Social Work Practice with People with Disabilities
The way a society responds to disability is influenced by its perceptions about causes of disability, the threats that it perceives to be related to the disability, and the amount and kinds of resources that are available to deal with the disability. People of ancient times believe that any sickness indicated the displeasure of the gods. Those with mental disorders were viewed as being either divine or demonic, depending on the behavior. Individuals seen as divine were worshipped and adored; those seen as demonic were ostracized, punished and sometimes burned at the stake.
Later, Aristotle attempted to relate mental disorders to physical disorders and developed his theory that the amounts of blood, water and yellow and black bile in the body controlled the emotions. These four substances, or humors, corresponded with happiness, calmness, anger and sadness. Imbalances of the four humors were believed to cause mental disorders, so treatment was aimed at restoring balance through bloodletting, starving, and purging. In early Christian times, primitive beliefs and superstitions were strong.
All diseases were again blamed on demons, and the mentally ill were viewed as possessed. Priest performed exorcisms to rid evil spirits. When that failed, they used more severe and brutal measures, such as incarcerations in dungeons, flogging and starving. . When society was seen as the cause, there was increased pressure for society to provide solutions. Services for people with disabilities have been afforded first to soldiers injured in war because societal responsibility was clear. The United States has the most comprehensive system of assistance for veterans of any nation in the world.
This benefits system traces its roots back to 1636, when the Pilgrims of Plymouth Colony were at war with the Pequot Indians. The Pilgrims passed a law which stated that disabled soldiers would be supported by the colony. The Continental Congress of 1776 encouraged enlistments during the Revolutionary War by providing pensions for soldiers who were disabled. Direct medical and hospital care given to veterans in the early days of the Republic was provided by the individual States and communities. In 1811, the first domiciliary and medical facility for veterans was authorized by the Federal Government.
In the 19th century, the Nation’s veteran’s assistance program was expanded to include benefits and pensions not only for veterans, but also their widows and dependents. Society also responds differently to specific impairments based on perceived cause. People with mental retardation or congenital disorders are not usually faulted for their disorder therefore willingness from the public to provide services are relatively high. Mental illness or chemical dependency, which is still perceived by many as a character flaw, receives less public attention and support even though these cases far exceed the number of mental retardation cases.
The potential threat of a disability can also greatly influence societal response. For example let’s compare the polio scare of the 1940’s early 50’s with the Acquired Immune Deficiency Syndrome (AIDS) epidemic. The cause of Polio is consider “guilt free” but has a substantial threat. The response from volunteers and the government to eradicate this disease was significant. The March of Dimes was also born in efforts to destroy the disease. In contrast, those who were deemed “responsible for” the spread of the Human Immunodeficiency Virus (HIV) that causes AIDS were seen as the only ones threaten. The general public response was low.
However, when the extent of the threat was realized, efforts at preventions and intervention were intensified. In my experience I have witness how the perceive cause or the perceive notion in regards to a person who is disabled effects the services they may received. I have been guilty of casting judgment myself. Working for a law firm which specializes only in helping individuals received Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), I have heard lawyers speak about clients who are poorly educated, disabled due to chemical dependency and/or have a low income.
They tend to frown upon the case and do not put full effort into helping the individual and the clerks are guilty of the same. Additionally, the Social Security Administration does not often award those who have a disability due a chemical dependency. I have found myself looking over case files and stereotyping the client based on the information given before I have interviewed the individual. I have also prioritized my case load based on a person status versus the seriousness of the disability.
I have found that my preconceptions were wrong and that I need a moment of introspection so that I can provide the best and the same level of service for everyone. Social Workers and People with Disabilities Social workers will encounter people with disabilities in all aspects of their lives. Social workers should not assume that a client with disability is seeking services in relation to the disability. Some service systems however, are designed to address issues specific to disability and social workers can find active roles within these systems of service.
Five major areas of legislation address disability issues specifically. These include workers compensation, rehabilitation, Social Security, education and civil rights. Additionally, as mention earlier a distinct service system exists to serve veterans with disabilities. I am going to focus on two of the areas which are Social Security and Veteran Affairs. The Social Security Act provides income and medical insurances for people with disabilities through the SSI and SSDI programs. The SSI program is financed through general revenues from taxes, meaning benefits are not based on your prior work history.
In most states, beneficiaries will automatically be eligible for Medicaid. SSI benefits are payable to individuals age 65 or older, adults who are disabled or blind and children who are disabled or blind. To be eligible the individual must have limited income and resources, meet the living arrangement requirements, a U. S. citizen or national, or in one of certain categories of aliens. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the state.
The SSDI program is financed with Social Security taxes paid by workers, employers, and self-employed persons. The worker will get Medicare coverage automatically after receiving disability benefits for two years. To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be “insured” for Social Security purposes. Disability benefits are payable to blind or disabled workers, their children, widows and adults disabled since childhood. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.
Special work incentive programs are available through SSI and SSDI to help individuals with disabilities make the transition from SSI supports to employment. The Department of Veterans Affairs has programs to assist soldiers who have become disabled while on active duty. Two specific programs are the VA Disability Compensation and Vocational Rehabilitation and Employment VetSuccess Program. The disability compensation is a benefit paid to a veteran because of injuries or diseases that happened while on active duty, or were made worse by active military service.
It is also paid to certain veterans disabled from VA health care. The benefits are tax-free. Soldiers may be eligible for disability compensation if they have a service-related disability and were discharged under other than dishonorable conditions. The VetSuccess program assists Veterans with service-connected disabilities to prepare for, find, and keep suitable jobs. For Veterans with service-connected disabilities so severe that they cannot immediately consider work, VetSuccess offers services to improve their ability to live as independently as possible.
Social workers are often employed by both the VA and SSA to assist people in accessing these services. My baby sister is a veteran who is disabled. She fought in the second Gulf war and returned home suffering from PTSD and grand mal seizures. I asked her what are her thoughts on the care that she receives from the VA and her response was “The health care has been above average. I can have my needs met under my VA insurance in a far timelier manner and is more cost efficient then if I didn’t have it”. I asked is it safe to assume that she is satisfied with the VA?
Her response “With the medical care yes but not the availability of information. Getting the information on benefits and the counselor I was promised to help with paperwork and re entering a civilian life I did not receive by any means. My papers were not updated and I usually have to request help when I’m suppose to have someone keeping track of me”. No matter what area of services as a social worker or a social change agent we may enter into, it is important remember the purpose which is to improve the quality of life for all individuals. The Ecosystems Model and People with Disability
The ecosystem model provides an opportunity to understand and have a broader view of disability. It helps to understand the history of discrimination against people with disabilities, the structural impact of government policies, the cultural assumptions about what people can and cannot do, and the impact of disability on the family, as well as the individual mental and physical specifics of the disorder. All of these pieces play a role in determining both problems and solutions. A social workers success will depend on the social workers understanding of the impact at all levels.