiency, infections, bed sore etc. It
can also be given to control pain
4. Surgical interventions:
It is Disorder specific. E.g.: Cochlear implant, amputation, Shunt (hydrocephaly).
5. Lifestyle changes:
 Diet: There will be specific diet to be followed in certain disabling conditions. E.g., for autism:
gluten free casein free diet and for epilepsy: ketogenic diet.
 Exercise increases flexibility & muscle strength which in turn helps to reduce pain. It can also
have psychological benefits of decreasing anxiety & depression.
6. Assistive technology:
Any item or a piece of equipment/system whether acquired commercially, modified or customized
that is commonly used to increase, maintain or improve functional capabilities of Person with
Disabilities are commonly called assistive technology. It helps them to undertake Activities of Daily
Living, pursue education, acquire movement in built environment, working and engage in leisure

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activities. It can be classified as Mobility devices, Postural supportive devices, Orthotic devices,
Prosthetic devices, Self-help & communication devices and Recreational aids. They compensate for
their limited action & promote independence. They aim to empower them to live with dignity and
enhance Quality of Life.
 Psychosocial Interventions
These interventions help the person as well as family to adjust effectively to the condition. They
include
1. Counselling:
It is an important step in the rehabilitation process and is a continuing process. It begins with the
initial interview. The rehabilitation professionals need to translate the technical facts about the
disabling condition of patient into simple language and communicate with empathy, openness but
in a realistic manner. They need to provide adequate time for information, question, and further
sessions for patients as well as families.
2. Psychoeducation:
Psychoeducation is providing scientific information about the disability, its symptoms, causes &
management. It increases patient’s self-efficacy and control and improves psychological and
physical functioning.
3. Parent training:
Parent Training involve receiving guidance from the professionals in order to cope with their
children’s problem and facilitate their development. It is an effective technique to create awareness
and to sensitize parents regarding the needs of child. It emphasizes on normal child development,
child rearing methods and behaviour management. Professionals must be careful regarding how
specific techniques can be communicated to parents because their application may be
misunderstood and misused. They can be trained in advocacy skills as well as coping skills.
4. Psychotherapy:
 Supportive therapy: Focus is on prevention of emotional breakdown & teaching of new coping
skills. This helps the patient/family to facilitate through the adaptive process
 Behaviour therapy: Based on the theories of learning, and aims at changing maladaptive
behaviour and substituting it with adaptive behaviour. Different methods are employed to
increase the desirable behaviour and decrease the undesirable behaviour.
 Cognitive Behavioural Therapy: Focus is on challenging irrational beliefs about the
disability/condition and providing them coping skills to handle their condition. Eg “my
disability is a punishment”, ‘It is impossible for a PwD to be happy’
 Stress Management Techniques: It provides training in various techniques to help people handle
the stress of having disability. The following techniques are helpful: Progressive relaxation,
meditation, biofeedback and guided imagery.
 Group Therapy: In Group therapy the groups consist of people facing same problem. It helps
them to compare coping strategies, solutions to daily life problems and provide support to
each other. They can share emotions & discuss topics such as physical problems, relationship
with family/friends, finding meaning in life, &various other issues.
 Family Therapy: Focus is on problems in the family structure or communication pattern which
helps to understand the dynamics of families. Interventions are designed to bring about
constructive change in functioning of family as a whole.
5. Parent associations:
Parents have a feeling of solidarity towards other parents which leads to the formation of such
associations. They receive emotional support and obtain information about services, benefits
available for their children. It gives them a common platform to come together and fight for a

cause. Nowadays not only parents, but also family members, volunteers, professionals and even
friends of PwDs are joining such organizations.
6. Respite care:
Family is under continuous strain of taking care of PwD. They can’t ask for temporary help from
others because PwD has specific needs. As a result, family has restrictions in free time, ability to
respond to urgent demands. Also, occupational restrictions become serious when both
parents/single parents are working. Respite care helps families with such needs and provides care
to PwD in place of the family.
 Educational
Aim of education is the development of total personality of the child by providing program of
academic excellence, vocational orientation and cultural fulfilment. The primary task of education
for a child with disability is to prepare the child to face the challenges of life and take up
responsibility of citizen despite his/her disability. It also prepares him/her to adjust to
sociocultural environment designed to meet the needs of normal. The difference lies in the method
employed to teach the child and the means the child uses to acquire the information. These
differences in methodology do not influence the content/goals of education. This form of education
is referred to as Special education. It refers to classroom/private instructions involving techniques,
exercises & subject matter designed for students whose learning needs cannot be met by a standard
school curriculum.
 Economic &Vocational
It involves vocational training & employment. It aims at developing and enhancing the functional
abilities of a PwD so that h/she is gainfully occupied resulting in economic contribution to self and
family. It improves Quality of Life of PwDs, socially & economically mainstreams them, contributes
to self-esteem. It is the toughest aspect of rehabilitation. The avenues of employment for the PwD
can be unorganized and organized sector. Under Unorganized sector it could be Self-employment,
Homework, Cooperatives formed by PwD and CBR. Under Organized sector it could be Open
employment, Special employment, Sheltered workshop, transitory employment and On-the-job
training centers.
 Community Based Rehabilitation

Disability requires lifelong management. Therefore, activities aimed at enabling PwD need to be
community based as much as possible. CBR is an effective method of intervention; it is a strategy
within community development for the rehabilitation, equalization of opportunities and social
integration of all PwDs. Its primary objective is to improve quality of life of PwDs. It is
implemented through the combined efforts of PwDs, families & communities and the appropriate
health, education, vocational, social and empowerment services. Some of the advantages of
community-based rehabilitation are more number of PwD can be reached, cost effectiveness,
greater sustainability and improved Quality of Life. It makes social integration of PwDs possible.
Keywords
 Disability
 Rehabilitation
 Coping
 Models
 Intervention
 Adaptation

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Course Name
Self- Assessment
1. A child who reads ‘top’ as ‘pot’ falls in which category of learning disability?
A. Dyscalculia
B. Dyspraxia
C. Dyslexia
D. Dysgraphia
2. Which of the following are psychosocial intervention strategies for individuals and
families of disabled?
A. Neuropsychological interventions
B. Respite care
C. Self-help group/ Parent association
D. All of the above
3. Which type of school does not come under the same category as the other three in not
catering to CWSN?
A. Inclusive
B. Integrated
C. Multigrade
D. Special
4. Degree of severe hearing loss is:

A. 20-40 dB
B. 65-90 dB
C. 0-65 Db
D. 5 and up Db
5. Which of the following practices promotes inclusion in the context of children with
disabilities?
1. Barrier free access
2. Assistive devices and appropriate technology-based tools
3. Choice of regular or special schooling as well as home -based education
4. Uniform structured curriculum and means of assessment
A. 1, 2, 3
B. 1, 2, 4
C. 1, 3, 4
D. 2, 3, 4
6. According to Liveneh (1986), how many stages are in the unified model of adaptation to a
physical disability?
A. 3
B. 6
C. 5
D. 4
7. According to Liveneh&Antonakz’s Model (1997), which of the following are CID related
variables that were important in the process of adaptation?

A. Ethnicity
B. Lethality
C. Acceptance of CID
D. All the above
8. Orthotic and Prosthetic devices are…………… devices for medical based intervention
strategies for individuals and families disabled.
A. Surgical
B. Therapeutic
C. Adaptive
D. Assistive
9. How many disability areas are covered under the Rights of Person with Disability
(RPWD) Act,2016?
A. 7
B. 16
C. 21
D. 26
10. Optimizing access to tools and assistive technologies will help in inclusion of:
1. Students with loss of vision
2. Students with attention Deficit Hyperactive Disorder
3. Students with Cerebral Palsy
4. Students with extraordinary talent
A. 1
B. 2, 3
C. 1, 2, 3
D. 1, 2, 3, 4
11. In which year the Rights of Persons with Disabilities Bill was Passed?
A. 2016
B. 2005
C. 2012
D. 2010
12. Which of the following is a form of child abuse that is known to cause intellectual
disability?
A. Shaken baby syndrome
B. Abused child syndrome
C. Battered baby syndrome
D. Damaged infant syndrome
13. What is the visual acuity for legally blind?

A. More than 20/200
B. Less than 20/200
C. Exact 20/200
D. None of the above

Notes
Course Name
14. Which is not a type of speech disability?

A. Dysarthria
B. Cleft Palate
C. Dyspraxia
D. Amputation
15. Autism is a type of……………… disability.

A. Intellectual
B. Developmental
C. Physical
D. Other
Answers for SelfAssessment

1. C 2. D 3. C 4. B 5. A
6. C 7. B 8. D 9. C 10. D
11. A 12. A 13. B 14. D 15. B
Review Questions
1. What is Disability? Give examples.

2. Discuss adaptation models in brief.
3. What is stage model? Explain.
4. What are seven stages of adaptation process?
5. Discuss medical based interventions.
6. What are Psychosocial interventions?
Further Readings
 Rehabilitation counselling: approaches in the field of disability by Brown, R. &
Robertson, S. (1992)
 Disability management in India: challenges & commitments by Mohapatra, C.S.
(2004)

Unit 04: Psychological Assessment-Assessment of Cognition, Aptitudes, Psychopathology, Notes
Work/Vocational and Daily Functioning
Unit 4: Psychological Assessment-Assessment of Cognition,

Aptitudes, Psychopathology, Work/Vocational and Daily
Functioning
CONTENTS
Objectives
Introduction
2.1 Meaning and Definitions
2.2 Assessment of Cognition
2.3 Assessment of Aptitude
2.4 Assessment of Psychpathology
2.5 Work/Vocational Assessment
2.6 Daily Functioning
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
This unit will enable you to:
 Understand the nature of psychological assessment

 Elucidate the basic meaning of psychological assessment;
 Evaluate the various assessment types of psychological assessment;
 Acknowledge daily functioning module of assessment
Introduction
Psychological rehabilitation helps disabled individuals to develop emotional, social and intellectual
skills needed to live, learn and work in the community with the least amount of professional
support. The main objective of psychological rehabilitation is to help individuals who have special
needs so that they can lead a happy and confident life.
Assessment is the first step in psychological rehabilitation. Psychological rehabilitation intervention
can be used in cases of mental disorders, harmful addictions and in wellness programs. It is a key to
psychosocial and social integration difficulties that usually people undergo. These interventions
give support in their daily lifestyles in the most independent and decent manner.
The main aim of this type of intervention is to focus on personal and social skills and lay a
guideline for the affected people and their families. The assessment in rehabilitation is a trust-based
relationship between client and psychologist. Psychologist must be well trained and has good
interpersonal skills.

Notes
Course Name
2.1 Meaning and Definitions
Essentially, psychological assessments involve the process of gathering data or critical information
on a child’s areas of development and growth. This can include cognitive ability (IQ testing),
behavioral and emotional functioning, and academic skills, among others.
Early childhood psychological assessments are tools used to have a comprehensive understanding
of a child’s capabilities. This means parents are educated about their children’s challenges and thus
help them to address it. It can also serve as an early resource to improve their learning.
Thanks to these assessments, parents are able to augment their child’s strengths and improve their
areas of weakness. Moreover, physiological assessments make way for early interventions and
support treatments that may be necessary for the child.
Psychological assessment can be as written, verbal and visual evaluations so that to assess the
cognitive, aptitude, psychopathology, vocational and neurological functioning of children.
2.2 Assessment of Cognition

IQ evaluations in the form of cognitive assessments are essentially used to measure and determine
a child’s learning capacity by recognizing a kid’s strengths and weaknesses on a cognitive level.
This assessment makes it possible to establish a learning profile for a child that can be useful for an
IEP or individualized education program that educators can utilize.
Cognitive assessments typically involve verbal comprehension tests, visual-spatial ability, cognitive
processing speed, and reasoning skills. Moreover, cognitive assessments, just like psychodiagnostic
ones, assist in the diagnosis of intellectual giftedness (Savant syndrome), ADD/ADHD, and autism.
2.3 Assessment of Aptitude

This assessment gauges a student’s academic aptitude. Regardless of age, any student, either young
or old can take it. Psycho-educational assessments are especially useful for children to realize their
academic potential. Apart from this, they can also determine if the child has learning disabilities, so
it can be addressed as early as possible.
Educators can take advantage of psycho-educational reports in formulating educational plans that
are specific for the needs and academic ability of a child.
Numerical Reasoning Test
Measure the ability to work with numerical and problem solving skills.
Verbal Ability Test
Analyze skill of writing and effectively work with words.
Spatial Reasoning Test
Assess the ability of distance and direction.
Deductive Reasoning Test
Assesses the ability to work effectively with analytical abilities.
Inductive Reasoning Test
Measures the ability to access inductive reasoning.
Memory Retention Test
Assess the memory related to attention.
Attention & Error Detection Test
Measures trial and error problems through stimuli and also learn about span of attention.
2.4 Assessment of Psychpathology

This type of assessment is used to assist in the diagnosis of ADD/ADHD and ASD. It also sheds
light on a child’s behavior (disruptive or not), emotional functioning, moods, and personality, as

well as mental and cognitive processing. Psychometric psychologists then interpret data to identify
the most effective measure to address behavioral and developmental challenges.
In this assessment individual can get knowledge about mental impairment in the form of
psychological symbols and symptoms. In it there are so many techniques by which we can measure
like as an interview method, projective techniques and also behavioral assessment tools as
observation and inventories.
2.5 Work/Vocational Assessment

A Vocational Psychological Assessment is a detailed assessment of psychological functioning and
transferable skills, as well as formal testing of cognitive functioning, academic achievement, and
vocational interests. The assessment results are provided in a detailed report, with specific,
individualized recommendations to support successful vocational planning.
Vocational tests are used to assess interest, personality and abilities. It is also related to provide
information about career or career counseling. We have so many inventories to measure interest of
an individual to choose path about work/vocational related.
There are so many inventories which we can use like Strong Interest Inventory, Self-Efficacy Scale,
Minnesota Importance Questionnaire and Self-Confidence Inventory etc.Because of these
questionnaires person can predict their future platforms and can assess interesting factor that they
are able for that career or not.
2.6 Daily Functioning

Webster (1990) defined functioning as activities or performance, ‘a natural or proper action for
which a person, office, thing or organization is fitted or employed’. An assessment of functioning
may focus on global functioning or specific evaluation of skills and behaviors.
Daily functioning skills based mainly on the result of functioning for example an individual is a
married and also have friends and employment tasks. In psychological rehabilitation assessment
involves later in the process of assessment. Firstly, interview and observational skills are used to
assess the person and then assessment of functional activities has been started.
Functional assessment in psychiatric rehabilitation and in functional assessment of daily can be
used as in both symptoms and universal functioning also. The Behavior and Symptom
Identification Scale (BASIS-32) a 32-item self-report measure includes items related to symptoms
and role functioning to check daily functioning skills of an individual.
The date of September 8 was chosen as World PT Day in 1996. World

Physiotherapy was established on this day in 1951. The day honours the
world's physiotherapy community's togetherness and unity.
Summary
 Psychological rehabilitation intervention can be used in cases of mental disorders, harmful
addictions and in wellness programs.
 Psychological assessment can be as written, verbal and visual evaluations so that to assess the
cognitive, aptitude, psychopathology, vocational and neurological functioning of children.
 A Vocational Psychological Assessment is a detailed assessment of psychological functioning
and transferable skills, as well as formal testing of cognitive functioning, academic
achievement, and vocational interests.
 Cognitive assessments typically involve verbal comprehension tests, visual-spatial ability,
cognitive processing speed, and reasoning skills. Moreover, cognitive assessments, just like
psychodiagnostic ones, assist in the diagnosis of intellectual giftedness (Savant syndrome),
ADD/ADHD, and autism.

Notes
Course Name
Keywords
Rehabilitation: -A set of interventions designed to optimize functioning and reduce disability in
individuals with health conditions in interaction with their environment.
Cognition: - Cognition refers to set of mental abilities and process of acquire knowledge
andexperience with the help of thinking and cognition.
Aptitude: - Aptitude can be said as ability or capability to learn skill through experience and
training.
Intervention: - A unique interrelationship between a client and a counselor, which aims to create a
change and a growth in three main areas: Personal development, social adjustment, and
professional development.
Psychopathology: -Psychopathology is the study of mental disorders in which we have to go
through causes, symptoms, prevention and treatment.
SelfAssessment
1. Which of this is not correct for rehabilitation?
A. It helps only to develop emotional skills.
B. It can help only some individuals
C. It is a short-time process
D. It is helpful for those individuals who have special needs.
2. __________ involve the process of gathering data or critical information on a child’s areas
of development and growth. -
A. Physical agility test
B. Assessment
C. Physical examination
D. None of above
3. ADHD is basically related to –

A. Children
B. Young adults
C. Old age
D. None of above
4. Spatial reasoning test is related to

A. Memory
B. Numerical ability
C. Verbal ability
D. Distance
5. _________is a detailed assessment of psychological functioning and transferable skill.

A. Vocational psychological assessment
B. Aptitude assessment
C. Cognition assessment
D. Psychopathology assessment
6. Is aptitude relates to an individual special ability?

A. True
B. False
C. Can’t say
7. Cognition refers to –
A. Thinking
B. Mental ability
C. Attention
D. All of the above
8. Strong inventory is related to:

A. Aptitude
B. Cognition
C. Interest
D. Psychopathology
9. Is Psychopathology the study of mental disorders in which we have to go through causes,

symptoms, prevention and treatment?
A. True
B. False
C. Can’t say
10. By which test we can assess verbal ability of an individual?

A. Vocational
B. Cognition
C. Aptitude
D. Attitude

1. D 2. B 3. A 4. D 5. A
6. A 7. D 8. C 9. A 10. C
Review Questions
1. What are the salient features of rehabilitation?
2. Explain the process of cognition assessment?
3. Why psychopathology assessment is important?
4. Explain vocational assessment?
5. What is the difference between aptitude and cognition assessment?

Notes
Course Name
Further Readings
 Elliott, Timothy R. & Frank, Robert G.- Handbook of rehabilitation psychology,3rd

Notes
Unit 05: Models of Disability and Rehabilitation: Biological Model

CONTENTS
Introduction
Objectives
5.1 Disability Models
5.2 Biological Model or Biocentric Model, And The Medical Model
5.3 Disability and The Social Model
5.4 Disability and The Bio-Psychosocial Model
5.5 Rehabilitation
5.6 Rehabilitation Component
5.7 Restorative rehabilitation
5.8 Supportive rehabilitation
5.9 Palliative rehabilitation
5.10 Rehabilitation Phase
5.11 Rehabilitative Advantages
5.12 Rehabilitation Therapy Types
5.13 Disability Rehabilitation Model
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Introduction
The models of disability and rehabilitation are explained in this chapter. There are numerous
disability models that have already been explained by various authors. In this chapter, many
models of disability will be addressed.
Objectives
Once you've finished reading this chapter, you'll be able to:
1. Differentiate between disability models.

2. Describe how the disability model helps people with disabilities.
3. Explain the purpose, elements, and different types of rehabilitation.
4. Describe how rehabilitation enables people with disabilities to leave in more regular lives.
5.1 Disability Models

In order for society and government to construct various methods to satisfy the needs of persons
with disabilities, it is necessary to define impairment using models of disability (Todd, 1918). Two
major ideas shape it. The first regards persons with disabilities as dependent on society, which can

Notes
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lead to paternalism, segregation, and prejudice. The second, meanwhile, views individuals with
disabilities as consumers of society's goods and services, which promotes autonomy, human rights
equality, and integration (Chin, 2021).
5.2 Biological Model or Biocentric Model, And The Medical Model

Goodley (2016) claims that the medical model of disability is also known as the bio-centric model of
disability. It explains the person's physical or mental handicap caused by a sickness. A disabled
individual is seen as a problem who requires special care and treatment (Mitra, 2018). Generally
speaking, the organization for people with impairments uses a biological model specifically.
According to this theory, disabilities are caused by a person's physical or mental limitations and
have a biological basis; if the person is cured, these issues will no longer exist. On this basis, people
with impairments are regarded as abnormal human beings who require medical attention and
rehabilitation specialists.
According to Brickman et al. (1982), in this concept, a person's physical or mental limitations cause
their impairment, which is unrelated to their social or physical circumstances. The model
acknowledges that a challenging economic environment will limit a disabled person's employment
options. Rehabilitation is essential since there is no other option than to accept the abnormality and
give the necessary care to help the person with the impairment (Parsons, 1951). This approach
holds that the individual is the one with the issue; hence, interventions seek to provide the person
the necessary skills to deal with the abnormality (Deacon, 2013).
This approach makes the following four assumptions about how to assist those with disabilities:
1. Disability is a disease state that falls within the clinical framework, and it is characterized by a
problem that is focused on the individual as a deviation from the norm in order to treat and
resolve the issue and restore the individual to normalcy.
2. Professionals are trusted with determining the objective state of normality; the disabled and
their families have limited opportunity to influence the decision-making process.
3. Because they are not viewed as completely human and lack the capacity to make their own
decisions, people with disabilities are biologically and psychologically inferior to people with
normal abilities.
4. Disability is seen as a personal tragedy that typically has an impact on a person's life (Retief,
M., &Letosa, 2018).
The study of the nervous system, hormones, and genetics as they relate to behaviour is referred to
as the "biological model" in psychology. This field's primary objectives are to investigate the
interplay between the mind and body, neurological systems, and the impact of heredity on
behaviour. As is well known, every thought, emotion, and behaviour has a biological basis. This
means that biological factors account for the majority of disabilities (Deacon, 2013).
Three biological aspects can each assist in explaining human behavior in respect to normality and
abnormality, and each of these biological aspects is relevant to the study of psychology. These three
biological aspects are as follows:
1. Comparative approach: from this angle, it is possible to study and compare animals in order
to comprehend both normal and pathological human behavior.
2. Physiology teaches how the nervous system, hormones, and the brain operate, as well as how
changes in structure and function can affect people's ability or inability to behave in certain
ways. For instance, a doctor may give medication to treat depression and anxiety because
these conditions interact with the neurological system to alter behaviour.
3. Examining inheritance: these viewpoints describe the traits that an animal acquires from its
parents and exhibits in order to behave like their ancestor

Notes
5.3 Disability and The Social Model
According to the model, impediments in the environment, in society, and in people's attitudes
restrict persons with disabilities from fully participating in society. This refers to the loss or
restriction of opportunities to participate in everyday life on an equal footing with others as a result
of physical or social barriers (Mitra, 2018). Or, to put it another way, it is also known as the
Minority-Group Model of Disability. From a sociopolitical perspective, Hahn (2002) contends that
disability results from society's failure to adapt to the needs and aspirations of a minority of
impaired people. It indicates that this limitation does not prohibit them from fully engaging in
community life, hence, the model concludes that there is a problem in both society and the
environment. According to the model, removing institutional, physical, and attitude barriers will
improve the lives of persons with disabilities by providing them with the same chances as everyone
else fairly (Hahn (2002).
5.4 Disability and The Bio-Psychosocial Model

This is the result of the interaction between biological, psychological, and social factors. According
to the paradigm, biological, psychological, and social factors play a significant impact in how well
people function and engage in activities when they have a handicap or illness (George et al. 2013).
In this concept, social, psychological, and biological factors—rather than just medical or
biological—are combined to provide a deeper understanding of the health status (Santrock, 2005).
5.5 Rehabilitation
The process of assisting a person in obtaining the highest level of function, independence, and
quality of life is known as rehabilitation and is hotly debated on a global scale (Whittaker et al.,
2021). Additionally, rehabilitation is a continuous effort that can be accomplished in a variety of
methods (Shah, 2017). More than 15% of people worldwide have some form of disability. In light of
the fact that 1 in 3 persons require rehabilitation services at some point throughout their sickness or
accident, 2.4 billion people globally are dysfunctional and its effects on their everyday lives. The
world's population is ageing, more people are losing function as a result of unmet rehabilitation
needs among the most vulnerable and poor populations, and there are more conflicts around the
world. The damage that was caused by rehabilitation cannot be undone. While rehabilitation aids
in restoring a person to their ideal health, functionality, and well-being, it does not repair any
damage caused by any causes. (Nagano et al., 2020).
Services for rehabilitation are required in a variety of contexts:
1. Skills for taking care of oneself, such as those required for feeding, clothing, washing, and
performing sexual functions.
2. Physical care requirements: These include dietary requirements, medication, and skin care.
3. Needs for family support: Assistance with adjusting to lifestyle changes, money worries, and
discharge plans, for example.
4. Psychological counselling: This sort of problem-solving for emotional, behavioral, and
cognitive disorders.
5. Needs for pain management, such as prescription drugs and complementary pain
management techniques; Skills connected to the workplace, are taught in vocational training.
6. Socialization abilities: Interacting with others at home and in the neighborhood.
7. Memory, focus, judgement, problem-solving, and organizing abilities are examples of
cognitive capabilities.
8. Speech, writing, and other forms of communication are all examples of communication
abilities.
9. Respiratory care includes things like ventilator care, if necessary, breathing exercises, and
therapies to improve lung function.
10. Mobility abilities: including the ability to walk, transfer, and self-propel a wheelchair;

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11. Education and training should cover the ailment, medical treatment, and adaptive approaches
for patients and their families (Franklin, &Cheville, 2015).
5.6 Rehabilitation Component

Rehabilitation that is preventative takes place after a new diagnosis or the advent of new
impairments. The major objective is to provide information, suggestions, and interventions to stop
or delay the onset of new impairments in order to maintain a person's level of ability.
5.7 Restorative rehabilitation

It is primarily used after surgery, illness, or even acute situations like trauma or any sort of stroke.
It focuses on therapies that address impairments like muscle strength, respiratory function, and
cognitive impairment to gain the most complete return of function.
5.8 Supportive rehabilitation

It is also known as adaptive rehabilitation, aims to increase a person's mobility and capacity for
self-care by giving them self-help tools and teaching them compensating shortcuts. It includes
making infrastructure changes or providing assistive technology.
5.9 Palliative rehabilitation

This enables a disabled person to live with a high quality of life on a physical, psychological, and
social level. It minimizes functional reliance and supports comfort, dignity, and quality of life by
reducing symptoms like pain and oedema, preventing contractures, breathing aid, psychological
well-being, relaxation, or the use of assistive devices (Timm et al., 2021).
5.10 Rehabilitation Phase

Phase One: Control Pain and Swelling
The fundamental rule is rest, ice, compression, and elevation; therefore, electrical stimulation
provided by sports or physical therapists may aid to speed up this process.
Phase Two: Increase flexibility or range of motion

This stage focuses on extending a joint's range of motion or a muscle's flexibility. Athletes may
receive manual stretching from a physical therapist or athletic trainer, or they may be given
particular stretching exercises to perform on their own. Ideally, stretches during this period should
last up to 30 seconds (Van, 2010).
Phase Three: Increase strength and start your balance training

Strengthening is the main objective. Prior to using elastic bands of different resistance, free weights,
cuff weights, or weight equipment, isometrics that involve pushing against an immovable object
may be performed (Van, 2010).
Phase four: Training for balance, proprioception, and a specific sport makes
During this stage, an athlete's ability to balance is minimal while still experiencing physical pain.
Enhancing proprioception is a fantastic approach to aid in the prevention of injuries recurring (Van,
2010).
Phase Five: Gradual Return to Activity

The athlete gradually resumes full exercise during this phase. Exercises, techniques, or drills that
can be used in games are demonstrated during sport training events. In this way, as the injured
person heals, the therapist slowly advances them from simple exercises to those requiring more
advanced competence (Van, 2010).

Notes
5.11 Rehabilitative Advantages
As stated by (WHO, 2017).
1. Reduce the negative effects of health problems, such as acute or chronic illnesses, diseases,
or injuries, in order to support other health interventions and get the best results.
2. Gives people the tools they need to manage their own pain and other difficulties, therefore
reducing the incapacitating impacts of chronic health conditions.
3. It has financial advantages for both people and society.
4. Reduce the amount of family support.
5. Assurance of everyone's physical and mental health (WHO, 2017).
5.12 Rehabilitation Therapy Types

There are other varieties of rehabilitation therapy; however, just the three major varieties of
occupational, physical, and speech therapy will be covered here. Each type of rehabilitation has a
specific function in assisting a patient in achieving full recovery, but they all aim to aid the patient
in resuming an active and healthy lifestyle.
Occupational therapy:This form of therapy offers remedies to people who need specialist
assistance to take part in daily tasks. Self-care routines, regular chores, and leisure pursuits are all
included. By altering the way, a task is approached, the environment in which it is completed, or by
assisting a person in developing the skills necessary to complete a task, therapists assist a person in
making changes in things that hinder the ability to complete tasks like eating, dressing, completing
schoolwork, and working. People of all ages require occupational therapy, including: Seniors with
physical limitations; People with spinal cord injuries; Children with physical disabilities; Adults
with depression; People who have lost the ability to hold a fork due to an injury; Children with
physical disabilities; Corporate: Spinal cord injury victims, corporate executives, and someone who
has had a catastrophic brain injury and lost cognitive function (Enderby et al., 2013).
Physical therapy:In this type of therapy, therapists treat patients who are in discomfort or are
having trouble moving, interacting, or going about their daily lives regularly. Typical physical
therapy include: Specialized stretches and exercises made to reduce pain, increase mobility, or
build strength; practicing with mobility or balancing aids, such as wheelchairs, walkers, canes, or
crutches; To relieve muscle discomfort and spasms, try massage, heat or cold therapy, or
ultrasound; Cardiovascular strengthening; burn treatment; using orthotics (braces or splints) for
burns; learning to utilize an artificial limb through rehabilitation; balance and gait retraining; and
pain management (Hanks et al., 2015).
Speech-language pathologists: are sometimes known as speech therapists. With the use of
communication exercises, this therapy can help cure a wide range of disorders relating to language,
communication, voice, swallowing, and fluency in both children and adults with learning
disabilities, stroke, neck or head cancer, Parkinson's disease, or dementia. Speech therapy's goal is
to improve the patient's ability to communicate in more beneficial and effective ways (Enderby et
al., 2013).
Common methods used by speech therapists include:
1. Language therapy exercises (language drills to practise communication skills).

2. Articulation training (demonstrating how to move the tongue to create certain sounds).
3. Therapy for swallowing and eating (tongue, lip and jaw exercises designed to strengthen
the muscles of the mouth and throat)

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The following elements or conditions may necessitate the services of a speech therapist:
1. Dyslexia causes problems with accurate and fluent reading.

2. Dyspraxia is the inability to regulate muscle function for speech, language, coordination, or
movement.
3. Aphasia is a neurological disorder that results in a loss of speech or comprehension abilities.
4. Dysphagia is a problem in swallowing.
5. Having trouble speaking clearly and making sound mistakes is a sign of articulation issues.
6. Fluency issues – difficulties speaking naturally, like stuttering
7. difficulties with resonance or voice - issues with voice quality, loudness, and pitch
8. Oral feeding issues, such as drooling or trouble swallowing
9. Parkinson's condition
10. Spinal palsy
11. Missing palate
12. Dwarf Syndrome
13. A number of sclerosis
14. Alzheimer's disease
15. Throat, head, or neck cancer
5.13 Disability Rehabilitation Model

The medical paradigm, from which the rehabilitation model derives, sees the disability as a
deficiency that has to be corrected by a rehabilitation specialist. Armstrong, Elliott, and (2019)
Similar to the medical model, this paradigm sees the disabled person as in need of services such as
training, treatment, counselling, or other assistance. People with disabilities have potential in both
the medical and rehabilitative models. People with impairments are very capable of contributing to
society, and the institutionalization and confinement policies that go along with the sick role are
just unacceptable (Elliott, & Armstrong, 2019).
According to Jahan and Ellibidy (20017), research has shown that successful rehabilitation plans are
based not only on medical judgments but also on other factors that affect health-related quality of
life, such as social, cultural, and psychological factors. These factors are crucial to the rehabilitation
process and should be taken into account alongside biological factors in order to improve health
wellbeing. This concept aims to enhance the quality of life for people with disabilities and their
families by empowering them to carry out their daily chores on their own and actively engage in
society. This paradigm enables people with disabilities to have access to social, community, health,
and employment services (Jahan, &Ellibidy, 2017).
Summary
In conclusion, medical professionals are the only ones who can effectively treat the effects of a
handicap using methods like prosthetics, surgeries, and drugs. Over and above medical and social
models, there is the biopsychosocial model. As a result, the medical model and the rehabilitation
model are tightly intertwined. It focuses on the idea that a person with a handicap may swiftly
overcome their impairment if they put out the effort and work with rehabilitation services. As a
result, no single model of disability can be helpful on its own in helping persons with activity
limitations lead regular lives again. The usage of these models in combination, however, is more
beneficial and fruitful.
Keywords
The process of assisting a person in obtaining the highest level of function, independence, and
quality of life is referred to as rehabilitation.
The biological model of disability is the theory that explains how a person's physical or mental
impairment results from a disease.

Notes
The social model of disabilityholds that barriers in the environment, in society, and in people's
attitudes are what keep people with disabilities from fully participating in society.
The biological, psychological, and social aspects of disability are included in the biopsychosocial
paradigm.
Disability rehabilitation model: The medical model of rehabilitation views a disability as a
deficiency that needs to be corrected by a rehabilitation specialist.
Self Assessment
1. Rehabilitation is
A. The process of assisting a person in achieving their maximum level of independence,
function, and quality of life.
B. A physical condition that impairs a person's dexterity, endurance, or mobility
C. Achieving a standard of living
D. None of the aforementioned.
2. The following ailments or conditions may necessitate the services of a speech therapist:
A. Parkinson’s disease.
B. Cerebral palsy.
C. Cleft palate.
D. A, B, and C
3. A condition in which one has trouble speaking correctly and makes sound mistakes
A. Multiple sclerosis.
B. Articulation problems.
C. Huntington’s Disease.
D. Down syndrome.
4. Which phrase best describes dyslexia?

A. Difficulty swallowing
B. A loss of ability to understand or express speech due to brain damage
C. Difficulty reading accurately and fluently
D. Difficulty controlling muscle function for movement, coordination, language or speech
5. Resonance or voice problems

A. Difficulty with voice pitch, volume and quality.
B. Difficulty with eating, swallowing or drooling.
C. Difficulty with the flow of speech, such as stuttering.
D. Difficult feeding problems.
6. There are 2.4 billion people in the world who are

A. Well
B. Normal
C. Dysfunction and impact their daily life.
D. Normal and abnormal
7. One in three individuals requires

A. Counselling services

Notes
Course Name
B. Medical services
C. Psychological services
D. Rehabilitation services
8. Larger than
A. 25% of the world population are disabled.
B. 15% of the world population are disabled.
C. 35% of the world population are disabled.
D. 45% of the world population are disabled.
9. Rehabilitation
A. Does not undo the damage caused by any causes.
B. Undo the damage caused by any causes.
C. Both undo and does not undo the damage caused by any causes.
D. None of the above.
10. The disability model.

A. Social
B. Medical
C. Biopsychosocial
D. All the above
11. Increase Strength & Start Balance/Proprioception Training, Describe Which Phase of
Rehabilitation
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
12. What does the social model of disability mean according to which of the following
statements?
A. Disabilities are disorders that originate before 18 years of age.
B. Resulting from physical causes or non-physical causes such as lack of stimulation.
C. Characterized by a limited mental capacity and difficulty with adaptive behaviors.
D. ABC are incorrect.
13. According to this theory, a person's physical or mental limits cause disability. Which type
of disability model is described well in this sentence?
A. Biological model
B. Social model
C. Psychological model
D. All the above
14. Education and training: One of the topics covered by this is patient and family education
and training on the condition, medical care, and adaptive approaches.
A. Social model
B. Medical model

Notes
C. Psychological model
D. Rehabilitation.
15. The issues with oral feeding.

A. Difficulty with eating, swallowing or drooling.
B. Difficulty with hearing, swallowing or drooling.
C. Difficulty with walking, swallowing or drooling.
D. Difficulty with sleeping, swallowing or drooling.

1. A 2. D 3. B 4. C 5. A
6. C 7. D 8. B 9. A 10. D
11. C 12. D 13. A 14. D 15. A
Review Questions
1. Identify the key variations among the models of disability.
2. How rehabilitation enables persons with disabilities to lead normal lives again.
3. Describe the stages of the rehabilitation process using an example.
4. Describe forms of rehabilitation therapy.
5. List and describe the four elements of rehabilitation.
6. Describe how the social model differs from the medical paradigm.
7. Describe the premise behind aiding those with disabilities.
8. Describe the ailments that call for speech therapy.
9. Analyze the various areas that the rehabilitation programme covers.
10. Describe how the Rehabilitation model compares to the biopsychosocial model of disability in
terms of effectiveness.
Further Readings
 Cifu, D. X. (2020). Braddom's Physical Medicine and Rehabilitation E-book. Elsevier
Health Sciences.
 Franklin, D. J., & Cheville, A. L. (2015). Medical Rehabilitation and the Palliative
care Patient. Oxford textbook of palliative medicine, 1-31.
 Frontera, W. R., Silver, J. K., & Rizzo, T. D. (2018). Essentials of Physical Medicine
and Rehabilitation e-book. Elsevier Health Sciences.
 Retief, M., &Letšosa, R. (2018). Models of Disability: A brief overview. HTS
Teologiese Studies/Theological Studies, 74(1).
 Scanlon, V. C., & Sanders, T. (2018). Essentials of Anatomy and Physiology. FA Davis.
 Waugh, A., & Grant, A. (2014). Ross & Wilson, Anatomy and physiology in health
and illness E-book. Elsevier Health Sciences.
Web Links
 Barnes, M. Oliver, & L. Barton (Eds.), Disability Studies Today. Malden: Blackwell.

Notes
Course Name
 Brickman, P., Rabinowitz, V. C., Karuza, J., Coates, D., Cohn, E., & Kidder, L. (1982).
Models of helping and coping. American psychologist, 37(4), 368-384.
 Chin, N. M. (2021). Centring Disability Justice. Syracuse L. Rev., 71, 683.
 Deacon, B. J. (2013). The Biomedical Model of Mental Disorder: A critical analysis of
its Validity, Utility, and Effects on Psychotherapy Research. Clinical psychology
review, 33(7), 846-861.
 Elliott, T. R., & Armstrong, T. W. (2019). Disability and Health. Cambridge Handbook
of Psychology, Health and Medicine, 12.
 Enderby, P., John, A., &Petheram, B. (2013). Therapy Outcome Measures for
Rehabilitation Professionals: Speech and language therapy, physiotherapy,
occupational therapy. John Wiley & Sons.
 Goodley, D. (2016). Disability studies: An interdisciplinary introduction. Sage.
 Jahan, A., &Ellibidy, A. (2017). A Review of Conceptual Models for Rehabilitation
Research and Practice. RehabilSci, 2(2), 46-53.
 Hahn, H. (2002). Academic Debates and Political Advocacy: The US disability
movement. In C. Nagano, A., Maeda, K., Koike, M., Murotani, K., Ueshima, J.,
Shimizu, A., ... & Mori, N. (2020). Effects of Physical Rehabilitation and Nutritional
Intake Management on Improvement in Tongue Strength inSarcopenic Patients.
Nutrients, 12(10), 3104.
 Mitra, S. (2018). The Human Development Model of Disability, Health and
Wellbeing. In Disability, health and human development (pp. 9-32). Palgrave Pivot,
New York.
 Parsons, T., (1951), The Social System. Free Press, Glencoe, IL.
 Shah, R. (2017).The Meaning of Rehabilitation and its Impact on Parole: There and back
again in California. Routledge.
 Timm, H., Thuesen, J., & Clark, D. (2021). Rehabilitation and Palliative Care: histories,
dialectics and challenges. Welcome Open Research, 6.
 Todd, M. J. L. (1918). The Meaning of Rehabilitation. The Annals of the American
Academy of Political and Social Science, 80(1), 1-10.
 Whittaker, J. L., Truong, L. K., Dhiman, K., & Beck, C. (2021). Osteoarthritis Year in
Review 2020: Rehabilitation and Outcomes. Osteoarthritis and cartilage, 29(2), 190-
207.
 World Health Organization. (2017). Health information systems and rehabilitation (No.
WHO/NMH/NVI/17.2). World Health Organization.

Notes
Unit 06: Sociological Model of Rehabilitation Psychology
CONTENTS
Objectives
6.1 Goals of Psychosocial Rehabilitation
6.2 Psychosocial Rehabilitation Principles
6.3 Approaches Used in Psychosocial Rehabilitation
6.4 The Increasing Need for Community-Based Programmes
6.5 General Objectives of Community-Based Rehabilitation Programs:-
6.6 The Key Principles of Community-Based Rehabilitation: (C.B.R)
6.7 Family Ethos in Rehabilitation Counselling
6.8 Family Voice in Community
6.9 Advocacy Roots for Rehabilitation Counselling
6.10 Medical Model Obfuscates Family Role
6.11 Social Movement, Social Model
6.12 The Family Voice Emerges
6.13 Rehabilitation Counselling Responds to the Family Voice
6.14 Family, Theory, and Rehabilitation Counselling
6.15 Social Construction of Disability and the Family
6.16 Field Theory
6.17 Group Dynamics
6.18 Change Theory
6.19 Action Research
6.20 Extension in Rehabilitation Psychology
6.21 Impact of the Social Context
6.22 Impact of Advocacy
6.23 Evolving Constructs
6.24 Systems in Rehabilitation Counselling
6.25 Sense of Community: A System of Inclusion
6.26 Membership/Spirit
6.27 Influence/Trust
6.28 Integration of Fulfilment of Needs/Trade
6.29 Shared Emotional Connection (1986)/Art (1996)
6.30 Family as First Community: Implications for Rehabilitation Counselling
6.31 Strengthening Community in the Family
6.32 Strengthening Family in the Community
6.33 Family and the Rehabilitation Counselling Ethos
Review Questions

Notes
Course Name
Self Assessment
Objectives
 People with mental illness and other psychiatric concerns sometimes need help in different
aspects of their lives including work, living, social, and learning environments. One approach
that can help these individuals manage symptoms and improve functioning is known as
psychosocial rehabilitation.
 Psychosocial rehabilitation is a treatment approach designed to help improve the lives of
people with mental illness.
 Its goal is to teach them emotional, cognitive, and social skills to help them live and work in
their communities as independently as possible.
6.1 Goals of Psychosocial Rehabilitation

Regardless of what form psychosocial services take, core goals include helping people feel:
1. Empowered: Each individual needs to feel that they are able to set their own goals and
have the power and autonomy to pursue those aims.
2. Hopeful: People may be left feeling demoralized as a result of their condition.
Rehabilitation focuses on helping clients feel hopeful about the future.
3. Skilled: Rehabilitation aims to teach people skills to help them manage their condition and
live the life they want to live. This includes life skills, work skills, social skills, and others.
4. Supported: Mental health professionals offer support and help clients build relationships
and social connections in their community.
6.2 Psychosocial Rehabilitation Principles

There are a number of key principles of psychosocial rehabilitation that help guide how mental
health professionals working in this field approach their work. These principles include:
 All people have potential that can be developed.

 People have a right to self-determination.
 The emphasis is on the individual's strengths rather than their symptoms.
 Each person's needs are different.
 Professional services should be committed and take place in as normalized an environment as
possible.
 There is a focus on a social model of care (as opposed to a medical model).
 It is centered on the present rather than fixated on the past.
Rehabilitation psychologists assist individuals who have disabilities and chronic illnesses; the
disability may be congenital or acquired -- for example, an accident or stroke.

Notes
Psychologists provide psychotherapy and administer assessments. Assessments may be
neurological (testing memory and other cognitive functions) or psychological (assessing emotional
handling of disability-related issues). Rehabilitation psychology duties may overlap with those of
health psychologists. Rehabilitation psychologists sometimes work alongside neuropsychological
specialists. They often collaborate with other health and medical professionals, for example,
physical therapists.
The specialty developed as a result of the need to reintegrate veterans, but today’s rehabilitation
psychologists more often work with the civilian disabled population, including the elderly. Some
rehabilitation psychologists specialize in working with children. At Rusk's Pediatric Outpatient
Psychology Service, for example, psychologists treat children with conditions ranging from spina
bifida to traumatic brain injury. They provide comprehensive evaluations, conduct individual and
family therapy, write educational prescriptions, and carry out neuro-rehabilitative interventions as
needed.
Rehabilitation psychologists also work at the societal level to make the lives of the disabled better.
They carry out research and may be involved in program development and administration. Those
in vocational rehabilitation improve lives for individuals with psychiatric illnesses as well as
physical ones.
The Division of Rehabilitation Psychology (Division 22 of the American Psychological Association)

would like to see psychologists at the forefront: developing new service delivery models. Division
22 also strives to see more psychologists employed as directors in programs like sub-acute
traumatic brain injury and work restoration.
Rehabilitation psychology is part of an occupational group that has been projected by the BLS to see
22% growth in the 2010 to 2020 decade.
6.3 Approaches Used in Psychosocial Rehabilitation
 Psychosocial rehabilitation is based on the idea that people are motivated to achieve
independence and are capable of adapting in order to achieve their goals.
 To achieve this, psychosocial rehabilitation uses a combination of evidence-based best
practices and emerging, promising practices. No matter what the specific strategies are, the
focus is on restoring social and psychological functioning.
 Specific psychosocial rehabilitation treatments can vary considerably from case to case
depending upon a person's needs and the resources available. The process is highly
individualized, person-centered, and collaborative.
 Effective rehabilitation involves a comprehensive plan that addresses the client’s life and
functioning. A psychosocial rehabilitation professional is usually only one part of the process.
The plan is often overseen by a psychiatrist, clinical psychologist, or licensed counselor and
typically involves working with the client individually and in community settings.
6.4 The Increasing Need for Community-Based Programmes

Rehabilitation psychologists assist individuals who have disabilities and chronic illnesses; the
disability may be congenital or acquired -- for example, an accident or stroke. Psychologists provide
psychotherapy and administer assessments. Assessments may be neurological (testing memory and
other cognitive functions) or psychological (assessing emotional handling of disability-related
issues). Rehabilitation psychology duties may overlap with those of health psychologists.

Notes
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Rehabilitation psychologists sometimes work alongside neuropsychological specialists. They often
collaborate with other health and medical professionals, for example, physical therapists. The
specialty developed as a result of the need to reintegrate veterans, but today’s rehabilitation
psychologists more often work with the civilian disabled population, including the elderly. Some
rehabilitation psychologists specialize in working with children. At Rusk’s Paediatric Outpatient
Psychology Service, for example, psychologists treat children with conditions ranging from spina
bifida to traumatic brain injury. They provide comprehensive evaluations, conduct individual and
family therapy, write educational prescriptions, and carry out neuro-rehabilitative interventions as
needed.
Rehabilitation psychologists also work at the societal level to make the lives of the disabled better.
They carry out research and may be involved in program development and administration. Those
in vocational rehabilitation improve lives for individuals with psychiatric illnesses as well as
physical ones. The Division of Rehabilitation Psychology (Division 22 of the American
Psychological Association) would like to see psychologists at the forefront: developing new service
delivery models. Division 22 also strives to see more psychologists employed as directors in
programs like sub-acute traumatic brain injury and work restoration. Rehabilitation psychologists
work in a variety of settings, including acute care hospitals and healthcare centres, inpatient and
outpatient physical rehabilitation units/centres, assisted living and long-term care facilities,
specialty clinics (e.g., pain and sports injury centres, cardiac rehabilitation facilities), and
community agencies serving individuals with specific disabilities or chronic illnesses (e.g., cerebral
palsy, multiple sclerosis, spinal cord injury/disease, brain injury, deafness).
Rehabilitation psychologists provide services with the goals of increasing function and quality of
life for persons living with disability, activity limitations, and societal participation restrictions.
Because disability impacts multiple areas of a person’s life, rehabilitation psychologists provide
services within the network of biological, psychological, social, environmental, and political
environments to assist the persons served in achieving optimal rehabilitation goals via intervention,
therapeutic support, education, consultation and interdisciplinary collaboration, and advocacy.
6.5 General Objectives of Community-Based Rehabilitation

Programs:-
 Improve the functional capabilities of disabilities persons as much as possible through

rehabilitation.
 Community activation and mobilization to achieve environments, information and ways to
communicate free of obstacles in order to create a society that included a comprehensive and
an inclusive that Disabled people will have the equal opportunities and enjoy full
participation.
 Enable disabilities persons and their family’s decision-makers at all levels of community-
based rehabilitation programs, and create public awareness that effects on the local policies
and ensure access for disabilities persons to all aspects of life in the community.
6.6 The Key Principles of Community-Based Rehabilitation: (C.B.R)
 The rehabilitation is right for disabled people and that comes to response to their needs and
based on social justice, dignity and equality of opportunity and equality of rights and duties.

Notes
 Strengthening (or) reinforcement and enabled special-needs persons, their families, and their
organizations an essential basis for the integration of these people and their Participation them
in their communities.
 On one side, the community orientations and situations, and on the other hand Strengthening,
enabling and activating the resources and the experiences of the local societies it is the
fundamental guarantee for the Community participation in planning implementation and
follow-up (the local community plan for disability)
 Freeing and providing and simplify the transfer of knowledge and experience are the basic
necessities to use the available potential and based on what exists.
 The integration and comprehensiveness work to ensure the success of rehabilitation in the
frame of overall development.
 Community-based rehabilitation is based mainly on the rehabilitation of society to
accommodate disabilities persons and integrate them in the path of the general life and it
doesn’t be limited Preparing disabilities persons.
 Community-based rehabilitation seeking to provide access to services (quality) are available,
are geographically accessible to potential citizens financially, do not distinguish against
disabilities persons, and quality (general, technical, and administrative).
 Community-based rehabilitation depends on the curve of my rights community (reference of
legal texts, matter, enable, post, non- distinguish).
The family system is a powerful source of environmental influence to consider. Family forms a
context for a great deal of human development it is a site where individuals learn behaviors
through operant conditioning (reinforcement and punishment of their behaviors) and observational
learning (behavioral models), as well as become socialized into their culture, social norms, and
social roles. The physical environment established by a family can also influence development and
behavior through constraints and opportunities provided to individuals for example, ease of access
to alcohol, tobacco products, or other psychoactive substances. Family social relationships influence
a person’s motivation for social conformity or deviance, as well. Family can be a source of stress to
which a person might respond with substance use, or a source of resilience and protective factors
that reduce the probability of engaging in substance misuse.
The family is the natural and fundamental group unit of society and is entitled to protection by
society and the State, and that persons with disabilities and their family members should receive
the necessary protection and assistance to enable families to contribute towards the full and equal
enjoyment of the rights of persons with disabilities. Preamble, UN Convention on the Rights of
Persons with Disabilities (United Nations, 2006)
Defining the family presence in rehabilitation counselling has been a perennial issue often engaged,
but never fully resolved. Family members have been recognized for their influence on rehabilitation
process and outcomes (Sutton, 1985; Westin & Reiss, 1979). Academics have argued the potential
role of family therapy models within rehabilitation counselling (Millington, 2012; Power & Dell
Orto, 2004). Family experience with service has been explored from a systems perspective (Cottone,
2012). Ecological models have been employed to justify families as partners in service and as service
recipients (Kelley & Lambert, 1992; Power, Herschensohn, & Fabian, 1991). The specialized
knowledge of family counselling has become part of the qualified rehabilitation counsellor identity
(Leahy, 2012). Despite these advances, the family discourse has not translated into a sustained
movement in research (Bryan, 2009), practice (Frain, Berven, Chan, &Tschopp, 2008; Freedman
&Fesko, 1996), training (Riemer-Reiss &Morrissette, 2002), or policy (Kneipp& Bender, 1981).
What accounts for this gap between intent and achievement? The premise of this book is that
rehabilitation counselling’s failing with the family is a problem of models. Originally shaped by the
values and epistemology of a psych medical model, rehabilitation counselling struggles with the
residual effect of a worldview that it has ostensibly left behind. A new social construction is

Notes
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requiredto make sense of the proper relationship between service and family. The social movement
has provided one on a global stage. Rights-based advocacy, as part of the movement, changed the
meaning of disability and reoriented the relationship between family and care at an international
level. Rehabilitation counselling has embraced this movement in principle, but has not addressed
the conceptual work of constructing a new model for the family around movement values.
Rehabilitation counselling for families is cast as community counselling, with family as first
community. The discipline’s identity in this new context is explored through the applied values of
the fundamental mission. An argument is made that rehabilitation counselling in the family has
three distinct transactional expressions in identity, power, and capital.
6.7 Family Ethos in Rehabilitation Counselling

Finding the family ethos in rehabilitation counselling begins with an understanding of community
values. John Dewey, an American educational philosopher and contemporary of the psychologist
William James, argued that ethical behaviour is a social and humanistic pursuit. For the individual,
it is the pursuit of a satisfying life within social institutions, that is, in community. For society, it is
the pursuit of policy that provides a satisfying community life for its citizens. We pursue the good
life through the moral behaviour of the individual and the collective. The path is always a
challenge. There is no simple concordance of the good, the right, and the virtuous; no imperative
rule or immutable truth that precludes thinking (Field, 2005). Directed at living an ethical life or
building an ethical profession, the path to moral behaviour is always a social process of discovery.
The ethos that emerges from experience is a rational, value-laden extension of our epistemology
(see Tarvydas, 2012). Our professional identities are driven by our values and shaped by reflective
praxis.
The special identity of rehabilitation counselling (Maki &Tarvydas, 2012) is negotiated in the lived
community experience of disability. It is unique among counselling specialties in that it exists in the
space of society’s ethical failure in this specific regard. The profession was legislated into being to
address the exclusion of people with disabilities from society. Rehabilitation counselling is society’s
ethical policy response to that injustice. Rehabilitation counsellors are agents of social justice (see
Marini, 2012), advancing an applied theory and practice of community values.
Miller and Millington (2002) described the ethos of the profession (the moral character of the
profession as it is expressed through action) in terms of the historical democratic ideals of equality,
liberty, and fraternity. These values guide professional practice, infusing both process and outcome
with meaning:
Equality is a reciprocal respect and regard for the unique nature of the individual and a valued
recognition for his or her distinctive contribution to the whole, without consideration of physical or
mental function. Accordingly, all are valued equally. Due respect and regard are expressed through
the equitable allotment of resources. Each person is provided what he or she needs and receives it
such that he or she is able to utilize it in the expression and development of his or her potential
whatever that potential may be.
Liberty is the space created by this transaction in equity that allows for the expression and
development of individual potential. Liberty is the freedom to choose one’s path through one’s
intentional and unencumbered actions. Through the expression and development of the
individual’s potential, each person makes a distinctive contribution to the whole. Because it is only
through cooperation that this becomes possible, both the individual and the community come to
appreciate and desire that cooperation.
Fraternity is that shared space beyond liberty where people are free to choose their associations,
free to align their work with the cooperative of community. Fraternity directs our actions because
what we seek to achieve together is viewed as worth achieving by each participant. It produces in
us a desire to continue to work together in order to sustain what we have achieved. Disability

Notes
legislation is an expression of these values’ writ large. To realize a democracy, however, legislation
must find expression through the good work of local community action (Dewey, 1916).
Rehabilitation counsellors as agents of the democratic ideal on behalf of people with disabilities are
citizen professionals (see Doherty, Mendenhall, & Berge, 2010) and the instruments of that good
work. Rehabilitation counselling philosophy (Maki & Murray, 1995) is derived from these
community values and this ethos. Rehabilitation counselling is a value-driven profession
(Tarvydas, 2012) anchored in community by a fundamental mission of full community inclusion
(Szymanski, 1985).
6.8 Family Voice in Community

The fundamental mission links rehabilitation counselling with an evolving, global social
movement. The history of democracy in the United States is told in the narratives of marginalized
and disenfranchised peoples who united in common cause to resist oppression; negotiate their
identities; trade in the marketplace; and claim their share of liberty, equality, and fraternity. People
with disabilities have been engaged in this political struggle for decades and family has figured
prominently in their action. As rehabilitation counselling has been a party to the movement, it is
within this advocacy frame that the emerging family voice is most clearly heard.
6.9 Advocacy Roots for Rehabilitation Counselling

Counselling has its roots in the social reform movements of the 19th century (Sales, 2012) and the
programmatic governmental response in the early 20th century (Elliott &Lueng, 2005). Vocational
counselling was created to meet an urgent public need to facilitate the rapid shift of the population
from rural/agriculture to urban/industrial life and work (Savickas& Baker, 2005). Rehabilitation
counselling was an early offshoot of vocational counselling conceived in spirit as a government-
sponsored alternative to charity for veterans with disabilities following World War I. It was
established in principle under the Vocational Rehabilitation Act of 1920. A detailed account of
vocational rehabilitation (VR) counselling in legislation is beyond the scope of this chapter.
However, the political subtext of the profession’s evolution is clear: Community advocacy defines
and advances rehabilitation counselling through the promise of inclusion.
6.10 Medical Model Obfuscates Family Role

The family connection to VR counselling was strained by the residual paternalism of the charity
movement, the epistemological constraints of the psych medical model (Cottone& Emener, 1990)
that gave them legitimacy, and the subtle social oppression of a society that was designed to
exclude. The language, structures, and functions of rehabilitation were forged in a medical model,
and rehabilitation counselling was a party to the process. In the medical model, disability was
pathology within the person that required a diagnosis and a “cure.” Assessment focused on a
statistical approximation of normality to which the client, by definition, fell short. Strategies were
arranged by experts. Treatment was meant to resolve shortcomings. Failure only proved the
model’s assumptions of client inadequacy. Services in such a climate tended to institutionalize and
segregate (Nosek, 2012) people with disabilities. Vocational evaluation often culled out those who
required the most support for being “too disabled” (Cottone&Cottone, 1986). Sheltered workshops
promised competitive employment, usually without success. People were warehoused in nursing
homes and hospitals far from family and any sense of community. All of this was expertly done for
the good of the client. Typically, neither the client nor the family was asked to define what “good”
meant.
The medical model has no active role for the family. When disability is in the body, its impact on
significant others is a tragedy that falls outside of service. When experts control the language, the

Notes
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client has no voice. When the science is reductive, the social network is invisible and the issues of
family are not recognized. For all the good intent, the medical model falls short for all rehabilitation
professions, but particularly for rehabilitation counselling, which had democratic values in its
theoretical bones (Wright, 1983).
6.11 Social Movement, Social Model

The social model arose as a rejection of the medical model (Stubbins, 1984). Disability was
redefined as a social construction (Oliver, 1983) imposed on people as “systematic patterns of
exclusion that were—quite literally—built into the social fabric” (Hughes & Patterson, 1997, p. 328).
The social model reinterprets psychological wellness in terms of the relationship between
impairment and the disabling effects of the environment. It focuses on the political, the importance
of personal resistance, and group advocacy in claiming an identity within the community.
The initial social model was complete in its rejection of medical hegemony (Oliver, 1990). The
confluence of interests across disability groups aligned in the rejection. A political community of
practice arose with the movement; it was the shared vision, history, and emerging language of a
true disability community based on civil rights. Rejecting the medical model was the beginning of
the normalization of disability. Disability was embraced in the social model as an authentic part of
the human experience, to be accepted on its own terms, and celebrated for what it contributes to
community (Remley, 2012). The full meaning of disability, its value and its challenges, came from a
complex of social relationships (Llewellyn & Hogan, 2000), not from the person in isolation. The
medical perspective was eventually rehabilitated back into the social model’s worldview
(Shakespeare, 2006), but without the power to ascribe meaning beyond the physical structure and
function of impairment.
6.12 The Family Voice Emerges

The socio-political perspective recognized the importance of family and provided a platform and a
voice. Family became a central theme in the disability studies literature. Family experiences across
cultures, disabilities, and roles opened up the dialog to consider the impact of disability within the
family and on the relationship between the family and the larger community. Families figured
prominently in the collective response of the recovery movement in substance abuse (White &
Savage, 2005) and mental health, giving rise to unprecedented family engagement in advocacy,
treatment, and community-based peer support (Howe & Howe, 1987).
Family activism within the disability movement influenced the course of legislation. The
Individuals with Disabilities Education Act and the Americans with Disabilities Act recognized the
family support role in preserving the rights of the family member. Title 1 of the 1998 Amendments
to the Rehabilitation Act identifies families as direct recipients of support services and training
designed to empower them as informed consumers within the VR system (Section 103(a) [17]).
Family access to services is contingent on instrumental impact on client employment (34 CFA
361.5(b) [23]), but offers extensive support and liberally inclusive family criteria. Compensable
services include interpreters, support groups, information resources, peer networks, counselling
(referrals to therapy beyond the scope of VR), day care, respite, financial management, and
education. Family is defined as any person with a substantial interest in the client’s welfare who
lives within the home.
The empowering family trend has continued. The Family Medical Leave Act advanced
employment protections to families coping with emergency care. President Obama included family
leadership in policy development around the “year of community living” initiative (ca. 2009–2010).
Family efforts were key in advocating for improved access to information, one-on-one counselling,
and streamlined services for home-based care (Perez, 2012).

Notes
6.13 Rehabilitation Counselling Responds to the Family Voice
Rehabilitation counselling has attempted to move in concert with policy trends. What should have
been the watershed moment for systems change, the 26th Institute on Rehabilitation Issues (IRI,
2000) addressed the emerging family ethos in VR counselling and proposed a way forward to more
family-integrated and family-responsive service. Families were to be supported in their caring
roles. VR’s propensity for poor communication with family and the resulting unwarranted
lowering of family expectations of VR service delivery were identified as systemic barriers to client
success. The IRI recognized that client-centered service was not defined by the client in isolation,
but the client embedded in family. The client had a right to choose who “family” was and to direct
family roles in VR service partnership. As bona fide stakeholders in the VR process, family
members had rights to informed choice and autonomy. Family was not simply to be recognized; it
was to be understood. The family was to be respected in its diversity with sensitivity to its changing
needs and accommodated accordingly. The family offered specialized knowledge, skills,
connections, and resources that were essential for long-term successful employment outcomes. And
with that, the family moved from the periphery to the core of rehabilitation counselling practice at
least in (emerging) theory.
Proclamation was the easy part. The 26th IRI was literally a summation of what was already
expressed in legislation. Its recommendations were merely guidelines describing what the family in
rehabilitation counselling should look like. What the recommendations did not include was any
strategy for implementing family inclusion in VR practice. This shortcoming was recognized within
the IRI and it foreshadowed the historic lack of progress made since:
Yet, even when we understand the value of and need for family involvement, even when we are
empowered to act, we remain hesitant. Perhaps our hesitancy arises, in part, from confusion over
the role and function of the rehabilitation counsellor. Our profession continues to struggle with the
limitations of the medical model, which focuses on disease and deficits. When such pathology
dominates our thinking, we continue to look for evidence of disease, deficiency, or malfunctioning
when we should shift our primary focus to family strengths. We should assess those strengths and
work with the family rather than working around the family or standing in opposition to the
family. As vocational rehabilitation enters the 21st century, our challenge must be to create a new
model that creates a true partnership between people with disabilities, families and rehabilitation
professionals. (IRI, 2000, p. 44)
6.14 Family, Theory, and Rehabilitation Counselling

Rehabilitation counselling’s science and practice is predicated on the values of human rights.
Rehabilitation counselling transacts specifically in the gap between society’s egalitarian aspirations
for its citizenry and society’s failure in achieving these just ends. Defined as it is by these
community transactions, rehabilitation counselling’s identity is differentially expressed across
settings, developmental across time, and always in the context of the gap. Rehabilitation
counselling is embedded in a social movement and defined by the search. It is a transitional
profession (Miller & Millington, 2002) with a dynamic identity that requires constant challenge and
revision.
The family conundrum at the center of this identity issue is not a feature of rehabilitation
counselling; it is a passing symptom of professional growth. Rehabilitation counselling evolves in
its role and function, albeit unevenly, in response to societal change because rehabilitation
counselling science is not simply a description of the world as it is, but the investigation of what
makes a more humane world. Rehabilitation counselling is a science of social construction where
empirical observation is charged with meaning. The social construction of rehabilitation
counselling requires a social psychology that embraces liberation.

Notes
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6.15 Social Construction of Disability and the Family
Lewin (1935) is known in rehabilitation counselling for the ubiquitous citations of his
conceptualization of behaviour as a function of the person and the environment. The gestalt of
Lewin’s work reveals the deep connections of theory to rehabilitation counselling values, to the
pursuit of systems change, and to the irreducible nature of family and community. Lewin’s
understanding of the social nature of psychology is a proper framework for engaging the family in
rehabilitation counselling.
Lewin’s theoretical work was unified by his dedication to applied social science in the service of
advocacy. He was concerned with the issue of power and its ability to eclipse social justice for the
disenfranchised (Burnes, 2004). The origins of social psychology are inseparable from the values of
democracy in Lewin’s strongly held belief; society’s complete commitment to democratic values
was its only protection from the worst extremes of social conflict (Burnes, 2004). Gordon Allport
went as far as to aver that Lewin’s corpus of theory was the epistemological complement to
Dewey’s educational philosophy. “Without knowledge of, and obedience to, the laws of human
nature in group settings, democracy cannot succeed. And without freedom for research and theory
as provided only in a democratic environment, social science will surely fail” (Allport, 1948, p. xi).
Lewin sought to improve the circumstances of the individual through planned change in the group
and saw his theoretical themes of field theory, group dynamics, change theory, and action research
as interdependent components of planned change at the individual, group, and societal levels.
6.16 Field Theory

Lewin’s famous B = ƒ (P, E) equation addresses the interdependent physical, psychological, and
sociological characteristics of lived experience. The function establishes the inseparability of the
individual and the “life spaces” he or she navigates (Hall &Lindzey, 1978). Behaviour is enmeshed
in a complex network of proximal and distal influences; that is, vector forces that push and pull-on
self-expression. We shape, and are shaped by, our environments through unceasing reflexive
transactions.
6.17 Group Dynamics

The evolving social identity that binds individual to group manifests through group dynamics.
Through “interdependence of fate and task,” individual behaviours coalesce in fraternal
collaboration. A complex and reciprocal social system arises where identity is negotiated group-to-
individual and individual-to-group (Smith, 2001).
6.18 Change Theory

Continuity of group behaviour creates a social equilibrium not easily changed by individual action.
Group change is best affected through collective action. Intentional change is initiated by a
disruption of the status quo, a shared desire for transition to a new state, and a consensus that the
effort to change is worth the risk (Schein, 1996). Change is accomplished as new models of
behaviour become engrained in habit; new structures and traditions crystalize around social
transactions; equilibrium returns; and a new identity emerges for group and individual (Burnes,
2004).

Notes
6.19 Action Research
The means to direct intentional change in constructive ways is accomplished through action
research. Action research was meant to empower (minority) groups to address and resolve local
problems and to identify general laws of group life through the application of basic social research.
Group members collaborate through a cyclical process of planning overall goal and incremental
steps, implementing change, and evaluating outcomes. Outcomes have three purposes, to evaluate
the action against the goal, provide an opportunity to learn from the experience, and inform the
next iteration (Lewin, 1946).
Lewin interpreted Dewey’s educational philosophy into an applied science of advocacy for
oppressed groups. The practice that followed would facilitate democratic social change toward
fuller participation in a more democratic society (Smith, 2001). Lewin and Dewey shared the social
constructionist view, later professed of the disability rights movement, that planned change is not
authoritarian but egalitarian in a process that combines research, education, and management to
community-enhancing ends (Hatch, 1997).
6.20 Extension in Rehabilitation Psychology

Lewin’s social psychology provided a system alternative to the clinical appraisal of psych medical
tradition. Wright’s seminal work (1983) in the somatopsychological and psychosocial dynamics of
physical disability was a turning point. She conceived a value-laden set of principles that recast
disability as a complex phenomenon embedded in a social system (World Health Organization
[WHO], 2002) and set the precepts for the nascent field of rehabilitation psychology.
6.21 Impact of the Social Context

Human beings are by nature social creatures that fail to thrive without care (Bowlby, 1969) and for
whom isolation is the ultimate punishment. We seek out social attachment and negotiate who we
are through social learning. We are constantly engaged in proximal social processes
(Bronfenbrenner & Morris, 2006) with the people, things, and information that populate our
environment. Through this sustained activity, we develop habits of behaviour, thinking, and
feeling that define our social identity (Sluzki, 2010). Our social identities are contextually
dependent and constantly in flux. As we move from role to role, we find that social identities are
the compromise between what we believe ourselves to be and what society will allow. We flourish
where we are accepted, and we struggle to adapt where we are not.
People with disabilities find themselves assigned to an identity (Goffman, 1963) not of their
choosing (Barker, Wright, Meyerson, &Gonick, 1953), historically one of stigma and devaluation
(Dembo, 1982). The social lessons taught and learned are embedded in the disabling context, for
example, the attitudes of others (Shontz, 1977), inaccessible physical environments, policies that
create dependency, and language that denies respect. To these insults, add the pervasive
professional negative bias (Dunn & Elliot, 2005) of a disability industry that reifies its assumptions
of deviance in the population it purports to serve (see Cottone&Cottone, 1986; Tremain, 2005).
These contextual barriers, often invisible to those who do not live the experience, are a far greater
threat to positive adjustment than the functional aspects of impairment (Shontz, 1977).
6.22 Impact of Advocacy

Early researchers drew parallels between the struggle of people with disabilities and the
marginalization and disenfranchisement of other minority groups (Barker et al., 1953). The minority
meme resonated with people with disabilities and their families (Meyerson, 1988). It made

Notes
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empiricaland intuitive sense and, for the first time, provided for an activist response to one’s
position as outsider (Fine & Asch, 1988). This collective activist response is the impetus for action in
Lewin’s action research. The disability rights movement moved special education into the
mainstream, sheltered employment into competitive employment (with supports), and
institutionalization into independent living. Research did not lead these movements, but responded
to them as part of a larger system of change.
The disability rights movement has encouraged an epistemological shift from interindividual traits
to intraindividual relationships; from psychological states to ecological processes; from individual
counselling to counselling in systems. Theoretical constructs have evolved accordingly. Families are
recognized as the most proximal of many nested and networked social systems (Bronfenbrenner,
1977) in which the person with a disability interfaces. They are constituted of a complex of social-
emotional bonds (Dembo, Leviton, & Wright, 1975) interacting in dyadic (parents), triadic (parents
and child), and higher order exchanges (e.g., female members of the extended family) that provide
the scaffold for group and individual identity and the tools for adapting to change (see Bateson,
1972; Minuchin, 1985).
6.23 Evolving Constructs

Systems thinking redefines disability in the social sphere. Impairment is a personal experience, but
disability resides in the relationships that connect people. Disability happens to a family as well as
an individual, and the response to it can be registered at both levels. For example, rehabilitation
psychology was predicated on the psychosocial framework of coping with disability (Wright, 1983)
a construct with both inter- and intraindividual interpretations. An individual’s response to
environmental stressors is dependent on cognitive appraisal (Lazarus, 1993) of the situation, the
consequent perception of self-efficacy, and the choice and implementation of coping strategies.
Each impacts the next in succession. Generalized practice of effective coping strategies across
contexts and time (Maddux, 1995) creates psychologically resilient individuals. Self-appraisal of a
supportive social network raises an individual’s perceived self-efficacy in problem solving and
thereby encourages self-directed change-making in his or her world, and stress reduction (Bandura,
1997). Similarly, groups are collectively more effective when their members are confident in their
abilities to overcome obstacles (Bandura, 1998). The concept of coping has expanded to strategies of
social support (Pierce, Sarason, &Sarason, 1996). The perception of strong social support provides a
degree of affective coping simply by its presence. Supportive relationships lead to more positive
and accurate assessment of self and support network efficacy. Support within specific dyadic
relationships, especially spousal support, has been found to be effective in rehabilitation settings
(Revenson &Majerovitz, 1990). Networks of supports, most notably families, enhance individual
coping with challenges in the rehabilitation process (Porrit, 1979).
Resilience, once reserved to describe individual’s ability to “bounce back” following personal loss,
has now taken on an additional systemic application in describing families (Walsh, 2003). Resilience
is recognized in the synergistic relationship between the individual and the group. The person is
simultaneously an extension of the family and feature of its resilience, and a recipient of family
support and the resilience it affords. This is particularly poignant for people with disabilities and
their families. The key to coping with the stressors around disability, foremost among these being
community exclusion, is to find strength in the family and purpose in the community (Li & Moore,
1998).
6.24 Systems in Rehabilitation Counselling

Cottone’s (1987) systemic theory of VR represents the first steps taken in building a rehabilitation
counselling framework that bridges family and service structure (Cottone, Handelman, & Walters,
1986). The theory posited that the degree of “fit” between the service systems governing

Notes
rehabilitation practice and the family systems governing client participation was an influential
arbiter of rehabilitation success, perhaps more important that the person × environment fit that the
system itself espoused. Cottone and Cottone (1986) proposed that VR actually functioned as a
complex system for screening social deviance before it functioned in its formal capacity. In their
critique of vocational evaluation, they suggested that vocational evaluation recommendations were
heavily influenced by counsellor expectations and agenda, making it more of a tool for preserving
the organization than a resource for advancing the client’s goals (Cottone&Cottone, 1986).
Preliminary research suggested that social relationships were more influential in determining
employability determinations than psychological evidence (Cottone, Grelle, & Wilson, 1988),
specifically in regard to clients with nonphysical disabilities. It was Cottone’s contention that
family-oriented rehabilitation counselling would provide a more effective point of client
engagement in a self-serving service system. The professional community’s response to this call
was underwhelming, despite the ethical questions raised for state VR and the implied need for
organized family advocacy.
In 2012, Cottone renewed his call for systems applications in rehabilitation counselling in further
explorations of the role of families. For Cottone, the inclusion of family in rehabilitation process
requires a rejection of the psych medical model and its Newtonian trait/factor worldview for the
Lewinian-inspired relational worldview of field theory. Cottone saw systems theory leading to a
true paradigmatic change for the profession, then and now. But paradigmatic change comes slowly
and unevenly. Today, systems theory has a broader appeal and a more receptive audience in
rehabilitation counselling. With family in the vanguard, we have both an impetus and a framework
for progress.
6.25 Sense of Community: A System of Inclusion

Moving to a systems model creates a language that includes the family in the social discourse of
disability, but to what end? What is the relationship between the family experience of disability and
the fundamental mission of full community inclusion? How is rehabilitation counselling supposed
to engage this relationship on behalf of its client? Coming out of a quasi-psych medical worldview,
these questions were difficult to even ask. Rehabilitation has adopted a biopsychosocial model to
expand its explanatory power, but the activities and participation of the ICF (WHO, 2002) give us
only the mechanics of inclusion. These advancements in construct do not yet capture the dynamics
of the relationships through which community is actually expressed. Community is like music in
this sense. It is expressed only in the moment of exchange between players. It is a subjective
experience that lives in the collected and collective memory of those moments.
McMillan’s “sense of community” (2005) provides a vocabulary upon which we may build a “sense
of family.” Sense of community reflects the basic human need for affiliation, group cohesion,
psychological attachment, and personal bonding. Sense of community is an empirical theory rather
than a normative one. Sense of community describes the phenomenon of people coming together.
McMillan (1996) conceptualized the affective “sense” of community in psychosocial terms,
revealing both its human nature and the demands humans place on it. Sense of community arises
from lived experience of community inclusion, framed by four community transactions (McMillan,
1996; McMillan &Chavis, 1986): (a) membership/spirit, (b) influence/trust, (c) need
fulfilment/trade, and (d) shared emotional connection/art.
6.26 Membership/Spirit
The first sense of community, or perhaps the deepest, is the sense of belonging to something larger
than oneself. It is a primal drive (gemeinschaft), evident in every social gathering. Individuals
derive their identity and a concordant sense of well-being from the safety and welcoming
acceptance afforded by membership. Members share symbols and rituals that bind them in

Notes
Course Name
affiliation and mark them as insiders. Membership is the spirit in esprit de corps, and the allegiance
to the corps can run very deep.
Spirit grows in finding common ground. The novice shares increasingly personal and sensitive
information about him- or herself within the space of the community. The community members
share similar stories and secrets in turn. McMillan and Chavis (1986) referred to this as “freedom
from shame.” Such sharing is a risk taken through a call and response. The individual reveals,
“Here I am.” The community responds, “One of us.” The danger is when the community does not
respond or rejects the call outright. Shame and humiliation are the death of community and the
denial of identity. The more we risk in self-revelation, the higher the emotional stakes, the deeper
the meaning of membership.
6.27 Influence/Trust
Communities exist to serve the membership. Structures and processes form around these intents as
strategies and plans, rules and regulations, roles and functions. Structure and habit allow for
specialization and more effective pursuit of community goals and impart a comfortable
predictability and trust among members. People are drawn to order. It creates a framework for
identity and makes relationships among members clear.
Order requires a subjugation of individual freedoms to the common good. It is part of the dues of
membership and part of the assumed social identity. Order and community cohesion are sustained
through the negotiation of authority and responsibility among members. Individuals are attracted
to groups that can leverage their collective influence (e.g., labour unions, advocacy groups) in areas
of individual interest. Members are more willing to acquiesce to authority when they believe they
have input into its exercise. Community is most successful when authority is responsive to and
works in service of the membership (McMillan &Chavis, 1986). Trust evolves from the perceived
benefit of compliance, equity of power relationships, and the predictability of consequences. An
individual’s sense of community is enhanced if he or she has a say in what the community does,
sees the community as working in his or her interest, and believes that he or she is being treated
fairly within it.
6.28 Integration of Fulfilment of Needs/Trade

Having established a sense of belonging and an orderly environment within which to act, the
economic work of community may commence. Trade is the engine of community. It is the essence
of Gesellschaft, that is, membership as personal benefit. Community action is shaped around the
collective leveraging of individual resources.
Individuals exchange economic, social, psychological, and political capital in the internal
community marketplace, which advances both community cohesion and individual prosperity in
all dimensions. Cohesiveness comes from a proper matching of needs to resources. Sense of
community is advanced when the individual’s contribution is valued, he or she can fulfil his or her
needs, and he or she is free to trade in equity.
6.29 Shared Emotional Connection (1986)/Art (1996)

Community is a process reified by its history and the artifacts it creates. Community histories are
replete with origin stories, recollections of pivotal moments in history, the journeys of heroes, and
cautionary tales of members gone wrong. Buildings and monuments are testament to the history.
Celebration and ceremony mark the milestones of life, honour membership, and instil faith in the
constancy and relevance of the group.

Notes
This is the fruition of the sense of community, the celebration of one’s part in the whole. In the
sense of transaction, it circles back to the first sense, membership and spirit. But now the novice is
the master. He or she transacts in wisdom as one who listens to the initiate’s story and responds
with the group’s secret mythology to include the novice as “one of us.”
6.30 Family as First Community: Implications for Rehabilitation

Counselling
Synomorphy describes the natural systems “fit” that occurs between standing patterns of group
behaviour (e.g., shopping) and the features of the nonbehavioral environments in which they occur
(e.g., business hours, malls, advertisements, public transportation; Barker, 1968). Fit in this sense is
a self-organizing process, where form follows function and function follows form. It is possible to
deduce one knowing the other and to find them paired wherever either is found. Lewin (1951) used
this concept to study measures of economic interdependence and demonstrated that Synomorphy
could be explored at multiple levels (e.g., the economic interdependence of city, neighbourhood, or
family). The same can be said for Dewey’s conceptualization of big “D” democracy’s dependence
on small “d” participation of local communities, and the origins of democracy in the education of
the individual within a democratic system. McMillan similarly bridged sense of community theory
to couples (McMillan, 1997) and the families they evoke. Thus, the thread of community runs
unbroken from the broadest contexts of philosophy, to society and its problems, through
professional praxis and its solutions, down to the family and its lived experience with disability.
Family is the first synomorphic instance of community and thus the most immediate experience of
inclusion available to the client or counsellor. If community inclusion is the fundamental mission of
rehabilitation counselling, the most sensible strategy for pursuing it would be to start with its
function in the family and work outward.
6.31 Strengthening Community in the Family

The sense of family arises out of collaborative participation in instrumental tasks that achieve goals
that are collectively valued (Verdon Schott, de Witte, Reich raft, Buntinx, &Curfs, 2009). The degree
and character of a family member’s active inclusion in the business of the family provide social
learning content about his or her role and efficacy in the world. A client-centered approach to
community inclusion begins with an evaluation of the familial relationships. How does the
individual express her- or himself in family rituals of membership? How does the individual
negotiate the authorities and obligations of his or her role within the family structure? How does
the individual contribute to and draw from the collective family resources? For each of these issues
add, “... and how does the family respond?” Unlike the questions and contexts that opened this
chapter, these are questions that can now be entertained.
Each member of the family will experience the phenomenon of disability differently, but it is a
shared experience that contributes to group identity. Deepening the sense of family requires
sharing these personal experiences (in culturally appropriate ways), reflecting upon them, and
responding to them in intentional and inclusive ways. A strong sense of family shared by all
members is the optimal foundation for advancing the goals of rehabilitation counselling in the
community at large.
6.32 Strengthening Family in the Community

Individual family members draw strength from their trade with multiple communities beyond the
family. These may be communities of practice that revolve around work, school, or other shared

Notes
Course Name
interests. They may be geographically bound or virtual. These communities may be an individual
pursuit of one family member, the family as a whole, or a subset. In every permutation, the
experience of disability follows the individuals into other memberships, as it is a part of their
identity. It is part of the stories they tell. When they negotiate their role in the organization, they
negotiate within the experience of disability. When they trade in resources, the experience of
disability contributes in some fashion for good, ill, or otherwise.
Families are nested and networked in a community of their own making. The groups they join, they
join because it serves a family need. Peer and advocacy groups may trade in disability specific
knowledge, support, and connections designed for individuals or families. Cooperatives may serve
a broader mission (e.g., fair trade products, culture and the arts) that builds inclusion into service.
Even strictly social groups (e.g., work-sponsored bowling teams) potentially provide linkages
between the family and desired resources that may serve the client (e.g., job openings).
Rehabilitation counselling in the community engages family efforts in marshalling existing
community resources and expanding their social network to strategic advantage.
6.33 Family and the Rehabilitation Counselling Ethos

An unbroken thread runs from the values that unite the profession, community, and family, to the
models that make sense of the disability experience, to the practice of rehabilitation counselling.
Community values resonate through the relationship with the family. At the point of transaction,
they take on the look of action research. The client invites the family and the counsellor to
collaborate on problems of mutual concern. Employment is often the proximal reason for the
gathering, but the family’s perspective is complex and extends over the course of years. They see
employment as the first step in a career. They see the career as part of a social life beyond work and
home. They see the arc of a social life into old age. And each family member sees him- or herself in
the family narrative or he or she sees none of this, and that is the problem. The client and his or her
family set about the task of visioning an objective and planning the steps required. They share,
negotiate, and settle on something worth doing. They proceed, succeed or fail, and then share their
perspectives in review. Then they repeat the process. Along the way, they acquire knowledge and
learn new skills. This is what families do.
The rehabilitation counsellor engages the family process as a resource designed to facilitate the
work of families through three community-based transactions:
Identity provides the working alliance and space for psychosocial support as persons with
disability and their families negotiate life challenges. Identity is rooted in the democratic ideal of
liberty. It asks, “Who am I (who are we) in the face of change?” It is realized in the exchange of the
personal with the collective in search of belonging—the spirit of family and community.
Power provides a voice for the family seeking social justice, alone and in the collective. Power is
rooted in the democratic ideal of equality. It asks, “What do I (we) direct and what directs me (us)?”
It is realized in the exchange of authority and responsibility in search of an empowered sense of
justice—the sense of structure, stability, and trust.
Capital provides networks and networked resources for the development, implementation, and
evaluation of planned action. Value is rooted in the democratic ideal of fraternity. It asks, “What do
I (we) have to offer and what is proffered in return?” It is realized in the exchange of capital, real
and social, in search of sense of enrichment and quality of life.
We can recognize the familiar in these transactions as they track closely to traditional counselling,
advocacy, and case management roles. Here the roles are unified in community values. Dealing
with the family requires all three orchestrated in delivery. As we attend to each in the coming
chapters, it will become apparent that they are facets of a single irreducible whole, much like the
fundamental mission that drives them.

Notes
Review Questions
1. Who are entitled to receive social rehabilitation services?

2. What changes were made to the social rehabilitation system in 2016?
3. What is the difference of a rehabilitation program, a plan of action and a rehabilitation plan?
4. In which cases will a case manager visit me at home?
5. If I submitted an application for social rehabilitation before the year 2016, if and how will the
changes that took effect on January 1st, 2016 affect me?
6. If I have a current rehabilitation plan and received social rehabilitation services on the basis of
said plan in the previous year, how will the changes affect me?
7. What is the reason behind the evaluation of rehabilitation needs and what does it mean for
individuals applying for the service?
8. What does the evaluation of rehabilitation need mean for a disabled person?
9. If I have a current rehabilitation plan that was prepared before the year 2016 and I am turning
16 this year, will I be able to use services on the basis of the target group of children or persons
of working age?
10. Is it required to reapply for rehabilitation if a child for whom a rehabilitation plan was
prepared with the purpose of establishment of disability is awarded a disability?
Self Assessment
1. With Barbiturate and Benzodiazepine Abuse and Dependency, sedative intoxication is

generally associated with:
A. Slurred speech
B. Uncoordinated motor movements
C. Impairment in attention and memory
D. All of the above
2. Which of the following is derived from the hemp plant "cannabis sativa"?
A. Opium
B. Marijuana
C. MDMA
D. Crack
3. A synthetic form of opium was developed by Germany during WWII. This is known as?
A. Prednisolone
B. Cortisone
C. Methadone
D. Polyheroin
4. A long-term user of cocaine may well develop symptoms of other psychological disorders,
such as:
A. Major depression
B. social phobia
C. Eating disorders

Notes
Course Name
D. All of the above
5. A motivational syndrome in cannabis users suggests that those who use cannabis
regularly are more likely to:
A. Exhibit apathy
B. Exhibit loss of ambition
C. Have difficulty concentrating
D. All of the above
6. Lysergic Acid Diethylamide (LSD) starts to take effect around 30 to 90 minutes after taking
it and physical effects include:
A. Raised body temperature
B. Increased heart rate and blood pressure
C. Sleeplessness
D. All of the above
7. Individuals with Hallucinogen Dependency can spend many hours and even days
recovering from the effects of the drug some hallucinogens - such as MDMA - are often
associated with physical 'hangover' symptoms. Which of the following are MDMA
hangovers?
A. Insomnia
B. Fatigue
C. Drowsiness
D. All of the above
8. Which of the following is an important factor in substance abuse?

A. Whether the substances are regularly used by other family members
B. Whether the family environment is rural or urban
C. Whether you are a twin
D. Whether you are born in the winter
9. The alcohol intoxicated individual has less cognitive capacity available to process all on-
going information, and so alcohol acts to narrow attention and means that the drinker
processes fewer cues less well. This is known as:
A. Alcohol myopia
B. Alcohol dependency
C. Alcohol abuse
D. Alcohol amnesia
10. In substance abuse, the term self-medication refers to?

A. Amelioration of psychological distress thorough substance use
B. Doctors prescribing their own drugs
C. Motive for using a substance
D. Deciding the drug of choice
11. Community-based services to offer support in substance abuse consist of self-help services
such as?

Notes
A. Alcoholics Anonymous
B. Crack
C. Cannabis Collective
D. Hashish Home
12. Drug-prevention schemes targeting young people and their parents who may be
specifically at risk provide:
A. 24-hour telephone help lines
B. Internet web-sites
C. Treatment, and availability
D. All of the above
13. Local community drug prevention schemes have used which of the following?
A. Peer-pressure resistance training
B. Peer pressure
C. Peer promotion
D. Peer propaganda
14. Which of the following are treatments offered by residential rehabilitation centres?
A. Group work
B. Psychological interventions
C. Social skills training
D. All of the above
15. In aversion therapy clients are given their drug followed immediately by another drug
that causes unpleasant physiological reactions such as nausea and sickness. Rather than
physically administering these drugs in order to form an aversive conditioned response
the client to imagine taking their drug followed by imagining some upsetting or repulsive
consequence. The variant on aversion therapy is known as:
A. Covert sensitisation
B. Inverted de-sensitization
C. Overt desensitisation
D. Covert habituation

Support Systems
UNIT – VIISupport Systems

UNIT 7: Support System: Group Dynamics,Self Help groups,Self-
advocacy movement, Community awareness, Community based
rehabilitation
Contents
Objectives
Introduction
2.1. Meaning and definitions
2.2. Group Dynamics
2.3. Self Help Group
2.4. Self-Advocacy movement
2.5. Community Awareness/Community based
rehabilitation
2.6. Summary
2.7. Keywords
2.8. Self-Assessment
2.9. Review Questions
2.10. Further Readings
Objectives
This unit will enable you to: -
Understand the nature of support groups;
Elucidate the basic meaning of group dynamics;
Evaluate the self-help group and self-advocacy movement;
Acknowledge rehabilitation related to community.
Introduction
Support groups are those groups in which people come together on a daily base. They can meet at
any clubs or meetings or anywhere else. They provide support to each other and they shared their
experience about rehabilitation for patient. Support groups are basically for those who want extra
support in their life. Support groups are always ready to provide a new lifestyle, support structure
and supportive colleagues. To achieve success in starting years is attending meeting regularly.
Support groups are built by individuals who needs same therapy means support groups are for
those who are in a team and they set a common goal. Support groups are always ready to motivate
and to help and these groups play always a basic role in recovery for needy people and for their
loved ones.

Support Systems
Support group has form two types of groups in which first is group therapy session keep by a
psychotherapist for those group members who have similar goals. These group are treated with a
similar recovery plan and all members are to be counseled together by counselor. It is also known
as group counseling or group psychotherapy.
The other support groups are co-workers led. These groups are held in informal settings. Support
groups are important because these types of groups offer a skill-building activities to the peoples
and this type of an experience can be aid to their future achievement goals. The support groups
always open new doors for coping strategies and also influence insights so person can get a
successful rehabilitation. Support groups can be considered as a powerful weapon so it will
motivate the other one and they can get a better life.
2.1. Meaning and definitions
According to APA,”a group similar in some ways to a self-help group in that members who share a
problem come together to provide help, comfort, and guidance.”
Support groups are form with those peoples whose have same experience in their life, these groups
can be same in on same ground that e.g. any disease or disorders. Support groups shares personal
experience on same ground. These groups filled a gap between doctors as medical treatment and a
need of emotional support.
Support groups are work as nonprofit advocacy, organization and clinic and these groups are led
by professionals, psychologists, doctors, nurses and social workers. Support groups reduce anxiety,
stress. They improve quality of life of peoples. They learn about health, economic or social
resources.
2.2. Group Dynamics
Group dynamics is the study in which we study how people come together, which factors effect to
cohesion and co-operation and also how groups effect to outsider groups. Basically, group dynamic
is the explaining way of roles, behaviors and communication between groups.
Structure of group is primary key to influence on groups. How group is formed, how they build
their trust on each other and how members in group are connected to each other. Healthy group
interaction is the most important factor to form and to maintain group dynamic. The dynamics of a
group depend heavily on its goals. In order to survive, humans have an innate propensity to set
long-term as well as short-term goals.
According to McGrath (1984), a group accomplishes its objectives by first creating ideas, selecting
among alternatives, haggling over solutions, and then carrying out activities. To fulfill both the
group's aims and the individual ambitions of each member, being a member of a team can be a
significant source of encouragement. Group dynamics is based on the group cohesion, group think
and structure of the group.

Support Systems
There are two types of Group dynamics-
1. Formal Group Dynamics- Groups formed by an organization or other body to accomplish

a certain aim those with formal group dynamics. Its formation is intentional, and the
group size is frequently big. The hierarchy within the group is essential and formal group
dynamics are more professional.
2. Informal Group Dynamics- Informal group dynamics are more prevalent in groups that
develop more naturally and typically result from an opportunity or organizational
necessity. Smaller groups typically experience this kind of group dynamic. Members opt
to join the group, and approval is typically not necessary. Although informal group
dynamics lack a clear structure, they can still have an impact on formal group dynamics.
TUCKMAN’s Approach of group Dynamics-
Group development is a dynamic process and it is flow from 5 stages-
1. Forming- The formation of a group occupies the first phase of its existence. Members in this
stage are known for seeking either a job (in a formal group) or another reward, such as status,
affiliation, power, etc (in an informal group). At this stage, members either engage in active
activities or display disinterest.
2. Storming- The emergence of dyads and triads in this group indicates the progression to the
next stage. Members look for people who are like them or who they are familiar with and start
a deeper self-sharing. As the subgroup receives more attention, the group becomes more
distinct, and tensions between the dyads or triads may manifest. Pairing is a typical
occurrence. Conflict will arise about who will run the group.
3. Norming- It is the third stage in which team members start to take responsibility and set
standards rules and regulations for the team.
4. Performing- In this stage of a group's development, participants engage in the work and
perceive the group as a whole. Each member contributes, and the group as a whole includes
the authority figure. In order to ensure the efficacy of the group's process of group, group
norms are observed and collective pressure is applied.
5. Adjourning- It is the last stage or closing stage of temporary group. For permanent group
the above four stages are important.
2.3. Self Help Group
Gerald Goodman and Marion Jacobs predicted that self-help groups will become the nation's
“treatment of choice” in the next 10 to 20 years.
Self-Help Groups (SHGs) are unofficial organisations where people gather to discuss how to better
their living circumstances.It can be characterised as an identity, consensus informational group of
individuals with a common socioeconomic background and the intention to work together to
achieve a common goal.SHG use the concept of "Self Help" to facilitate growth and reduce

Support Systems
poverty.People with disabilities and their family members participate in groups to resolve common
problems, enhance their individual strengths, and improve their quality of life.
Social help groups are basically needed for social integrity, gender equity, financial inclusion and
also the alternate source of job.
By assisting others, we can achieve this through mutual assistance. A self-help group can be joined
for a variety of issues, including:
 behavioural health issues
 mourning and loss
 parenting and drug usage
 weight management or loss
 caregiver assistance.
Sternlicht asserts that support groups have a variety of advantages that could be advantageous for
people interested in self-help:
Mutual assistance-When facing hardships in life, connecting with others can make you feel more
supported and less alone.
Network construction-You might find it easier to keep on track and connect with relatable people if
you create a support network with others who have similar life experiences or goals.
A higher sense of self- Making great life choices and encouraging others to do the same may make
you feel more empowered, which may boost your self-esteem
Fostering optimism- Observing the development of others may give you hope for your own
position.
2.4. Self-AdvocacyMovement
Self-advocacy is, quite simply, the act of defending oneself and one's rights. Self-advocacy is a word
of personal identification that emphasizes one's political power and right to self-decision for
thousands of disabled individuals around the world. It is also a civil rights movement that stands
up for people of all racial, ethnic, and religious backgrounds who have historically been routinely
mistreated, abused, imprisoned, and misunderstood.
Self-advocacy is a movement driven mostly by and for people with mental retardation who are
taking charge of their own life, making their own decisions, and speaking up for themselves and
other people with disabilities. The larger disability rights movement and a separate movement that
focuses on important issues are both a part of self-advocacy.Self-advocacy is a separate movement
that focuses on important concerns for people with developmental disabilities while also being a
part of the greater disability rights move.
2.5. Community Awareness/Community Based Rehabilitation
Awareness regarding disability means to educate to the people for disability. It is to be

educated that people must be assured that they never discriminate to the disable persons
because disability discrimination is unlawful.

Support Systems
A community development method called community-based rehabilitation (CBR) attempts to

improve the quality of life for those who have impairments and their families while also
ensuring their inclusion and engagement in society.CBR was first introduced by WHO as a
plan to give more people with disabilities accessible to rehabilitation programs just at local
level, but now it has extended into a significantly extensive and multisectoral strategy for
community-based inclusive development.
Community based rehabilitation creates a greater understanding of the variety within the
community, including the diversity in how elderly people, children, and individuals with
impairments function.
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2.6. Summary
 Support groups are always ready to provide a new lifestyle, support structure and
supportive colleagues. To achieve success in starting years is attending meeting regularly.
 The support groups always open new doors for coping strategies and also influence
insights so person can get a successful rehabilitation.
 Group dynamics is the study in which we study how people come together, which factors
effect to cohesion and co-operation and also how groups effect to outsider groups.
 Self-Help Groups (SHGs) are unofficial organisations where people gather to discuss how
to better their living circumstances. It can be characterised as an identity, consensus
informational group of individuals with a common socioeconomic background and the
intention to work together to achieve a common goal.
2.7. Keywords
Rehabilitation- Rehabilitation is care that can help you get back, keep, or improve abilities that you
need for daily life. These abilities may be physical, mental, and/or cognitive (thinking and
learning).
Storming-This stage begins to occur as the process of organizing tasks and processes surface
interpersonal conflicts. Leadership, power, and structural issues dominate this stage.
Self Help Groups -Self-help Groups (SHGs) are informal associations of people who come together
to find ways to improve their living conditions. They are generally self-governed and peer-
controlled.
Community- A group of people with a common characteristic or interest living together within a
larger society.

Support Systems
2.8. Self-Assessment
1. __________can be considered as a powerful weapon so it will motivate the other one and they
can get a better life.
a. Self-help groups
b. Support groups
c. Self-advocacy movement
d. Community awareness
2. Which stage is showing about team members start to take responsibility and set standards rules
and regulations for the team?
a. Forming
b. Storming
c. Adjourning
d. Norming
3. Are support groups work as non-profit organization?
a.True
b. False
c. Can’t say
d. None of the above
4. Is Community development method known as also community-based rehabilitation?
a. True
b. False
c. Can’t say
d. None of the above
5. Which type of group formation is intentional, and the group size is frequently big?
a. Informal
b. Formal
c. Simple
d. All of above
6. CBR was first introduced by whom?
a. ICD

Support Systems
b. DSM
c. WHO
d. ICSSR
7. Which factor is responsible to make great life choices and encouraging others to do the same
may make you feel more empowered, which may boost your self-esteem?
a. mutual assistance
b. network construction
c. higher sense of self
d. fostering optimism
8. ________ is a movement driven mostly by and for people with mental retardation who are
taking charge of their own life, making their own decisions, and speaking up for themselves and
other people with disabilities.
a. self-advocacy
b. community-based rehabilitation
c. community awareness
d. self-help groups
9. The fourth stage of group dynamic is –
a. Norming
b. Forming
c. Storming
d. Performing
10. Is informal group dynamics lack a clear structure, they can still have an impact on formal
group dynamics?
a. True
b. False
c. None of the above
d. Can’t say
Answers
01 02 03 04 05
b d a a b
6 7 8 9 10
c c a d a

Support Systems
2.9. Review Questions

1. What is group dynamics? Explain Tuckman’s approach of group dynamic?
2. Discuss Self-help groups?
3. Describe community-based rehabilitation?
4. Write a note on self-advocacy movement?
5. Describe about support groups?
Further Readings
Elliott, Timothy R. & Frank, Robert G.- Handbook of rehabilitation psychology,3rd

Notes
Unit 08: Disability Dealing with Families

CONTENTS
Objectives
Introduction
8.1 Families’ Reaction to the disabilities
8.2 Coping styles
8.3 Family Counselling
8.4 Coordination with Multidisciplinary Team
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To know family’s reaction to disabilities
 To understand cognitive styles and family therapy related to Disability
 To familiarize with coordination with multidisciplinary team
Introduction
If you are a family member who cares for someone with a disability, whether a child or an adult,
combining personal, caregiving, and everyday needs can be challenging.
The impact of having a family member with an intellectual handicap can be felt by the entire
family, including the parents, siblings, and extended family. It is a one-of-a-kind shared experience
for families that can have an impact on all aspects of family life.
On the plus side, it has the potential to extend perspectives, boost family members' knowledge of
their inner strength, strengthen family togetherness, and stimulate community ties. The time and
financial costs, physical and emotional strains, and logistical challenges of caring for a disabled
child or adult, on the other hand, can have far-reaching consequences. The consequences will most
likely be determined by the type and severity of the ailment, as well as the family's physical,
emotional, and financial resources.
Caring for a disabled family member can cause stress, impair mental and physical health, make it
difficult to locate adequate and inexpensive childcare, and influence decisions regarding career,
education/training, having more children, and relying on government assistance. It may be linked
to feelings of guilt, blame, or low self-esteem. It has the potential to draw attention away from other
parts of family life. Medical care and other services may have astronomical out-of-pocket prices. All
of these potential consequences could have an impact on the quality of family connections, living
arrangements, future partnerships, and family structure
8.1 Families’ Reaction to the disabilities

Caring for a disabled family member can cause stress, impair mental and physical health, make it
difficult to locate adequate and inexpensive childcare, and influence decisions regarding career,
education/training, having more children, and relying on government assistance. It may be linked

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to feelings of guilt, blame, or low self-esteem. It has the potential to draw attention away from other
parts of family life. Medical care and other services may have astronomical out-of-pocket prices. All
of these potential consequences could have an impact on the quality of family connections, living
arrangements, future partnerships, and family structure.
Refusing to admit that your child has a disability is known as denial. Parents make excuses for their
children's academic failures because they refuse to admit that their children have a disability.
Instead, they may blame their child's difficulties on teachers or a spouse. Alternatively, they may
accuse the child of being lazy and refuse to give special education assistance.
Denial occurs for a variety of reasons. Recognizing a disability can be extremely frightening for
some parents. Denial stems from a parent's great fear of their child struggling in life or being
rejected by others, which is frequently a parent's worst nightmare.
Kandeland Merrick have complied results from studies about families having a child with a
disability. The birth of such a child usually follows five stages: "denial, anger, bargaining,
depression and acceptance." Parents usually react with "psychological stress, a feeling of loss and
low self-esteem." The child is "disappointing" and a "social obstacle" leading to shame and
embarrassment." Parents may direct their anger toward others, their partner, the physician, or other
families who do not have this stress. Some parents bargain with their higher power: e.g. If you heal
my child of the disability, I'll quit drinking or... They may feel guilt, that the child is a punishment
for a past sin. They may overly protect this child who is a symbol of their failure. The frustrations of
finding specialized help, managing added costs of care, maintaining social communications may
mean that the parents aren't able to communicate with each other. It is usually the mother who
assumes more responsibility, so that the father often feels neglected by his wife who is busy with
the child. A report concerning Down syndrome in Israel found that 25% of families abandon the
child in the hospital. One United State study found that "the divorce rate was ten times larger in
families with a disabled child than in the general population." Whether the child is placed in an
institution or kept at home the grief of the loss of an expected normal child is a life-long "chronic
sorrow." Parents need to talk with a competent professional about their reactions and strategies for
coping.
Sibling reactions:Gretchen Cook and others report that siblings of children with disabilities need
a place to vent their feelings and help them cope with the family situation. Siblings often report that
they are ashamed or embarrassed by their sibling with a disability and don't have the words to
explain to their pals why their sibling is different. They often feel guilty for having those aversions,
feel that they don't deserve to have friends or a successful life, and even wish that they be punished
with a disability. They often report that they feel neglected because their parents are overburdened
with care for their sibling. They may worry that they could "catch" the condition or that they carry
the gene so that their children will be disabled. They may resent the extra burden of caring for the
brother or sister, which is placed on them at an early age and worry that they may have to take over
long-term care. On the other hand, those children who have open communication with their
parents were better at establishing relationships with friends. Later in life the sibling often feels that
he/she benefitted because of the responsibility placed on them--they feel they understand that
people are different and that they have learned how to manage difficult situations.
Children's reactions:People having a disability do not want to be labelled: e.g., the blind girl.
They want to be known as an individual and to share experiences with others based on like
interests. They want opportunities to be independent and to have access to transportation, jobs, and
socialization. When they receive love and respect they develop self-assurance, which makes it
easier for others to know them.
8.2 Coping styles

Caregivers, their family members, and their host families have built close and trusted connections
as a result of their participation in Home Sharing / Short Breaks.
The Host Family, according to the parents, is a great step toward community inclusion.
For other parents, simply comprehending the gap between their desires for their child and the
disability that exists exacerbates their emotional and cognitive efforts to adjust to the situation.
They can be experiencing sadness, depression, or embarrassment. Some people may wonder "why
me?" and believe they are being punished for past crimes or poor actions. Depending on the
severity of the handicap and the size of the coping demand, some parents may consider suicide for
their kids or for themselves. These sentiments indicate a universal desire to find inner serenity.

Notes
Recognize and embrace parental dominance as a normal part of the adjustment process and offer
support. Adjustment, on the other hand, can hasten the acceptance process. It can, in turn, provide
a majority of competent and supportive parents to aid educators and other associated workers in
the difficult effort of satisfying all of the children's requirements.
Developmental disability refers to a range of conditions including intellectual disability, cerebral
palsy, autistic spectrum disorder, learning disability, epilepsy, etc., Most childhood disabilities are
referred to as developmental disabilities, defined as any physical or mental condition that may
impair or limit a child's ability to develop cognitively, physically, and emotionally compared to
other children. Most of the disabilities unlike physical, which are noticed at birth, get undiagnosed
until a child enters a school. It is difficult for parents to identify a developmental disability as they
are normally not aware about the developmental stages of a child and more so if it is their first
child. Professionals often have difficulty diagnosing a specific disability at such an early age, so the
term developmental delay is utilized to qualify a child for services in infant and preschool
programs.
A disabled child's family adjusts on several aspects in life to suit his needs. The physical and mental
stress associated with raising such children could be multimode. Caring for such children can be a
physically and mentally tasking job, depending on the type of disability resulting in compromised
quality of life (QOL) of the carers too. While treating and rehabilitating the disabled children, the
needs of the carers are seldom thought about. It is quite possible that even the carers need help to
cope with the physical, mental and emotional stress they bear while caring for their loved one. QOL
as defined by the World Health Organization (WHO) is an individual's perception of his/her
position in life in the context of the culture and value systems in which he/she lives, and in relation
to his/her goals, expectations, standards, and concerns. Coping strategies can be defined as “the
cognitive and behavioral efforts required to manage specific external and/or internal demands that
are appraised as taxing or exceeding the resources of the person.”
Care that is given to a normal child itself is taxing for the parents many a times and to provide a
higher level of lifelong care to a child suffering from long-term functional limitations may be
strenuous for the parents and thereby may be affecting their QOL. Becoming the parent of a child
who has some disability can be a time of great stress and change. The birth of a disabled child can
influence the relationships of all the family members. It also requires a reassessment of the family
functioning. Majority of family’s cope with the situation relatively well and are able to continue
their life normally. However, coping with a physically or intellectually disabled child is a highly
individual process, and there is evidence to suggest that some families may never adjust fully to
this event. Coping requires a cognitive reappraisal of the situation to manage it properly. A number
of studies have concentrated on the degree to which families with disabled children feel stress, how
they manage, what factors support them, and what coping strategies they use.
Over the last 50 years, right to education has evolved in India inspired by a host of factors including
judicial interpretations, enactment of special laws, and amendment to the constitution. The
constitution of India has made education a fundamental right for all children including the children
with disabilities in the age group of 6–14 years. Section 26 of Persons with Disabilities Act (1995)
affirms the capacity of Indian state to afford free education beyond 14 years of age, particularly in
the context of children with disabilities.
According to the Census (2001), there are 2.19 crore people with disabilities in India who constitute
2.13% of the total population. This includes persons with visual, hearing, speech, loco motor, and
mental disabilities. Seventy-five per cent of persons with disabilities live in rural areas, 49% of
disabled population is literate and only 34% are employed. The earlier emphasis on medical
rehabilitation has now been replaced by an emphasis on social rehabilitation. Approximately 3–5%
of the population of children experience or get affected with physical, intellectual, and mental
health problems according to the National Health Survey.
The Persons with Disability Act, 1995 is built on the premise of equal opportunity, protection of
rights and full participation. It provides definitions of disabled person by following the medical
model. According to the Persons with Disabilities (Equal Opportunities, Protection of Rights and
Full Participation) Act, 1995, “person with disability” means a person is suffering from not <40% of
any disability as certified by a medical authority (any hospital or institution, specified for the
purposes of this act by notification by the appropriate government).
It is also important to note that caring for a child with disability does not equally affect all parents.
There are families who cope well despite the adversity. There could be number of factors that can
affect the QOL of carers which could include severity of the disability of the child, presence of
cognitive or behavioural problems, socioeconomic status of the families, lack of education, low

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social support, etc., Therefore, the following study has been undertaken to assess the QOL and also
the kind of strategies used by the carers of disabled children.
The first stage

The parent may be taken aback and cry or get depressed. Parents may occasionally show their
feelings through physical outbursts or inappropriate laughter.
The second stage

This is a continuation of stage one, and some parents may ignore or try to avoid their child's
impairment in some other way. In an attempt to influence reality, some parents would look for or
propose various actions. Some people may try to "negotiate" for a different reality or "shop for a
cure.“
The third stage

Parents may be enraged at this point. They may express their wrath in the form of rage, or they
may withdraw and become inactive as a result of deep guilt feelings. It is normal for people to
verbally attack anyone who they believe is to blame for their sad situation, including shifting the
blame on the original diagnostician or any supportive professionals. If the parents are angry, guilty,
or both, experts must recognize that this is a very positive step in the transition process and not
become defensive if they are attacked.
The fourth stage

Parents come to terms with the knowledge that their child has a handicap. In some cases, one or
more members of the family may become depressed. Shame, remorse, helplessness, and anxiety can
all arise because of a new heavy burden of obligation. For some parents, withdrawing and
attempting to hide their child, particularly from friends and strangers during structured or routine
social interactions, may be the first sign that they have begun to accept their child's impairment.
Any tendency toward or display of conduct that leads in abnormal isolation of one or more family
members, on the other hand, must be avoided or removed.
The Fifth Stage

This is the acceptance stage, which means the parents have earned unconditional favorable regard
for their child. Experts disagree about whether this stage of adjustment includes parents who
simply accept their child's condition, known as neutrality, or a critical new stage of cognition in
which parents not only learn to understand and appreciate their child, but also strengthen their
skills in coping with life's challenges and in helping their child, themselves, and others. The school
encourages parents to become team members in a program with caring professionals, and
frequently paraprofessionals, that are structured to satisfy all the child's needs are highly connected
with reaching this stage.
This is the sixth stage

Parents can reassemble their life and enjoy living again, anticipate a future, and speak freely about
their kid. They may objectively discuss and participate in the design or delivery of instruction.
8.3 Family Counselling

Other complications can cause setbacks in adjustment, such as unanticipated experiences of being
socially rebuffed by friends and strangers or being treated inappropriately by poorly informed
educators, even after parents find acceptable ways to cope with their child and their lives by
following a healthy path beyond acceptance of their child's disability. The arduous process of
remaining in the highest degree of adjustment is only made more difficult by such recurring bad
experiences. Parents, like professionals, are acutely aware of the inhumanity of those who show
little or no empathy or compassion for disabled people or their caregivers. Parents and children
commonly regress into states of anger, frustration, or other earlier stages of feelings and behaviors
as a result of other people's actions rather than circumstances.
Most parents require assistance in order to go through the stages of adjustment in a positive and
timely manner. At least until their child reaches the usual and customary developmental
milestones, their progress toward a level of reasonable acceptance, closure, and reconstruction
includes an accurate understanding of reality. Professionals can assist parents in finding a happy
medium between their expectations and reality. For example, no need exists to engage in prediction

Notes
about what a 4-year-old child will be able to do when s/he has reached the age of 21. While most
parents want and need professionals to be honest as a condition of being seen as trustworthy and
credible, they do not require information that is grim and full of doom and gloom.
As their child progresses through the stages of development, the majority of parents will come to
comprehend the realities and ramifications of their child's success. This is especially true if parents
believe that educators prioritize the needs of their children when creating educational and related
services. These stages of grief, pain, and acceptance are not experienced by all parents. However, as
professionals, we must be prepared to assist parents in navigating these stages if necessary.
Every family is different, with its own patterns and experiences, and every child's family is the
most significant social institution. Family is defined as "interacting communication networks in
which each member influences and is influenced by the characteristics of the family system".
Adversity has the potential to either enhance or weaken family bonds. In the face of adversity,
some parents and families adapt successfully and remain resilient. However, not all of them are
successful in adapting. Adaptability is defined as a family's ability to adapt its rules,
responsibilities, and power structure in response to situational and developmental stress, according
to Olson's Model. In general, systems theory emphasizes circular causality – a concept that events
are linked by a succession of interconnected loops. In these families, an undesirable pattern known
as 'fusion and triangulation' might occur, putting the family's mental health at risk.
The interaction of experienced stress, available coping resources, and the ecological circumstances
in which the individual family functions determines family adaptability. Parents are the foundation
of the family and have a significant impact on their offspring. This emphasizes the necessity of
dealing with special-needs families. Having a special kid is typically a watershed moment for
parents, necessitating a paradigm shift in expectations and a shift in vision.
Parents of children with exceptional needs were interviewed. Children share life tales with themes
that include an obvious trauma (child's diagnosis), followed by the parent either moving forward
and solving/coping with these life difficulties or stagnating and at times regressing from where he
or she started. It's critical to acknowledge the distinct set of parents who were able to cope
effectively despite various pressures and to apply what we've learned to help and support parents
who require assistance and good coping skills.
Being a caregiver is a challenging responsibility. Add disability into the equation, and it can
exponentially strain the commitment. Such relationships can, however, also be very rewarding. I
understand the intricacies of the dependent-caregiver relationship because I have a physical
disability and require daily assistance to maintain a healthy lifestyle at home, which has proved to
be very helpful throughout my career as a therapist and life coach.
For parents, physical caregiving usually ends when their child reaches the age of maturation—
around age 18. But this is not always possible for children with chronic disabilities, who rely on 24-
hour care.
While physical disabilities may not affect the individual's mental capacities, their physical needs
can still be that of a young child. For example, I am a 24-year-old working woman. But in order for
me to get to work and see my clients, I must first have assistance with dressing, preparing meals,
transportation, and other daily needs. While such tasks can, at times, feel taxing and overwhelming
for my mother or any caregiver, it’s extremely important for caregivers to monitor their attitudes
toward the individuals who receive care.
The attitudes, emotions, and mindset of caregivers are easily transferred to the individuals who
need care, and can have a significant impact on their mood and the way they view themselves.
Negative emotions from caregivers may leave people with disabilities feeling like a burden, which
can be detrimental to their mental and physical health and recovery. Caregivers can minimize
negativity by maintaining their own physical and psychological health.
One way for caregivers to alleviate stress is to develop a strong support network of family and
friends that can lend a helping hand or listening ears when caregivers become overwhelmed. There
is nothing wrong with asking for help; at times, it is necessary.
Caregivers must also maintain healthy relationships with their spouses, partners, and other
children. Ignoring these critical relationships leads to loved ones feeling alone and withdrawing
from the caregivers—causing further burden and isolation. Sadly, many couples separate as a result
of the strain. To avoid this, caregivers and their spouses or partners should set aside regular date
nights when they can enjoy activities outside the home or have a romantic night in. Caregivers
should also schedule time to spend with their other children who do not have disabilities. As they
often think of themselves last, caregivers need time for themselves. Support systems should be

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called upon to temporarily care for the individual with the disability so that the caregiver can take
this necessary time.
Maintaining open communication is critical for healthy relationships between caregivers and those
receiving care. They should feel comfortable expressing their feelings and find a balance between
care and having as ‘normal’ a life as possible. Compromising on the timing of care needs allows
both individuals to enjoy other activities. For parents, it is often difficult to suppress their natural
parental instincts once their dependent children achieve adulthood. An individual who still need
needs physical care may have grown to be mentally self-reliant and wants to make decisions
independently, without feeling constant parental judgment.
In my experience, the constant reliance on my parents was very challenging during my teenage
years. I felt that I had no privacy. In a way, I felt trapped. I saw my friends getting older and
gaining more independence from their parents, while I was still being picked up from parties by
my mother. Unavoidably, our relationship has been affected in both positive and negative ways. I
have some negative feelings about my lack of privacy; my parents feel constrained about their
inability to come and go as they please. As an adult, however, I am grateful for the sacrifices my
parents have made to give me a good life. Because of our family dynamics, we are a stronger, more
open family and communicate very well with each other.
Seeking therapy or counselling is helpful to learning how to cope with giving and receiving care
and maintaining healthy relationships throughout the process. In family sessions, therapists act as
mediators and help caregivers and individuals with disabilities communicate their needs and
feelings to one another, so that both sides feel respected. Caregiving is best with a team. Learning
how to come together, share responsibilities, and maintain equality of attention leads to positive
outcomes in health and overall happiness. With the right system in place, caregiving can bring
families closer than ever with a tremendous amount of love.
The majority of adults and children with disabilities receive support for their daily living from a
family caregiver. As such, families are and will continue to be the largest providers of care and
support for individuals with disabilities in the United States (Larson et al., 2015). Because family
members play an integral role in meeting the needs of individuals with disabilities, promoting
family resilience has strong implications for health and wellbeing of all family members.
Despite the widespread acknowledgement of the importance of families in quality of life for people
with disabilities, there is a concerning lack of guidance to define and identify best practices and
policy for effectively supporting families (Burke, Lulinski, Jones, & Gallus, 2018; Hewitt, Agosta,
Heller, Williams, &Reinke, 2013).
The practice of marriage and family therapy (MFT) inherently assumes the interdependence
between personal and relational functioning as influenced by contextual factors. This clinical
framework suggests M/CFTs are ideally trained to meet the unique needs of families of people
with disabilities, Yet, the majority of MFT training curricula do not routinely address clinical
training or supervision related to disabilities. As a result, many M/CFTs consider therapy with
families impacted by disabilities as outside their scope of practice. Systemically informed
professionals have an opportunity to play a key role in bridging the gap to address the growing
need for accessible mental health services that support individuals with disabilities and their
families by managing risks and enhancing resilience.
Individual and relational outcomes

While some families and relationships of individuals with disabilities develop strong coping
strategies to function quite well (Bayat, 2007), research also illustrates that unique challenges can
negatively affect the health and wellbeing of many families (Brown, Anand, Alan-Fung, Isaacs, &
Baum, 2003; Greenberg, Seltzer, &Greenley 1993; Jokinen & Brown, 2011). Due to the added
caregiving responsibilities that are necessary for individuals with disabilities, members of families
affected by disabilities have an increased prevalence of physical, psychological, and relational
distress (Brown, Whiting, Kahumoku-Fessler, Banford Witting, & Jensen, 2020; Pilapil, Coletti,
Rabey, &DeLaet, 2017). Parents, spouses, and siblings of children with disabilities experience
higher rates of mental health concerns such as anxiety and depression when compared to families
of typically developing children (Marquis, McGrail, & Hayes, 2020). Caregivers in particular have
higher rates of health problems and report a variety of physical symptoms like migraines, heart
conditions, and sleep problems (Lee, Park, Matthews, & Hsieh 2017). These mental and physical
health effects lead to reports of decreased quality of life and general wellbeing (Arora, Goodall,
Viney, Einfeld, & the MHYPEDD team, 2020; Pilapil et al., 2017).
In addition to the physical and psychological outcomes of individual family members, families
affected by disabilities are also affected by greater relational concerns. Parents of children with

Notes
developmental disabilities face difficult and unique challenges to meet the needs of a child with a
disability, which leads to greater marital and relational strain. Previous reports that suggested
nearly 80% divorce rates among parents of children with disabilities have been shown to be
misleading, as there are differences according to family size and child development stage.
However, there is still a disproportionately high divorce rate among parents of children with a
disability compared to parents of typically developing children when number of children was
comparable (Namkung et al., 2015).
While parenting and co-parenting a child with a disability poses significant challenges, couples in
which one or both partners has a disability also face unique relational difficulties. A growing area
of clinical interest is dedicated to exploring couple therapy approaches that are appropriate for
addressing the unique needs of adults with disabilities. Romantic partners of individuals with a
disability experience similar trends in mental and physical health decline as parents. For example,
neurotypical partners of people with autism spectrum disorder (ASD) experience physical health
decline, negative self-image, and a profound loss of hope (Bostock-Ling, Cumming, & Bundy 2012;
Lewis, 2017). Couple therapy approaches should address discrepancies in relationship expectations
for adults with a disability and their romantic partners, as inconsistent relational expectations are
associated with unmet emotional needs and poor relationship satisfaction (Parker & Mosley, In
Press; Strunz et al., 2017).
Social support
Many of the adverse physical, mental, and relational health effects described by family members of
individuals with disabilities are compounded by a lack of social support. Families often explain that
there is a notable deficit in available social support, which they generally attribute to two main
reasons: 1) family members’ lack of free time to socialize with friends and family due to the added
caregiving responsibilities, or 2) societal stigma associated with disabilities that may be attributed
to personal shame and embarrassment of family members or the disapproval and ostracization by
others (Recio, Molero, Garcia-Ael, & Perez-Garin, 2020). Unsurprisingly, caregivers of individuals
with intellectual and developmental disabilities were disproportionately affected by the social
distancing measures implemented during the recent COVID-19 pandemic. Not only were
caregivers unable to access their already strained social supports, professional support services
were also significantly reduced due to school and professional clinic closures (Chung, 2020; Willner
et al., 2020). An unexpected outcome of the pandemic has been a surge in research that
demonstrates promising findings in the evaluation of online platforms (e.g., Facebook) as a means
of social support for caregivers. Clinicians working with families affected by disabilities can
support caregivers by connecting them with appropriate online platforms to increase social
support, which acts as a protective factor against the harmful effects of caregiver stress and
burnout.
Although having a family member with a disability may result in greater demands on family
resources, the presence of family coping strategies, social support, and community resources can
effectively reduce the stress associated with having a loved one with a disability (Asberg, Vogel, &
Bowers, 2007). Research indicates that access to social support and interventions that promote
adaptation to meet everyday challenges helps families mitigate many of the negative effects often
noted as outcomes in family research (Caldwell, Jones, Gallus, & Henry, 2018; Jones & Gallus, 2016;
McConnell & Savage, 2015).
Despite the additional obstacles and challenges, parents also describe positive outcomes, such as
patience, compassion, and family cohesion amidst the overwhelming struggles of caring for a child
with a disability (Sim, Cordier, Vaz, &Falkmer, 2019). Greater resiliency is noted among families
that are able to ascribe a positive meaning to adversity or seek the benefits of caring for a family
member with a disability. It is therefore essential for M/CFTs to consider ways to identify and
build on families’ strengths and inherent competence to overcome the challenges they face.
Greater resiliency is noted among families that are able to ascribe a positive meaning to adversity or
seek the benefits of caring for a family member with a disability.
Contextual influences and intersectionality

The conceptualization of intersectionality (Crenshaw, 1989) enables a complex understanding of the
ways in which race, gender, class, sexuality, ability and other dimensions of social, cultural, and
economic determinants intersect to shape daily life and social structures. Disabilities are an
important, albeit often overlooked, representation of diversity and contextual considerations.
Varied abilities and needs among individuals with disabilities are associated with differences in the
experiences and challenges families encounter across the lifespan. As such, identifying associated
contextual and social factors is critical for clinicians to conceptualize the impact of disability on

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individuals and families. However, the intersection of disability with other important
sociodemographic factors are often overlooked. Due to diagnostic overshadowing of disabilities
over other key elements, individuals with disabilities and their families are frequently assumed to
share the same experiences, needs, and strengths regardless of gender, age, religion, socio-economic
status or other determinants (Goethals, De Schauwer, & Van Hove, 2015).
Families of those with disabilities broadly experience financial strain due to added medical
expenses and difficulty maintaining full-time employment outside of the home (Liu, Dokos, Fauth,
Lee, &Zarit, 2019). The loss of income has a different impact on families according to other
contextual factors that influence access to treatment. Families that maintain access to the necessary
disability treatments despite the loss of income experience far fewer adverse outcomes in personal
and relational functioning. Marginalized and underserved populations, such as racial/ethnic
minority families or those living in rural communities, often experience even greater negative
effects of caregiving due to lack of appropriate resources. For example, Hispanic and African-
American youth are more likely to receive the appropriate frequency of necessary treatments if they
are school-based (as opposed to healthcare clinics) services (Siller, Reyes, Hotez, Hutman,
&Sigman, 2014). However, schools that are located in rural communities have fewer school-based
services and are often deemed by the U.S. Health Resource and Services Administration as Health
Professional Shortage Areas. Therefore, individuals with disabilities living in rural communities
experienced disproportionately higher rates of unmet treatment needs (Karpur, Lello, Frazier,
Dixon, & Shih, 2019). There is an opportunity for MFTs to support families who are
disproportionately affected by disabilities by engaging in an expanding body of disability treatment
research related to care coordination.
Coordinating care
Recent U.S. trends in disability-related specialty care, which we will discuss in further detail, are
strongly associated with negative effects among family members by further limiting access to
appropriate providers (Parker & Killian, 2020). In addition to providing routine support for daily
living, family members of individuals with disabilities also assume a primary role in advocating for
and accessing appropriate supports and services (e.g., education, transportation, healthcare).
Among the common barriers to accessing effective supports and services for individuals with
disabilities are the availability and affordability of care (Douma, Dekker, &Koot, 2006; Krauss,
Gulley, Sciegaj, Wells, & Taylor, 2003).
The American Academy of Paediatrics (2014) has proposed that care coordination is a vital service
that improves access to multi-provider treatments and supports the added challenges that family
members of people with disabilities face. There are various, specialized disciplines that are focused
on addressing the medical (e.g., neurology), psychological (e.g., applied behaviour analysis), and
educational (e.g., special education) needs associated with disabilities. The growing trend toward
decentralization of these disability subspecialties further limits access to treatment providers for
many patients. Families must endure increasingly long wait periods for appointments and are often
required to drive long distances to attend appointments. In extreme, but not uncommon
circumstances, some treatments may not be available at all due to the growing number of
healthcare provider shortage areas in the United States that disproportionately affect individuals
with disabilities (Martinez et al., 2018). Barriers to accessing appropriate supports and services
place an excessive burden on family resources (i.e., financial, time) that are strongly associated with
adverse effects to caregivers’ mental and physical wellbeing (Pilapil et al., 2017; Parker et al., 2020).
8.4 Coordination with Multidisciplinary Team

Multidisciplinary teams consist of several members, each of whom plays a key role. For example,
Lorraine is a special education teacher who serves several middle school students in an inclusion
setting. One of her students, Charles, has a specific learning disability in written expression, along
with type 1 diabetes. Charles's condition, classified as a health impairment, requires frequent
monitoring and sometimes affects his learning.
Lorraine's role, in addition to providing and monitoring classroom and testing accommodations, is
to serve as the leader of the multidisciplinary team. Lorraine manages the flow of information on
Charles, writes or updates his Individualized Education Program (IEP), and schedules and leads
meetings that concern him.
In addition to Lorraine, Charles's multidisciplinary team consists of his mother, his general
education teachers, his physician, the school nurse, and the school counsellor. In key years, such as

Notes
when Charles transitioned from elementary school to middle school, his multidisciplinary team
also included the district's transition coordinator.
Charles' mother, as with any parent or guardian of a special education student, serves as his
advocate. Sometimes, if a child's parent is unable to fulfil this role, an advocate is appointed to
speak and act in the child's best interests. As her son's advocate, and with specific parental rights in
the special education setting, Charles' mother has the role of approving or rejecting specific services
for Charles.
Each one of Charles' general education teachers plays a contributing role on his multidisciplinary
team by speaking to his current educational needs. They provide accommodations as prescribed in
Charles' IEP and help Lorraine monitor his learning and progress.
While Charles' physician does not normally attend meetings, she monitors Charles' diabetes and
health and provides information to the team. The school nurse aids Charles in monitoring his
condition during the school day, communicating with Lorraine and his mother as needed.
Managing a chronic disease can be stressful for an adult, let alone a pre-adolescent. The school
counsellor meets with Charles as needed to help him cope with the normal stresses of school, along
with the daily strains associated with diabetes.
Procedures for Collaborating

Because so many factors can affect the success of a multidisciplinary team, procedures for
collaboration are crucial. A key function of any multidisciplinary team is to collect and organize
background information so that its members have a complete picture of a student's strengths and
needs in order to make informed decisions.
Remember, Lorraine serves as the leader for Charles' multidisciplinary team. One of her main
responsibilities is to help its members understand what information is needed and to facilitate
meetings to discuss that information.
Organizing people in self-help groups serves different purposes, depending on the situation and
the need. Such a forum can help people to be visible members of the larger community. Members
can support one another through sharing information on referral services and other available
resources, help make decisions on family and individual matters, etc. Self-help groups with the
support of other such groups can advocate jointly to obtain services, aids, and equipment, and for
integration into the larger community.
In case of disabled, the SHGs can be formed with 5 members. Many Exclusive SHGs possibly
cannot be formed because of many reasons but inclusion of PWDs in normal group is very much
possible. The SHGs are encouraged for saving within the range of Rs. 20 to Rs. 100/- and they
rotate this common pooled resource within its members on minimum rate of interest. Each group
usually has a leader called the President/Secretary. These leaders maintain the record of
transactions, meetings etc and initiate steps for grading and financial linkages. As per PWD ACT,
1995; 3% reservation has been kept for PWDs under poverty alleviation programme. The SHGs of
PWDs may be linked with Government schemes such as NHFDC SGSY, Mission Shakti & financial
institutes like NABARD. Some funding agencies like CASHE, CARE, BASIX, Action Aid etc. are
also supporting SHGs. Identification of feasible and viable venture, long term market, linkages,
quality product and competitive rates are the key factors of success of SHGs.
NHFDC- National Handicapped Finance & development Corporation
SGSY- SwarnaJayanti Gram SwarojgarYojana
NABARD- National Bank for Agriculture & Rural Development
Summary
Disability places a set of extra demands or challenges on the family system; most of these demands
last for a long time (Murphy 1982). Many of these challenges cut across disability type, age of the
person with the disability, and type of family in which the person lives. There is the financial
burden associated with getting health, education, and social services; buying or renting equipment
and devices; making accommodations to the home; transportation; and medications and special
food. For many of these financial items, the person or family may be eligible for payment or
reimbursement from an insurance company and/or a publicly funded program such as Medicaid
or Supplemental Security Income. However, knowing what services and programs one is eligible
for and then working with a bureaucracy to certify that eligibility (often repeatedly) is another

Notes
Course Name
major challenge faced by families. Coordination of services among different providers (such as a
physician, physical therapist, occupational therapist, dietician, social worker, teacher, and
counsellor) who often are not aware of what the other is doing and may provide discrepant
information is another challenge faced by families (Sloper and Turner 1992). While care
coordination or case management is often the stated goal of service programs, there are many flaws
in implementation. Families experience the burden of this lack of coordination.
Keywords
Coping styles, developmental disabilities, census, the persons with disability act, family
counselling, relational outcome, autistic spectrum disorder, self-help group.
Self Assessment
1. Caregiving to the disabled person is challenging.
A. True
B. False
2. Denial may be found in the field of disability.

A. True
B. False
3. Section-28 of PwD Act, 1995 affirms that the capacity of Indian State to afford free
education beyond 14 years of age.
A. True
B. False
4. According to Census 2001, there are 2.19 crore people with disability in India.
A. True
B. False
5. Families of disabled face family stress when the cost of medical apparatus is highly
demanding.
A. True
B. False
6. Self Help Group can be formed with -------- members.

A. 3
B. 5
C. 7
D. 9
7. Some ------ is associated with disability.

A. Custom
B. Stigma
C. Task
D. None of them
8. Full form of MFT is-------

Notes
A. Mixed Male Female Therapy
B. Marriage and Family Therapy.
C. Male & Females Therapy
D. None of them
9. There are ------- types of caregivers.

A. 1
B. 2
C. 3
D. 4
10. Respite is a -------- for caregivers.

A. Recreation
B. Orientation
C. Compensation
D. None of them
11. Siblings feel --------- for the disabled.

A. Jealous
B. Guilty
C. Friendly
D. None of them
12. Coping of caregivers are ---------- parameter in disability.

A. Important
B. Unimportant
C. Casual
D. None of them
13. The Persons with Disability Act was published in --------

A. 1990
B. 1992
C. 1995
D. None of them
14. People with disability does not have -------- friends.

A. Good
B. Bad
C. Jealous
D. None of them
15. How many stages are there in QOL?

A. 4
B. 5
C. 6
D. 8

Notes
Course Name
Answersfor SelfAssessment
1. True 2. True 3. False 4. True 5. True
6. B 7. B 8. B 9. B 10. A
11. B 12. A 13. C 14. A 15. C
Review Questions
1. What are the families to illness?
2. Write a note on the epidemiology of the disabled people in India.
3. Briefly elucidate the stage of Quality of Life.
4. Discuss briefly about The Persons with Disability Act, 1995.
5. Write a note on Family Counselling.
6. What do you know about individual & relational outcome?
7. Explain social support for the PwD.
8. What do you mean by contextual influences and intersectionality?
9. Write a note on Coordinating Care.
10. How the caregivers can coordinate with Multidisciplinary Team?
Further Readings
 Quality of Life by Alison Carr, et. al. BMJ Books.2002
• Quality of Life- An Interdisciplinary Perspective by ShrutiTripathi, et. al. CRC
Press,2022.

Notes
Unit 09: Models of Rehabilitation

CONCEPTS
Objectives
Introduction
9.1 Medical Model of Rehabilitation
9.2 Psychological Model of Disability:
9.3 Socio-Cultural Model of Disability
9.4 Institutional Model:
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To understand different models of Rehabilitation
 To know the implementation of these models.
 To familiarize with the interrelation of these models with regard to Rehabilitation.
Introduction
Rehabilitation is the process of supporting a person in reaching his or her full physical,
psychological, social, vocational, and educational potential while taking into account his or her
physiologic or anatomical disability, environmental restrictions, as well as his or her desires and life
plans.
According to WHO, “Rehabilitation is the combined and coordinated use of the medical, social,
educational, and vocational measures for training and re-training the individual to the highest
possible level of functional ability
Models of rehabilitation are, the medical model, psychological model, socio-culture model and
institutional model.
9.1 Medical Model of Rehabilitation

In the field of medical science, the medical model of disability came into prominence. The medical
model is also known as the biomedical model; Disability is viewed as an illness or medical problem
that affects an individual. This paradigm of disability is also known as the personal-tragedy model.

Notes
DPSY-696-Psychology of Rehabilitation
The medical model of disability focuses on the medical components of a disability and attempts to
"cure" a person of their condition so that they can return to a functional state as closely as feasible.
This has been a popular way of thinking about disability in the past, and it continues to be so now.
Instead of the problem being with the environment around them, the fault being with the person
who has the condition. Medical practitioners are the ones who can heal the effects of a disability
using things like prosthetics, surgery, and drugs.
 The medical model and the rehabilitative model are inextricably linked. It is based on the
notion that if a disabled person makes an effort and works with rehabilitative services, they
will be able to overcome their handicap.
 Many disabled people, as well as disability studies experts and advocates, criticise this
paradigm for its limited vision of people's whole lives, both despite and because of their
impairment. Many disabled persons believe that their impairment is an intrinsic part of their
identity, rather than something that can be fixed. The social model of disability frequently
criticises the medical paradigm.
9.2 Psychological Model of Disability:

The psychological impact of disability Models that attempt to explain the emotional reaction to
impairment rather than the disability itself are likely the most commonly utilized in psychology
studies of disability. The following models were used:
life-events models, in which the emotional response to the life. event that precipitated the
impairment/disability is investigatedmental health models, in which disorder rates are analyzed
Disability is viewed as a stressor in stress models, with high levels of anxiety elicited by residents.
People with mental illness and other psychiatric concerns sometimes need help in different aspects
of their lives—including work, living, social, and learning environments. One approach that can
help these individuals manage symptoms and improve functioning is known as psychosocial
rehabilitation.
Psychosocial rehabilitation is a treatment approach designed to help improve the lives of people
with mental illness. Its goal is to teach them emotional, cognitive, and social skills to help them live
and work in their communities as independently as possible.
Regardless of what form psychosocial services take, core goals include helping people feel:
Empowered: Each individual needs to feel that they are able to set their own goals and have the
power and autonomy to pursue those aims.

Notes
Hopeful:People may be left feeling demoralized as a result of their condition. Rehabilitation
focuses on helping clients feel hopeful about the future.
Skilled:Rehabilitation aims to teach people skills to help them manage their condition and live the
life they want to live. This includes life skills, work skills, social skills, and others.
Supported:Mental health professionals offer support and help clients build relationships and social
connections in their community.
Psychosocial Rehabilitation Principles

There are a number of key principles of psychosocial rehabilitation that help guide how mental
health professionals working in this field approach their work.4 These principles include:
All people have potential that can be developed.
People have a right to self-determination.
The emphasis is on the individual's strengths rather than their symptoms.
Each person's needs are different.
Professional services should be committed and take place in as normalized an environment as
possible.
There is a focus on a social model of care (as opposed to a medical model).
It is centered on the present rather than fixated on the past.
Psychosocial rehabilitation treatments are multidisciplinary and often biopsychosocial in nature.
This perspective recognizes that mental illness impacts multiple areas of life, including the
biological, social, and psychological systems.
Not only are each of these systems affected by mental health, but they are also inextricably
interlinked. When something affects one area, it is bound to have an influence on other areas
aswell.
In light of this, psychosocial rehabilitation takes a whole-person approach and recognizes that other
mental health professionals and physicians may be needed to make contributions to the treatment
process. Individual care may require a mixture of services and effective treatment.
For example, a person with a mental illness may need psychosocial rehabilitation services that
target basic living and social skills, but they might also need treatment involving medication and
psychotherapy. The treatment of their condition targets the person’s specific symptoms, while
rehabilitation focuses on the recovery and reintegration process.
Who Can Benefit from Psychosocial Rehabilitation?

Many people can benefit from psychosocial rehabilitation, but not all people with mental illness
require it. For some, medication, therapy, or a combination of the two may be sufficient to restore
functioning. Rehabilitation can be useful when people need additional recovery assistance to help
them restore functioning.
Those who might benefit from psychosocial rehabilitation include:
People who need help restoring their full functioning after treatment
Those who are disabled and need ongoing assistance in multiple life domains
Individuals who, while functional, feel that they need a boost of support and assistance
People who lack the supportive environment and resources they need to achieve full functioning
People with chronic and severe psychiatric conditions can benefit from psychosocial rehabilitation
services. It can help them learn basic skills that allow them to function and cope with their
condition. People with intellectual and cognitive disabilities can benefit from gaining life, social,
and self-care skills.
The time following the diagnosis of a mental health condition is a period of major transition.
Patients may lose some functionality but new approaches may allow them to manage their
condition better. Their illness may have made it difficult to go to school or work, or to maintain
supportive relationships with others. Many aspects of life can be affected, including the person's
employment status, housing situation, and family life.

Notes
Once the underlying condition has been addressed through treatment, psychosocial rehabilitation
focuses on helping people find the skills and support they need to live full, satisfying lives.
Approaches Used in Psychosocial Rehabilitation

Psychosocial rehabilitation is based on the idea that people are motivated to achieve independence
and are capable of adapting in order to achieve their goals.
To achieve this, psychosocial rehabilitation uses a combination of evidence-based best practices and
emerging, promising practices. No matter what the specific strategies are, the focus is on restoring
social and psychological functioning.
Specific psychosocial rehabilitation treatments can vary considerably from case to case depending
upon a person's needs and the resources available. The process is highly individualized, person-
cantered, and collaborative.
Effective rehabilitation involves a comprehensive plan that addresses the client’s life and
functioning. A psychosocial rehabilitation professional is usually only one part of the process. The
plan is often overseen by a psychiatrist, clinical psychologist, or licensed counsellor and typically
involves working with the client individually and in community settings.
Builds on Strengths
Rather than simply focusing on areas of weakness, psychosocial rehabilitation focuses on
empowering clients and building on their existing capabilities. These abilities help form a
foundation upon which other important life skills can be developed through observation,
modelling, education, and practice.
Some specific areas that psychosocial rehabilitation might address include skills, training, and
experiences designed to boost:
This might be accomplished through one-on-one educational sessions that focus on specific skills,
or it might involve incorporating training and experience in other life domains such as cooking or
recreation. Such experiences allow people to practice their abilities in a safe environment, with
supervision and support from a psychosocial rehabilitation professional.
Is Holistic
This type of rehabilitation strives to address areas of the person’s life that contribute to their overall
physical and psychological well-being. Professionals who work in this field provide a range of
individual and community-based psychological services.
In determining each patient's needs, mental health professionals look at the physical and social
environment, develop a service plan, and collaborate with other professionals.
Psychosocial rehabilitation providers look at each client's situation and help determine what they
need to live and function as independently as possible. This frequently involves locating those
services in the community and coordinating their delivery.
Is Person-Oriented
The client plays a role in setting goals for what they hope to accomplish in psychosocial
rehabilitation. Each client’s goals are individualized based upon their specific needs or concerns.
The rehabilitation process is not about the therapist deciding what the client's goals should be.
Instead, the client determines what they want to achieve. The focus is then on providing the
support and resources they need to make these goals a reality.
Psychosocial Rehabilitation Activities

Psychosocial rehabilitation activities include those related to basic living skills, family relationships,
peer and social relationships, employment, education, recreation, health, and wellness.
Work
Working is beneficial for mental wellness and can help people feel productive, which is why
vocational assistance is an important component of psychosocial rehabilitation.
Finding and maintaining work can often improve social connections, boost self-esteem, and
improve one's overall quality of life.

Notes
Psychosocial rehabilitation workers can assist clients with finding and maintaining employment.
This might include helping clients develop vocational skills, connecting the client to employment
services in the community, assisting with career planning, and providing transportation assistance.
Another activity related to this aspect of the psychosocial rehabilitation process is assistance with
filling out job applications or practicing job interviews. In other instances, clients may work in
temporarily or supported work settings where they are able to develop and practice skills.
Housing
Psychosocial rehabilitation may involve connecting clients with safe, affordable, and appropriate
housing. Clients may live independently in their own homes or in family homes. Other housing
situations may include group homes, residential services, and apartments.
Depending on the client's needs. housing support exists on a continuum. It ranges from fully
staffed, round-the-clock supportive care to minimally staffed or fully independent living.
Relationships
Social skills and interpersonal functioning are important parts of psychosocial rehabilitation. Skills
training may focus on activities designed to help clients better function in their social worlds,
including family, work, school, friendships, and romance.
This is accomplished by teaching skills related to emotional understanding, interpersonal problem-
solving, verbal and conversational abilities, and nonverbal communication.
Community Functioning
One of the overriding goals of psychosocial rehabilitation is to help those with mental illness
become better integrated within their community. Rehabilitation professionals often work with
clients in community settings and locations.
For example, a child receiving psychosocial rehabilitation services may work with a mental health
professional in school settings, but also spend time on social outings to local businesses, doctor's
offices, libraries, and other locations. Practicing social and life skills in these settings allows the
child to gain experience and rehearse interactions they might face as part of daily life.
Effectiveness of Psychosocial Rehabilitation

Research investigating the outcomes and effectiveness of psychosocial rehabilitation treatments is
still ongoing, but there is evidence indicating these approaches have an overall beneficial effect.
Can Improve Life Skills

A study of patients with schizophrenia and affective disorders found that psychosocial
rehabilitation was linked to significant benefits in a variety of areas—including family relations,
communication, community participation, self-care, money management, transportation, and
vocational abilities.
9.3 Socio-Cultural Model of Disability

The social model of disability is a way of looking at the world that disabled people have created.
People are disabled, according to the social model of disability, by societal impediments such as
buildings without a ramp or accessible toilets, or by people's attitudes, such as presuming people
with disabilities can't perform particular things. The social model assists us in identifying obstacles
that make living more difficult for people with disabilities. By removing these barriers, people with
disabilities gain more independence, autonomy, and choice.

Notes
It claims that people have impairments, but that oppression, exclusion, and prejudice experienced
by persons with impairments are caused by the way society is administered and organized, rather
than by the impairment itself. The social model helps us recognize barriers that make life harder for
people with disability. Removing these barriers creates equality and offers people with disability
more independence, choice and control. The Social Model not only recognizes society as a source of
disability, but it also gives a framework for describing how society goes about impairing people
with disabilities. The Social Model, often known as a "hurdles approach," is a "route map" that
identifies both the barriers that hinder persons with disabilities and how these barriers might be
removed, mitigated, or countered by other types of support.
Barriers in social models:

Language:
Language encompasses far more than just words. It represents our society, our viewpoints, and
even our actions. The Social Model rejects phrases like 'handicapped,' 'wheelchair-bound,'
and'retarded,' because they promote negative stereotypes about disabled people and, more
importantly, portray them as powerless victims. Instead, it concentrates on terms like "disabled
person" and "wheelchair user.”
Physical Barrier:
Physical hurdles that disabled people’s experience on a daily basis include the lack of lifts, poorly
constructed buildings, and the use of stairs rather than ramps. That's before we consider poor
lighting, a lack of parking spaces, inconvenient public transportation, poorly maintained public
spaces, and inaccessible toilets and homes.
Attitude Barrier:
These are social and cultural attitudes and assumptions about people with disabilities that explain,
justify, and perpetuate prejudice, discrimination, and exclusion in society; for example,
assumptions that people with certain disabilities can't work, can't be independent, can't have sex,
shouldn't have children, need to be protected, are "childish," "dangerous," should not be seen
because they are upsetting, are scroungers, and so on.
Communication:
These include information and communication challenges, such as the dearth of British Sign
Language interpreters for Deaf individuals, the lack of hearing induction loops, and the lack of
information in various accessible forms such as Easy Read, plain English, and large print.
9.4 Institutional Model:

This model emphasizes institutional, environmental and attitudinal discrimination as the real basis
for disability. Thus, it is the society at large which disables the person with disabilities through
discrimination, denial of rights, and creation of economic dependency.

Notes
Institutional based rehabilitation sets the policy and directions with care standards of homes for
children and young persons with rehab or disability-related cases. The care framework in the
rehabilitation aims to guide and support the patients at every step, from the homes to their re-entry
into the society. Rehabilitation is acknowledged as an opportunity when self-care, family support
arrangement, and community options are not enough.
The role of rehabilitation is viewed as a significant help for a person to improve his overall mental
and emotional behavior. It offers intervention programs which follow an institution-based rehab
that aims to equip the person with life skills and knowledge to handle personal issues. It is the
institution’s goal to help the patient to function in everyday life.
Institutional Based Rehabilitation Services

Rehabilitation Process – The rehabilitation process and social reintegration preparation phases
extend beyond its functions. The process helps the patient restores the respective areas of his life. It
allows him to integrate fundamental factors that affect his decision making and commitments. It
brings back the individual’s sense of responsibility to his families, school and society. The process
enables him to have a smooth transition back to his healthy way of living.
Institutional Rehabilitation Aftercare Services –After the rehabilitation process, the patient is
given proper support and monitoring, provided with the help of his family. The aftercare service
continues to provide service that takes care of the person’s mental, emotional, and behavioral
alterations. This type of service tries to reinforce positive values that assist in the reintegration of an
individual’s life back to his home and community. Not only the process helps him understand the
things he needs to do, but it also gives him the chance to get jobs and rebuild their relationship with
respective families.
Institutional Rehabilitative Strategies– Two key strategies are part of this service. First is the
holistic assessment. This strategy assesses the patient in three areas such as education, personal
mastery, and socio-emotional development. With the use of the relevant tools, these services
objectively and efficiently identify the needs and risk factors of the patient. These set of tools are
supervised timely with specific interventions through the creation of individual care plans in every
core area that need assessment. The second strategy is the Individual family and work. The family
members are brought together with the patient to conduct a formal conference. This strategy allows
both sides to address their behavior that needs to be altered to adjust their relationship for the
better.
Institutional Rehabilitation Programs -This program primarily focuses on essential factors
such as therapy, holistic education, personal mastery of habits and self–discipline. In the
therapeutic program, the service motivates the patient to rethink everything, assess reasoning, react
to sessions and manage relationship building. For the education program, the service provides
sessions for restoring self-belief and strengthening the foundation for future learning. The personal
mastery of habit focuses on strength and weaknesses. It broadens horizon, adapts to skills, and
explore opportunities. And self-discipline manages to evaluate the person’s overall capability to
adjust to stressful situations.
Restorative Institutional Rehabilitation – This program focuses on restoring lives, empower
transformation and recreate the patient’s future. It possesses a multidisciplinary approach in its
work that draws plans from a variety of fields such as psychology, education, criminology, and
social work.
Institutional rehabilitation plays a significant role towards re-establishing the life of its patient back
to the society. It provides a safe environment for improvement and a foster care program during
the rehabilitation process. The institution maximizes the strength and potential of its patient, not
only for himself but also for his families and the community.
Summary
Models assist understanding by allowing one to examine and think about something that is not the
real thing, but that may be similar to the real thing. People use a variety of models to obtain a
clearer understanding of a problem or the world around them. Such models include physical
models, three-dimensional graphical models, animal models of biological systems, mathematical or
ideal models, and computer models. When relationships are highly complex, however, as they are
in rehabilitation processes and other areas of human endeavor, it is seldom possible to develop
models that are quantitatively predictive. Nevertheless, it is often possible to establish rough
relationships between various variables that are observable.

Notes
Models based on partial knowledge are often called conceptual models. Conceptual models may
help people to think about behaviors of components in complex systems, even though they may not
yield quantitative answers. They may allow one to understand general relationships without the
necessity for an extensive verbal or written description. In this way they are like an out-of-focus
picture that partially reveals relationships. It is common in science and engineering to use models
to help develop hypotheses that can be examined experimentally, but even as models assist
scientists in moving forward with new understanding, they are abandoned for new versions.
Experimental results may suggest that the models must be altered or even abandoned in favor of
new models.
The prevailing wisdom about the causes of disability has changed in the last several decades. In the
1950s, impairment of a given severity was viewed as sufficient to result in disability in all
circumstances; in contrast, the absence of impairment of that severity was thought to be sufficient
grounds to deny disability benefits. Thus, the American Medical Association's Committee on
Medical Rating of Physical Impairments stated that "competent evaluation of permanent
impairment requires adequate and complete medical examination, accurate objective measure of
function, and avoidance of subjective impressions and nonmedical factors such as the patient's age,
sex and occupation" (American Medical Association, Committee on Medical Rating of Physical
Impairment, 1958).
Keywords
Rehabilitation, Medical Model, disability, psychosocial rehabilitation, holistic, person-oriented,
social rehabilitation, socio-cultural model, barrier, institutional model,
SelfAssessment
1. There are four models of Rehabilitation.
A. True
B. False
2. Medical Model is also known as biomedical model.

A. True
B. False
3. Medical Model deals with emotional reaction to disability.

A. True
B. False
4. After care centre is related to Institutional model.

A. True
B. False
5. All Models are not conceptual Models.

A. True
B. False
6. Rehabilitation is a process of --------- a person.

A. Supporting
B. Segregating
C. Neutralizing
D. None of them

Notes
7. ------- Model is known as Personal Tragedy Model.
A. Psychological
B. Institutional
C. Socio-Cultural
D. Medical
8. There are ------ goals of Psychological Model.

A. 1
B. 2
C. 3
D. 4
9. -------- Model is highly individualized.

A. Psychological
B. Institutional
C. Socio-Cultural
D. Medical
10. ------- Model is a way of looking the world what the disabled people have created.
A. Psychological
B. Institutional
C. Socio-Cultural
D. Medical
11. There are ----- barriers in social model.

A. 2
B. 4
C. 6
D. 8
12. There are ---- kinds of services in Industrial Model.

A. 2
B. 3
C. 4
D. 5
13. All Models are known as-------- Model.

A. Effective
B. Conceptual
C. Experience
D. None of them
14. -------- Model was to cure a person so that he can come to functional state.
A. Psychological
B. Institutional
C. Socio-Cultural
D. Medical

Notes
15. ------- Model deals with the emotional reactions to impairment.

A. Psychological
B. Institutional
C. Socio-Cultural
D. Medical
1. True 2. True 3. False 4. True 5. False
6. A 7. D 8. D 9. A 10. C
11. B 12. D 13. B 14. D 15. A
Review Questions
1. What is the role of Models in Rehabilitation?
2. Briefly elucidate the Medical Model.
3. Write the salient features of Psychological Model.
4. What are the characteristics of Socio-Cultural Model?
5. Briefly narrate the Institutional Model.
6. What are the barriers of Socio-Cultural Model of Rehabilitation?
7. How these Models help the disabled persons in dealing with the coping in daily activities?
8. What are the initiatives are taken by WHO in executing these Models?
9. What the roles of caregivers in these Models?
10. Which Model of Rehabilitation is the best to your view? Why?
Further Readings
• Quality of Life- An Interdisciplinary Perspective by ShrutiTripathi, et. al. CRC
Press,2022.

Notes
Unit 10: Community Based Rehabilitation
Unit 10:CommunityBasedRehabilitation
CONTENTS
Objective
Introduction
10.1 Goals of Community Based Rehabilitation
10.2 Components of Community Based Rehabilitation
10.3 Role of Professionals
10.4 Role of Community
10.5 Ethical Issues
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objective
 To understand the concept of Community Based Rehabilitation
 To familiarize with the goals and components of Community Based Rehabilitation
 To know the role of professionals and community in Rehabilitation
Introduction
Community Based Rehabilitation (CBR) is a local area improvement technique that targets at
upgrading the living of people with disabilities (PWDs) in their community. Community Based
Rehabilitation was started by WHO under the Declaration of Alma-Ata in 1978 to upgrade the QOL
for individuals with PwDs; meet their essential requirements; and guarantee their consideration
and cooperation. While at first a methodology to expand access to recovery administrations in asset
compelled settings, CBR is presently a multi-sectoral approach attempting to work on the evening
out of chances and social consideration of individuals with handicaps while battling the unending
pattern of poverty and incapacity. CBR is carried out through the joined endeavors of individuals
with inabilities, their families and networks, and pertinent government and non-government
wellbeing, instruction, professional, social and other services.
10.1 Goals of Community Based Rehabilitation

Advocating &creating awareness: PwDs get the equal rights to take part in every economic project
also they can possess an ability to access services in microfinance & business advice.
Pre-vocational training:Measures are generally executed to assist schools & educational
institutes to provide good quality education/ training to persons with disabilities. Pre-vocational
training helps to improve their basic knowledge other than developing the quality of theoretical
education.
Vocational training:All NGOs of disabled people and government bodies help to organize
vocational training programmes to enhance the practical skills & knowledge of the people with
disabilities.

Notes
Course Name
Self-employment:CBR programme targets to offer self-employment scope by taking some
initiatives such as business advice, microfinance & provisions for loans.
Mainstreaming: Mainstreaming of training programmes is a primary goal of CBR. This can
empower the people with disabilities within the community to access as well as integrate into the
inaccessible programmes for work & vocational training.
10.2 Components of Community Based Rehabilitation

Making positive attitudes towards PWD’s: CBR is very important for ensuring the equalize the
opportunities for PwDs. A positive attitude among the community members can be created by
making them involved in the method of design & execution of the programme, and by transferring
of the knowledge about the different disability issues to the members.
Providing functional rehabilitation services: The majority of persons with disabilities require
support in order to reduce or eliminate the impact of functional disabilities or restrictions.
Community-Based Rehabilitation, must provide the ultimate solutions in some communities where
professional treatments are not available.
Making macro and micro income-generation opportunities:PWDs have a constant desire to
participate in macro and micro income-generating activities. They also require financial credit from
a variety of existing systems. Income-generating activities in rural communities and villages must
emphasize proper vocational skills.
Developing training and educational opportunities: People with disabilities are entitled to the
same educational and training opportunities as everyone else. These opportunities enable them to
remain content in society. Professional services may be unable to establish these opportunities in
some communities; CBR trainers should be able to provide basic levels of assistance to people with
disabilities in those communities.
Providing care facilities:CBR communities offer a variety of services to persons with disabilities
who have no family or friends, or whose relatives are incapable of caring for them. These amenities
assist them in surviving in society. Day-care facilities are available for relief families who work or
require recreation for any other reason.
Prevention of disabilities:The most important strategy to avoid the causes of impairments is to
eat well. Disabilities can also be reduced by recognizing any type of disability in children and
intervening early in their development to reduce the impact of their handicap.
Monitoring and evaluation:The efficiency and efficacy of all components of a CBR programme,
which exist both within the community and in service delivery areas outside the community, is
dependent on the management's effective practices. These operations should, in general, be
measured on a regular basis, and personnel should be well-versed in management techniques. To
ensure that the program's objectives are realized, data should be collected, examined, and
appraised.
10.3 Role of Professionals

As a community rehabilitation specialist, you'll help people discover their strengths while also
recognizing and responding to their limits. The goal is to help patients live and work more
independently after suffering from a debilitating illness or disability. This could include assisting
people in obtaining housing, social activities, jobs, and other life skills that will help them gain
independence as they recover from their injuries.
You'll work with people from various walks of life, including wounded employees, military
veterans, adults with learning difficulties, deaf or blind people, physically challenged persons,
people with mental health issues, and people who are addicted to drugs or alcohol. You'll also
collaborate with other health-care professionals, such as social workers.
Professionals’ Participation in Cbr Programmes

yourself to be one, or not? What are the good things about professionals?
What things are not so good? To what extent do you fulfil these criteria?

Notes
Which of the people you work with, are professional and what makes them different from the
others? What do you have in common with these different groups? Could you aspire to change
yourself and your activities, to match those of the people you admire the most? Do you want to be
considered a professional at all? If so, why? If not, why not? The responses to the above questions
reflect the definition adopted for a professional, which according to the Oxford English Dictionary,
is a person who follows an occupation or ‘calling’, together with other people who have the same
‘calling’. It assumes a similar educational experience with jointly maintained standards and
involves using thisknowledge and skills to earn a living. Using these criteria to examine the
professional status of CBR workers, I think we would all agree that they have a common
occupation or calling, and most use their knowledge and skills to earn their living, some of course,
are volunteers. But do CBR workers have a similar educational experience with jointly maintained
standards? Perhaps the more important question we need to ask here is, is it desirable for CBR
workers to have a similar educational experience with jointly maintained standards, or is their
diversity and flexibility their strongest ingredient?
Another question we might like to consider is: if CBR became a profession in its own right who
would benefit most? the CBR professional or the people with disabilities? For most of the present
century it has been considered ‘honorable’ to be a professional. Traditionally, professionals work
hard, serve other people, can be depended upon for their good judgment and can be turned to, for
help, in times of trouble. Many CBR programmes were and still are, started by established
professional groups such as therapists, doctors, and teachers. Many CBR programmes are run by
professionals and controlled by professionals. BUT IS THIS A GOOD THING?
Advocacy has been mentioned as a suggested activity throughout the CBR guidelines. Advocacy
can be undertaken in different ways and by different people, e.g., self-help groups or disabled
people's organizations might advocate as a group to influence decision-makers to create change
and ensure inclusive policies and programmes for people with disabilities. This element however
focuses on self-advocacy, meaning individuals speaking up for themselves.
Successful advocacy depends on important messages being communicated and heard. However,
many people with disabilities experience barriers to communication, so frequently their voices are
not heard and they have few opportunities to influence decisions on the issues, policies and
services that affect their lives. The Convention on the Rights of Persons with Disabilities highlights
the importance of communication for people with disabilities. Article 9 calls on States parties to
ensure that persons with disabilities have access on an equal basis with others to” … information
and communications, including information and communications technologies and systems …”
and Article 21 confirms the right to” … freedom of expression and opinion, including the freedom
to seek, receive and impart information and ideas on an equal basis with others and through all
forms of communication of their choice …”.
Self-advocacy and effective communication are an important part of the empowerment process for
people with disabilities. This element highlights the important aspects of each of these and provides
basic suggestions for activities which can be carried out by CBR programmes.
10.4 Role of Community

The ability to fully be a part of their community is the most significant benefit of community
inclusion for people with disabilities. People with disabilities are kept engaged in community
integration programmes, which give them opportunities to learn, work, and play alongside their
peers. You'll work with people from various walks of life, including wounded employees, military
veterans, adults with learning difficulties, deaf or blind people, physically challenged persons,
people with mental health issues, and people who are addicted to drugs or alcohol. You'll also
collaborate with other health-care professionals including social workers, physiotherapists, and
speech pathologists to provide comprehensive care. Individuals with disabilities who participate in
the community are able to interact with others and move around independently. People with
impairments are more likely to acquire mental diseases such as depression, anxiety, and dementia
as a result of social isolation and loneliness. People with impairments build a network of support
systems through community engagement, which helps them avoid mental diseases.
The community-based rehabilitation (CBR) matrix, which was described in the introduction,
consists of five components (Health, Education, Livelihood, Social and Empowerment) and their
associated elements. It provides a basic framework which can be used to develop new CBR
programmes. Even though a common matrix now exists, each CBR programme will continue to
demonstrate unique differences because it is influenced by a wide range of factors, e.g., physical,
socioeconomic, cultural and political factors. This chapter will be a guide for programme managers

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to provide a basic understanding of how to select the components and elements for a CBR
programme, which are relevant and appropriate to local needs, priorities and resources.
While all CBR programmes are different, there is a universal sequence of stages that help to guide
their development. These stages are usually collectively referred to as the management cycle, and
comprise: Situation analysis (Stage 1), Planning and design (Stage 2), Implementation and
monitoring (Stage 3) and Evaluation (Stage 4). This chapter will describe the management cycle in
more detail to help programme managers understand the important aspects of each stage and to
develop effective programmes that are inclusive of all key stakeholders and ultimately meet the
needs of people with disabilities and their family members.
Please note that this chapter does not present a fixed approach which every CBR programme must
follow. Because programmes are often developed through partnerships with others, e.g.,
governments or funding bodies, these may provide the necessary guidelines about how
programmes are to be developed. In addition, while this chapter focuses mainly on the
development of new CBR programmes, it will also be useful for strengthening existing ones.
10.5 Ethical Issues

People with disabilities (PWD) are more likely than others to live in poverty, not participate in their
communities or in the workforce, and be denied access to basic rights.1–3 In many contexts around
the world, PWD have limited institutional supports and resources available to them as they seek to
meet their daily needs and develop the full range of their capabilities, and recognizing these
realities prompted the development of the community-based rehabilitation (CBR) approach.
Emerging from a World Health Organization (WHO) proposal after the 1978 International
Conference on Primary Health Care and the Declaration of Alma-Ata, it has since become a
widespread development practice that aims to support PWD, particularly in settings in which
institutional rehabilitation programmes are ineffective or not widely available.4 In 2004, the
International Labour Organization; the United Nations Educational, Scientific, and Cultural
Organization; and WHO endorsed an updated definition of CBR as “a strategy within general
community development for the rehabilitation, equalization of opportunities and social inclusion of
all people with disabilities.” Diverse commentators have proposed conceptions of CBR that
emphasize elements such as the promotion of human rights, the balancing of fundamental power
inequalities, and the fulfilment of basic needs.
Alongside evolving definitions of CBR, there has been a lively discussion of the purpose, principles,
and commitments that underlay CBR programmes and practices. Several authors have identified a
range of ethical considerations as being important for the CBR model and for the implementation of
CBR projects. A key contribution to the analysis of ethical issues in CBR was a 2002 article by
Turmusani and colleagues,1 which canvassed ethical issues for CBR in low- and middle-income
countries. Ethical considerations have also been raised by other authors writing about the practice,
policy, and politics of CBR, as well as its evidence base.10–13 In light of the continued evolution of
the CBR movement and ongoing discussions of CBR ethics, we reviewed the academic literature
related to CBR to investigate how it addresses ethical considerations.
This commentary provides both theoretical and practical insights into the concept of community-
based rehabilitation (CBR) and its application in developing countries. In doing so it explores
current practices in CBR and the debate surrounding them, namely the ethical question and how
this may impact on future CBR. The main argument in this account is that disability is a
development issue; with widespread poverty, inequality and violation of human rights, and should
be addressed within the broader context of community development which may include strategies
such as CBR. A review and analysis of recent literature on CBR has been conducted including the
review of a number of empirical research documents from various CBR initiatives in developing
countries. CBR has increasingly been under scrutiny in terms of the extent to which these have
succeeded in delivering rehabilitation services to those in need in the community as well as the
permitted level of participation and control of disabled people over the rehabilitation process.
Many programmes have been unsustainable and it has been difficult to evaluate their full
usefulness to disabled people. These issues raise an ethical question about CBR being an
appropriate strategy for the rehabilitation of people with impairments in developing countries. This
background emphasizes that new directions in CBR need to be put in place in order to maximize
the realization of the ultimate goal: the greatest participation for disabled people in all spheres of
life. Effective rehabilitation programmes should allow people with disability to have greater control
in the nature of their rehabilitation and that the role of professionals and other stakeholders is one

Notes
of allies and resources in the rehabilitation process. Moreover, the participation of community
members in the rehabilitation policy should be assured.
Physiatrists are rehabilitation specialists trained to care for patients with complex medical
conditions, including brain injury, neuromuscular disorders, spinal cord injury, musculoskeletal
injuries, pain syndromes and cardiopulmonary disorders. As the leader of an interdisciplinary
team, physiatrists are accustomed to actively engaging multiple clinicians simultaneously and
empowering patients in key decision-making processes. Because this unique paradigm is not
typically employed in other areas of medicine, it is imperative that physiatrists have a firm
understanding of the possible ethical scenarios they may encounter. This article will provide an
overview of bioethical principles and how they are applied within the field of physical medicine
and rehabilitation.
In 1978, the Belmont Report was published which outlined three main bioethical principles which
ultimately became accepted by all medical fields
Respect for persons (autonomy for those with decisional capacity and protection for those lacking
capacity)
Benevolence and non-maleficence (do good, do no harm)
Justice (equal treatment regardless of social, financial, sexual, or cultural factors)
Furthermore, the American Medical Association Journal of Ethics specified five ethical
considerations in rehabilitation:2
Scarce resource allocation and the potential for discrimination against disabled people
The ethics of accommodating people with disability and chronic neuromuscular disorders,
including medical settings
Identifying optimally inclusive nomenclature and terminology (e.g., “physical diversity” rather
than “disability”)
Conflict between the goals of promoting acceptance and accommodation for persons with disability
on one hand and securing resources for restoration of functional efficiency and meaningful mission
on the other hand
The ethics of rehabilitating persons with neurological and behavioral disorders with anosognosia
(deficits of awareness), in which maximizing rehabilitation may mean abandoning or overriding
patient autonomy.
These ethical considerations are important to address as it helps construct public health policies
promoting greater diversity, tolerability, and functionally appropriate environments for patients
who are often poor, underserved, marginalized, and physically disabled.
Several aspects of physiatrist practice are applicable to the aforementioned ethical principles and
considerations, including (A) informed consent and determination of decisional capacity, (B)
addressing patients who refuse treatment/discontinue treatment, (C) providing patient cantered
care and justice, and (D) research/education.
A. Informed Consent and Decisional Capacity

Informed consent and decisional capacity are virtually inseparable; together they constitute the
foundation for ethical clinical practice. Informed consent represents an interactive process between
the physician performing the procedure and the patient. This process provides patients with
information regarding the purpose of treatment, treatment options, risks and benefits of the
procedure, and the opportunity for them to indicate their understanding prior to giving or
withholding consent. Once consent is provided, a document reflecting this discussion is signed by
both patient and physician and is included in the medical record.
Consent for research purposes is obtained in order to carry out research studies in an informed
setting. Research consent includes a description of the investigational study, the possible risks and
benefits, contact information for study staff, and status of the study being reviewed by an
institutional review board. It is important to note that both informed and research consent are for
ensuring patient safety, and allows the patient or healthcare proxy to partake in the decision-
making process.
Competence and capacity are often used interchangeably in clinical practice, but it is important to
distinguish them. Competence is a purely legal concept which can only be formally determined
through legal proceedings. Capacity is determined by a physician, and is an essential element in the

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informed consent process for medical treatment. The patient populations whose capacity to make
medical decisions are most commonly questioned include: elderly, mentally ill, and/or mentally
disabled adults; patients with head injuries; and patients who object to a recommended treatment.
suggests three simple questions which the physician can ask when determining decisional capacity:
 Does the patient understand the disclosed information?

 Does the patient appreciate the consequences of the choices?
 Does the patient use reasoning to make his/her choice?
Decisional capacity of patients receiving rehabilitation treatment may vary based on a number of
different factors including:
Patients whose communication is affected by aphasia/dysarthria, or impaired comprehension of
the language being used will require alternative communication strategies for the former and
interpretive services for the latter.
The patient’s decisional capacity needs to be regularly evaluated since there is a continuum of
treatment rather than a series of isolated events such as diagnostic and/or therapeutic procedures.
Furthermore, while determination of decisional capacity rests exclusively with the physician, the
setting and communication of treatment goals involves all members of the rehabilitation team.
Surrogate decision makers named in legal documents such as Power of Attorney or Living Will
become active if and when the patient chooses to and/or no longer possesses decisional capacity.
Physicians should become familiar with state laws dealing with advanced directives, and should
not hesitate to consult legal representatives or a bioethics team when necessary. It is also
recommended for physiatrists to obtain next of kin and health care proxy information to protect
patient information and privacy.
In institutional settings such as hospitals and nursing homes or home health agencies, there may be
a conflict between the administrative requirements for standards of care and those of the
rehabilitation team. However, physiatrists and the interdisciplinary team are positioned to provide
a more realistic assessment of patient preferences and practical options.8 Insuring a safe home
environment as a primary goal for a home care agency could reflect caregivers’ fear of patient
injury despite that patient’s desire for greater independence, even if it results in an increased risk. A
similar scenario occurs in nursing homes or rehabilitation units whose administrative policies stress
the need to prevent falls, while the rehabilitation team and patient strive for maximal independence
in ambulation.
B. Refusing or Discontinuing Treatment

Respect for patient autonomy during rehabilitation includes the right to refuse treatment.
Occasionally this can present the physiatrist with an ethical dilemma, as illustrated in an article
published in 1989 documenting the case of a C3 quadriplegic admitted to a rehabilitation unit who
decided that he preferred to die rather than live as a quadriplegic. Thus, an ethical conflict arises
due to the patient refusing nutrition while the rehabilitation team is aware that there may be a
clinical improvement over a period of weeks or months. Therefore, it is incumbent on the physician
and rehabilitation staff to discuss these factors with the patient and family so that they can make
decisions regarding future quality of life with a realistic perspective. When refusal of treatment has
potentially dire or even fatal implications, immediate referral for bioethics and legal consultation is
indicated.
More commonly, physiatrists encounter patients who decline to undergo inpatient or outpatient
rehabilitation therapies. In this situation, even if medical/rehabilitation professionals are of the
opinion that it offers major benefits and that there would be negative consequences without it, the
patient’s autonomy must be respected as long as decisional capacity is not impaired.6 There are
many valid reasons for refusing rehabilitation, including:
Concerns about loss of home services

A patient’s need to provide care or support for a spouse with medical problems
Preference for the home environment as location for rehabilitation care
Financial concerns.
Terminating rehabilitation should reflect a consensus amongst medical staff, patient, and family.
However, other factors may lead to discontinuing or changing treatment such as reaching the limits
of insurance coverage, lack of functional improvement, medical issues interfering with treatment,
or inadequate participation or cooperation by the patient. Terminating or changing treatment

Notes
should be approached by the physiatrist and/or rehabilitation team discussing the reasons for
terminating treatment and alternative options such as therapy at home, transfer to longer term
facilities, or outpatient follow-up care. Detailed chart documentation of this discussion is necessary,
especially if the patient or family disagree with the decision. If indicated, the patient’s decisional
capacity should be reassessed. If conflict persists after these discussions, it may be necessary to
involve legal and/or bioethics consultants.
Often times, patients with severe impairments such as spinal cord injuries and/or traumatic brain
injuries, find it difficult to conceive of their “new normal” or life after their injury. It is the role of
the physiatrist to guide patients and their families through these changes.
C. Ethics in Patient Cantered Medical Care and Justice

In their role as the leader of an interdisciplinary team, physiatrists develop personalized plans of
care for patients with disabilities in order to optimize their quality of life. Physiatrists must
carefully and judiciously consider the following seven core elements of patient cantered care
outlined by the New England Journal of Medicine in 2017
Mission and values aligned with patient goalsCare is collaborative, coordinated, accessible
Physical comfort and well-being are top priorities Patient and family viewpoints respected and
valued Patient and family always included in decisions Family welcome in care setting Full
transparency and fast delivery of information Physiatrists need to also address the many clinical
barriers patients may encounter in order to ensure justice is provided. Jonsen et al. proposed that
these clinical problems can be subdivided as four priorities or topics to examine, review, and
manage in the course of the patient’s care:
Medical indications Patient preferences according to the principle of respect for autonomy
Assessment of patients’ expected quality of life Context, such as economic constraints, standard
operating and laws.
At times justice can be difficult to achieve for patients who are differently abled. It may be
challenging to reach consensus about a patient’s treatment plan because health care clinicians may
rate the quality of life of patients with disability or chronic illness lower than the patients rate it
themselves, fostering disagreement between patient and treatment team. This ultimately places
these patients at a disadvantage. Recently there has been a paradigm shift in medicine toward a
more patient-cantered approach.
D. Ethics in Research and Education

Whyte has explored some of the ethical ramifications of rehabilitation research as illustrated by
efficacy studies. The concept of clinical equipoise is central to such research, meaning that there is a
real uncertainty about whether or not a treatment is beneficial. The three concepts of autonomy,
beneficence, and justice, as enumerated by Blustein1 need to be scrupulously observed. Selection
bias in the choice of subjects and selective use of inappropriate statistics to influence conclusions
are particularly to be avoided.
A recent article by Fronteradiscusses how scientific article publication has been growing, and is
becoming ever more important in the field of physical medicine and rehabilitation. This requires
physiatrists understand the elements of scientific article writing, levels of scientific evidence,
current rules of scientific reporting, and the importance of preventing scientific misconduct.
The principles of bioethics should be considered a core competency and should be included in all
physiatry residency curricula. Since many large academic medical centers have a bioethics team
with consultative services, physiatrists should avail themselves of this resource when faced with
challenging cases. Also, since physiatrists can offer a valuable perspective on chronic disease and
disability, their inclusion and participation in bioethics committees is recommended.
In terms of graduate medical education, residents face varying levels of comfort and mastery with
performing procedures as their training progresses.16 There is still the ethical dilemma for
physicians to balance academic education and competency with patient care and safety. Residents
learn to balance evidence-based research and expert opinion with the patient’s level of acceptance
or denial of her/his situation. Residency education involves learning to educate patients on best
practices. It is not uncommon for physicians to have to re-educate patients if they have been
exposed to incorrect community hearsay or misinformation.16 Finally, residents, like their
attendings, face barriers with access to healthcare and a lack of resources necessitating enhanced
teamwork to ensure justice for their underserved populations.

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E. Future Trends in Rehabilitation Ethics
In 2013, Hunt and Ells developed the Patient-Centered Care Ethics Analysis Model for
Rehabilitation (PCEAM-R) to guide ethical rehabilitative care given the complexity of the care team,
patient’s degree of impairment/disability and a variety of possible interventions.
The six steps of the PCEAM-R are:

Identify the ethical issue(s) to address: What is at stake and for whom?
Collect information: What do we need to know to be able to evaluate the issue(s)?
Review and analyse: Do we need to reformulate the issue(s) and what can help us better
understand it?
Identify and weigh options: What are our options and what rationales support them?
Make decision(s): What is the best option and how should we implement it?
Evaluate and follow-up: What was the outcome and how can we learn from it?
This six-step process for ethical decision making is theoretically grounded in the International
Classification of Functioning Disability and Health and has a sufficiently detailed list of questions
to provide a comprehensive and balanced assessment of each patient’s situation.17 This may be the
best method for the practice of physiatry to ensure justice for all patients of differing abilities.
The inclusion of ethical issues within the rehabilitation process is an encouraging development,
since they ought to be routinely part of physiatrists’ thinking. As new developments in medical and
surgical care preserve the lives of many individuals whose injuries or diseases would previously
have been fatal, it can be anticipated that a growing number of patients with severe physical
disabilities will require physiatrist care, and will bring with them an increasing number of complex
ethical challenges.
Summary
Community Based Rehabilitation (CBR) is a community development strategy that aims at
enhancing the lives of persons with disabilities (PWDs) within their community. Community-based
rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in 1978 in an
effort to enhance the quality of life for people with disabilities and their families; meet their basic
needs; and ensure their inclusion and participation. While initially a strategy to increase access to
rehabilitation services in resource-constrained settings, CBR is now a multi-sectoral approach
working to improve the equalization of opportunities and social inclusion of people with
disabilities while combating the perpetual cycle of poverty and disability. CBR is implemented
through the combined efforts of people with disabilities, their families and communities, and
relevant government and non-government health, education, vocational, social and other services
(WHO).
It emphasizes utilization of locally available resources including beneficiaries, the families of PWDs
and the community. According to the UN Convention on the Rights of Persons with Disabilities,
comprehensive rehabilitation services focusing on health, employment, education and social
services are needed to enable PWDs/CWDs attain and maintain maximum independence, full
physical, mental, social and vocational ability, and full inclusion and participation in all aspects of
life (UN, 2006).
Recommendations to develop guidelines on community-based rehabilitation (CBR) were made
during the International Consultation to Review Community-based Rehabilitation which was held
in Helsinki, Finland in 2003. WHO; the International Labor Organization; the United Nations
Educational, Scientific and Cultural Organization; and the International Disability and
Development Consortium – notably CBM, Handicap International, the Italian Association Amici di
Raoul Follereau, Light for the World, the Norwegian Association of Disabled and Sights avers –
have worked closely together to develop the Community-based rehabilitation guidelines? More
than 180 individuals and representatives of nearly 300 organizations, mostly from low-income and
middle-income countries around the world, have been involved in their development.

Notes
Keywords
Community based rehabilitation, ethics, aphasia, quadriplegic.
SelfAssessment
1. There are six steps in PCEAM-R
A. True
B. False
2. Informed consent is not necessary in Therapy.

A. True
B. False
3. Ethical issues are important factor for PwD.

A. True
B. False
4. Community Integration Programme give opportunities of learning many skills to PwD.

A. True
B. False
5. There is a universal sequence of stages to guide the development of PwD.

A. True
B. False
6. Health Belief model was introduced in -------

A. 1950
B. 1962
C. 1980
D. 1982
7. Self-Advocacy & effective communication are a part of------- process.

A. Validity
B. Socializing
C. Empowerment
D. None of them
8. Successful -------- depends on important messages being communicated & heard.

A. Achievement
B. Advocacy
C. Advertisement
D. None of them
9. ------ is a primary goal of CBR.

A. Mainstreaming
B. Advocacy
C. Adjustment

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D. None of them
10. In 1978 Convention of WHO, --------- of QOL for the PwD.

A. Inclusion
B. Exclusion
C. Upgradation
D. None of them
11. One biggest risk factor of health is ---------

A. Home situation
B. Ambition
C. Life Style
D. None of them
12. CBT has extensive popularity in the last -------- decades.

A. 2
B. 3
C. 4
D. 5
13. The majority of PwD require --------- service.

A. Monitoring & Evaluation
B. Functional Rehabilitation
C. Prevention of Disabilities
D. None of them
14. Which year the Belmont Report was published?

A. 1978
B. 1968
C. 1988
D. 1998
15. Physicians should familiar with------- law.

A. National
B. State
C. Local
D. None of them
1. True 2. False 3. True 4. True 5. True
6. B 7. C 8. B 9. A 10. C
11. C 12. B 13. B 14. A 15. B

Notes
Review Questions
1. What are the goals of Community Based rehabilitation?
2. What are the components of Community Based rehabilitation?
3. What are the roles of professionals in CBR?
4. Discuss about the professional participation in CBR Programmes.
5. What is the role of community in disability?
6. Briefly elucidate the ethical issues related to disability.
7. Write in brief about informed consent & decisional capacity.
8. What are the consequences of not following ethical issues in Profession?
9. Explain PCEAM-R.
10. To what extent, the professionals are participating in CBR programme?
Further Readings
 Quality of Life- An Interdisciplinary Perspective by ShrutiTripathi, et. al. CRC
Press,2022.

Notes
Unit 11: Health Behavior

CONTENTS
Objectives
Introduction
11.1 Theories of Health Behavior Changes
11.2 Intervention Strategies for Individuals
11.3 Families of Disabled
11.4 Behavior Modification & Cognitive Therapy
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To know the theories of behavior change
 To understand intervention strategies for individuals, families of disabled
 To familiarize with Behavior Modification & Cognitive Therapies in Rehabilitation.
Introduction
Health is a state of complete emotional and physical well-being. According to WHO 1948, “Health
is a state of complete physical, mental, and social well-being and not merely the absence of disease
or infirmity. In 1986 WHO made further clarifications, “A resource for everyday life, not the
objective of living”. Behavior is an act or action by a person in response to a particular situation or
stimulus. So, health behavior means actions taken by any person which affects their health
positively or negatively. It includes actions that lead to improved health, such as eating well and
being physically active, and actions that increase one’s risk of disease, such as smoking, excessive
alcohol intake, and risky sexual behavior. It is important to consider that not everyone has the
means and opportunity to make healthy decisions. Policies and programs put in place have
marginalized some population groups and communities, keeping them from the supports and
resources necessary to thrive.
A key factor of people’s health is connected with the behavior of an individual. One of the biggest
risk factors now a days recognized is lifestyle. Lack of physical exercise, high calorie intake and
excessive alcohol consumption, leading to obesity, high cholesterol levels and high blood pressures
are the result of disturbed lifestyle.
11.1 Theories of Health Behavior Changes

The models and theories designed by behavioral scientists to understand and influence health
behaviors. As theories has advanced, scientists have more interested in behavior changes over
understanding why individuals engage in particular health behavior as well as the physiological &
environmental input to health behavior change. There are many theories on health behavior
changes such as health belief model (HBM), social cognitive theory (SCT), relapse prevention (RP),
self-determination theory (SDT), Incentives/affect, and last but not the least socioecological models.

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Health behavior changes, we want to improve health and well-being, consider the leading causes of
death such as cancer, heart disease etc. A health-related behavior plays an important role in not
develop these conditions. So many expect about behavior influences our health standard not the
least is our dietary habits. So, understand human behavior and designing intervention is
interconnected.
Health belief Model (HBM) is introduced in 1950 by social scientist in order to understand the
failure of the people to adopt disease prevention strategies or screening tests for the early detection
of disease. The health belief model suggests that person’s belief in a personal threat of an illness or
disease together with a person’s belief in the effectiveness of the recommended health behavior or
action will predict the likelihood the person will adopt the behavior. This model drives from
psychological and behavioral theories with foundation that the two components of the health-
related behavior are first the desire to avoid illness or consciously get well if already ill and second,
they believe that a specific health action will prevent or cure illness ultimately an individual’s
course of action often depends on the person’s perception of the benefits and barriers related to
health behavior. There are six constructs of the health belief model. The first four constructs were
developed as the original tenant of the health belief module and the last two were added as
research about health belief model evolved. First in line perceived susceptibility, refers to an
individual’s subjective perception of the risks acquiring an illness or disease. An example of these is
when a person was exposed to other person with an illness, he or she might think that he or she is
more vulnerable in getting that disease. Second perceived severity, an individual on the seriousness
of contracting an illness. An example, fluctuations on number of cases of a certain illness may affect
the general public’s perception of its severity. Third perceived benefits, an individual’s perception
of effectiveness of various actions to reduce threat of illness or cure an illness an example of these is
promotion and applying preventive measures to prevent being infected by a disease or illness.
Fourth perceived barriers refer to an individual’s feelings on obstacles in performing recommended
health actions, example of these is factors such as inconvenience, costs, life style changes and others
with affects a person perception. Fifth is cue to action, the stimulus needed to trigger an action on
the obstacles to performing recommended health standards, an example, person experiences of
symptoms or illness of a family member. Sixth is self-efficacy refers to the level of an individual’s
confidence in his or her ability to successfully perform a behavior an example, a person who has a
healthy lifestyle feels confident about-facing daily activities amidst prevalence of a certain illness.
Social cognitive theory has been used to investigate modifiable lifestyle factors that are associated
with weight gain. This theory describes that behavior is a product of the individual’s learning
history their intellectual and physical capacities and their present perceptions of their environment.
It focuses on people having agency to make choices and attain goals concepts involving social
achievement outcomes and self-influences are part of a dynamic system that are in constant
interaction with one another specific concepts such as self-efficacy agency and self-regulated
learning are fundamental in social cognitive theories. We look at two main ideas from this theory,
firstly learning by observing others is a key part of social cognitive theory here we may ask what
causes a person to learn and perform specific behavior and skills modeled by others well several
factors play a role first we learn through observation we have to pay attention. Imagine someone
learning how to play basketball from more experienced player paying attention would include both
selective attention which is paying attention to the correct cues and information such as how you
can dribble a basketball as well as sustained attention that is maintaining focus during a basketball
practice. Second you need retention perhaps through practice the person can remember the steps
learning how to properly dribble the basketball toward the basket. Third once we understand a
behavior the production phase helps makes the behavior smoother with more and more practice
and feedback from the experienced player. Lastly, we should include more motivation to pay
attention and reinforcement to maintain learning through persistence. The role model can help
reinforce the production of the behavior by complementing the good form in shooting the
basketball. Another main concept in social cognitive theory is self-efficacy, people beliefs about
their abilities have a profound effect on those abilities. Ability is not a fixed property where is huge
variability in how you perform. People who have a sense of self efficacy bounce back from failure
they approach things in terms of how to handle them rather than worrying about what can go
wrong. There are four sources in self-efficacy, first mastery experiences are our own personal and
direct experiences these are usually the most powerful sources of self-efficacy information for
example if you are learning how to draw your success is ultimately attributed to your ability
persistence and effort. Second there is degree of physiological arousal that affects self-efficacy as
you learning to draw are you anxious and worried which lowers efficacy or are you excited and
psyched which tend to efficacy. Third there are vicarious experiences where someone else models’
accomplishments as you learn to draw yo may watch a YouTube channel or tv shows that models
how to draw the more closely you identify with the artists of that show the greater the impact on

Notes
self-efficacy. Lastly social persuasion from teachers or peers can be helpful social persuasion alone
can’t create enduring increases in self-efficacy but it can lead to a momentary increase in self-
efficacy. This enabling student to make better efforts or try hard enough to succeed.
Relapse prevention targeted specifically to behavior change. Relapse prevention was to describe the
process of relapse’s behavior. A key aim is to avoid or to learn how to cope with high-risk
situations. A risk of relapse is identified in two categories one is immediate determinants and
covert antecedents. It is an interesting feature in which the person is aware that conscious goals
related to recovery often succumb to the physiological symptoms of withdrawal, negative affective
states, and the emotional tipping point created by the abstinence violation effects. The one of the
best technique specific to relapse prevention is mindfulness. The mindfulness has been successful in
countering the influence of negative affective states on the likelihood of relapse, and enhancing
individuals’ abilities to cope with distress.
Self-determination theory in which goal-driven behavior are regulated are given importance. The
feelings of interest, enjoyment, or satisfaction, and it is theorized that this produces self-motivated,
or self-determined behavior. The important outlined in this theory are positioned to be innately
valued, aligning the content of one’s goals with an individual’s core needs for example, an exercise
goal formed for the explicit purpose of looking better to one’s peers, an extrinsic personal goal, will
lose salience more rapidly than an intrinsic exercise goal emanating from the value of human
connection and focused for the purpose of being able to engage with one’s grandchildren or to
foster a relationship with friends.
Incentives/ affect is associated with particular outcomes of a health behavior are evident in the
model. An interest in the affective determinants of health behavior, including work on both
reflective and reflexive affect. A reflective affect is revered to as subjective liking and it’s cognitive
based on the other hand reflexive affect has been associated with core liking which is related to a
function of contextual stimuli and associations. As per previous researches reflexive affect maybe
more helpful in predicting further behavior than reflective affect. A key factor of these model this
can help at various levels of influence, including the individual, community, state or national level.
11.2 Intervention Strategies for Individuals

To enable people with disabilities to contribute to creating opportunities share in the benefits of
development and participate in decision making may be required by many communities.
Many communities working to break this cycle between disable by empowerment of
individuals/families/organizations and by breaking down barriers in society. Those community-
based activities are designed to meet the basic needs of people with disabilities and enable access to
health, education and professional opportunities.
There is no consensus on how certain behaviors are best supported. Model and theories need to be
used to facilitate and evaluation.
11.3 Families of Disabled

Due to the disability impact on family a set of extra demand or challenges for long time on family.
And those demand or challenges can be varied because of disability type, age of the person with
disability, and type of family in which the person lives. These challenges can be financial burden
due to medical treatment, education, social services, accommodation, transportation, and special
food. Finding appropriate therapy or treatment one is eligible for and then working with an
institute to certify that eligibility which can be regular follow up is a major challenge faced by
family. Next major challenges faced by family is coordination with service providers such as
physician, physiotherapist, counsellor, psychiatrist, occupational therapist, dietician, social worker,
teacher etc.
The everyday routine task dependency of disable person on his/her family leads to exhaustion and
fatigue, tired (physically and emotionally) energy of family members. There are bunch of
challenges that creates emotional strain, including worry, guilt, anxiety, anger and uncertainty
about the causes of disability, need of other family members, future, and so on.
Due to all of this in major way family life changed. Care for disabled person responsibilities may
lead to change in planning of the families. Mostly female caregivers take responsibilities for
disabled person, due to emotional attachment, or our Indian culture, thus changed their work role.

Notes
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Emotional attachment in between primary caregivers and person with disability, such as mother of
child with disability, can impact on the time spending with other family members, father rarely
spend time with his disabled child this makes marital conflict in between husband wife or family.
The unequal share of families’ resources of time, energy, and money, family needs go unmet.
11.4 Behavior Modification & Cognitive Therapy

In health behavior change, knowledge of what is useful is very crucial for achieving improvements
in health and preventing disease. Many communities growing in this field and recognition of this
and a lot of work has been undertaken to Damien the best approach. Previous researches revealed
that the use of such theory in designing and implementing health promotion programs improves
their effectiveness. One of the best techniques is cognitive therapy.
Cognitive behavioral therapy is a treatment for emotional and behavioral issues that aims to help
an individual to identify and modify dysfunctional thoughts, assumptions and patterns of
behavior. It helps to explores the range and factors that influence one’s behavior due to
environmental or reinforcement (external) and thoughts (internal). This therapy helps to set goal
and self-monitoring which is based on the belief that all behavior is learned and can be unlearned.
People with learning disabilities have a particular need of help both with learning skills and with
unlearning problem behaviors, and particular methods exist to supply this need. Behavioral
management has much in common with teaching and management methods in general but
includes some special features. It is applicable to both children and adults, although naturally the
context in each case will differ.
It is important to emphasize at the outset that there is no one method that should be prescribed for
any one problem. The first essential is to study the individual concerned - his or her likes and
dislikes, circumstances, idiosyncratic behavior patterns, history, family set-up, and so on. Only
following that study will a treatment program me, tailored to the characteristics of the individual
and to his or her environment, be arrived at.
There are however certain procedures that will normally be considered.
 Changing the Surroundings

 Positive Reinforcement
 Differential Reinforcement of Other Behaviors
 Extinction
 Time Out from Positive Reinforcement
 Functional communication training
 Stimulus Control
 The Least Restrictive Alternative
 Fading programs
Definition
Problem, or challenging, behavior, is defined as: 'behavior of such intensity, frequency or duration
that the physical safety of the person or others is likely to be placed in serious jeopardy, or behavior
which is likely to seriously limit or deny access to and use of ordinary community facilities'
(Emerson et al 1988). It is important to note that such behaviors are shown by only a minority of
people with intellectual disabilities - 6.1% (Emerson 1995, p.24).
Changing the surroundings

It may be possible to lessen a challenging (problem) behavior by altering the person's circumstances
to make it less likely that the behavior will occur. For example, a young man who could not tolerate
noisy places and caused so much disruption that he was no longer taken out to shops and cafes,
was given a headset and a portable cassette player with tapes of music that he liked. When he used
these they screened out the other noises and he could then be taken out. (See Donnellan et al 1984).
By itself this may not change the behavior but it can help to allow other methods to be put into
place and to take effect.
Positive Reinforcement

Notes
Many of the methods described here involve the use of positive reinforcement. This is defined as:
anything which, when it follows a behavior, increases the likelihood of that behavior occurring
again. So, a preliminary to most programs is the search for and identification of whatever is likely
to have that effect for this individual. No assumptions are made as to what this will be - anything
assumed to be a reinforce 'for most people' will not do unless it is known, or can be shown to be, a
reinforce for this individual. The search for reinforces should be wide-ranging, taking in sensory
stimulation - lights, sounds, music, tastes, smells - preferred activities, favorite foods and drinks.
Social reinforces - attention, approval, praise, hugs - are powerful reinforces for some people but
ineffective for others, and for others still may actually be aversive, so cannot be invariably relied on.
Whatever is finally selected, it is crucial that it is of great interest to the person concerned, and can
be shown to increase any behavior that it regularly follows. Used to increase appropriate and to
teach new behaviors, it works best when given after every occurrence of the behavior, at least at
first.
In some cases, the normal response to a behavior, that would normally be thought of as unpleasant
and leading to a decrease in any behavior it follows, may have a contrary effect for a person with a
learning disability. One example of this is remonstrance, disapproval or anger. A person with a
learning disability, if he or she enjoys attention, may relish the attention involved in the scolding;
even angry attention may be better than none. If this is the case then the scolding will act as a
reinforcer, and will result, not in a lessening but rather in an increase of the behavior, as the person
realizes that this is a good way of ensuring that people attend to him or her.
Differential Reinforcement of Other Behaviors

One way of diminishing a challenging behavior is to build up other behaviors, by deliberately
reinforcing them, to compete with the target one. These other behaviors may be those that are
incompatible with the problem one, i.e., it is impossible for the person to do both behaviors
simultaneously. So a girl who frequently poked her eyes with her fingers, damaging her sight, was
provided with a piece of apparatus which produced sounds and noises that she loved when she
pressed its switches with her fingers. While she pressed the switches and heard the sounds, she
could not at the same time poke her eyes, and the eye-poking diminished.
Sometimes it is not possible to identify a behavior that is incompatible with the target behavior. In
this case all other behaviors may be reinforced, apart from the target one. Here it is the absence of
the target behavior that is reinforced: the person receives reinforcement for each period of time (five
minutes, ten minutes, half an hour or more, depending on the person and on the behavior) during
which the target behavior has not occurred. The person learns that he or she has a better time when
not displaying the target behavior, and so will display it less.
Next, two methods used to reduce problem or challenging behaviors by withholding
reinforcement.
1. Extinction
Behaviors that are followed by a reinforce are maintained or strengthened. This may happen also,
inadvertently, with a challenging behavior. If the reinforce for this challenging behavior can be
identified it may be possible to determine that it will never again follow the behavior. Without
reinforcement, the behavior should eventually die out (extinguish).
There are two caveats. First, the reinforce must be one that can be controlled. Second, the behavior
must be expected to increase initially (the 'extinction burst').
Regarding the first of these: if, for example, it was thought important to reduce a person's
masturbation, extinction would not be a suitable method to choose because the reinforcement
cannot be externally controlled; if the person masturbates the reinforcement will inevitably follow.
Some other method must be looked for.
Secondly, if a reinforce, which can be controlled, is prevented from following the behavior, then
initially this can result in an 'extinction burst'. The person finds that the expected reinforcement is
not forthcoming, so tries a repeat of the behavior. If still there is no reinforcement the person may
raise the level of the behavior (worsen it). If the reinforcement is rigorously withheld, no matter
how much worse the behavior becomes, the behavior should then begin to lessen, slowly at first
and then more rapidly.
As the behavior worsens during the extinction burst it may be that the worker in charge of the
program me cannot tolerate the increased level, gives in, and gives the reinforcement. In this case
the person learns that, even if the original level of the behavior will not be reinforced, an
exacerbation of it will. From then on it is likely that the behavior will be worse than it was

Notes
Course Name
originally. So it is of the utmost importance that, when the use of extinction is considered, the
process is carefully thought through, including whether it could be kept up through an extinction
burst. If there is any doubt about this, it would be better not even to attempt extinction but to use
another method.
2. Time Out from Positive Reinforcement

Often referred to as Time Out, but the full title is important. Time out from positive reinforcement
is an option where the problem behavior usually happens when the person is already in a
reinforcing situation - eating favorite food, enjoying music, TV, a social situation. Whenever the
behavior occurs, the reinforcement is temporarily suspended. So, if the person very much enjoys a
social situation, time out could involve him or her being removed from the situation, perhaps to
another room, for a short period (say, five minutes, or even less). But, if the person is not interested
in social interaction, removing him or her to another room would not remove the reinforce and
would be pointless, even possibly reinforcing (in allowing the person to escape from a situation he
or she dislikes). So, time out essentially does not mean the invariable use of a time-out room. On the
other hand, it has been effective where, for example, the person is fond of music, which is playing,
or of TV, and on the occurrence of the behavior the music or TV is briefly turned off.
Functional Communication Training

Sometimes a challenging behavior appears to function in people with a learning disability as a way
of 'asking' for something. It may be a way of asking for attention, or for a tangible item, or for
something to be stopped - a task perhaps, or an aversive situation. In such cases an effective
treatment may be to teach the person to use a word or sign to ask appropriately for what they want.
So if children are misbehaving in order to get the teacher's attention, teaching them to say or sign
'Come here please' can result in a reduction of the misbehavior. Similarly, if they were misbehaving
in order to escape from a too-difficult task teaching 'Help please' can also bring about a lessening of
the misbehavior.
Stimulus Control
Certain stimuli lead to certain kinds of behavior - rain prompts us to put on a mackintosh, a red
traffic light to stop the car. Without these stimuli, these behaviors might not occur. Similarly, it is
possible for a stimulus to become associated with a behavior that is permitted - reinforced - while
the absence of the stimulus indicates that the behavior will not be reinforced. These conditions can
be put to use to help to manage difficult behaviors.
A 13-year-old boy was causing major problems in school, among them the relentless questioning of
staff. Although this sounds a trivial problem, the tensions it produced led on to other difficulties
including physical aggression. The boy was given a sticker to wear on his shirt, and was told that
when it was on his shirt his questions would be answered. When it was not on his shirt his
questions would not be answered; he should wait until the sticker was back on his shirt. At first the
sticker was removed very briefly - for 15 seconds, four times in every hour. His questioning
dropped off in frequency very rapidly, within three weeks, even when he was wearing the sticker,
and the other associated problems declined too.
Stimulus control can be a useful method in some situations. However since, like extinction, it
allows for some occurrence of the behavior, it is not suitable for tackling behaviors that are
dangerous either to the person or to others.
Deliberately Programming Reinforcement

Some of the methods described above involve the withholding or removal of reinforcement. It is
then important to ensure that the person gets reinforcement at other times - our aim is to improve,
not impoverish, the person's life. So, for example, if the reinforcer were attention, which was
withheld when the behavior occurs, the person should receive plenty of attention at other times:
not necessarily for any markedly virtuous but simply for acceptable behavior. This precaution will
also make it less likely that other problem behaviors will emerge to take the place of the original
one.
The Least Restrictive Alternative

In work with people with learning disabilities we have an ethical obligation to cause them as little
distress as possible. Therefore, in tackling a challenging behavior we should at the outset select a
method which, while having at least some prospect of being effective, is the least aversive option
available (changing the surroundings, differential reinforcement of other behaviors, etc.). Only if
this is shown convincingly to fail will other, more stringent, methods, be tried.

Notes
Fading Programs
When a program me has been put into practice and has been effective, the question arises as to how
to end it. This applies particularly to methods that involve giving reinforcement (differential
reinforcement of other behaviors, stimulus control). As a rule, the principle is that it should not be
stopped abruptly but gradually tailed off. If the reinforcement is suddenly stopped the likelihood is
that the behavior, which had improved, would worsen. So instead, the reinforcement can be given
at gradually lengthening intervals; for gradually increasing standards of behavior; or where
appropriate, the reinforcement may be transferred to a new target behavior. Another strategy is to
give the reinforcement at irregular intervals - some short, some longer - so that the person cannot
predict exactly when it will arrive. This can make it less problematic for the person when the
intervals become generally longer, until eventually the reinforcement, for this behavior, comes to an
end.
If the program me has been devised with an appropriate goal - that of improving the person's life -
then when it succeeds the person should experience the improvement, finding new sources of
pleasure and enjoyment. This too should help to make deliberate reinforcement less necessary.
Cognitive behavior therapy (CBT) is an evidence-based intervention that is well-suited for use with
clients with disabilities and can be leveraged to reduce distress and to promote well-being and
empowerment. Therapists can begin to develop disability cultural competence through attention to
frameworks for understanding disability that incorporate biopsychosocial, familial, and
sociopolitical factors; by gaining self-awareness and challenging ableist attitudes; and by attending
to the reality of minority experiences and oppressive contexts when working with clients to change
behavior and challenge dysfunctional attitudes and cognitions. This chapter highlights the
complexity of disability by drawing attention to the socioenvironmental context of disability and
the ways in which thoughts, feelings, and behaviors can be addressed in therapy without
minimizing the real constraints that are imposed by environments that limit access. It presents
clinical data from two individuals with disabilities who received CBT. (PsycInfo Database Record
(c) 2020 APA, all rights reserved)
The American Psychological Association (2002) has included cultural competence in working with
people with disabilities as a standard in its "Ethical Principles of Psychologists and Code of
Conduct." However, the field is still in its infancy in achieving such cultural competence, with few
disabled people represented in the field of clinical psychology and little formal training available
for conducting therapy with disabled people. The goal of this chapter is to move beyond the
individually oriented deficit model in conceptualizing the difficulties experienced by clients with
disabilities and discuss the utility of cognitive-behavioral therapy (CBT) with disabled people. To
foster a broader conceptualization, we discuss the emerging recognition of disability as a cultural
identity and contrast it with historical perspectives on disability, followed by research on
psychological resources that aid people living with disability. Finally, examples of the use of
behavioral and cognitive strategies to improve adjustment among persons with disabilities are
described and illustrated. Although the issues we present are broadly applicable across diverse
impairments, we have chosen to focus primarily on physical and sensory disabilities. We begin
with a brief overview of the components of disability culture, followed by a discussion of the ways
in which disability has been conceptualized within psychology and other disciplines, thus setting
the stage for examining CBT applications within this diverse community.
Cognitive behavioral therapy (CBT) has extensively popularized particularly in the last three
decades. As a standard therapeutic approach, CBT has been widely applied in solving numerous
mental related problems. As will be seeing later in the paper, majority of persons with learning
disabilities are the ageing population and this population is on the rise. This implies that that the
evidence base of their mental problems requires intensive care, therefore, the world countries ought
to ensure that there is a comprehensive range of psychotherapies who would cater for the
increasing population of persons suffering with learning disabilities.
Cognitive Behavioral therapy (CBT) is contemporary an accepted and effective method of treating
people with learning disabilities, this is evidenced by the reducing numbers of persons suffering
from learning disability illnesses. However, as the paper shows, there is an immediate need to
support the education practices as well as developments contributing to the emotional
requirements of persons with learning disabilities.
A discrimination is offered between disability and handicap. Common cognitive schemes and
irrational beliefs of people with physical disabilities are explored. The development of belief
systems from a social learning perspective and several cognitive assumptions of parents and
families of children who have physical disabilities are presented. Finally, certain self-evaluative
beliefs specifically related to physical disability are examined in terms of how they relate to self-

Notes
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image and, concomitantly, behavior. The article offers information arrived upon from the author's
clinical practice as well as the author's personal experience as a person with a physical disability.
Summary
Despite the recognized importance of maintaining and improving the health status of persons with
disabilities, there has been little research conducted to determine their health care attitudes and
behaviors and what interventions might serve to enhance their health. Using Pender's Model of
Health Promotion (1987), this study investigated the factors associated with the occurrence of
health promoting behaviors among 135 adults with disabilities. Staff and peer counsellors from two
Independent Living Centers in Texas administered the questionnaires and conducted brief semi-
structured interviews with participants. Seventy-three percent of the sample rated their current
health as good or excellent. Findings from both interviews and questionnaires suggest that
participants are more likely to define health as being able to function well than as simply the
absence of illness. High scores on Adaptive definition of health, the Self-Efficacy-Scale, age, and
low scores on the Barriers to Health Promotion Activity for Disabled Persons scale accounted for
31% of the variance in scores on a self-report measure of health promoting behaviors. These
findings suggest that interventions which address self-perceived barriers to health promotion, work
to build participants' sense of mastery of their health behaviors, and encourage a definition of
health that is broader than simply absence of illness may be more effective than those that focus
only on information about good health practices.
An individual's disability can play a major role in his/her life: whether it's positive or negative. But
overcoming the challenges and developing confidence is vital and admirable. As a society, it is our
utmost duty to allow people with disabilities to experience a life they deserve.
An individual’s disability can play a major role in his/her life: whether it’s positive or negative. But
overcoming the challenges and developing confidence is vital and admirable. As a society, it is our
utmost duty to allow people with disabilities to experience a life they deserve. We are all different
but very much alike at the same time.
The importance of disability awareness has been given prominence over the recent decades,
making it easier for the people with disabilities and the society to develop empathy for one another.
Disability awareness helps in subsiding the stereotypical mindset of the society, hence providing
vast opportunities for everyone to get involved in creating a positive, inclusive society for all.
Keywords
Incentives, cognitive theory, replace prevention, self-determination theory, health belief model,
disability, caregiver, behavior modification, cognitive therapy, extinction, time-out.
SelfAssessment
1. An individual’s disability can play a major role in his/her life.
A. True
B. False
2. Pender proposed health model in 1977.

A. True
B. False
3. CBT is not effective among disability population.

A. True
B. False
4. APA has included cultural competence in working with people with disabilities.
A. True

Notes
B. False
5. Certain stimuli lead to certain kind of behavior.

A. True
B. False
6. People’s health is related to people’s ----------

A. Feeling
B. Knowledge
C. Behavior
D. None of them
7. Social cognition theory investigates ----------- lifestyle factors.

A. Direct
B. Modifiable
C. Never changing
D. None of them
8. A reflect affect is revered to -------- likings.

A. Subjective
B. Objective
C. Neutral
D. None of them
9. Cognitive Behavioral Therapy is a treatment for ------ & behavioral issues.

A. Social
B. Official
C. Emotional
D. None of them
10. Sometimes normal response to a behavior is thought of-----------

A. Pleasant
B. Unpleasant
C. Euthymic
D. None of them
11. Without reinforcement, the behavior should eventually --------

A. Repeating
B. In the same speed
C. Extinguish
D. None of them
12. There are ---- methods to reduce problem or challenging behavior by withholding
reinforcement.
A. 1
B. 2
C. 3

Notes
Course Name
D. 4
13. CBT has got extreme popularization in the last ------- decades.
A. 1
B. 2
C. 3
D. 4
14. Self- influence is ----------- of a dynamic system.

A. Not a part
B. A part
C. An equal of
D. None of them
15. One biggest risk factor of health is -----------.

A. Home situation
B. Ambition
C. Life style
D. None of them
Answers forSelfAssessment
1. True 2. False 3. False 4. True 5. True
6. C 7. B 8. A 9. C 10. B
11. C 12. B 13. C 14. B 15. C
Review Questions
1. Briefly elucidate the theories of human behavior changes.
2. Describe different Models of behavior change.
3. Describe the intervention strategies for individuals
4. Cite with examples, briefly describe families of the disabled.
5. Define the role of behavior modification in disability.
6. Describe the characteristics of Cognitive Therapy in disability.
7. What is the role of reinforcement in disability?
8. What is the relation between Behavior Modification and Cognitive Therapy?
9. Write about the health status of the caregivers in the field of disability.
10. Write about the changing scenario of health behavior over the decades.
Further Readings
 Disability, Health & Human Development by Shaun Grech et. al. Palgrave
Macmillon.2017
 Understanding Disability & Inclusive Practices by Supriya Singh. Shivalik
Prakashan.201

Notes

Notes
Unit 12: Caregivers
Unit 12: Caregivers

CONTENTS
Objectives
Introduction
12.1 Impact of Disability on Family
12.2 Role of Caregivers
12.3 Challenges and Mental Health Issues
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To know the impact of disability on Family.
 To understand the role of caregivers in Rehabilitation
 To familiarize with the challenges on Mental Heal Issues.
Introduction
A caregiver is a person who is taking care all the needs or concerns of a person with short or long-
term limitations due to illness, injury or disability. There are two types of caregivers one is
professional such as nurses, doctor, ward boy, paid attendant and second category is family
caregivers such as blood relationship, neighbors, or close friends. Both the caregivers play a vital
role in health care.
To understand the importance of a caregiver, think of health care as three pillars. A person or
patient as one pillar; professional caregivers (doctors, nurses, etc.) act as another; and the third
pillar is the person who is recipient the care from others. So, we can say that it’s a team work.
One of another name for family caregivers is informal or unpaid caregivers. They are getting
different type of rewarding; caregivers can also be at higher risk of negative health consequences.
These may include stress, depression, difficulty maintaining a healthy lifestyle, and staying up to
date on recommended clinical preventive services.
12.1 Impact of Disability on Family

Having a family member with any type of disability/disease/disorder can have an effect on the
entire family such as the parents, siblings, and extended family members. It is an unusual
experience for families and can affect all aspects of family functioning.
Stress can be increased due to caring for a disabled family member, physical as well as mental
health, which makes a person or family to take any affective decisions about work, education, and
finding society support. This may be associated with guilt, blame, or reduced self-esteem. And this
may also divert the attention from one aspect to another aspect of family functioning. Due to high
medical care increase the financial burden on the family members. All of these things impact on the
potential effects on the quality of the relationship between family members, their future
relationship in between family, and their living arrangements.

Notes
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On the other hand, there is a positive side also, it can provide a wider prospective, increase family
members’ awareness of their inner strength, enhance family cohesion, and encourage connections
to community. At the same time, the time, financial costs, physical, emotional demands, logistical
complexities are connected with caring for a disabled person. The impacts will likely depend on the
type of condition and severity, as well as the age, gender, relationship, physical, emotional, and
financial of the family and the resources that are available.
One of the supports that family caregivers may need to enable them to continue to care for their
family member at home are short breaks. Short Breaks give them a break from their role as career
and also provide their family member an opportunity to be with others and benefit from new
experiences.
Having a family member with an intellectual disability can have an effect on the entire family; the
parents, siblings, and extended family members. It is a unique shared experience for families and
can affect all aspects of family functioning.
On the positive side it can broaden horizons, increase family members’ awareness of their inner
strength, enhance family cohesion, and encourage connections to community. On the other hand,
the time and financial costs, physical and emotional demands, and logistical complexities
associated with caring for a disabled child/adult can have far-reaching effects. The impacts will
likely depend on the type of condition and severity, as well as the physical, emotional, and financial
wherewithal of the family and the resources that are available.
For families, caring for a disabled family member may increase stress, take a toll on mental and
physical health, make it difficult to find appropriate and affordable child care, and affect decisions
about work, education/training, having additional children, and relying on public support. It may
be associated with guilt, blame, or reduced self-esteem. It may divert attention from other aspects
of family functioning. The out-of-pocket costs of medical care and other services may be enormous.
All of these potential effects could have repercussions for the quality of the relationship between
family members, their living arrangements, and future relationships and family structure.
Families are telling us that one of the supports that they may need to enable them to continue to
care for their family member at home are short breaks. Short Breaks give them a break from their
role as career and also provide their family member an opportunity to be with others and benefit
from new experiences.
12.2 Role of Caregivers

An involvement and support of the family play a vital role in a patient’s recovery after a disability,
injury or illness. Usually, family caregiver plays a vital part in the rehabilitation process for a
number of reasons: number one is positive attitudes, second is reinforcement from family members
can motivate patients’ commitment to recovery and third is to help them adapt to new physical
challenges or limitations.
Support by family and motivate them can also help patients to deal with issues of self-esteem and
their condition. Family members know the patient better (in nature) then profession caregivers they
can assist the rehab staff in determining ways to motivate their loved one and maintain open
communication between the patient and the rehabilitation team this help the rehabilitation team to
make rapport more quickly with patient.
Family members are affected by the patient’s condition and often become co-managers of the
patient’s care. Family and caregivers both may experience changes in daily routine activity due to
caregiving that create stress within the family. For example, a spouse or son or daughter in a
caregiving role may need to rearrange their work schedule, decrease their hours, or even take a
leave of absence to manage his or her responsibilities. There may be a change in living
arrangements, issues that arise with childcare, financial problems due to medical bills or
unemployment that contribute to pressures on the family.
Family caregivers required emotional and psychological support of their new responsibilities.
While caring for a loved one can be exhausting and at times over whelming. Most common
experiences experienced by caregivers are feelings of burden, alone, sadness, stress and also
physical and emotional health problems. A copping way for family caregivers is to find a support
group. Talking with others who faces the same problem/issues/challenges can help caregivers and
provide an opportunity to share resources and tips.
A support group usually focuses on a specific situation or condition. support groups have been
formed by community members with the same condition or by someone interested in it, such as a

Notes
Unit 12: Caregivers
family member. In some cases, support groups are organized by nonprofit organizations. Others
are provided by Burke staff who are considered experts in a particular area of healthcare.
Caregiver duties & responsibilities are as follows: -

Personal care is not uncommon in some disabled family members to struggle with day-to-day
tasks. As the signs of aging progress, simple things like getting dressed, bathing or brushing teeth
can become tiresome. In some cases, they may even be painful. Due to that many of loved ones
neglect their hygiene because of their daily routine. In other words, responsibility of caregivers is to
assist as much as needed by the disabled person to keep up with their daily personal hygiene
routine.
Toilet using, grooming, or yoga and exercising is much easier with the help of a qualified caregivers
but it’s very difficult for family caregiver if this task were carried on for long time.
(ii) Meal planning and food preparation food restrictions, preferences, and requirements make it
difficult for many disabled persons to receive their daily nutrients.
(iii) Transportation is a big concern for the disabled people. To bring them to the doctor or any
other places it’s very difficult for caregivers because of regular follow up at doctor or therapist.
Here caregiver duty is to provide transportation to and from activities as well as be there to assist
disabled in and out of wheelchairs as needed.
(iv) Companionship, decreased quality of life due to loneliness and depression are common issues
disabled person. While relative’s visits and social activities may occur from time to time, many
disabled people feel alone in between engagements. To supervise disabled people while also giving
them someone to talk to on a daily basis.
(v) Medication management, sometimes few numbers of medications consuming by disabled
person and that number could grow or decrease, depending on individual needs and diagnoses.
Some disabled person may not possess the mental capacity to remember whether or not they have
taken specific pills. So, it is difficult to monitor medications and consumption among the disabled
person.
(vi) General health care, at home care may not be able to perform checkups or in-depth health
procedures, they are qualified for health monitoring and basic care. They can follow a care plan and
monitor the disabled person to ensure that no changes occur. If there is any issue arise the
caregivers should need to immediately consult with doctor or therapist.
(vii) Family support, it is difficult for a family member to come to terms with the signs of disability
that their disabled family member may display. Many caregivers don’t know how to help or how to
cope with the situation. They need to take education, ideas and methods to make family life easier.
To find for the right professional caregiver is not an easy task because the professional caregiver
should be the right combination of knowledge, ability, and empathy to fulfill the role. That’s why
so many people end up taking care of their family members’ needs by themselves.
The family members as caregivers are often juggling their own lives, along with acting as a
caregiver for a disabled person in their home. Unfortunately, this is not a tenable situation as family
members may have all the caregiver skills which their loved one required.
One of the most important factors in a patient’s recovery after a disability, injury or illness is the
involvement and support of the family. Usually, the patient’s family is the caregiver and thus plays
a vital part in the rehabilitation process for a number of reasons: Positive attitudes and
reinforcement from family members can inspire patients’ commitment to recovery and help them
adapt to new physical challenges or limitations. Family support and encouragement can also help
patients deal with issues of self-esteem related to their condition. And because family members
know the patient best, they can assist the rehab staff in determining ways to motivate their loved
one and maintain open communication between the patient and the rehabilitation team.
Approximately 65 million people—or 29 percent of the U.S. population—provide care for a loved
one that is disabled, chronically ill or aged. Family members are affected by the patient’s condition
and often become co-managers of the patient’s care. As a result, they may experience changes that
create stress within the family. For example, a spouse or son or daughter in a caregiving role may
need to rearrange their work schedule, decrease their hours, or even take a leave of absence to
manage his or her responsibilities. There may be a change in living arrangements, issues that arise
with childcare, financial problems due to medical bills or unemployment that contribute to
pressures on the family.

Notes
Course Name
But caregivers shouldn’t feel alone in their situation. By working together with the rehabilitation
team, the patient and family can help lessen the adverse effects of these changes and work toward
finding realistic solutions. First and foremost, families need to become educated about a loved one’s
condition and prognosis and involved in the development of the rehabilitation plan. The more
caregivers learn—by communicating with the health care team and taking advantage of
educational programs offered at the hospital— the better prepared they are to care for their loved
one at home. At Burke, for example, family members are encouraged to attend and participate in
treatment and training sessions in order to become aware of their loved one’s progress and learn
safe and effective techniques to assist them. Families and caregivers have ongoing access to
information about available services and resources that can help the patient successfully transition
to the next phase of rehabilitation.
In addition to education, family caregivers need support for the emotional and psychological
aspects of their new responsibilities. While caring for a loved one is undoubtedly rewarding, it can
also be exhausting and at times overwhelming. Caregivers commonly experience feelings of
burden, isolation, loneliness, depression and anxiety and research has shown they are at risk for
physical and emotional health problems.
One of the best ways for family caregivers to cope is to find a support group. Talking with others
who face the same challenges can help caregivers feel less isolated and provide an opportunity to
share resources and caregiving tips.
There are many benefits to participating in a support group:
 Feeling less lonely

 Social interaction in a safe environment
 Sense of empowerment
 Improved coping skills
 Venue to speak openly and honestly about your feelings
 Reduction in stress, depression or anxiety
 Better understanding of what to expect with your situation
 Information about new medical research
 Opportunity to gain information about treatment options
A support group usually focuses on a specific situation or condition. At Burke, there are support
groups for ALS, Amputees, Aphasia, Pulmonary, Osteoporosis, Spinal Cord Injury, Traumatic
Brain Injury, Stroke, and young-onset Parkinson’s. There’s also a support group dedicated entirely
to the “well spouse” that provides peer support and education about the unique issues facing the
caregiving partner in a couple.
Some of Burke’s support groups have been formed by community members with the same
condition or by someone interested in it, such as a family member. In some cases, support groups
are organized by nonprofit organizations. Others are provided by Burke staff who are considered
experts in a particular area of healthcare.
In addition to joining a support group, there are several ways that you as a family member can ease
the day-to-day stress of caregiving. First, don’t be afraid to ask your family and friends for
assistance. It may help ahead of time to make a list of all the caregiving tasks required, and then
determine which activities you can realistically accomplish on your own and which ones you’ll
need help with. Second, take care of yourself: exercise regularly, eat right, get enough sleep and
keep up with regularly scheduled doctor’s appointments. Third, make it a priority to meet
regularly with friends and do things you enjoy. By taking time to relax and recharge, you’ll feel
more energized and better able to care of your loved one.
12.3 Challenges and Mental Health Issues

Caregivers often find they have less time for activities like chores, spending time with family &
friends, hobbies, or running errands. Those who maintain full or even part-time employment may
have difficulty in keeping a healthy work-life balance.
They’ll quickly become overwhelmed if precautions, plans, and proactive measures are not in place
to combat the many issues that emerge.

Notes
Unit 12: Caregivers
One of the biggest challenges faced by caregivers is time management. Caregivers often sacrifice
much of their schedule to care for their loved one, even if it means a lesser quality of life for
themselves. It’s important, then, to understand that there are ways to provide care without
sacrificing your own mental and physical health. This starts with effective time management skills.
Most people who claim they don’t have enough time for themselves are unaware of how much time
they waste intermittently throughout the day. Therefore, the single best time management tactic
starts with keeping a daily diary.
Second most common issue faced by caregivers is lack of privacy. To provide adequate care, close
proximity is somewhat of necessity, sometimes as close as living with a loved one. In that case, it
may seem difficult to find time alone for any extended period of time.
Depending on how advanced an illness or ailment may be, some patients need round-the-clock
care. Eating, bathing, light exercise, medication–these tasks can take up large chunks of a
caregiver’s day.
A general lack of privacy can lead caregivers to feeling depressed, lonely even. The world feels
small when you’re only interacting with your loved one every day. Although it may be difficult to
ask for help
Strain on relationship is another issue faced by caregivers. Caring for a loved one can take away
time from relationships with others, just as much as it can take away time from self. Dinner dates,
hobbies, and other activities with friends and family may seem difficult to attend.
Practicing honesty with others is of great importance. Let your friends know your schedule ahead
of time, and if you are going to be late with an event, call in advance. Caregivers can feel like
they’re a burden to their friends if they are constantly late or absent. If you are open and honest,
your friends will understand.
Conflict about care is also the issue for caregivers. If you split responsibilities with a sibling, friend,
or another family member, you may find from time to time–perhaps often–arguments about
caregiving duties getting in the way. This is common, as conflicts can emerge regarding scheduling,
level of care, medication, and more.
Conflict with loved one is another challenge for caregiver. When you’re inside all day with the
same person–no matter the situation or dynamic–there is going to be tension at times. Human
beings are complex creatures with a plethora of wants and needs. Sometimes these wants and
needs are drastically different from other individuals, and this is where conflict emerges.
This can be even more difficult to handle when dealing with a loved one whose needs are
immediate and necessary. The relationship between caregiver and patient can also become toxic if a
patient begins to take the caregiver for granted, taking advantage of their kindness and asking for
more than they need.
Stress, caregivers should covet stress management. Routinely, they may find their days not going
according to plan. Problems will arise when you least expect it. Physical stress dealing with a loved
one can induce various kinds of stress that physically manifests. Pain, anxiety, even hair loss, is
your body’s way of signaling that you’re overloaded with stress and need a break. Emotional stress
managing expectations goes hand in hand with stress management. Be careful in expecting things
to go exactly as planned, and certainly do not expect other people will have your best interests in
mind. Just this small change in perspective can help you manage your mood better.
Isolation, the daily drudgery of menial tasks associated with caregiving can leave caregivers feeling
isolated. You’re normally dealing with the same person and problems day in and day out with
seemingly no end in sight. Friends and family members, knowing your situation, rarely call or text–
they don’t want to bother you. Or perhaps, because you are so busy with caregiving, you stopped
answering the phone, and now the phone rarely rings. You look to your loved one for support, but
they’re medicated or too tired to keep up a conversation.
Depression, many of the aforementioned issues are not singular issues existing in a vacuum. These
problems usually come with more problems, and those problems domino down the line until
caregivers are neck deep in depression, feeling completely defeated. A caregiver’s primary task in
dealing with depression relies on their ability to experiment and try new things as well as speaking
to professionals who can advise.
But, first, you need to gauge the severity of your depression. Is it clinical depression or just a
general feeling of malaise and lack of motivation? The former needs an evaluation from a medical
professional like a psychiatrist.

Notes
Course Name
Guilt can spring up from time to time in the caregiving journey, although it may not be as obvious
as other emotions. Caregiver guilt normally arises during caregiving in three specific ways: Guilt
over inadequate care (even if only perceived), Guilt over neglected relationships, Guilt over
negative feelings towards your loved one.
The end of the caregiving experience, unfortunately, ends with a loved one passing on. While some
of the issues on this list can be avoided with careful planning and proactivity, grief is something
many caregivers will experience during their caregiving journey. It’s an unavoidable part of life.
When a caregiver’s loved one passes on, they may feel like a part of them has passed on, too. Much
of a caregiver’s identity can be tied into the caregiving process, routinely bringing them a sense of
purpose. When that ability is taken away, even if a loved one is simply moving to an outside
facility, caregivers may feel an intense, stinging sense of loss.
Fatigue, when an individual takes on the caregiving challenge, they are essentially committing to
two schedules: their own and their loved ones. Without help, many caregivers run around
frantically, cramming tasks while haphazardly finishing others. At the end of the day, they feel
drained with little energy to offer.
Sleep Loss, it’s important that a caregiver has energy in order to take care of themselves first and
their loved one second. Sleep loss or lack of deep sleep can wreak havoc on a caregiver’s life,
leading to poor energy levels throughout the day. This, in turn, leads to half completed tasks,
unscheduled daytime naps, falling asleep at work, and even dangerous behavior like falling asleep
while driving.
Finances, caregiving can be extremely expensive, almost too much for one person to manage.
Medication, medical devices, transportation, and surgical procedures are costly. Many caregivers
have to get more than one job in order to make ends meet.
Health risks associated with caregiving include (but are not limited to) stress, sleep issues, a
weakened immune system, depression, and anxiety. These risks are normally attributed to a
confluence of factors like lack of help, lack of rest, finance troubles, poor self-care and more.
When person experience an injury or trauma, he/she may have psychological and emotional
response to this injury and mental health issues may be triggered, such as depression, anxiety,
eating disorders. There is evidence that support that mental health issues may inhibit outcomes of
rehabilitation process so good mental health increase the outcomes of rehabilitation of your patient.
Depression is common for about one third during inpatient rehabilitation that interfere with patient
quality of life and functional activities.
Psychological responses/ mental issues

The effect of injury on mental health and psychological response isn’t predictable it extends from
the time immediately after injury, to the post-injury phase, rehabilitation phase and finally with
return to activity. These emotional reactions and mental response to injury are normal. But if the
symptoms are unresolved or worsen over time it becomes a problem. These responses effect on the
time of rehabilitation.
Sadness.
Lack of motivation, the patient will find it is difficult to maintain his motivation without
predictable time of return to their activity and full recovery as it is generally unknown like
concussion
Changes in appetite, for example athletic injury may reflect on one’s appetite they may feel they
don’t deserve to eat as they are injured or the failure of their performance.
Depression and suicidal ideation.
Sleep disturbance.
Experience emotional symptoms including feeling of sadness or irritability as a direct result of the
brain trauma.
Denial of injury severity and they think the injury isn’t bad as the health care providers say.
Fear of re–injury: the patient tends to analyze the situation to find out what went wrong, and how
to avoid it next time, in patients with emotional and mental health reactions may create
overthinking and unhealthy level that in turn hinder the rehabilitation process.
Concussion and psychological reaction to concussion such as depression, treated by cognitive
therapy and physical rest.

Notes
Unit 12: Caregivers
Isolation.
Irritation.
Anger.
How to support mental health issues
1- Education, explain to the patient about the the injury and the recovery process, the
demonstration should be introduced in the way the patient can understand well, and
misinformation from internet should be corrected.
2- Build trust, listen to your patient to make a medical diagnosis but also to assess and monitor
their emotional state, experience a range of emotions that make it difficult for care network
members to establish connection.
3- Set goals, help patient to be motivated, to complete their rehabilitation by setting short- and long-
term goals to achieve.
4-Create a network support between your patient, family members, and friends.
Depression is considered the first or second response in patient with trauma according to many
researchers. Once the patient goes through depression it emotions of disbelief, denial movement,
anger. And may find themselves dealing with antidepressant but this isn’t the only treatment it’s a
behavior-change strategy.
It is important for the rehabilitation team members to take care of depression symptoms and
emotional difficulties during the process of rehabilitation.
Stroke patients:depression in stroke patient may considered to be biological process that
correlates with the size and location of the area affected on brain. It is called post-stroke depression
and may slow the recovery rate, hinder patient outcomes, negatively effects on lower functional
status and stroke survivors’ quality of life, and secondary complication. Depression believed to be
more common in stroke patients with aphasia than those without and when it was treated
medically the studies show decrease in the mortality rate. As our goal of rehabilitation is to
improve one’s adaptation to a disability in cope with functional improvement, the physician will
sometimes need to deal with depression before dealing with physical rehab.
Athletic injury rehab: the rehab process may be affected by psychological responses such as loss of
identity, fear, anxiety, loss of confidence, denial of injury, rapid mood swing, and unreasonable fear
of re-injury. Though using goal setting, cognitive structures, maintain patient motivated, and
psychological support are helpful strategies for faster recovery and cope with process of
rehabilitation and social strategy.
In critical care:after discharge from critical care younger and older patients showed significant
incidence of long-term cognitive and psychological dysfunction that impact on long-term function
and quality of life.
Summary
Family members are also affected by your disability. In many cases, they may become co-managers
of your care. They may undergo many changes as a result of your disability. For example, your
family members may also grieve your loss of ability. Severe injury, chronic disease, or disability
may mean a change in family roles. For example, a housewife may need to return to work after her
husband's disability. A son may need to adjust his work schedule to help care for an elderly parent.
These changes can cause stress and conflict in the family. Financial problems due to medical bills or
unemployment can occur, adding more stress on the family. Changes in living arrangements,
childcare issues, and community re-entry can all pose new problems.
Family acceptance and support can help you deal with issues related to self-esteem and self-image
after disability. Positive attitudes and reinforcement from loved ones often help you work towards
recovery. Family participation, flexibility, and open communication can overcome many barriers
associated with disability. Families who inspire hope can help you adjust and become more
confident in your abilities.
While your family are motivated to take care of you, the emotional and physical toll of caregiving
can be overwhelming at times. First of all, consider the amount of caregiving that is expected of
families outside the rehabilitation facility. Most caregivers are unpaid family members or friends
that provide full- or part-time care, even when you also have a healthcare professional.

Notes
Course Name
As a result, caregivers have unique stress. Caregivers often feel unprepared for their caregiving
role. Often, they feel isolated, anxious, and depressed. An additional concern is maintaining good
communication with the healthcare team and other available resources.
Caregivers must be educated to meet the demands of your rehabilitation plan. In fact, they should
be included in the development of this plan.
Not only should caregivers be educated for their role, they must also be supported. Whether this is
a counseling program or a problem-solving supportive team interaction, support helps diminish
the isolation and anxiety associated with caregiving.
Caregivers must also find time for themselves, away from their caregiving roles. This perhaps is the
most important, yet least available, coping strategy that may be accessible to caregivers. The
importance of caregivers cannot be underestimated in your successful rehabilitation. As caregivers
gain confidence, they and their loved ones, should find caregiving less stressful and more
rewarding.
Keywords
Caregivers, trauma, coping skills, recovery, disability, potential.
SelfAssessment
1. There are two types of Caregivers.
A. True
B. False
2. Stress can be increased due to caring for a disabled family member.

A. True
B. False
3. Family members are not affected by the patient’s condition.

A. True
B. False
4. To find out the right professional caregiver is an easy task.

A. True
B. False
5. There are many benefits to participate in a social group.

A. True
B. False
6. There are ----- ways to support mental health issues.

A. 2
B. 3
C. 4
D. 5
7. Caregivers should go for coping strategies for------

A. Themselves
B. Others
C. Patients

Notes
Unit 12: Caregivers
D. None of them
8. Depression of stroke patients may be considered as---------

A. Psychological
B. Biological
C. Statistical
D. None of them.
9. Changes in appetite may be a symptom of ---------

A. OCD
B. Hysteria
C. Depression
D. None of them
10. There are ------- benefits to participate in social group.

A. 3
B. 5
C. 7
D. 9
11. About------ of the US Population provide care for a loved one.

A. 20%
B. 29%
C. 30%
D. 39%
12. Stress can be -------- due to caring for a disabled family member.
A. Increased
B. Decreased
C. Same
D. None of them
13. Doctors, nurses are --------- caregivers.

A. Family
B. Primary
C. Professional
D. None of them
14. Short breaks -------- be given to the caregivers.

A. Should
B. Should not
C. No difference
D. None of them
15. Family caregivers know ---------- than Professional caregivers about the disabled person.
A. Lesser
B. Equal

Notes
Course Name
C. Better
D. None of them
1. True 2. True 3. False 4. False 5. True
6. C 7. A 8. B 9. C 10. D
11. B 12. A 13. C 14. A 15. C
Review Questions
1. Briefly elucidate the role of caregivers for PwD.
2. What are the duties and responsibilities of the caregivers?
3. Explain the benefits of participating in a social group.
4. What are the challenges of the caregivers for dealing with PwD?
5. What are the mental health issues of PwD?
6. How we can support mental health issues of PwD?
7. Briefly describe the impact of disability on family.
8. What are the roles of professional caregivers in disability?
9. What may be the mental health issues of the caregivers of disabled persons?
10. What are the techniques to be adopted to cater the mental health issues of the caregivers?
Further Readings
Press,2022.

Notes
Unit 13: Quality of Life

CONTENTS
Objectives
Introduction
13.1 Concept of Quality of Life
13.2 Domains
13.3 Assessment
13.4 Global and Specific Indicators of Quality of Life
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To understand the concept of quality of life of the persons with disability
 To familiarize with different domains of quality of life
 To know various assessment techniques of quality of life
Introduction
The purpose of modern health care is to improve quality of life (QoL). It's often mixed up with the
term "standard of living." Standard of living, on the other hand, relates to the possession of riches
or material items. Although having a specific amount of square feet of living space in the United
States or owning oxen in Ethiopia makes a visible impact in people's lives, it does not always imply
higher happiness or well-being; lottery winners demonstrate this.
The World Bank's international data on annual per capita income shows that after income reaches a
crucial level – $13,000 in 1995 – the strong link between subjective well-being and money becomes
progressively slack and dispersed. Furthermore, standard-of-living gains do not appear to make a
major difference in people's QoL in the world's wealthiest countries, a conclusion that policymakers
find confusing.
The best way to define and quantify QoL is still up for dispute. Its definitions in the 1970s have
terminological similarities to stress concepts. At a time when stress was perceived as a
phenomenon that outstripped people's resources, these resources needed to be appropriate in terms
of meeting people's wants, needs, and capacities in order to give a satisfactory QoL. Since then,
definitions have placed a greater emphasis on people's subjective impressions of crucial aspects of
their lives, examining the various meanings attributed to these experiences in particular. People's
perceptions of their QoL are influenced by how they interpret life's experiences (e.g., as stressful or
pleasant). "An individual's perceptions of his or her functioning and well-being in diverse realms of
life," defined Wenger et al. (1984). People's perceptions of their internal states, such as muscle
tension or happiness, and the external events that impact them from their environment, such as
moving jobs or being bereaved, are increasingly recognized as a rich interaction and balance
Skevington (2007).

Notes
Course Name
13.1 Concept of Quality of Life
Quality of life is defined by the WHO as “individuals' perceptions of their position in life in the
context of the culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns”. It is a wide notion that encompasses a person's physical
health, psychological condition, amount of independence, social interactions, personal views, and
relationships to key environmental factors in a complicated way.
This concept is based on the idea that quality of life is a subjective assessment that is influenced by
cultural, social, and environmental factors. (As a result, the terms "health status," "living style," "life
satisfaction," "mental state," and "well-being" are insufficient to describe quality of life.) WHO
(2012)
People have varied expectations, people may be at different places on their illness trajectory when
their quality of life is measured, and the reference value of their expectation may fluctuate with
time.
The first issue arises because expectations are formed through prior experiences and are thus highly
specific. They vary from person to person and are influenced by social, psychological,
socioeconomic, demographic, and other cultural factors. People's ties with their environment have a
strong influence on their quality-of-life expectations. This could result in fundamental differences in
assessments of the impact on quality of life. For example, as a technique of successfully living with
ageing, older persons have described the necessity to adapt to their changing circumstances.
The second flaw is that the magnitude of the impact is dependent on when the measurement is
taken. It's hard to tell when a measurement was taken based on an individual's disease trajectory
using current methods. Furthermore, people' reactions to disease are highly individual: no one-size-
fits-all approach is followed by all. This means that, even in a clinical study when all patients'
quality of life is measured at the same time (and after the same length of therapy), they may still be
in various stages of their condition.
The third issue emerges because people's expectations are continuously changing as a result of their
experiences: they are constantly moving towards an ever-changing point of balance. Quality of life
is a dynamic concept, according to psychological, social, and health services studies. People's
techniques for evaluating or quantifying their quality of life evolve over time and in response to a
variety of situations. As a result, its meaning is inherently unstable Carr, et al. (2001)
13.2 Domains
According to Lawrence (2011), In the 1960s, applied research on social indicators sparked QOL
research in the health and social sciences. Then it was claimed that there were just a few
quantitative metrics that might reveal whether or not there were tendencies toward or away from
social progress. Several scholars claimed that objective indicators generated from official statistics
were not the only way to assess socioeconomic situations. They claimed that the significance of
these indications could be deduced from the aggregation of individual replies using subjective
indicators. This method has been applied to a wide range of social and psychological issues,
including health and well-being.
QOL is a multifaceted notion that is difficult to define and quantify. This explains why there are so
many different conceptual and methodological interpretations. In general, QOL is a subjective
assessment of an individual's level of contentment with his or her life, particularly those aspects
thought to be essential. This popular definition of QOL equates life satisfaction and subjective well-
being. QOL is measured using two subjective dimensions: first, the relative importance of many
aspects of daily life, and second, the level of personal satisfaction with each of these aspects. Health
(defined as the absence of disease) is commonly included as a subcomponent of physical (and
sometimes psychological) well-being, according to a variety of typologies of components. Table 1
reproduces Flanagan's well-known typology.
Psychological Domain is used to assess the quality of life of psychological health, such as affective
states (feeling happy, optimistic, satisfied, and interested in life, in contrast to feeling negative,
anxious, or depressed), memory and attention span.
To evaluate the psychological domain of quality of life (PDQoL), anxiety and depression levels of
infertile women with endometriosis versus non endometriosis who applied for Assisted
Reproductive Technologies (ART).

Notes
This prospective case-control study compromised a total of 105 women who applied for IVF/ICSI
program. Ninety-three women were divided into two groups as endometriosis (n = 37) and non-
endometriosis (n = 56) after 12 patients who refused to participate in the study were excluded. The
WHOQOL-BREF questionnaire, Beck Depression and Anxiety Inventory scales were used to
determine the psychological stress levels.
Women with endometriosis seem to be more susceptible to depression and anxiety than women
without endometriosis. Although infertility treatment outcomes are not found to be significantly
affected, the impact of depression and anxiety over ART treatment success merit further research.

Notes
Course Name
13.3 Assessment
The 8+1 indicators of quality of life
The following 8+1 indicators have been defined as an overarching framework for measuring well-
being based on academic research and many projects. Because of potential trade-offs, they should
ideally be examined simultaneously:
 Material living conditions (income, consumption and material conditions)

 Productive or main activity
 Health
 Education
 Leisure and social interactions
 Economic security and physical safety
 Governance and basic rights
 Natural and living environment
 Overall experience of life
Material Living Conditions

The three sub-dimensions of material living standards are income, consumption, and material
conditions (deprivation and housing). Income is a crucial indicator because it influences the
majority of the other indicators in the framework. This sub-dimension contains a variety of metrics
derived from national accounts and household surveys (net national income, household disposable
income based on the EU-SILC). The same is true for consumption, where certain aggregated
measures (real individual household consumption per capita) are collected from national accounts
and additional household consumption indicators will be created in the future from the Household
Budget Survey. In addition, joint measures of income, consumption, and wealth are being
developed, with the potential to provide the most comprehensive picture of household
circumstances. However, for the time being, the wealth aspect of this framework is covered under
the sub-dimension Economic safety. The indicators chosen for this sub-dimension are likewise

Notes
based on the EU-SILC. Material conditions (poverty and housing) give crucial additional
information to these money-based approaches.
Productive or Main Activity

Three sub-dimensions of the productive or main activity dimension are measured: quantity of
employment, quality of employment, and other main activity (inactive population and unpaid
work). Every day, residents' lives are filled with a variety of activities, the most notable of which is
their work. Working hours, balancing work and non-working life, safety and employment ethics
are some of the indicators used in the European Union to quantify this element of quality of life,
and they largely come from the EU-LFS, as well as the Structure of Earnings Survey) and
administrative data. Because not everyone is employed, it's critical to include indications for the
unemployed and unpaid work in this dimension. Unpaid labor is, in reality, a significant indication
of both qualities of life and gender equality. The only possible source of comparable data on this
topic is Time Use Survey data, although it is collected on a voluntary basis and does not cover all
EU Member States.
Health
Health is an important aspect of residents' quality of life and can also be viewed as a type of human
capital. Poor health has the potential to stymie societal progress. Physical and/or mental issues can
also have a negative impact on one's subjective well-being. In the context of Quality of Life, the
health status in the European Union is usually measured through three sub dimensions: health
outcome indicators such as life expectancy the number of healthy life years and subjective
assessments of own health, chronic diseases and limitations in activity, health determinants and
access to healthcare.
Education
Education plays a critical part in the lives of citizens in our knowledge-based economies, and it is a
key component in determining how far they develop in life. The type of work a person will have
been determined by their level of schooling. Individuals with restricted abilities and competencies
are frequently barred from a wide range of employment and, in certain cases, miss out on
opportunities to achieve important social goals. They also have a lower chance of achieving
economic success. On a societal level, it is also the most essential form of human capital.
Leisure and social interactions

When attempting to quantify an individual's well-being, the importance of networks and social ties
should not be overlooked, as they have a direct impact on life satisfaction. This dimension is
measured in the European Union through two sub-dimensions, the first of which is leisure
activities. Quantity (how frequently individuals spend time with people at sporting or cultural
events) and quality (their pleasure with time use) are measured, as well as (lack of) access to this
sort of activity due to a lack of resources or facilities.
Economic security and physical safety

The importance of security in citizens' lives cannot be overstated. The ability to prepare ahead and
weather any unexpected changes in their economic and larger environments has an impact on their
quality of life. Physical and economic safety are measured in terms of two sub-dimensions: physical
safety (e.g., the number of homicides per country from police records and the proportion of those
who believe there is crime, violence, or vandalism in the area where they live) and economic safety.
Governance and Basic Rights

The ability to participate in public debates and have a say in how public policies are shaped is an
important feature of quality of life. The governance and basic rights dimension has three sub-
dimensions: faith in institutions and public services, discrimination and equal opportunities, and
active citizenship. A crucial part of democratic societies is providing citizens with adequate
statutory protections. Citizens' participation in public and political life is essential for good
government (for example, through active citizenship actions such as attending a demonstration,
sending a letter to those in office or signing a petition, indicator collected in the 2015 SILC Ad Hoc
Module).
Natural and Living Environment

Over the previous few decades, environmental preservation has occupied a prominent position. In
the most recent Eurobarometer on the subject, which was conducted in 2017, 94 percent of
Europeans stated that environmental protection was very important to them. Pollution of the air,

Notes
Course Name
water, and noise can have a direct influence on people's health and countries' economic
development. Environmental indicators are critical for assessing the quality of life in Europe and
the world at large.
Overall experience of life

Life satisfaction (cognitive appreciation), affect (a person's feelings or emotional states, both
positive and negative, typically measured with reference to a specific point in time), and
eudemonics (a sense of having meaning and purpose in one's life, or good psychological
functioning) are the three sub-dimensions used to assess one's life.
Measures such as the linear analogue self-assessment scales, the Functional Living Index — Cancer,
and the Breast Cancer Questionnaire are designed for repeated use before, during, and immediately
after treatment. The purpose of the repeated measures is to assess patients' short-term responses
during the course of therapy.
Global assessment measures, such as the Spitzer Quality of Life Index, are designed to reflect the
quality of life following the impact of disease and management or to reflect global changes in
assessments over a long period of time. Investigators have used the Spitzer Quality of Life Index for
repeated assessments during the course of therapy (Coates et al. 1987, Levine et al. 1988), but the
scores tend to be less responsive to short-term clinical changes than the disease-specific measures.
The basic issue is the use of quality-of-life measures to assess short-term against long-term
responses to therapy. For example, Levine et al. (1988) stopped taking assessments when patients
withdrew from treatment or relapsed. Conversely, Chubon (1987) used the Life Situation Survey to
compare the quality of life of patients in chronic care and rehabilitation programs with those of
healthy subjects.
There is a problem with repeated self-assessment during the course of therapy. Investigators have
found it difficult to maintain high self-assessment completion rates over several weeks (Finkelstein
et al. 1988, Raghavan et al. 1988) and were not able to use the assessments because of missing
values. Levine et al. (1988) minimized the problem by having nurses interview the patients during
clinic visits; this procedure, however, added considerably to the time and costs of the study. If these
measures are to be used repeatedly, the time and costs of maintaining high response rates over
multiple assessments must be considered.
13.4 Global and Specific Indicators of Quality of Life

Quality-of-life research has included the study of levels of economic, political, social, and
psychological well-being resulting from varying governmental and economic systems, as well as
policies and public programs related to health. Schuessler and Fisher (1985) wrote that quality-of-
life research began in the 1960s with the Report of the President's Commission on National Goals in
the United States. Most specialists agree that the term ''quality" has the same meaning as "grade" or
"rank,'' which can range from high to low or best to worst.
What elements of life are to be so graded? The units of analysis can be as large as a nation.
Countries can be ranked on their economic systems and on the types and amounts spent by
governments on social programs relative to expenditures on industry and the military. At the level
of the individual, the elements can be objective (for example, job, income, shelter, and food) or
subjective (happiness, sense of well-being, self-realization and the perceptions of the worth and
value of life, and the like).
The best known studies of the quality of life of individuals are those of Andrews and Witney (1976)
and Campbell and colleagues (1976, 1980) at the Institute for Social Research at the University of
Michigan. Both teams of investigators asked questions about the domains of life satisfaction,
including work, marriage, leisure activities, family, housing, and neighborhood. They developed a
global measure of satisfaction by combining the scores in a general measure.
Quality of life studies in the health sector are more limited in scope. In the health sciences, the task
at hand is to assess the impact of disease and its management, including interventions, on the well-
being of the patient. The health states of the individuals may influence their quality of life without
determining it. As Ware (1987) noted "jobs, housing, schools, and the neighborhood are not
attributes of an individual's health, and they are well outside the purview of the health care
system."
Health care researchers have developed numerous measures of quality of life over the past two
decades, and several review articles have commented on those so far available. Their use in

Notes
assessing the outcome of health care interventions has become popular. As we have seen in Chapter
2, recent studies have reported on the quality of life of men with mild to moderate hypertension
undergoing antihypertensive therapy, of women with advanced breast cancer undergoing
chemotherapy, and of cancer patients in hospice programs.
Although a variety of studies purport to assess quality of life, there is remarkably little agreement
about the underlying concepts or theoretical framework that the measures represent. These
measures may include clinical symptoms (for example, pain, nausea, vomiting), functional
disability (Katz Activities of Daily Living), health status measures (RAND health status measures,
Sickness Impact Profile), and measures of life satisfaction and psychological well-being.
The World Health Organization (WHO) has defined health as a "state of complete physical, mental,
and social well-being and not merely the absence of disease or infirmity." Ware (1987) argues that
five health concepts are inherent in this definition: physical health, mental health, social
functioning, role functioning, and general well-being. He takes a conservative approach to the
study of quality of life in the health sciences. Because the goal of health care is to maximize the
health component of the quality of life, he suggests that the measures be restricted to assessing
health status.
Spitzer (1987) includes the burden of symptoms in his operational definition of health. He would
restrict the assessment of the attributes of health to those who are definitely sick. He sees little point
in extending the studies of quality of life in health care to the ostensibly healthy, but few writers in
the field agree with this point of view.
Wenger et al. (1984), McDowell and Newell (1987), and Kane and Kane (1981) offer systematic
reviews of a number of measures used in quality-of-life studies, including functional disability
indices, health status scales, and measures of life satisfaction. In their reviews, these authors discuss
the reliability and validity of a number of the measures and their uses in health care studies. We list
the instruments they treat in the section entitled "Three Sources of Descriptive Information for
Quality-of-Life Measures." This chapter focuses on measures developed specifically to assess
quality of life.
Summary
Measures may focus on the symptoms, complaints, disabilities, and disruptions in life that are
specific to the clinical condition under study. Indeed, the disease-specific approach has been
advocated in the study of arthritis, heart disease, and the evaluation of chemotherapy.
Alternatively, one can assess the quality of life resulting from the overall consequences of disease
and management on the functional capacities and patients' perception of well-being. The more
global measures cover a number of dimensions within a summary score. For example, the Quality-
of-Life Index developed by Spitzer et al. (1981) includes one item for each of the following
dimensions: activities of daily living, principal activities, health, outlook, and support. Similarly,
measures of life satisfaction and general well-being are global in perspective.
Other measures, such as the linear analogue self-assessment scales developed by Priestman and
Baum (1976) or the Breast Cancer Questionnaire (Levine et al. 1988), are designed so that patients
may repeatedly assess their symptoms and report their physical and emotional responses to
adjuvant chemotherapy. The resulting scores show the patients' immediate and specific responses
to disease and treatment.
Objective measures are based on variables that can be observed and recorded by various testing
procedures and assessors. Measures of disease activity, remission of symptoms, presence of side
effects, changes in functional capacity, ability to carry out usual activities, and family and social
activities are phenomena that can be observed and recorded. These variables are important
determinants of quality of life, and agreement can be reached about changes in status that have
occurred.
Subjective measures provide opportunities for individuals to express their thoughts, knowledge,
attitudes, moods, and feelings. Subjective phenomena may be related to particular diseases or types
of therapy, or they may be more global.
Although researchers and policymakers tend to make much of the distinction between objective
and subjective measures, both are probably necessary when assessing quality of life, and both
require investigations into their reliability and validity. It is perhaps surprising that the objective
measures often are not as well standardized as the subjective measures; objectivity does not
automatically mean that measures are reliable and valid.

Notes
Course Name
Some quality-of-life studies maintain one perspective or point of view. Yet it is becoming
increasingly common for researchers to employ a mix of perspectives and methods in assessing
quality of life. We have reviewed what is known about the conceptual framework, reliability,
validity, and uses of specific measures. In any study, several tools may be combined to provide
information on various perspectives: subjective and objective, disease-specific and global, clinical
endpoints and long-term outcomes, and so on.
Keywords
Quality of life, World Health Organization, Persons with Disability, WHOQOL, Global and Specific
Indicators, Governance
Self Assessment
1. The purpose of modern health care is to improve Quality of Life.
A. True
B. False
2. The definition of Quality of Life in 1970, has no similarities on stress concept.

A. True
B. False
3. Quality of Life is defined by WHO is ‘individual’ perception of their position of life.

A. True
B. False
4. Quality of Life is multifaceted notion that is difficult to define and quantify.

A. True
B. False
5. Psychological domain is used to assess the cognitive aspects of Quality of Life.

A. True
B. False
6. There are ------- sub dimensions of maternal living standard.

A. 2
B. 3
C. 4
D. 5
7. Andrews and Whitney studied Quality of Life in --------

A. 1971
B. 1976
C. 1981
D. 1986
8. ------- defined health as a ‘state of complete physical, mental & social wellbeing’.
A. APA
B. UNICEF

Notes
C. WHO
D. None of them
9. Quality of Life is a -------- assessment.

A. Subjective
B. Objective
C. Correlational
D. None of them
10. Citizens should be provided -------- statutory protection.

A. Inadequate
B. Adequate
C. Least
D. None of them
11. ------- sub dimensions of the productive or main activity dimension of Quality of Life.
A. 2
B. 3
C. 4
D. 5
12. There are ------ indicators of Quality of Life.

A. 3+1
B. 4+1
C. 6+1
D. 8+1
13. Contentment and lack of stress is related to-------

A. Interpersonal relations
B. Material well being
C. Emotional well being
D. None of them
14. Financial status, employment and housing is related to------

A. Interpersonal relations
B. Material well being
C. Emotional well being
D. None of them
15. According to ------------, applied research on social indicators sparked quality of Life
researches in the health and social sciences.
A. Lawrence
B. Carr
C. Wenger
D. None of them

Notes
Course Name
Answers forSelfAssessment
1. True 2. False 3. True 4. True 5. True
6. B 7. B 8. C 9. A 10. B
11. B 12. D 13. C 14. B 15. A
Review Questions
1. Explain the concept of Quality of Life.
2. Briefly elucidate the domains of Quality of Life.
3. Explain in details the measurement of Quality of Life.
4. Explain the sub dimensions of the measurements of Quality of Life.
5. Briefly elucidate global & specific indicators of Quality of Life.
6. Explain the contribution of World Health Organization in Quality of Life.
7. Cite with examples the changing scenario of Quality of Life.
8. Analyze Quality of Life in respect to persons with disability.
9. Explain the subjective & objective measures of Quality of Life.
10. How Quality of Life is related to modern health care system?
Further Readings
Press,2022.

Notes
Unit 14: Adjustment & Well Being

CONTENTS
Objectives
Introduction
14.1 Personality Variables in PwD
14.2 Mediators and Moderators of Psychological Adjustment & Well being
14.3 Promotion of Well being
Summary
Keywords
Self Assessment
Review Questions
Further Readings
Objectives
 To know the concept of adjustment & well being
 To familiarize with personality variables in PwD
 To understand the mediators & moderators of psychosocial adjustment & well being
Introduction
Well-being, as a construct of long-standing interest in the field of psychology, requires further
attention for its primary preventative potential in supporting workplace health and performance
(Zelenski et al., 2008; Heuvel et al., 2010). While mental health professionals try to restore workers'
well-being who are experiencing psychological distress, primary preventive and health promotion
experts work to promote well-being and improve factors that protect persons from the harmful
consequences of psychological risk. (Hage et al., 2007).
The study of health promotion and well-being is gaining popularity as a variety of social, economic,
biological, psychological, and cultural elements threaten the attainment of well-being. Young
people in Italy, for example, are growing up in an era of fast social upheaval, job insecurity, and
high unemployment. Many youth and young adults face threats to their well-being as a result of
economic insecurity, unpredictable and shifting job prospects, and a growth in the number of
individuals living in poverty (Masten, 2014; Di Fabio and Bucci, 2016; Di Fabio and Palazzeschi,
2016).
Individuals and society experience well-being as a positive state. It, like health, is a daily resource
that is influenced by social, economic, and environmental factors. The ability of people and
civilizations to contribute to the world with a sense of significance and purpose is referred to as
well-being. Focusing on well-being aids in the tracking of equitable resource allocation, general
thriving, and long-term sustainability. The resilience, capacity for action, and readiness to
overcome problems are all factors that contribute to a society's well-being.
The Geneva Charter for Well-Being was endorsed by attendees at the 10th Global Conference on
Health Promotion in December 2021, which was organized by WHO. It identifies five critical areas
for action:
1. Design an equitable economy that serves human development within planetary boundaries.
2. Create public policy for the common good.

Notes
Course Name
3. Achieve universal health coverage.
4. Address the digital transformation to counteract harm and disempowerment and to
strengthen the benefits.
5. Value and preserve the planet WHO (2021)
14.1 Personality Variables in PwD

Personality traits prior to the onset of illness or disability may influence how well an individual
psychologically adjusts after the illness or disability has occurred. Previous research has shown that
after the onset of a disability, people initially experience sharp drops in life satisfaction, and the
ability to regain lost life satisfaction is at best partial. However, such research has not investigated
the role of individual differences in adaptation to disability. We suggest that predictability
personality determines the speed and extent of adaptation. We analyzed measures of personality
traits in a sample of 11,680 individuals, 307 of whom became disabled over a 4-year period. We
show that although becoming disabled has a severe impact on life satisfaction, this effect is
significantly moderated by predictability personality. After 4 years of disability, moderately
agreeable individuals had levels of life satisfaction 0.32 standard deviations higher than those of
moderately disagreeable individuals. Agreeable individuals adapt more quickly and fully to
disability; disagreeable individuals may need additional support to adapt.
Intellectual disabilities (ID, formerly mental retardation) have multiple causes. For example, there
are many genetic causes. Brain injuries can cause an intellectual disability. Some types of medical
conditions can also affect the brain's development.
These different causes mean each person's disability is unique. There is no single set of shared traits
or features. For example, there are no personality traits common to people with ID. However,
certain specific syndromes that cause ID have personality characteristics associated with that
particular syndrome. For example, children with Williams's syndrome tend to be outgoing.
However, by definition, all people with ID have limited intellectual functioning. These limitations
often create some commonly observed difficulties.
One such problem is impulse control. You may recall that people with ID have trouble connecting
cause and effect. This in turn causes problems with impulse control. For instance, suppose a child
sees yummy, hot cookies coming out of the oven. The child wants to grab one immediately. If not
controlled, this impulse will cause a nasty burn. Experience is usually a great teacher. So, most
children only make this impulsive mistake once or twice. They form a connection between the hot
cookie (cause) and the burn (effect). They learn to control the impulse to grab a cookie right out of
the oven. However, this is not so easily learned by people with ID. This poor impulse control leads
to many unpleasant consequences.
A related problem is poor frustration tolerance. When an impulse is inhibited, it requires the ability
to tolerate a bit of frustration. This ability is called frustration tolerance. Frustration tolerance is an
important developmental skill. It allows people to comfortably endure the small frustrations of
everyday life. This in turn serves to limit the unpleasant consequences associated with impulsive
behavior. Returning to the previous example, it is frustrating to inhibit the impulse to grab a cookie.
However, it avoids the consequence of a nasty burn.
Frustration tolerance also enables people to build confidence. When we attempt to solve problems,
our initial efforts may fail. This can be very frustrating. Without frustration tolerance, people give
up. As a result, they do not put forth any effort. Clearly, if we make no effort to solve problems, we
cannot develop the skills we need to solve them!
Poor frustration tolerance is not the only problem. This is coupled with many more opportunities to
become frustrated. Return to the prior example of a child's impulse to grab a hot cookie. If a
caregiver attempted to stop the child from grabbing the cookie, it frustrates the child. She would
not readily understand her caregiver's benevolent motivation. It bears mentioning that not all
people with ID become easily frustrated. This example simply illustrates that the opportunities for
frustration are significantly increased.
The increased opportunities for frustration highlight the importance of frustration tolerance. People
respond to frustration in different ways. Some people respond in an impulsive, stubborn, and
aggressive manner. Others respond with passivity, withdrawal, and compliance. Poor frustration
tolerance may cause aggression toward caregivers. It may also lead to self-injurious behavior. These
behaviors are observed in some people with ID.

Notes
Another common difficulty is low self-esteem. Self-esteem naturally develops as children learn to
solve problems. The ability to solve problems builds self-confidence. However, limited intellectual
functioning makes it difficult to solve problems. Skillful problem solving requires sustained
attention and persistence in the face of difficulty. These abilities are limited in persons with limited
intellectual functioning. Thus, a low self-esteem may develop. Psychiatric disorders related to low
self-esteem, such as depression, may accompany intellectual disabilities. However, many people
with ID are quite happy and content. They don't exhibit problematic behavior.
14.2 Mediators and Moderators of Psychological Adjustment & Well

being
The 5 Approaches to Health Promotion
1. Health Promotion Model (HPM)
Pender's Health Promotion Model is predicated on the notion that people's experiences influence
their health outcomes. Health promotion models are concerned with investigating people's
attitudes toward health and their own experiences with it. To understand most of people's health-
related decisions, the theory suggests looking at their lifestyles, psychological health, and social and
cultural surroundings. For example, not eating fresh vegetables since one grew up without eating
produce is one approach to understand why someone may suffer from a serious ailment such as
obesity.
2. Health Belief Model (HBM)

According to the Health Belief Model idea, a person's belief in a diagnosed ailment, together with
their perception of the success of a therapy, predicts their chance of making a change. If a person
has a difficult-to-diagnose condition, it may be more difficult to priorities therapy for the reason.
Based on this concept, health professionals may take urgent action by informing someone that they
are either vulnerable or have a significant medical condition. Furthermore, they may anticipate that
a person may doubt the medical approach if they do not experience the symptoms and display fear
toward medical counsel.
3. Transtheoretical Model (TTM)

Following this initial outcome, an informed recommendation of risk factors that potentially worsen
sickness may be made. In more extreme cases of noncompliance, healthcare leaders must design
HBM-based interventions.
When a healthcare expert warns a patient about a potential medical concern and educates them on
preventive measures, the patient may believe them but refrain from taking immediate action. This
option is based on the premise that when someone receives health-related information, they may
consider it before acting on it. As a result of such behavior, the transtheoretical theory specifies six
stages that a person may go through:
Pre-contemplation: while being aware of the medical condition, the patient does not intend to act.
Contemplation: the patient is preparing to act with purpose.
Preparation: The patient decides on a course of action and sets a deadline.
The patient decides on a course of action.
Maintenance: the patient concentrates on not relapsing and sticking to the plan in their everyday
activities. Some people may have this for a few months, while others may experience it
permanently. A recovering alcoholic, for example, may experience relapses and remain in the
maintenance stage their entire lives.
Termination: the patient is actively healthy and has no desire to revert to previous behaviors.
4. Theory of Reasoned Action (TRA)

Although not a model, this theory is highly regarded in the HBM and is treated separately.
According to the notion, a person will act in a certain way on a health issue based on their
willingness owing to subjective norms. Norms are frequently the outcome of a person's social and
environmental surrounds, as well as their perceived influence over that conduct.

Notes
Course Name
A healthcare expert, for example, might ask a young man if his tight circle of friends believes he
should incorporate exercise into their daily routine. Researchers at Iran University of Medical
Sciences utilized TRA to assess the effectiveness of an educational intervention aimed at increasing
breakfast consumption among children and adolescents in a medical study.
5. Diffusion of Innovation Theory (DOI)

Another theory that fits under community and organizational participation paradigms is Diffusion
of Innovation (DOI). The theory looks into how a new thought or health practice spreads in a social
structure or society and what factors determine how quickly the idea or behavior is accepted.
The type of invention, communication methods, time, and social structure all influence the
adoption of new ideas. The DOI model "highlights the uncertainties associated with new behaviors
and helps public health program me implementers identify approaches to overcome these
uncertainties," according to the Health Communication Capacity Collaborative.
Personality dimensions such as openness and agreeableness have been found to be associated with
prejudice levels towards several minority groups. Yet these variables have been mostly ignored by
existing research into attitudes towards people with intellectual disability (PWID), which has
primarily focused on contact and demographic variables. The current study investigated the
relationship between personality dimensions and attitudes toward PWID.
Background Personality dimensions such as openness and agreeableness have been found to be
associated with prejudice levels towards several minority groups. Yet these variables have been
mostly ignored by existing research into attitudes towards people with intellectual disability
(PWID), which has primarily focused on contact and demographic variables. The current study
investigated the relationship between personality dimensions and attitudes toward PWID. An
online survey was completed by 466 adult participants recruited through a variety of sources. The
survey consisted of a well-validated attitude survey, the Big Five inventory, contact related and
demographic questions.
Because personality traits are relatively stable in adulthood and have widespread influences on
behavior, they have the potential to affect the disablement process. Yet, there have been few
prospective studies of the association of personality with disability risk, and cross-sectional studies
have yielded inconsistent results. One obstacle to the progress is that such a diverse array of
personality traits has been examined that it is difficult to integrate findings across studies. In the
past decade, the big five taxonomy of personality has gained wide acceptance. Because the model is
relatively new, however, few studies have related it to disability, and most of these have focused on
neuroticism and extraversion to the exclusion of the other three traits.
At baseline and annually thereafter, participants had a uniform clinical evaluation, with examiners
blinded to previously collected data. The evaluation included assessment of selected risk factors,
medical history, cognitive testing and neurological examination. The diagnosis of dementia was
made by an experienced physician using National Institute of Neurologic and Communicative
Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association criteria [6], as
reported in detail elsewhere.
Public attitudes towards persons with intellectual disabilities (IDs) have a significant effect on
potential community integration. A better understanding of these can help target service provision
and public awareness programs.
14.3 Promotion of Well being

The principle underlying this Call to Action is that, with good health, persons with disabilities have
the freedom to work, learn and engage actively in their families and their communities. Health and
wellness are not the same as the presence or absence of a disability; they are broader concepts that
directly affect the quality of a person’s life experience. Research and clinical experience have shown
that persons with disabilities can be both healthy and well (Krahn 2003). And good health opens
the door to employment and education for persons with disabilities, just as it does for persons who
do not have disabilities.
This Call to Action’s goals and strategies for action, too, are based on a growing body of scientific
knowledge and evidence-based practice about disability, health and wellness. They also recognize
the costs of inaction in both human and economic terms. The impetus for this Call to Action has
been the recognition that health is a key to realizing the goals of the President’s New Freedom
Initiative (NFI) for persons with disabilities. Only with accessible, comprehensive health care and

Notes
wellness promotion services can all persons with disabilities enjoy the intent of the NFI: full,
engaged and productive lives in their communities.
Surveys have found that a substantially lower percentage of persons with disabilities than those
without disabilities report their health to be excellent or very good (28.4% versus 61.4%) (Centers
for Disease Control and Prevention 2004a). While at risk for the same ailments and conditions as
people in the general population (for example, injury, obesity, hypertension and the common cold),
persons with disabilities also are at specific risk for secondary conditions that can damage their
health status and the quality of their lives (Kinne et al 2004; Rimmer et al 1996; Hough 1999;
Simeonsson and Leskinen 1999). Yet, particularly when it comes to access, many health and
wellness programs do not address the needs of persons with disabilities.
Healthy People 2010, the national health promotion agenda, has included health indicators
designed to measure how America is promoting the health of per sons with disabilities, to prevent
secondary conditions and to eliminate health disparities that now affect per sons with disabilities. It
identified four main misconceptions that continue to plague how disability status has been
perceived: (1) disability is equated with poor health status; (2) public health should focus only on
preventing disabling conditions; (3) no standard definition of disability is needed for public health
purposes; and (4) the environment is not a factor in the genesis of disability.
These Healthy People 2010 goals are reflected in those of the Call to Action, which calls for: (1)
public knowledge and understanding about disability, (2) provider training and capacity to see and
treat the whole person and not just a person’s disability, (3) health and wellness promotion for
persons with disabilities, and (4) access to needed health care services for persons with disabilities.
The balance of this section discusses these goals.
GOAL 1: People nationwide understand that persons with disabilities can lead long,
healthy, productive lives.
Despite progress in science, technology and advocacy, disabilities of all kinds are still equated—
incorrectly and by too many people—with ill health, incapacity and dependence. Welner and
Temple (2004) point out that the misperception remains that “only a person who is physically agile
and neurologically intact can be considered healthy.” Similarly, with regard to individuals with
mobility difficulties, Iezzoni (2003) has observed that “much of society still holds persons with
mobility difficulties individually responsible for problems….” Early disability advocate and
sociologist Irving Zola (1982) suggested some believe that mobility difficulties are a weakness or
personality defect to be overcome. Age-old perceptions, misunderstandings and fears, while still
prevalent, are far from the reality of disability today.
The reality is that with accommodations and sup ports, ample access to health care, engagement in
well ness activities and the impetus that comes from supportive friends and families, persons with
disabilities can— and do—lead long, productive, healthy lives. Issues about disability and the lives
of persons with disabilities increasingly are becoming part of the American consciousness and are
beginning to be addressed.
GOAL 2: Health care providers have the knowledge and tools to screen, diagnose and
treat the whole person with a disability with dignity.
Health care providers and their staff may harbor many of the same misconceptions about persons
with disabilities as are found in the general public. Too often, health care service programs and
personnel have not adopted the biopsychosocial approach to disability. Reports from persons with
disabilities suggest that health care providers often focus on their disabling condition rather than
on other health issues that might be of concern to the individual (Panko Reis 2004). In part, this is
the product of the historical “compartmentalization” of health care education and training.
As a result, individuals with disabilities often encounter professionals unprepared to identify and
treat their primary and secondary conditions and any other health and wellness concerns. For
example, when it comes to persons disabled by mental illness, health care providers need to be
aware of and respond to the full array of medical, physical, psychosocial, cultural and spiritual
issues associated with—and separate from—an individual’s mental disorder. They need to
recognize that mental illnesses, as other disabling conditions, need to be treated within the larger
context of the individual, including the range of other health care needs that might require medical
attention (U.S. Department of Health and Human Services, 2000; U.S. Department of Health and
Human Services 2003).
Secondary Conditions

Notes
Course Name
The presence of a particular disability is not the only factor a health care provider should consider
when working to meet ongoing, quality health and wellness needs of a person with a disability.
Rather, the health care provider should also pay close attention to the person’s full range of health
concerns, including the onset of possible secondary conditions. These are medical, social,
emotional, family, or community problems for which a person with a primary disabling condition
is at increased risk (Marge 1988; Simeonsson and Leskinen 1999; Krause and Bell 1999; McMillen et
al 1999; Wilber et al 2002).
Some have suggested that the high direct health care costs of disability are a result of insufficient
attention early on to secondary and other health needs of individuals with disabilities. The result is
increasing numbers of persons with multiple, complex and often preventable, chronic conditions
and a health care system insufficiently prepared educationally, structurally and economically to
recognize and address those needs (Panko Reis et al 2004; U.S. Department of Health and Human
Services 2003; Institute on Disability and Development 2003). The vast majority of these secondary
conditions can be mitigated with early intervention; many can be prevented altogether.
Some individuals with disabilities develop no specific secondary health issues related directly to
the condition or conditions accompanying their disabilities. Rather, they require only a routine
regimen of ongoing health care. However, many persons with disabilities experience secondary
conditions directly related to their disability.
A recent Centers for Disease Control and Prevention-supported study by Kinne and colleagues
(2004), the first population-based prevalence study of its kind, suggests why clinical attention to
secondary conditions among persons with disabilities is a critical element in the quality-of-life
equation. They found that 87 percent of persons with disabilities reported experiencing a secondary
medical condition.
Persons of all ages with disabilities are susceptible to secondary conditions. For example,
unrecognized and untreated depression coupled with another kind of disability potentially places
children at risk for poor school performance, developmental delay lost potential as adults in the
workforce and community, and suicide (U.S. Department of Health and Human Services 2003).
Depression also is not an uncommon secondary condition among adults with such potentially
disabling illnesses as diabetes, arthritis and heart disease. In persons of all ages, mobility limitations
can lead to decubitus ulcers (pressure sores), lost muscle tone and gait instability. Substance use
disorders occur more often in persons with a disability than in the general population. This
includes problems related to the abuse of prescription medications as well as illicit drugs (Moore
and Li 1998; Heinemann et al 1991; Fann et al 1995). Moreover, an injury such as a hip fracture, may
give rise to fears about loss of independence, triggering depression, lowered immune function and
factors that can exacerbate or increase the risk for still other secondary conditions. These issues take
on particular significance for older adults, who run a greater-than-average risk of multiple
disabling conditions than do younger individuals (National Institute of Mental Health 1999).
GOAL 3: Persons with disabilities can promote their own good health by developing and
maintaining healthy lifestyles.
Healthy living is a positive concept—a concept that has been highlighted through health promotion
and disease prevention efforts for people of all ages, from smoking cessation to obesity control,
from the value of exercise to the benefits of mental health. Maintaining good health by adopting
healthy lifestyle choices, both physical and mental, is a key component of a satisfying life. It is a
goal of the U.S. Department of Health and Human Services, and embodied in both its HealthierUS
Initiative and the objectives for Healthy People 2010.
When it comes to persons with disabilities, healthy behaviors and a drive toward positive health
across the life span need be no different than it is for persons who do not experience disabilities.
Indeed, for persons with disabilities, health promotion efforts can be of critical importance. Studies
have shown that individuals with disabilities can run a higher-than-average risk for such
preventable chronic problems as osteoporosis, obesity, diabetes and heart disease (Center et al 1998;
Walsh et al 2001; Coyle and Santiago 2000; Nosek 2000; Pitetti and Tan 1990; Rimmer et al 1993;
Rimmer et al 1996). Similarly, research has shown that by engaging in healthful behaviors such as
exercise, persons with disabilities can lower the risk of these common chronic problems. Further,
they can prevent additional disability-related losses (for example, muscle tone, bone density and
dexterity) and increase overall mental and physical wellbeing (Compton et al 1989; Janssen et al
1994; Santiago et al 1993; Thomas 1999).
GOAL 4: Accessible health care and support services promote independence for persons
with disabilities.

Notes
Without regard to the number and types of health care issues facing an individual with disabilities,
access to the full range of all health care and services to meet his or her specific needs is a key factor
that can affect his or her health throughout a lifetime. It is clear that, at present, existing health care
and wellness systems— including the providers who staff them, as noted earlier—are not
sufficiently responsive to the needs of these individuals. In part, this may be the product of gaps in
training and education. As a result, access to prevention, screening, diagnosis, treatment and
services for both disability- and no disability-related health care can be limited, incomplete, or
misdirected.
International Day of Disabled is not confined just to physical conditions, but it also encompasses
mental disabilities like autism, down syndrome to neurological problems like multiple sclerosis.
Unfortunately, India is far behind in providing various comfortable facilities for the disabled. Our
government buildings, hospitals, public places still lack ramps, there are no specially designed
restrooms for those with physical disabilities, our public transport doesn’t offer any extra support
system for them during travel.
A poor treatment and a negative comment can affect their self-esteem, confidence, performance at
work place and push them into further depression.
If you have a loved one, a colleague or come across even a stranger with disabilities, read the
following on what you could do to make their lives better.
Make Changes:
If you are expecting a visitor with certain disability at home or in office, try making few simple
changes that would make them feel comfortable. Place necessary items within their reach in
restrooms, bedrooms, offer to help with items in shelves or cupboards. Also try and respect their
daily routine and if there is a sudden change in the daily activities help them to cope up with the
transition.
The COVID-19 pandemic and the subsequent stringent lockdowns, with rigorous social distancing
norms and having to wear face masks at all times in public places have no doubt affected the ease
of living for persons with disabilities as well, all over the world. Nevertheless, in these difficult
times, when we are all going through various challenges on the personal, professional and health
fronts, some simple steps help to ensure that disabled people can obtain what they need on a daily
basis and assure one and all of an inclusive, cooperative and kind society.
Respect Personal Space:

People with disabilities need their own space and may not like others touching their mobility aids
without permission, as you may not know how to handle their equipment. If you want to move
their wheelchair, ask for permission. Always knock on the doors before you enter the room, like
you do with others. Do not discuss their disability with others.
Engage in Positive Conversations

While maintaining social distancing is the need of the hour to halt the further spread of coronavirus
infection, keep in mind to not completely isolate the disabled in your community. Meet with
visually challenged or physically handicapped people and talk to them about constructive topics
like work, family, music or discuss happy memories from the past. This helps persons with
disabilities have a sense of belonging and uplifts their overall mood and mental health in these
tough times.
Offer Help with Medical Support

While it is quite simple for us to stock up on all our nutrition supplements and immunity boosters,
go for health check-ups, consult a doctor online, besides buying any medications for other pre-
existing conditions, it is not so easy for disabled people to acquire their healthcare needs amidst
current partial lockdowns. Identify these people in your neighborhood, sit down with them and
help them order all their medicines online, set up doctor’s appointments virtually or take them to a
nearby clinic for their routine medical check-ups.
Ensure They Receive Day-To-Day Needs

In these times of widespread infectious disease, it is very important to eat healthily and take meals
on time. During the day, check up on your neighbors with disabilities, to make sure they have
ample groceries and foodstuffs stocked up in their homes, to avoid going out frequently. In case
they find it difficult to do so, go ahead and help them purchase their essential supplies online,

Notes
Course Name
ensure it gets delivered to their homes and their caretakers, house help is present every day to cook
meals and provide them with nourishing food.
Ask Before Offering Help:

Don’t assume that people with disabilities would always require some assistance in leading their
lives and the first step is to treat them as equals. Understand that they know more about their needs
and how to handle their day-today lives. In case, if you want to extend any support, ask first.
Understand their needs and learn about specific details on how you can assist.
Speak Clearly, And Listen:

If you have a loved one or colleague with mental or developmental disabilities, always use simple
words. Don’t use complex terms, explain your views in simple sentences and allow them to make
their own decisions. Practice restraint and patience while dealing with those with speech disability
as they take some time to finish their sentences. Do not try to interrupt the flow of speech by trying
to complete their sentences.
Make Them Feel Confident:

Few disabled people may suffer from lack of self-esteem and confidence. Remember, many of them
don’t like sympathy and don’t stare at them. Always make eye contact while talking and do not try
to strike up a conversation around their disabilities. If you are conversing with a person in a
wheelchair sit down and talk face-to-face, instead of talking down to them.
Summary
Disability refers to the interaction between individuals with a health condition (e.g., cerebral palsy,
Down syndrome and depression) and personal and environmental factors (e.g., negative attitudes,
inaccessible transportation and public buildings, and limited social supports).
Over 1 billion people are estimated to experience disability. This corresponds to about 15% of the
world's population, with up to 190 million (3.8%) people aged 15 years and older having significant
difficulties in functioning, often requiring health care services. The number of people experiencing
disability is increasing due to a rise in chronic health conditions and population ageing. Disability
is a human rights issue, with people with disability being subject to multiple violations of their
rights, including acts of violence, abuse, prejudice and disrespect because of their disability, which
intersects with other forms of discrimination based on age and gender, among other factors. People
with disability also face barriers, stigmatization and discrimination when accessing health and
health-related services and strategies. Disability is a development priority because of its higher
prevalence in lower-income countries and because disability and poverty reinforce and perpetuate
one another.
Disability is extremely diverse. While some health conditions associated with disability result in
poor health and extensive health care needs, others do not. However, all people with disability
have the same general health care needs as everyone else, and therefore need access to mainstream
health care services. Article 25 of the UN Convention on the Rights of Persons with Disabilities
(CRPD) reinforces the right of persons with disability to attain the highest standard of health,
without discrimination. However, the reality is that few countries provide adequate quality
services for people with disability.
Keywords
Cerebral Palse, Down Syndrome, Intellectual disability, accessible health, support service, persons
with disabilities, health care providers.
SelfAssessment
1. Well being is a long standing interest in Psychology.
A. True
B. False
2. Individuals & society experience well being as a positive state.

Notes
A. True
B. False
3. Intellectual disability formerly known as handicapped.

A. True
B. False
4. Frustration tolerance enables people to build confidence.

A. True
B. False
5. Persons with disabilities cannot live a long & healthy life

A. True
B. False
6. Global Conference on Health promotion was organized by----------

A. UNICEF
B. WHO
C. UNAIDS
D. None of them
7. This conference identifies ------- critical areas.

A. 2
B. 3
C. 4
D. 5
8. HBM stands for ---------

A. Health Behavior Model
B. Health Based Model
C. Health Belief Model
D. None of them
9. The patient is preparing to act with the purpose.

A. Pre-contemplation
B. Contemplation
C. Termination
D. None of them
10. The patient is actively healthy & has no desire to revert to previous behavior.
A. Pre-contemplation
B. Contemplation
C. Termination
D. None of them
11. ------- conversation is the need of the hour for PwD.

A. Positive

Notes
Course Name
B. Negative
C. Neutral
D. None of them
12. PwDshould feel --------

A. Disturbed
B. Confused
C. Confident
D. None of them
13. There are ------- steps can be taken for the adjustment & wellbeing of PwD.
A. 3
B. 5
C. 7
D. 9
14. People’s experience ----- their health outcome.

A. Influence
B. Has no relation
C. Has no effect
D. None of them
15. The difficulty of PwD is ------- self-esteem.

A. High
B. Low
C. Extreme
D. None of them

1. True 2. True 3. False 4. True 5. False
6. B 7. D 8. C 9. B 10. C
11. A 12. C 13. C 14. A 15. B
Review Questions
1. What do you mean by adjustment & wellbeing in Persons with disabilities?
2. What are the personality variables for the persons with disabilities?
3. What are the mediators & moderators of psychological adjustment & wellbeing?
4. Write a note on promotion of wellbeing.
5. What are the goals of wellbeing?
6. What aspects we should consider to deal with PwD?
7. Write a note on Geneva charter of wellbeing.
8. How wellbeing varies in different types of disabilities?
9. Briefly describe different approaches to health promotion.
10. What are the roles of caregivers in promoting wellbeing to PwD?

Notes
Further Readings
 Disability, Health & Human Development by Shaun Grech et. al. Palgrave
Macmillon.2017
 Understanding Disability & Inclusive Practices by Supriya Singh. Shivalik
Prakashan.2015

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Psychology of Rehabilitation

Unit 1: Introduction: Overview of the Profession of Rehabilitation 1

Unit 2: Disabilities: Definition, Nature, Types and Characteristics 13

Unit 3: Models of Disability: Theories and Models of Adaptation 24

Unit 4: Psychological Assessment-Assessment of Cognition, 34

Unit 5: Models of Disability and Rehabilitation: Biological Model 40

Unit6: Sociological Model of Rehabilitation Psychology 50

Unit 7: Support System: Group Dynamics, Self Help groups, Self

Unit 8: Disability Dealing with Families 77

Unit 9: Models of Rehabilitation 89

Unit 10: Community Based Rehabilitation 99

Unit 11: Health Behavior 110

Unit 12: Caregivers 121

Unit 13: Quality of Life 131

Unit 14: Adjustment & Well Being 141

Unit 1: Introduction: Overview of the Profession of Rehabilitation

 Understand the history of rehabilitation psychology

1.1 Overview and Practice:

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1.2 Historical Perspectives in Rehabilitation Psychology

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4 LOVELY PROFESSIONAL UNIVERSITY

 In 1994 Division 22 of APA (established in 1958) which focused on Rehabilitation psychology

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1.3 What is Rehabilitation Psychology?

6 LOVELY PROFESSIONAL UNIVERSITY

1.5 Scope of Rehabilitation Psychology

 Assessment of an individual’s physical, personal, psychological, cognitive, and behavioral

1.6 Goals and Objectives of Rehabilitation

 Develop services for meeting psychological and social needs

 Unique aspects of rehabilitation psychology

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1.7 Methods of Rehabilitation Psychology

 Administration of standardized and non-standardized tests to assess cognitive and

1.8 Functions/ Role of Rehabilitation Psychologists

8 LOVELY PROFESSIONAL UNIVERSITY

 Development of new services patterns

 Individuals with brain injuries

 Emotional coping, mental and psychological status.

LOVELY PROFESSIONAL UNIVERSITY 9

2. When did Division 22 come into existence?

10 LOVELY PROFESSIONAL UNIVERSITY

3. What is the full form of NCPAPD?

5. Name the recipient of the Distinguished Service Award 1988.

6. Who coined the term ‘Soma to psychology’?

7. The NCPAD published a newsletter, which kept division members up to date on

LOVELY PROFESSIONAL UNIVERSITY 11

11. When was the Roger Baker Award initiated?

Answers for Self Assessment

12 LOVELY PROFESSIONAL UNIVERSITY

Unit 02: Disabilities: Definition, Nature, Types and Characteristics

 Understand the meaning and definition of disability

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2.1 General Causes of Disability

2.2 Dimension of Disability

2.3 Types of Disability

14 LOVELY PROFESSIONAL UNIVERSITY

Types of Physical Disabilities

2.5 Intellectual/Cognitive Disability