© Springer International Publishing Switzerland 2017
Maggi A. Budd, Sigmund Hough, Stephen T. Wegener and William Stiers (eds.)Practical Psychology in Medical Rehabilitation10.1007/978-3-319-34034-0_1010. Social Participation and Ability/Disability
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Louis Stokes VA Medical Center, Rehabilitation Psychologist, Cleveland, OH 44106, USA
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Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
Keywords
Social participationSelf-advocacyBarriers to participationDisabilityTopic
Social participation following acquired disability is an important focus of rehabilitation for all members of the interdisciplinary rehabilitation team. Evidence demonstrates that social participation leads to increased life satisfaction and quality of life [1, 2]. However, “the presence of disability has been found to lead to participation that is less diverse, is located more in the home, involves fewer social relationships, and includes less active recreation” [3]. When individuals with disabilities return to their homes and communities, they often encounter psychological and physical barriers that limit their social participation. Historically the problems of people with disabilities were perceived to be more social and psychological rather than physical; however, later research examining all potential barriers found physical, medical, and political barriers to be more difficult [4]. This chapter outlines these barriers, highlights assessments to help identify or measure the barriers, provides interventions to overcome them, and expected outcomes of these interventions.
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Key concepts
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Social Participation
“Organized patterns of behavior that are characteristic and expected of an individual or a given position within a social system ” [5]. In its simplest terms, social participation is the fulfillment of social roles in home, work, school, leisure, and community activities.
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Interaction Between Person and Environment
Social participation occurs as a result of a complex relationship between the person and his/her environment. Behavior is a function of the person and the person’s environment [6]; thus, behavior and social participation of persons with disabilities are dependent on their ability to access the environment and interact with it via social roles. This theory later fueled the Social Disability Model, as well as many occupational science theories and frameworks [7].
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Social Disability Model
Fueled by the theory regarding the interaction of person and environment, it conceptualizes disability as a problem resulting from an unaccommodating and inaccessible environment rather than the actual impairment. It stems from the disability rights movement.
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Importance
Successful rehabilitation is not completed when a client leaves a hospital or rehabilitation center. Rehabilitation success is often measured by acceptance at work, inclusion into educational systems, and ability to resume one’s right as a citizen in the built and social environment; rehabilitation takes place through reintegration into the community [8] and social participation is essential to this process.
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Models and Evidence Supporting Social Participation’s Impact on Quality of Life
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International Classification of Functioning (ICF)
The ICF outlines that “functioning and disability are results of the interaction between the health conditions of the person and their environment” [9]. Functioning is defined as “an umbrella term for body functions, body structures, activities and participation” [9]. This view of disability emphasizes that participation is essential to health and well-being. For rehabilitation professionals, this means that focusing on improving a patient’s bodily functions and structures is no longer enough; attention to a person’s meaningful activities, participation, and environments are essential to achieve the highest level of health and well-being.
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Importance of Participation with Specific Subgroups
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Spinal Cord Injury (SCI) . Researchers [2] found in a longitudinal study of individuals with traumatic spinal cord injuries that participation (which included mobility and social integration) impacted life satisfaction and self-rated health 1 year after discharge. Other research also found life satisfaction is greater for those with SCI who are involved in productive activities such as work, education, and recreation [10, 11].
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Traumatic Brain Injury (TBI) . Social participation, including occupational activity and mobility, mediates the prospective relationship of functional impairment and severity to elements of quality of life. Researchers hypothesized that participation “increases the probability for rewarding interactions with others and for experiencing positive emotions in these interactions” [1], which thus improves quality of life.
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Practical Applications
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Physical Barriers to Participation
These are architectural components of the physical environment, also referred to as the “built environment” [3, 8] that limit social participation. Physical barriers frequently exist, because “constructing the built environment to suit the needs of the average person restricts accessibility” for people with limited mobility [3]. Architectural barriers (i.e., inaccessible design features) include but are not limited to steps and stairs; pathways and doors that are too narrow to accommodate a wheelchair; lack of wheelchair accessible parking and public transportation; counters, signs, dispensers, and drinking fountains that are too high or too low for a wheelchair user to utilize; and controls that cannot be manipulated by someone with decreased fine motor function.
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Home and Community Barriers and How to Help
Research on populations with physical disability, like SCI and multiple sclerosis, identified multiple environmental barriers to productive community integration, including barriers in the natural environment, transportation, help at home, health care, government policy [4], affordable mobility aids, and inaccessible public transportation [12].
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Psychologists. Physical barriers in the home and community must be considered by psychologists to increase social participation, as “interests often precede participation, but interests may not lead to participation because of environmental barriers” [3]. Psychologists play an important role to help patients foster problem-solving strategies needed to increase self-efficacy and independence upon return to home
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Occupational and physical therapists can recommend home modifications and adaptive equipment to increase participation and independence in the home environment. Common recommendations include, but are not limited to purchasing or renting medical equipment such as hospital beds, commodes, handheld showerheads, and shower chairs; adding an exterior ramp or railing; and removing clutter and/or rugs to improve safe mobility [13].
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Resources for identifying and managing architectural barriers within the community
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The Americans with Disabilities Act (ADA)
Enacted July 26, 1990, the ADA is a comprehensive civil rights law that covers employment, public entities and public transportation, accessibility of public accommodations, and telecommunications, for individuals with disabilities. Title III concerns public accommodations, prohibits discrimination in the delivery of goods and services, and provides minimum guidelines for wheelchair accessibility in all public and private facilities. In 2010, the regulations in titles II and III were revised and published as the 2010 ADA Standards for Accessible Design, which are the most up-to-date accessibility guidelines [14]. Many physical barriers encountered by individuals with disabilities in the community are violations of the ADA; however, the ADA provides minimum guidelines, thus even community sites that comply with ADA may not be functionally accessible for someone with a disability.
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The Community Health Environment Checklist (CHEC)
The CHEC is an objective assessment based on the performance needs of individuals with mobility impairments within the community [15]. It asks the question, “Can a person with a disability get in, do what they need to do, and get out without much difficulty?” [16]. The CHEC-Mobility version examines the functional accessibility of community sites and was designed for use by healthcare practitioners, patients, and their families and to help identify objective barriers that limit participation.
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The Craig Hospital Inventory of Environmental Factors (CHIEF)
The CHIEF is an instrument that measures the “frequency and magnitude of physical, attitudinal, service, productivity, and policy barriers that keep people from doing what they need to do and want to do” [17].
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The Measure of the Quality of the Environment (MQE)
The MQE assesses “the perceived influence of specific environmental factors on social participation of people in relation to their abilities and limitations ” [7].
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Psychological Barriers to Participation
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Attitudes
Negative attitudes regarding people with disabilities held by those without disabilities are prevalently documented in the literature and can serve as a barrier to social participation [18]. Social and cultural beliefs as well as anxiety stemming from ignorance of disability etiquette contribute to negative attitudes toward people with disabilities. Positive attitudes, in which people with disabilities are viewed as inspirational simply for living with their limitations, can also be problematic, as they focus more on the disability rather than the person.Related posts:
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