Rehabilitation Psychology

Disaster case management and individuals with disabilities.
Purpose: To examine the case management and disaster recovery needs of individuals with disabilities following Hurricane Katrina. The case managers and supervisors in this study provided case management to individuals with disabilities as part of the largest coordinated disaster case management program in U.S. history, the Katrina Aid Today consortium. This study provides an account of the disaster case management needs of individuals with disabilities as well as a picture of their long-term recovery process two years following the disaster. Design: Forty-two case managers and 12 case management supervisors from this program provided services to a collective caseload of 2,047 individuals with disabilities and their families. Interviews and telephone surveys were conducted with these participants 20–24 months after the disaster. The qualitative data were analyzed using grounded theory methodology, and descriptive statistics summarize the demographic data. Results: Findings suggest that the disaster recovery process is typically more complex and lengthy for individuals with disabilities and requires negotiation of a service system sometimes unprepared for disability-related needs. Barriers to disaster recovery for individuals with disabilities included a lack of accessible housing, transportation, and disaster services. Supports to disaster recovery included the individual effort and advocacy of a case manager, connecting with needed resources, collaboration with other agencies, and client motivation and persistence. Implications: Results suggest that disaster recovery is facilitated by case managers with disability expertise, including knowledge about the needs of individuals with disabilities and about disability-related services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Prevalence and consequences of disaster-related illness and injury from hurricane ike.
Objective: To explore the extent to which disasters may be a source of injury and disability in community populations, we examined the prevalence and short-term consequences of disaster-related illness and injury for distress, disability, and perceived needs for care. Design: A random population survey was conducted 2–6 months after Hurricane Ike struck Galveston Bay on September 13, 2008. Participants: The sample was composed of 658 adults representative of Galveston and Chambers Counties, Texas. Results: The prevalences of personal injury (4%) and household illness (16%) indicated that approximately 7,700 adults in the two-county area were injured, and another 31,500 adults experienced household-level illness. Risk for injury/illness increased with area damage and decreased with evacuation. In bivariate tests, injury or illness or both were related to all outcome measures. In multivariate analyses that controlled for co-occurring stressors representing trauma, loss, adversities, and community effects, injury or illness or both were associated with global stress, posttraumatic stress, dysfunction, days of disability, and perceived needs for care, but not with depression or anxiety. Conclusions: The associations of injury with distress and disability suggest that community programs should reach out to injured persons for early mental health and functional assessments and, where indicated, intervene in ways that reduce further disability and need for complex rehabilitative services. The results also point to the potential effectiveness of evacuation incentives with regard to the prevention of disaster-related injury and disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The psychosocial impact of Hurricane Katrina on persons with disabilities and independent living center staff living on the American Gulf Coast.
Objectives: To determine the impact of Hurricane Katrina on the psychosocial health of people with disabilities and on the ability of people with disabilities in the affected area to live independently. Participants: Transcribed conversations were analyzed for 56 survivors of Hurricane Katrina on the American Gulf Coast, all of whom were persons with disabilities or persons working with them. Method: Semi-structured interviews were conducted either individually or in focus groups with participants. Qualitative analysis was undertaken using hermeneutic techniques. Results: Six major themes emerged: faith, incredulousness, blaming others or oneself, family adaptation and resiliency, and work and professional responsibility. Conclusions: The resiliency of persons with disabilities to adapt to disasters can be better understood through factors such as these, providing an effective barometer of social capital that can help societies prepare for future disasters among those most vulnerable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
A tale of two studies of two disasters: Comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees.
Purpose: An accumulation of disaster mental health research literature in the last few decades has contributed knowledge to direct disaster mental health interventions. However, no single set of principles can necessarily outline all anticipated mental health needs to be encountered in a particular disaster. Methods: To illustrate how different disaster scenarios may yield a divergence of mental health needs, this article compares mental health findings from two distinctly different studies of two very different populations affected by two very different disasters: directly exposed survivors the Oklahoma City bombing and sheltered evacuees from Hurricane Katrina. Results: Research on the two disasters reviewed illustrates many facets and complexities of postdisaster mental health needs in different populations in different settings after different types of disasters. The major findings of the Oklahoma City bombing study related to posttraumatic stress disorder and the main findings of the Hurricane Katrina study involved need for treatment of preexisting chronic mental health and substance abuse problems. Conclusion: The disaster studies in this review diverged in type of disaster, affected populations, setting, and timing of the study, and these studies yielded a divergence of findings. One disaster mental health model clearly cannot adequately describe all postdisaster scenarios. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Emergency preparedness as a continuous improvement cycle: Perspectives from a postacute rehabilitation facility.
Objectives: To describe the iterative process of emergency planning and preparedness: risk assessment, planning, rehearsal, implementation, and refinement. Design: A narrative reflection of two complete facility evacuations in advance of major hurricanes in 2005 (hurricane Rita) and 2008 (hurricane Ike) conducted by a postacute rehabilitation facility located on the Texas gulf coast. Participants: Facility staff involved in the evacuation and ongoing care post evacuation, and adults with moderate to severe acquired brain injury receiving residential postacute rehabilitation and long-term care services. Results: Experiences from two evacuations revealed that planning and preparation beyond what is required by licensing and accrediting agencies is necessary; attending to the needs of staff during and after and the emergency is a critical component of planning and preparedness; and the necessity of incorporating “lessons learned” into refinement of emergency preparedness plans. Conclusions: Facilities providing residential services to persons with neurological injury are potentially vulnerable to a number of natural and manmade disasters. Careful planning, preparation, and practice are necessary to ensure safe evacuation of persons served and facility personnel in response to an emergency. Experiences (i.e., “lessons learned”) from each evacuation, subsequent changes to emergency preparedness plans, and recommendations for emergency preparedness beyond a natural disaster, such as a hurricane, are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.
Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders. Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment. Results: Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures. Conclusions: People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Development of a safety awareness group intervention for women with diverse disabilities: A pilot study.
Objective: Describe the development and preliminary evaluation of a safety awareness program for women with disabilities. Design: Baseline and postintervention questionnaires administered to a sample of women who completed a safety awareness program. Participants: Seven women with diverse disabilities. Intervention: Eight interactive sessions designed to increase protective factors. Setting: Community site for persons with disabilities. Main Outcomes: Safety self-efficacy, safety skills, social support/isolation, and safety promoting behaviors. Results: Significant increases from baseline to postintervention were found on measures of self-efficacy and safety skills. Although not statistically significant, improvements were also found in safety promoting behavior. Conclusion: Despite the small sample, findings suggest that participation in a safety awareness program may improve protective factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Reporting results of latent growth modeling and multilevel modeling analyses: Some recommendations for rehabilitation psychology.
Objective: There has been a general increase in interest and use of modeling techniques that treat data as nested, whether it is people nested within larger units, such as families or treatment centers, or observations nested under people. The popularity can be witnessed by noting the number of new textbooks and articles related to latent growth curve modeling and multilevel modeling. This paper discusses both of these techniques in the context of longitudinal research designs, with the main purposes of highlighting some benefits and issues related to the use of these models and outlining guidelines for reporting results from studies using multilevel modeling or latent growth modeling. Implications: These longitudinal analytic techniques can be greatly beneficial to researchers conducting rehabilitation studies, but there are several issues related to their use and reporting that need to be taken into consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
A longitudinal examination of the parent–child distress relationship in children with juvenile rheumatic disease.
Objective: To examine the longitudinal relationships between parent and child distress in a sample of children with juvenile rheumatic diseases (JRDs). Design: Cross-lagged panel correlation analysis tested the temporal precedence of parent distress versus child distress over a 1-year period. Participants: Thirty-seven children (ages 9–17 years; 22 girls) diagnosed with JRD and their parents completed self-report measures on 2 occasions (assessment interval M = 12 months). Primary Outcome Measures: Child Depression Inventory and Brief Symptom Inventory. Results: Significant cross-sectional parent–child distress associations were observed at both time points. Moreover, Time 1 parent distress predicted child distress at Time 2 after child-reported functional ability was controlled; Time 1 child distress was unrelated to Time 2 parent distress. Cross-lagged panel correlations demonstrated the temporal precedence of parent distress relative to child distress in the parent–child distress relationship. Conclusions: These preliminary findings underscore the importance of parent distress in parent–child transactional adjustment, and suggest a predominant role for parent distress in children's adjustment to JRDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The reliability and validity of the Community Integration Measure in persons with traumatic brain injury.
Objective: To investigate the psychometric properties of the Community Integration Measure (CIM), a scale that assesses self-perceived quality of community integration, among persons with traumatic brain injury (TBI). Method: Persons (N = 279) with TBI completed the CIM, as well as other measures of community integration and quality of life, and were followed up to 15 years postinjury. Results: The CIM was found to be a reliable instrument with adequate internal consistency. Validity was demonstrated in its relationship to other measures of community integration and life satisfaction. Utility was evident in its prediction of perceived social support. Conclusion: Results suggest that the CIM is an adequate measure of community integration for persons with histories of TBI of up to 15 years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Attitudes toward people with disabilities: The perspective of attachment theory.
Objective: Attachment theory was employed as the theoretical framework for the purpose of examining attitudes toward people with disabilities. Method: A total of 404 Jewish Israeli students without disabilities completed the Multidimensional Attitudes Scale Toward Persons With Disabilities (MAS) and the Experiences in Close Relationships Scale (ECR). Results: Reading a scenario about an encounter with a person with a disability gave rise to more negative emotions than reading a similar scenario about an encounter with a person without a disability, regardless of participants' attachment orientations. However, attachment orientations moderated participants' positive cognitions and distancing behaviors. Conclusions: Findings suggest a dynamic process of self-regulation when reacting to a written scenario about people with disabilities. This process consists of an initial spontaneous negative emotional response accompanied by compensatory positive cognitions and behavioral tendencies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The detection of malingered pain-related disability with the Personality Assessment Inventory.
Objective: This study presents and evaluates a method to detect malingered pain-related disability (MPRD) using the Personality Assessment Inventory (PAI), a multiscale self-report instrument with a number of useful applications in pain assessment. Method: In this study PAI scores from respondents in a chronic pain clinic (N = 317) and college students instructed to feign chronic pain (N = 152) were compared. Results: Although existing PAI validity indicators demonstrated strong effects in discriminating actual pain and MPRD cases, these indicators were not sufficiently sensitive to feigned pain to recommend for clinical practice. A discriminant function was developed and cross-validated, which improved upon the sensitivity of the other indicators and yielded an overall hit rate of 88% for detecting individuals instructed to malinger pain-related disability. Conclusion: These data suggest that this new PAI indicator holds some promise for more effective detection of MPRD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Public policy: Extending psychology's contributions to national priorities.
Overview: Much of today's psychological research and practice is relevant to our national health agenda and can serve the public interest. President Obama's landmark health care reform success provides an unprecedented opportunity to revolutionize society's definition of “quality care” and highlight rehabilitation's potential. Advocacy, vision, and a public policy presence with persistence are critical. Those involved often focus exclusively upon specific issues (e.g., reimbursement, research funding, or graduate student support). Summary: By developing a “bigger picture” approach addressing society's real needs and embracing the changes technology will ultimately bring, psychology can have a more lasting impact. There are unlimited opportunities to advance the profession through personal involvement in the public policy arena. It is essential that psychology's next generation receives relevant mentoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Rehabilitation Psychology - Vol 55, Iss 3