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1、Rehabilitation Psychology 2000 by the Educational Publishing Foundation February 2000 Vol. 45, No. 1, 89-100For personal use only-not for distribution. Psychological Adaptation Among Racial and Ethnic Minority Individuals Following Spinal Cord Injury A Proposed Culturally Inclusive Ecological Model
2、Helen A. NevilleBlack Studies Program University of Missouri ABSTRACTBuilding on the work of G. Uswatte and T. R. Elliott (1997) and recent rehabilitation counseling theoretical writings (e.g., D. B. Hershenson, 1998 ), a culturally inclusive ecological model of spinal cord injury adaptation is prop
3、osed. The purpose of the model is to integrate and extend existing literature to better examine factors leading to differential psychosocial outcomes. An important component of the model is explicating general as well as socioracial and ethnic factors potentially influencing the adaptation process.
4、Consistent with national trends incorporating multiculturalism into specific fields of study, there has been a recent increase in both theoretical and empirical research on racial and ethnic minority issues related both to disabilities in general (e.g., Belgrave, 1998 ; Walker, Turner, Haile-Michael
5、, Vincent, & Miles, 1995 ) and to specific conditions such as spinal cord injury (SCI; e.g., Krause & Anson, 1997 ; Waters, Adkins, Sie, & Cressey, 1998 ). In a recent effort, Uswatte and Elliott (1997) reviewed relevant literature in the broader field of rehabilitation, with a focus on psychosocial
6、 adaptation among ethnic minority populations. A strength of this work was the articulation of specific socioenvironmental risk factors related to the rehabilitation process. Although the authors outlined key variables related to adaptation, what appears to be missing in their commentary is a theore
7、tical framework to conceptualize adaptation and inform rehabilitation practice. The purpose of this brief commentary is to build on the work of Uswatte and Elliott (1997) and also on recent theoretical advancements in rehabilitation psychology (e.g., Hershenson, 1998 ) by proposing a model designed
8、to systematically integrate the literature on SCI psychosocial adaptation among racial and ethnic minority populations. The Culturally Inclusive Ecological Model of Spinal Cord Injury Adaptation (CIEM-SCIA) is unique in that it provides a framework for examining socioracial and ethnic factors potent
9、ially related to differential psychosocial outcomes. I have delimited the focus of discussion to traumatically sustained SCI (as opposed to disability in general) for two main reasons: (a) It provides a focus, and (b) an unforeseen event is the cause of the injury, and thus adaptation falls within t
10、he rubric of a stress and coping paradigm, a theoretical archetype consistent with the proposed model. To help contextualize the CIEM-SCIA, I first provide brief definitions of race and ethnicity as well as an overview of SCI incidence and etiology; this is followed by a brief explication of psychos
11、ocial adaptation; I then describe and outline the specific components of the model. RACE, ETHNICITY, INCIDENCE, AND ETIOLOGY Consistent with Uswatte and Elliotts (1997) definition, ethnicity here refers to the national origin of an individual, which has implications for cultural expressions, norms,
12、values, language, and customs that are passed down from generation to generation (e.g., African American, Filipino). This differs from pan-ethnic groups, a superordinate classification of individuals based on national origin with shared cultural practices, social experiences, or both (e.g., Asian Am
13、erican, Latino). Race, on the other hand, is becoming more accepted as a social construction as opposed to a biological marker. By social construction I mean that racial classifications differ depending on a given geohistorical location. For example, a light-complexioned person considered Black in t
14、he United States at this historical moment may have been classified as Colored in South Africa during the apartheid regime. Whiteness has also been precarious. Irish individuals, for instance, were not considered White in the early nineteenth century in the United States. The point here is that ther
15、e is no universally accepted racial category that has transcended time and space (see Thompson & Neville, 1999 , for a more detailed discussion). Multicultural psychology expert Janet Helms (1994) prefers the term sociorace because it underscores the role of sociohistorical realities of groups that
16、have been identified as minority and majority, and it encourages examination of nonnominal racial constructs (e.g., racial identity). For the purposes of this article, ethnicity refers to specific national groups (e.g., Mexican American), and race refers to socioracial groups (e.g., Black) or pan-et
17、hnic groups (e.g., Native American) identified in the United States. I recognize that Latinos can be of any race (White, Black, Asian, or a mixture thereof), but this population is typically treated as a separate social group in the literature, reflecting the ambiguous and inconsistent constructions
18、 of broad social classification systems. The racial and ethnic distribution of persons with SCI is different from the general population. African Americans and, to a lesser degree, Native Americans are overrepresented among persons with SCI. Nearly 20% of the persons with SCI during 19731992 in the
19、National SCI Database were African American, whereas the general African American population reported in the 1990 U.S. Census was a little over 12% ( Go, DeVivo, & Richards, 1995 ). On the other hand, although the majority of persons with SCI are White, this population is underrepresented among pers
20、ons with SCI. White individuals represented 70% of the SCI population (from 19731992), yet the 1990 U.S. Census indicated that Whites were a little over 80% of the general population ( Go et al., 1995 ). Although some psychosocial research on SCI reflects an almost all-White sample, many contain sig
21、nificant numbers of racial and ethnic minorities, primarily African Americans. Amazingly, some researchers fail to report the racial or ethnic composition of their sample. Many studies reporting a racially or ethnically diverse sample do little with this information conceptually or statistically. Mo
22、re recently, however, some researchers have begun to examine potential differences in psychological adaptation and predictors of adaptation between racialethnic groups. Krause and Anson (1997) , for example, found no differences between Whites and racial minorities on most psychological adjustment i
23、ndicators; however, Whites did report greater satisfaction with their career and fewer skills and financial deficits than racial minorities, primarily Blacks. Contradictory to findings with non-SCI samples, some research findings suggest that compared with White persons with SCI, African Americans w
24、ith SCI report lower levels of subjective well-being ( Krause, 1998 ). Predictors of psychosocial adaptation also appear to differ depending on the racial and ethnic group. For example, Zea, Belgrave, Townsend, Jarama, and Banks (1996) found that perception of severity of ones disability was a signi
25、ficant predictor of depression for Latinos, but not for African Americans. Data consistently indicate significant differences between racial and ethnic groups in etiologies of traumatic SCI. Vehicle accident is the leading cause of new injuries in White, Native American, and Asian populations. Howev
26、er, this is not the case for African American and Latino populations ( Go et al., 1995 ). According to information from the National SCI Database, violence accounts for over 40% and over 37% of the African American and Latino SCI injuries, respectively, whereas motor vehicle accidents have been repo
27、rted to account for 27% (African American) and 34% (Latino; see Go et al. ). According to the same database, Native Americans have the highest motor vehicle SCI incidence rates (upward of 67% of newly injured) and among the lowest violence incidence rates (about 9%; see Go et al. ). Uswatte and Elli
28、ott (1997) perceptively noted the importance of environmental hazards in sustaining an injury. For example, African Americans and Latinos are disproportionately represented among the urban poor and thus are more likely to live in economically depressed communities where violent crimes occur more oft
29、en. Thus, class appears to be an important factor. Gender is also a critical variable to consider. It is well documented that the overwhelming majority of SCI cases are menover 82% of the consumers enrolled in the National SCI Database are male ( Go et al., 1995 ). In fact, at one urban model SCI sy
30、stem site, men constitute over 90% of SCI incidents resulting from violence ( Adkins, Hume, Nabor, & Waters, 1998 ). It appears then that an interaction among raceethnicity, gender, and class play a role in understanding who gets injured and under what conditions. It may be that poor African America
31、n and Latino men are disproportionately more likely to sustain a traumatic SCI, especially by violence, compared with other populations (including middle class racial and ethnic minority men and women). When considered alone, etiology of the injury appears to have a negligible impact on psychosocial
32、 adaptation outcomes among racially diverse samples. For example, research suggests no differences in community integration, depression or post-traumatic stress ( Adkins et al., 1998 ), or functional independence ( Waters & Adkins, 1997 ) between racially mixed samples of persons sustaining an injur
33、y from a motor vehicle accident or a firearm. However, an interaction between race and etiology may play a factor in social perceptions of consumers and, consequently, the rehabilitation process. As part of the Missouri Model Spinal Cord Injury System, we conducted focus groups with racially diverse
34、 persons with SCI to examine helpful and hindering aspects of rehabilitation. A few African American male participants perceived a difference in their treatment in the hospital, commenting that professional staff assumed they were injured as a result of a gunshot wound and thus somehow deserving of
35、their injury. This resulted in a perceived difference in the level of empathy expressed toward them compared with their White male and female counterparts injured in automobile accidents. PSYCHOSOCIAL ADAPTATION Traumatically sustained SCI has differing degrees of acute or chronic psychosocial impli
36、cations. It is important to note that not all individuals experience postrehabilitation trauma reactions such as depression. However, the overwhelming majority of persons experience employment consequences, economic consequences, or both. The bulk of the research in the area of psychosocial adaptati
37、on has focused on understanding risk and protective factors associated with psychological (e.g., depression, anxiety, life satisfaction), behavioral (e.g., drug abuse), work, and recreational functioning; this commentary focuses on the psychological adaptation literature. CIEM-SCIA The CIEM-SCIA is
38、a modification of both an ecological model to describe the recovery process of women sexual assault survivors ( Neville & Heppner, 1999 ) and Hershensons (1998) Systematic, Ecological Model for rehabilitation counseling. The former provides the structure for systematically examining cultural factors
39、 related to a traumatic event, and the latter provides insight about the interaction of social systems and individuals on the rehabilitation process. The proposed model differs from Hershensons in the following three ways: (a) It focuses on contextualizing psychosocial adaptation, as opposed to reha
40、bilitation counseling, among a condition-specific population; (b) consistent with the intended purpose of ecological models, Hershensons model provides examples of socioracial and ethnic concerns; and (c) extending these periodic observations, the CIEM-SCIA provides a framework to systematically exa
41、mine socioracial and ethnocultural factors (see Table 1 and Figure 1 ). As indicated in the title, the CIEM-SCIA is grounded in the ecological literature suggesting that human behavior is dynamic and results from the dialectic between persons and environments. Ecological models underscore that human
42、 behavior is multiply determined by interrelations between subsystems within a larger ecosystem. Bronfenbrenner (1977) identified four major subsystems influencing human behavior: (a) microsystem, or the interpersonal interactions within a given environment, including work, school, and home; (b) mes
43、osystem, which comprises interactions between two or more microsystem environments, such as the relations between an individuals school and work environments; (c) exosystem, which consists of the linkages between subsystems that indirectly influence the individual, such as the police or health care
44、systems linkages with ones neighborhood; and (d) macrosystem, or the ideological components of a given society, including norms and values. Directly applied to SCI, adaptation is conceptualized as being multiply determined by factors both within and outside of the individual. Figure 1 provides a pic
45、torial depiction of the model. The concentric circles visually communicate the nested influence of subsystems. Table 1 profiles individual and environmental factors contributing to psychosocial adaptational outcomes, highlighting general factors (e.g., social support) and culture-specific factors (e
46、.g., acculturation). Below is a brief discussion of key aspects of the model. Macrosystem I begin the discussion of the model with a description of the macrosystem context because it influences every aspect of the adaptation process; individual, family, and other system responses to persons with SCI
47、 exist within the broad sociocultural context of the United States. Our political and economic climate and normative conceptions about physical disability, including SCI, shape the type and quality of services provided, employment opportunities, how one understands his or her disability, and individ
48、ual (e.g., primary physical assistant support) and system responses (e.g., family or work site support; see Hershenson, 1998 , for a more detailed discussion). Within this broader macrosystem are specific sociocultural contextual factors affecting the rehabilitation process of racial and ethnic mino
49、rity consumers. The racial climate and practices in the United States, including racial discrimination, shape the lived experiences of socioracial groups. A form of racial discrimination in the United States is the creation of a society in which most racial and ethnic minority groups are overrepresented among those living in poverty. This means that racial and ethnic minority groups have an increased chance of experiencing socioenvironmental barriers in the rehabilitation process, including restricted access to reliable tr
