African-American With Spinal Cord Injury

African-Americans Spinal

African-American with Spinal Cord Injury: Cultural Analysis of Disability

African-American's with a severe disability face many unique challenges socially. A number of programs have been instituted that impact the quality of life for minorities with disabilities, including those related to their career prospects and interpersonal well being. There have been numerous laws enacted in recent years to protect people with disabilities in the workforce. The ADA is the most well-known of these. Many studies have been conducted that identify the impact of a disability on an individuals lifestyle and career, whereas others have focused on the impact being a minority has on one's potential for life and career achievement.

There have been relatively few studies however that has addressed specifically minorities with disabilities and the impact the disability has not just on their employment opportunity, but also on their personal outlook, societal status and chances for success post disability. The intend of this paper is to examine how being a minority, specifically an African-American with minority with a spinal cord injury or other disability impacts one's lifestyle, outlook, social status and potential for success/employment.

To examine the relationship between disability status and minority status, a literature review will be conducted examining both the impact of minority membership and disability status on ones lifestyle and outcome.

Specifically, the study addresses how being a minority group member affects and interacts with the disability status of an individual. Key considerations will be whether these two factors affect the rehabilitation and work potential of the patient involved, and whether African-Americans in particular work better in different counseling and rehabilitative settings. A summary of the issues presented and analysis will be provided.

According to Killeen & O'Day (2002), a new paradigm of disability has emerged in the last two decades that views persons with a disability as the product of the interaction between individuals and their surroundings. New research has worked toward crafting a new definition of disability, one that defines disability as a product of the interaction between "the individual and environment" suggesting that the problems associated with a disability "stern from a disabling environment rather than from the personal defects of deficiencies" (Killeen & O'Day, 2002, p. 9).

This notion is confirmed among African-Americans with spinal cord injuries, who suffer many debilitating emotional effects including depression and lack of recognition of adaptive or accommodation programs that may be available to help them succeed in the workplace and with regard to personal outcome (Killeen & O'Day, 2002).

Minorities with a disability such as African-Americans with spinal cord injuries face not only the prospect of living with a disability, but also perceived notions of discrimination from a racial perspective. Many hesitate to achieve their personal best because they are uncertain whether they are being discriminated against because of their disability, racial make up or some other factor.

Numerous studies (Killeen & O'Day, 2002; Belgrave & House, 1998; Hall, 2002) suggest that a combination of factors including acknowledgement of the interplay between family/kin and rehabilitation among this population may impact an individual with a spinal cord injuries attitude and chances for success. Personal outlook is often for example, much higher in disabled minorities with strong familial relationships (Belgrave & House, 1998). These ideas and more are explored below.

Literature Review

The number of minorities with disabilities is on the rise. Thus it is important that researchers and rehabilitation specialists focus on the relationship between minority status and disability status in people.

Particularly in the African-American community a rise in recent years has been realized with regard to disability status. There is evidence to suggest that young inner city African-American males "disproportionately represent a fast emerging class of spinal cord injuries (SCIs), and than gun violence and other forms of aggression contribute to this growing trend (Anderson, Dyson & Grandison, 1998; p. 94).

Disability in any person has the potential for long-term health, social, economic and psychological consequences. Though little research has been directed specifically toward African-Americans, evidence exists that suggests the quality of life for African-Americans affected with disabilities is particularly negative (Belgrave & House, 1998).

African-Americans living in inner city neighborhoods are particularly at risk for violence often associated with drug trade, which can lead to "increased levels of trauma, including brain and spinal cord injuries" (Belgrave & House, 1998, p. 12). Disability is quite high in the African community, and the outcomes of individuals suffering SCD in particularly is poor (Belgrave & House, 1998, p. 12). Studies suggest that one out of seven African-Americans is disabled to the extent that their daily functioning and activities are limited (Belgrave & House, 1998, p. 12).

The demographic of this population is often poor, unemployed, and a living situation that lacks adequate support.

Studies do suggest that a supportive environment and intrapersonal resources can improve the outcome for African-Americans with disabilities markedly (Belgrave & house, 1998, p. 13).

In a study conducted of disabled African-Americans of which 31.3% reported spinal cord injuries, the level of disability was determined to be severe, and the study shows that African-Americans are more likely to use support systems such as family and kin than physicians (Belgrave & house, 1998, p. 84). African-Americans were also less likely to use rehabilitation services and more likely to support dissatisfaction with services rendered (Belgrave & House, 1998). Because fewer African-Americans utilized formal rehabilitative support, it is more likely that they experience increased difficulty returning to normal work function.

Studies do confirm that disparities exist between African-Americans and Caucasians in health, medical and rehabilitation utilization (Belgrave & House, 1998, p. 31). Factors that contribute include access, attitudinal barriers and cultural differences (Belgrave & House, 1998, p. 31). Increased empowerment and assuming responsibility for a positive health outcome have been cited as important in addressing this disparity; in addition training in cultural diversity is recommended for health professionals (Belgrave & House, 1998, p. 31).

Other studies suggest that though cultural preferences are divergent, they were not inferior, and by better understanding diversity rehabilitation among African-American disabled groups could be much higher (Balcazar, Block & Keys, 2001). Further, they go on to point out that African-American practices may be different "but not inferior to" white middle class norms, and that understanding the importance of family and role of kin may benefit disabled African-Americans even when facing other obstacles such as poverty (Balcazar et. al, 2001, p. 18).

Hall (2002) notes that there is a recognized need "for and a benefit from the exchange of insights and common concerns among people with disabilities" regardless of race, and that these needs are recognized "even among professionals who do not themselves have disabilities." Further he goes on to point out that disability culture embraces persons who have "been marginalized by society simply because they are viewed as defective" (p. 144).

He cites a study noting than 74% of people with disabilities feel a common group identity with other disabilities that cuts across "disability status, age, employment and race" (Hall, 2002, p. 144).

With regard to the workforce, studies suggest that African-Americans with spinal cord disabilities or other disabilities are subject to wage discrimination but do not indicate that the discrimination is caused by prejudice (Baldwin & Johnson, 2000). Rather, the results suggest that discrimination might be attributed to factors not related to the disability.

The Americans with Disabilities Act was created to benefit individuals with a disability in the workplace, to ensure that individuals with disabilities are not discriminated against. Schriner & Scotch (2001) suggest that the act is based primarily on the minority group model of disability, intended to eliminate discrimination and "the marginalization" of people with disabilities within the workplace (p. 100). The act states that an organizations failure to provide accommodation allowing basic social, economic and political participation will be characterized as discrimination (Schriner & Scotch, 2001). Studies suggest however that the act may be limited by factors such as race and gender, which may also tie into social and economic disadvantage (Schriver & Scotch, 2001).

Minorities with disabilities face not only discrimination because of race, but also discrimination because of their disability, which can't be ignored because it must be recognized in order to be accommodated (Schriver & Scotch, 2001). Schriner & Scotch (2001) state that because accommodations in a work situation must be tailored to individuals due to the divergent nature of disabilities, the concept of disability in and of itself represents many different conditions; it would be easy to eliminate discrimination if disability were "directly analogous to racial discrimination" but because it is not, constant communication and constructive planning between persons with disabilities and those responsible for their environments (employers) must be available (p. 100).

People with disabilities are disproportionately unemployed or underemployed and generally have incomes lower than those with non-disabilities, just as minorities similarly sometimes realize incomes less than non-minorities (Bruyere,2000). Employment situations have not generally improved for people with disabilities over the last decade, and disabled people of color "have particularly low levels of workforce participation, reflecting general trends in the economy for middle aged and minority workers" (Schriner & Scotch, 2001, p. 100).

Part of the trouble African-Americans with spinal cord injuries face is a demographic of below average educational attainment and unemployment in an economy that favors "high education and technical training" (Schriner & Scotch, 2001, p. 100). Inadequate social support systems have led to a decreased participation in labor involvement for many minorities who are disabled (Schwochau & Blanck, 2000).

Minorities are traditionally subject to prejudiced attitudes and discriminatory behaviors, as well as institutional and legal constraints that "parallel those experienced by African-Americans and other disadvantaged and excluded group" (Schriner & Scotch, 2001, p. 100). Thus disabled minorities face negative stereotypes that they may be more dependent and incapacitated and face discriminatory attitudes about race that may result in isolation and exclusion (Schriner & Scotch, 2001).

Lack of access to employment, support, and disabling assumptions may contribute to the decline in workforce participation among disabled African-Americans.

Many corporations still resist changes that may help disabled minorities truly adapt to a changing workforce (Russell, 2000). Laws prohibiting discrimination on the basis of disability will continue to be necessary to help people with disabilities, but even more help is needed for minorities including African-Americans who are disabled. Understanding the cultural differences between African-American disabled individuals is one step in a positive direction.

The research suggests that coping strategies and teaching African-Americans how to access social support in a "culturally congruent manner" can empower African-Americans with disabilities to achieve their goals (Belgrave & House, 1998, p. 98). African-Americans with spinal cord disabilities and other disabilities need adequate access to intrapersonal resources that are developed within "an individual, family, or community" (Belgrave & House, 1998, p. 98).

Other measures or factors that contribute to adjustment and coping with a disability and that contribute to employment success are tied to self-esteem and attitudes; studies suggest that social support may indirectly impact vocational success "through its impact on self-esteem and attitudes toward disability" (Belgrave & House, 1998, p. 63). A combination of intrapersonal, socioecological and stress processing variables within the African-American population is most helpful in coping with disability status and improving self-esteem (Belgrave & House, 1993). Thus, one may conclude that rehabilitative programs should emphasize a multi-tiered approach which recognizes the importance of all of these factors and combines them to elicit personal achievement and success among minorities with a disability status.

Studies do indicate that a majority of African-Americans with disabilities desire work and more than 78% believed they could; this desire supports the notion that culturally minorities are motivated as any individual to enhance employment option (Belgrave & House, 1998). The factors related to employment outcomes include self-esteem, beliefs about disability and perceived support in addition to the severity of disability (Belgrave & House, 198). Workplace employers might consider working in conjunction with health care providers to ensure an environment that is supportive and accommodating for both minority status and disability status. It is important to remember that minorities face additional barriers including potentially lower socio-economic status, educational opportunities and similar factors.

Many healthcare and rehabilitation providers perceive that a person approaches their interpersonal situations and care in a manner similar to their own; this is a common tendency, however can be debilitating on patients coming from a minority background and may place limitations on disabled minority individuals who may have different cultural traditions and perceptions of rehabilitative programs (Ramsden, 1999). The social structure of the health care system 'as is' may place limits on minority groups members and may contribute to predisposing those members to limited resources, reduced prospects for advancement and limited educational opportunities (Ramdsden, 1999). This is evidenced by the lack of faith many minority disabled persons have in rehabilitative programs. Studies suggest that a majority of African-Americans with spinal cord injuries and other disabilities are more likely to turn to family members for support, because they understand the impact a disability has on them culturally and provide a positive outlook and understanding (Belgrave & House, 1998).