Part of the trouble African-Americans with spinal cord injuries face is a demographic of below average educational attainment and unemployment in an economy that favors "high education and technical training" (Schriner & Scotch, 2001, p. 100). Inadequate social support systems have led to a decreased participation in labor involvement for many minorities who are disabled (Schwochau & Blanck, 2000).
Minorities are traditionally subject to prejudiced attitudes and discriminatory behaviors, as well as institutional and legal constraints that "parallel those experienced by African-Americans and other disadvantaged and excluded group" (Schriner & Scotch, 2001, p. 100). Thus disabled minorities face negative stereotypes that they may be more dependent and incapacitated and face discriminatory attitudes about race that may result in isolation and exclusion (Schriner & Scotch, 2001).
Lack of access to employment, support, and disabling assumptions may contribute to the decline in workforce participation among disabled African-Americans.
Many corporations still resist changes that may help disabled minorities truly adapt to a changing workforce (Russell, 2000). Laws prohibiting discrimination on the basis of disability will continue to be necessary to help people with disabilities, but even more help is needed for minorities including African-Americans who are disabled. Understanding the cultural differences between African-American disabled individuals is one step in a positive direction.
The research suggests that coping strategies and teaching African-Americans how to access social support in a "culturally congruent manner" can empower African-Americans with disabilities to achieve their goals (Belgrave & House, 1998, p. 98). African-Americans with spinal cord disabilities and other disabilities need adequate access to intrapersonal resources that are developed within "an individual, family, or community" (Belgrave & House, 1998, p. 98).
Other measures or factors that contribute to adjustment and coping with a disability and that contribute to employment success are tied to self-esteem and attitudes; studies suggest that social support may indirectly impact vocational success "through its impact on self-esteem and attitudes toward disability" (Belgrave & House, 1998, p. 63). A combination of intrapersonal, socioecological and stress processing variables within the African-American population is most helpful in coping with disability status and improving self-esteem (Belgrave & House, 1993). Thus, one may conclude that rehabilitative programs should emphasize a multi-tiered approach which recognizes the importance of all of these factors and combines them to elicit personal achievement and success among minorities with a disability status.
Studies do indicate that a majority of African-Americans with disabilities desire work and more than 78% believed they could; this desire supports the notion that culturally minorities are motivated as any individual to enhance employment option (Belgrave & House, 1998). The factors related to employment outcomes include self-esteem, beliefs about disability and perceived support in addition to the severity of disability (Belgrave & House, 198). Workplace employers might consider working in conjunction with health care providers to ensure an environment that is supportive and accommodating for both minority status and disability status. It is important to remember that minorities face additional barriers including potentially lower socio-economic status, educational opportunities and similar factors.
Many healthcare and rehabilitation providers perceive that a person approaches their interpersonal situations and care in a manner similar to their own; this is a common tendency, however can be debilitating on patients coming from a minority background and may place limitations on disabled minority individuals who may have different cultural traditions and perceptions of rehabilitative programs (Ramsden, 1999). The social structure of the health care system 'as is' may place limits on minority groups members and may contribute to predisposing those members to limited resources, reduced prospects for advancement and limited educational opportunities (Ramdsden, 1999). This is evidenced by the lack of faith many minority disabled persons have in rehabilitative programs. Studies suggest that a majority of African-Americans with spinal cord injuries and other disabilities are more likely to turn to family members for support, because they understand the impact a disability has on them culturally and provide a positive outlook and understanding (Belgrave & House, 1998).
Killeen & O'Day (2002) point out that traditional rehabilitation and programs based on a "medical model" focus on changing the individual, whereas from a minority perspective rights based approaches should concentrate on changing society in a manner that acknowledges that the limitations persons with disabilities faced are as much a product of environment as their disability. Further the National Institute on Disability and Rehabilitation Research are emphasizing "the inclusion of people from emerging disability populations" including racial minorities and those whose disabilities result from violence (U.S. Department of Education, 2000; Killeen & O'Day, 2002).
Unemployment among African-Americans with spinal cord injuries may result from a combination of the actual impairment, societal attitudes, problems with rehabilitation systems and interpersonal feelings including depression and frustration (Killeen & O'Day, 2002). Many believe they are rejected due to their disability, reflecting the idea that the new model of disability which defines it as a product of environment has not been fully explored. The concepts of reasonable accommodation and adaptation need be emphasized in a setting that incorporates interpersonal interaction to overcome these obstacles or barriers to achievement.
Studies suggest that minority status combined with disability status may doubly impair individual's chances for a positive outcome in work and in personal life unless health care professionals recognize the need for intrapersonal programs that incorporate family / kin as part of the rehabilitation program. In addition African-Americans with spinal cord disabilities and other severe disabilities would benefit from programs that work toward teaching that disability is only limiting when the environment creates a limiting scenario, and that employers and other members of society need shift culturally to recognize the importance of accommodation and adaptive behaviors.
There is some evidence that African-Americans with spinal cord injuries face additional barriers, including the increased perception that disability stems from socio-economic conditions and poverty. The incidences of spinal cord injuries among this population are on the rise, and studies suggest that this trend is due in part to increased violence in neighborhoods where minorities are subject to harsh living conditions (Belgrave & House, 1998; Hall, 2002). Many have a disdain for rehabilitative programs because they follow a 'standard' medical practice which may be geared culturally toward white middle class disabled victims rather than minorities. Recognition of the importance of individualized programs that take into account socio-economic factors and cultural preferences is important and may impact an individual's chances for healing and recovery.
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