突发事件视域下的残疾人应对机制厘定:关键概念透视与助残策略启示

如何帮助残疾人有效应对重大传染病疫情等突发事件,是残疾人保障体系建设的一项重点难点内容。本研究以残疾人的“脆弱性”为切入点,借助压力与释放模型,对残疾人在突发事件中的风险问题进行反思;依托“风险管理”的视角,认为残疾人风险管理包括“三项旨要、三种机制、五类措施”;结合“应对力”的概念和培养路径,主张应构建“新型的对话性助残体系”,以提升残疾人对突发事件的应对力。本研究在总结反思抗击新冠肺炎疫情的残疾人工作经验的基础上,认为应积极推进助残工作的重点、策略转型。     

Support networks and social support for persons with psychiatric disabilities—a Swedish mixed-methods study

The aim of this study was to explore the structure, interaction, and function of the support networks of women and men with psychiatric disabilities. The study took a mixed-methods approach, using quantitative (n=181) and qualitative (n=42) data from a region in southern Sweden. The quantitative results showed that the respondents received widespread support of different types and from many different sources. However, the qualitative interviews revealed that many of the interviewees did not perceive the received support as supportive. The respondents’ internal resources influenced both their ability to receive support and their perception of the support. The informal and formal support sources formed the external resources of the respondents. Our interviewees often experienced formal support as conditional support, while informal support from the family was experienced as unconditional. There was thus a gap between the structure and function of the social support. This article contributes important knowledge from the perspective of persons with psychiatric disabilities.     

Comparing Opinions of People with Developmental Disabilities and Significant Persons in their Lives Using the Individual Supports Identification System (ISIS)

Fifty-two people with developmental disabilities were interviewed using the Individual Supports Identification System (ISIS). This study reports on persons with developmental disabilities, served by the State of Washington Division of Developmental Disabilities, and includes persons whose onset of disability was prior to 18. To be eligible for services, an individual must have a disability that falls within one of the following categories: (1) mental retardation; (2) cerebral palsy; (3) epilepsy; (4) autism; and (5) other types of central nervous system impairment closely related to mental retardation. Interviews were conducted with two groups. The first comprised individuals with developmental disabilities and the second, significant persons in the life of each participant in the first group. A significant person was considered to be someone known by the individual with disabilities for more than 6 months, spending more time with him or her than others. In addition, the significant person must like the individual with disabilities, and have his or her best interests in mind. Seventy-five per cent of significant persons interviewed were parents. Significant persons also responded to a series of ISIS questions. Responses from the individual with disabilities and from the significant person in his or her life were compared in order to determine similarities and differences in perspective. Comparisons focus on issues pertaining to friends and relationships, living environment and daily care needs.     

Severity of impairment in dually addicted gamblers

While much information about pathological gamblers has been gathered from clinical observations, few data exist from systematic, objective studies. Furthermore, still less is known about that subset of pathological gamblers who are also chemically dependent and/or substance abusers. Previous studies (e.g., McCormick et al., 1984) report that up to 45% pathological gamblers are substance abusers. The present study hypothesizes that inpatient chemically dependent pathological gamblers will exhibit greater impairment on a variety of life-functioning measures than a comparable group of chemically dependent psychiatric inpatient. Twelve chemically dependent pathological gamblers were matched on the basis of age, sex, alcohol/drug history and occupational status with twelve chemically dependent persons with no pathological gambling history. All study members were inpatients in an addictions program at a private psychiatric hospital. Each patient was administered the Addiction Severity Index (ASI) to assess impairment in seven problem areas: medical, employment/support, alcohol, drug, legal, family/social, and psychological/psychiatric functioning. The following findings emerged: 1) Chemically dependent (CD) gamblers report more chronic medical problems than CD psychiatric patients; 2) CD gamblers report more frequent conflicts with relatives and family members than CD psychiatric patients; 3) CD gamblers report more psychiatric symptoms both in amount and duration; Although not reaching statistical significance, 42% of the CD gamblers had made a previous suicide attempt as compared to 8% of the CD psychiatric patients; 4) CD gamblers and CD psychiatric patients appear comparable with regard to employment functioning and amount of legal problems. The clinical and theoretical implications of these findings are discussed further.     

Disability Services and College Students with Psychiatric Disabilities

Abstract

Weiner (1999) has suggested that the process of accepting a disability and its associated limitations is often protracted for students with psychiatric disabilities, thus leaving many students unable to fully participate in services or in the design of academic accommodations. This research examines the relationship between psychiatric disability identity and use of academic accommodation services for 57 undergraduates with psychiatric impairments who are experiencing problems in their academic functioning. Willingness to utilize services was related to students' identification as having a psychiatric disability. Social work interventions are needed to support students in accepting psychiatric disabilities while concurrently crafting necessary accommodations.     

Understanding emerging disabilities

This research seeks to understand social and environmental characteristics that distinguish emerging from traditional disability populations. We qualitatively analysed how emerging disabilities are understood by persons with disabilities, and used these themes with a public use data source to analyse differences between emerging and traditional disabilities. Our findings first illustrate the difficulty in diagnosing and categorizing emerging disabilities. This is true for both persons who have these conditions and medical personnel who are expected to interpret them. Compared with persons with traditional disabilities, persons with emerging disabilities had less education, greater difficulties with activities of daily living, lower income, less private insurance, more frequent medical care and were less likely to work. The picture emerges of that of an underclass within society. There is an ongoing need for a referral and support system with greater recognition and acceptance of all disabilities, especially within independent living centers and among employers.     

Is emergency preparedness a ‘disaster’ for people with disabilities in the US? Results from the 2006–2012 Behavioral Risk Factor Surveillance System (BRFSS)

This study compared emergency preparedness of people with activity limitations, with limitations who use specialized equipment, and with mental health conditions with that of people without these disabilities. Results of chi-square analysis and logistic regression analysis showed that people with activity limitations and/or mental health conditions were significantly less prepared for emergencies than people who used specialized equipment or persons without disabilities. Having an activity limitation and/or severe mental health conditions, and being non-white, uncoupled, female, and below the poverty line increases the likelihood of not being prepared. Suggestions for increasing preparedness related to training and policy development were discussed.     

Youth leadership program for changing self-image and attitude toward people with disabilities

Society has a negative attitude toward people with intellectual disabilities or psychiatric disabilities. It is well documented that they are subjected to prejudice, stigma, and negative attitudes (Di Giulio, 2003 ; Finger, 1994 ). Professional literature indicates that information about disabilities and encounters with persons with disabilities can change negative attitudes (Carter, Hughes, Copeland, & Breen, 2001 ; Krajewski & Flaherty, 2000 ). This study accompanied 164 9th-grade students from various junior high schools throughout Israel. Half of the students participated in an integration program for changing attitudes toward persons with disabilities, and the other half served as the control group. The research examined the existence and the degree of relationship between participation in the program, changes in attitudes toward people with disabilities, and self-image. The research findings pointed to a positive change in attitudes of the participants of the program in comparison with the control group, resulting mainly from personal contact with people with disabilities. No relationship was found between levels of self-image of the research group and attitudes toward people with disabilities.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.     

Social Return on Investment of an Innovative Employment Option for Persons with Developmental Disabilities

Common Ground Co‐operative (CGC) provides training, administrative, and job coach support to five social enterprises for which persons with developmental disabilities are the non‐share‐capital partners. This study examines the use of social return on investment (SROI) as a means of determining the value of program impacts related to quality‐of‐life changes for enterprise partners and their families. The process of conducting this SROI analysis is described and analyzed in terms of its utility in employment services for persons with developmental disabilities.     

Prejudice or Ambivalence? Attitudes Toward Persons with Disabilities

Attitudes toward persons with disabilities are often assumed to be negative and prejudiced. This assumption is shared by researchers with different theoretical perspectives and is usually based on quantitative empirical studies. The assumption of attitudes as prejudiced is questioned in this article. Based on a review of attitude research the argument is developed that most research is based on a simplified notion of attitudes and an accompanying simplistic methodological approach. Given the limitations of theory and methods, some conclusions can nonetheless be drawn about the content of attitudes toward persons with disabilities. An interpretation in terms of prejudice does not, however, fit these data very well. Instead an interpretation in terms of ambivalence is suggested, where reactions toward persons with disabilities are seen as a result of conflicting values. Such an interpretation can help to free attitude research from its present focus on the structure of thinking, rather than content, and help trace the linkage between individual responses and societal ideologies.     

Children in Foster Care: A Longitudinal Investigation,by David Fanshel and Eugene B. Shinn. Columbia University Press,New York, 1978. $25. 520 Pp.

This article presents findings of an exploratory study addressing social work program practices regarding psychiatric disabilities among social work students. An e-mail invitation to participate in an online survey was sent to approximately 875 social work educators, with 71 individuals choosing to participate. The findings indicated that 88% of respondents were in programs that had made accommodations and slightly less than 33% were in programs that had psychiatric disability policies. A positive relationship between ratings of the effectiveness of the accommodations and ratings of employability of students with psychiatric disabilities was found. These findings suggest that additional studies are needed to identify effective ways to deal with the complex legal and educational issues involved with accommodations and support.     

内涵式增权与外生性赋能:社会资本视角下的残疾人社会支持网络构建

残疾人是社会中的弱势群体,需要全社会的共同关注和支持。目前我国残疾人社会支持网络尚不完备,残疾人价值实现仍然面临诸多困境。本文从社会资本视角出发,就如何最大限度地激发残障群体的社会资本、构建以残疾人为中心的社会支持网络,进而实现残疾人的全面发展提出对策和建议。提升残疾人自身能力、促进残疾人社会角色转变和协调残障群体社会互动关系,是激活残疾人社会支持网络的内生动力;而构建多元协同的托养照护模式、完善福利制度供给、培育残障自助组织和推广助残志愿服务则构成了残疾人社会支持网络的外部保障。这种新型社会支持网络的构建,将有利于推动新时代残疾人事业的发展,不断满足残疾人对美好生活的向往。     

Perspectives on work (re)entry for persons with disabilities: implications for clinicians

Despite the prevalence of government funding to support employment opportunities for persons with disabilities, real jobs for this population still appear to be elusive. McMaster University researchers examined how six stakeholder groups defined workplace (re)entry success for persons with disabilities. Focus groups and individual interviews were conducted with representation from employers, unions, persons with disabilities, co-workers, supervisors and human resource departments. Participants numbered 86 and the average age was 42. Participant comments provided the researchers with rich data related to the study objectives. Success was perceived as not only a match between the employee and the job but also a win-win for employer and employer, a uniquely defined set of circumstances based on the specific individual and their environment as well as respect for the individual's dignity and quality of life. This article discusses the study and its outcomes and highlights implications for clinicians.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

A rights-based conceptual framework for the social inclusion of children and young persons with an intellectual disability

There is a basic principle that all children and young persons with intellectual disabilities should be able to enjoy citizenship on an equal basis with others. This includes enjoying personal dignity and exercising choice, control and freedom in social, community and cultural life, in keeping with their individual lifestyle preferences and aspirations. There is a need for a stronger human rights narrative to achieve this. This article identifies a conceptual framework for a rights-based approach to the integration of children and young persons with disabilities. Seven components of such a framework are identified: citizenship and social inclusion; recognition; agency; voice; capabilities; equality; and self-realisation. This framework was developed as part of an Irish case study involving consultation with young persons with intellectual disabilities, their parents or guardians and professional staff delivering support services. The rights of children/young persons with intellectual disabilities are essentially those of children generally. While this principle may be obvious in many respects, its implementation presents significant challenges. The need for a transformative narrative and its components are outlined.     

Complexities in attracting and retaining direct support professionals

Recruiting and retaining direct support professionals (DSPs) remains essential to the full inclusion for persons with disabilities. Using a mixed-evaluation model, we measured DSPs' views versus those of their supervisors. DSPs expressed lower perceptions concerning their supervisors, satisfaction with their work situation, and environmental and safety factors. Focus groups provided insights into resolving issues related to compensation, work environment, and recruiting and retaining future DSPs. Motivating factors included wanting to be part of a helping community where all are valued. To improve their performance, DSPs stated their desire to understand the roles of managers and of the consumer. DSPs indicated that having career paths that provided advancement opportunities and direct contact with persons with disabilities were primary motivators.     

Treatment services received in the CASAWORKS for Families program

This article presents information on treatment services received by women participating in an initial multistate evaluation of CASAWORKS families. Results indicated most women received services to address medical, employment, basic needs, alcohol and drug, family, and psychiatric problems during the first six months of the program. The clients also had frequent contact with their case managers and were retained in the program for an average of 222 days. Considerable variation was observed across sites in the percentage of clients who received various services and the number of sessions they received. In Cox regressions, shorter retention in the program was predicted by referral to program from Child Protective Services or parole/probation, social conflicts, employment, and marijuana use at baseline, whereas a history of suicide attempts was associated with longer retention. Longer retention was associated with better alcohol use outcomes but was unrelated to employment or drug use outcomes.     

Impact of retirement type on income for people with disabilities

The purpose of this paper is to investigate the impact of involuntary retirement on the economic security of persons with a disability. Very little research examines the economic consequences to forced retirement and no research focuses on persons with disabilities who have a higher rate of involuntary retirement than the general population. Analysing the 2006 Canadian Participation and Activity Limitation Survey, we find that persons with a disability who involuntarily retire have lower median personal and household incomes and they are more likely to be under the low-income cut-off point than those who retire voluntarily. When socio-demographic, socio-economic and geographical characteristics are controlled; those who retired involuntarily are more likely to be under the low-income cut-off point than those whose retirement was voluntary. Further, those who retired involuntarily are more likely to receive disability benefits whereas those who retired voluntarily are more likely to receive retirement income. The authors argue for employers and governments to implement accommodation in the workplace and flexible employment opportunities so that more persons with disabilities are able to continue in their employment for as long as possible.     

The College Student Psychiatric Emergency: II Diagnosis and Disposition

Abstract

Student psychiatric emergencies are a cause of great concern on college campuses, and they merit further study. The authors elucidate some of the characteristics of 1,156 visits to a hospital psychiatric emergency department made by 933 students over an eight-year period. The diagnoses given to students in emergencies were found to be equally divided among psychosis, neurosis, personality disorder, and “other.” Only about 30% of the students' visits to the psychiatric emergency department resulted in admission to the hospital; the implications, for college mental health programs, of having 70% of psychiatric emergencies returned to campus is discussed.

“Prevention of Acute Mountain Sickness by Dexamethasone,” T. Scott Johnson, et al. Acute mountain sickness is a syndrome that occurs when unacclimatized persons ascend rapidly to high altitudes. It is postulated that cerebral edema causes its symptoms. Since dexamethasone is useful in treating some forms of cerebral edema, we investigated its role in the prevention of acute mountain sickness. Using a double-blind crossover design, we exposed eight young men to a simulated altitude of 4570 m (15,000 ft) on two occasions. By random assignment, each subject received dexamethasone (4 mg every 6 hours) or placebo for 48 hours before and throughout the 42-hour exposure. The presence of symptoms of acute mountain sickness was established by two methods: a questionnaire and an interview by a physician. Dexamethasone significantly reduced the symptoms of acute mountain sickness. During dexamethasone treatment, the cerebral-symptom score (mean ± S.E.) decreased from 1.09 ± 0.18 to 0.26 ± 0.08, and the respiratory-symptom score decreased from 0.64 ± 0.09 to 0.31 ± 0.06 (both, P < 0.05). As judged by the interviewing physician, the symptom score decreased from 1.10 ± 0.11 to 0.28 ± 0.07 (P = 0.01). We conclude that dexamethasone may be effective in preventing the symptoms of acute mountain sickness. (New England Journal of Medicine 1984;310:683–6.)