PSYCH - PSYCHOSOCIAL ADAPTATION: CHRONIC ILLNESS AND DISABILITY

Models of Disability

• Medical Model of Disability

• Social Model of Disability

Medical Model of Disability

• This is a diagram of the traditional Medical Model of Disability, which the Social Model was developed to challenge. 

• Patient is the problem

• Focus of treatment is cure for the patient 

Social Model of Disability

• Problems with government policies, infrastructures, etc. 

• Accommodate the person with disability and adjust

Impairment

• “Organ level”

• Concerned with abnormalities of body structure and appearance and with organ or system function

• Any loss or abnormality of psychological, physiological or anatomic structure or function

• Disturbance at organ level

• Paralysis of limbs due to SCI

Disability

• Level of the individual

• Reflects the consequence of impairment in terms of functional performance and activity

• Disturbance at the level of person

• Inability to walk and perform ADL

Handicap

• Societal level

• Disadvantage which prevents from performing a role

• Reflect interaction with and adaptation to the individual's surroundings

• Societal level

• Immobility, dependence

Statistics on Chronic Illness and Disability

• According to WHO

  • Estimated 1.3B people experience significant disability. (16% of world's population or 1 of 6)

    • Increasing in number due to increase in noncommunicable disease and longer lifespan

  • Some persons with disability die up to 20 yrs earlier than those without disabilities

  • Persons with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity or poor oral health

  • Face many health inequities (arise from unfair conditions faced by persons with disabilities, including stigma, discrimination, poverty, exclusion from education and employment and barriers faced in the health system)

• Approximately 54M Americans (1 in 5) have physical, sensory, psychiatric or cognitive disabilities that interfere with daily living

• > 9M Americans with disabilities are unable to work or attend school

• Costs of annual income support and medical care provided by US government is about $60B

• Disabilities are higher among older people, minorities and lower socioeconomic groups

• 8 of the 10 most common causes of death in US are associated with chronic illness

Factors that Create Profound Effect on Individuals with CID

• Degree of functional limitations

• Interference with ability to perform daily activities and life roles

• Uncertain prognosis

• Prolonged course of medical treatment and rehabilitation

• Psychosocial stress associated with the incurred trauma or disease process itself

• Impact on family and friends

• Sustained financial losses

Dynamics to the Psychosocial Adaptation to CID

• Stress

• Crisis

• Loss and grief

• Body image

• Self-concept

• Stigma

• Uncertainty

• Unpredictability

• Quality of life

Stress

Crisis

Loss and Grief

Different Stages of Mourning

Body Image

Self-concept

Stigma

Social Avoidance

Stereotyping

Discimination

Condescension

Blaming

Internalization

Hate Crimes and Violence

Concealment

Disability Pride

Social Integration

Need for Respect

Uncertainty and Unpredictability

Perceived Uncertainty in Illness (Mishel, 1981)

Quality of Life

Domains of Quality of Life

CID Triggered Response

Early Triggered Response

Intermediate Trigger Response

Late Reactions

Shock

Anxiety

Denial

Depression

Anger/Hostility

Adjustment

CID Associated Coping Strategoes

Coping

Disengagement Coping Strategies

Engagement Coping Strategies

Intervention Strategies for People with CID

Psychosocial Reaction-Specific Interventions

Global Clinical Interventions

Quality of Life in Rehabilitation

Do’s and Dont’s to Establishing Respectful Communication

Do’s and Dont’s to Respecting Patient Privacy and Autonomy

Do’s and Dont’s to Respecting Disability Identity and Culture