Students with disabilities are becoming more and more common in higher education classrooms, including social work classrooms. The challenges that come with accommodating students so as to allow equal access to the educational experience are surmountable with the assistance of student disability offices. New technology is being developed to assist students with learning both in and out of the classroom. Supportive attitudes from faculty in including students with disabilities allow all students to benefit from the experience. As compliance with laws such as the ADA becomes commonplace for new construction, the concept of universal design makes inclusion a norm.
Accommodating Students with Physical Disabilities in Higher Education
Adult Day Care
Namkee G. Choi
Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.
Adults: Group Care
This article presents information about group settings that provide residential long-term care for older adults, focusing on nursing homes and residential care/assisted living communities. It provides an overview of both settings and describes their scope of services, funding, and clientele. The section “Issues in Residential Long-Term Care” addresses issues of special relevance to social workers: dementia and other psychosocial care needs; quality of life and quality of care; access to and disparities in care; end-of-life care; family involvement; and abuse and neglect. The article ends with a section on the role of the social worker in residential long-term care.
Ageism in the Workplace
Older workers make important contributions to the workplace, its productivity, and its culture. Work remains important for older adults for financial security, to give meaning to later life, to maintain social networks, and to promote lifelong learning. However, ageist beliefs about the capacity of older adults to remain productive and contributing workers in the workforce can create barriers for older workers. Understanding how older workers experience ageist behavior in the workplace can help employers, policy makers, and social workers learn more about how to address this social problem. Organizations can become more age friendly through enabling workplace programs, supportive management, and proactive human resource managers. Social workers serving older adults in employee assistance programs and in private practice can help them to challenge ageism in the workplace. Finally, legislation such as the Age Discrimination in Employment Act protects the rights of older workers; however, more legislation is needed to address bullying and harassment of older adults in the workplace.
Aging: Public Policy
Jeanette C. Takamura
Public policy advances in the field of aging in the United States have lagged compared to the growth of the older adult population. Policy adjustments have been driven by ideological perspectives and have been largely incremental. In recent years, conservative policy makers have sought through various legislative vehicles to eliminate or curb entitlement programs, proposing private sector solutions and touting the importance of an “ownership society” in which individual citizens assume personal responsibility for their economic and health security. The election of a Democratic majority in the U.S. House and the slim margin of votes held by Democrats in the U.S. Senate may mean a shift in aging policy directions that strengthens Social Security, Medicare, and Medicaid, if the newly elected members are able to maintain their seats over time. The results of the 2008 presidential election will also determine how the social, economic, and other policy concerns will be addressed as the baby boomers join the ranks of older Americans.
Nancy Morrow-Howell and Leslie Hasche
Despite high levels of functioning among older adults, chronic health conditions lead to impairment and the need for help. Family members provide most of the assistance; yet formal services such as in-home personal and homemaker services, congregate and home-delivered meals, adult day services, employment and educational services, transportation, nursing homes, assisted and supportive living facilities, legal and financial services, and case management are available. Even with the growing number and type of services, unequal access and uneven quality persist. In these settings, social workers develop and administer programs, provide clinical care, offer case management and discharge planning, and contribute to policy development.
Autism Spectrum Disorder
Sandy Magaña and Lauren Bishop
Autism spectrum disorder is a heritable, developmental disability that is characterized by challenges with social communication and the presence of restrictive and/or repetitive patterns of behavior. Autism spectrum disorder affects development and quality of life from very early development through old age. Social workers play a number of different roles in supporting and advocating for individuals on the autism spectrum and their families. It is important that social workers understand the etiology, diagnosis and treatment of autism spectrum disorder, how it manifests throughout the lifespan, and challenges faced by families affected by ASD.
Blindness and Visual Impairment
Adrienne Asch and Nancy R. Mudrick
Significant visual impairment affects ~8 million Americans, 1.8 million of whom are blind and must find nonvisual methods of performing life roles. Social workers should not assume that people with visual impairment or blindness are unable to work, have families, or engage in sports or travel, or that vision limitations are necessarily a part of every presenting problem. Key roles for social workers include assisting in access to services and training and advocacy to combat discrimination and exclusion.
Care Transitions, Patient Health, and System Performance in the United States
June Simmons, Sandy Atkins, Janice Lynch Schuster, and Melissa Jones
Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.
Shirley Gatenio Gabel
The history of social work is deeply rooted in helping vulnerable populations improve their well-being, and children have been at the forefront of these efforts since the inception of the profession. Health is long understood to be critical to children’s well-being. Social workers who are skilled in integrating different systems can play pivotal roles in engineering new and improving existing health-care infrastructures and can act as advocates for fusing health-service systems with other social infrastructures to optimize outcomes for children. This entry reviews trends in children’s health throughout the world, particularly in the United States. It describes the dramatic improvements in reducing infant mortality, child mortality and morbidity from many infectious diseases as well as accidental and environmental causes, and the unequal progress in realizing children’s health. The challenges that lie ahead that pose risks to children’s health are discussed, including the health inequities created among and within countries by social, economic, and political factors. An argument for a comprehensive, integrated, evidence-based, and cross-disciplinary approach to improve children’s future health is presented.
Diana M. DiNitto
This entry defines comorbidity and similar terms used in various fields of practice. It addresses the prevalence of comorbidity, suggests explanations for comorbidity, and discusses integrated treatment for comorbid conditions and the importance of the concept of comorbidity in social work practice.
Deaf and Hard-of-Hearing People
Martha A. Sheridan and Barbara J. White
Effective social work practice with deaf and hard-of-hearing people requires a unique, and diverse, collection of knowledge, values, skills, and ethical considerations. Salient issues among this population are language, communication, and educational choices, interpreting, assistive devices, cochlear implants, genetics, culture, and access to community resources. Competencies at micro, mezzo, and macro levels with a deaf or hard-of-hearing population include knowledge of the psychosocial and developmental aspects of hearing loss, fluency in the national sign language, and an understanding of deaf cultural values and norms. In the United States, the use of American Sign Language (ASL) is the single most distinguishing factor that identifies deaf people as a linguistic minority group. This entry presents an overview of the practice competencies and intervention approaches that should be considered in working with deaf and hard-of-hearing people, their families, communities, and organizations. It introduces the knowledge base, diversity in community and cultural orientations, social constructions, and international perspectives, current research and best practices, interdisciplinary connections, trends, challenges, and implications for effective social work practice with this population. An integrative strengths-based transactional paradigm is suggested.
Steven P. Segal
The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as transinstitutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, while it has expanded admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase/model programs illustrating what can be done, yet it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. Deinstitutionalization policy has motivated political, economic, legal, and social change in the care and control of six populations—older adults, children, people with mental illness, people with developmental disabilities, people under correctional system supervision, and, more recently, individuals without a home. A truer implementation of deinstitutionalization’s initial aspirations requires reconsideration of these changes.
Deinstitutionalization in Macro Practice
Steven P. Segal
The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as trans-institutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, expanding admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase and model programs illustrating what can be done; yet, it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. It has been documented, from political, economic, legal, and social perspectives, how this policy has affected the care and control of populations such as older adults, children, people with mental illness or developmental disabilities, people under correctional-system supervision, and, more recently, individuals without a home. Suggestions for a truer implementation of deinstitutionalization’s initial aspirations are available.
Characteristics associated with contemporary definitions of disabilities have existed in the human population from earliest recorded history. However, societal views on disability and those who have them have varied greatly over time. Disability has been viewed as a blessing from deity or the deities, a punishment for sin, or a medical condition. Social workers have worked with people with disabilities from the inception of the profession and have critical roles in the prevention and treatment of disabilities. Practice is driven by the promotion of the core values of the profession, including the dignity and worth of all people. Social workers recognize that variability in physical and cognitive abilities should not compromise access to opportunities and human rights. Social and political action focused on people with disabilities aim to promote inclusion, foster self-determination, and fight discrimination. Despite increasing services and policies to promote the well-being of people with disabilities, significant income, employment, housing, and quality of life issues still exist for those with disabilities. Macro social work practice is greatly needed to ensure that laws, organizations, and policies do not marginalize or oppress based on varying physical and/or intellectual abilities. Social work’s focus on policy and community development is well suited for reforming existing structures that prevent people with disabilities from achieving full integration within schools, work settings, and community living. Macro social work methods are needed to ensure that quality supports are provided to those with disabilities, to maximize their well-being and participation in all aspects of society.
Disability: Neurocognitive Disabilities
Lisa S. Patchner and Kevin L. DeWeaver
The multiplicity of disability definitions can be attributed to the heterogeneity of disability, its multifactoral nature, and its effects across the life span. Of particular concern to the social work profession are those persons with neurocognitive disabilities. Neurocognitive disabilities are ones where a problem with the brain or neural pathways causes a condition (or conditions) that impairs learning or mental/physical functioning or both. Some examples are intellectual disabilities, autism spectrum disorders, and savant syndrome. Neurocognitive disabilities are the most difficult to diagnose often times because of their invisibility. Providing services for people with neurocognitive disabilities is very difficult, and people with these disabilities are among the most vulnerable populations in today's society. This entry discusses neurocognitive disabilities and current and future trends in social work disability practice.
Disability: Physical Disabilities
Mary Ann Clute
Physical disability is traditionally defined by society's view of atypical function. The medical model offers information on factors contributing to physical disability, including genetics, injury, and disease. The social model of disability, however, defines the societal responses, not the physical differences, as disabling. People with physical disabilities have unique characteristics and experiences that fall into the broad range of human diversity. They belong as full participants in society. Social workers must focus on working in respectful partnerships with people with physical disabilities to change environments and attitudes. This will help build a just society that honors diversity. This entry addresses multiple factors that cause disability, from genetics to environment, as viewed through the medical model. The social model view of “the problem” is offered in comparison. It also introduces the wide diversity of people with physical disability. The entry discusses two major societal responses to physical disability. Environmental modification is one approach. A more recent approach, Universal Access, involves upfront design of environments to meet diverse needs. The final sections explain implications for social workers and lays groundwork for action. Creating access and respectful partnerships are foundations of the work ahead. It is difficult to define physical disability without situating the discussion in the model used to view and deal with human diversity. This discussion is based on the social model of disability, a view of disability that sees the environment as disabling, not the individual condition. Discussion of the medical model is offered as a contrast. (For a more complete discussion of disability models, see Mackelprang's Disability: An Overview in this publication.)
Disability: Psychiatric Disabilities
W. Patrick Sullivan
The psychosocial catastrophe that accompanies serious mental illness negatively impacts individual performance and success in all key life domains. A person-in-environment perspective, and with a traditional and inherent interest in consumer and community strengths, is well positioned to address psychiatric disabilities. This entry describes a select set of habilitation and rehabilitation services that are ideally designed to address the challenges faced by persons with mental illness. In addition, it is argued that emphasis on a recovery model serves as an important framework for developing effective interventions.
The role of disability rights has developed and evolved over the course of the United States’ history. The definition of disability has broadened as well as the pursuit for equal treatment, inclusion, and more accessible environments. Key pieces of legislation such as the Mental Retardation Facilities and Community Mental Health Centers Construction Act, the Rehabilitation Act, the Individuals with Disabilities Education Act, and the Americans with Disabilities Act demonstrate a course of steps toward these more empowering themes of independence for those with disabilities. Disability advocates are strong in their message of “nothing about us, without us.” The disability rights movement helped to propel culture shifts and has promoted inclusion of individuals with disabilities. Despite the intention of disability policy to move the nation to more accessible, inclusive, and less discriminatory environments, more work is still needed to support the rights of those with disabilities.
Disability Theory in Context
Jasmine P. Brown and Yolanda Suarez-Balcazar
The condition of disability and disabled persons in society has shifted and transformed throughout time and history with the rise of medical interventions, capitalism, and disability advocacy. This article discusses the different theories and models that have dominated the study of disability and further explains the contributions of disability theory on disability identity, as well as the intersection of disability and race. Also, with the rise of the social model ideals, there has been an increase in advocacy and empowerment within the disability community. This article concludes with an overview of advocacy and empowerment interventions for and with individuals with disabilities and recommendations for future research in sociology.