Considering disability in acute-care settings: The psychologist's role
By Ann Marie Warren, PhD, ABPP
In the United States, traumatic injuries are the leading cause of death for individuals between the ages of 1 and 44 and of those who survive, at least at least 2.8 million are hospitalized each year with varying levels of subsequent disability following hospital discharge.1 Not only do individuals enter into the acute care setting with a potentially new onset disability, many individuals may have a pre-existing physical, sensory, psychological or intellectual disability that may be overshadowed by the new injury or illness. Thus, psychologists can have an important part in recognizing, supporting and facilitating disability needs in the context of acute injury and initial hospitalization.
For psychologists working in the medical setting, the biopsychosocial evaluation usually guides the assessment, intervention and recommendations to the rest of the treatment team. Thus, it is imperative that psychologists use their expertise to communicate to their health care colleagues about disability issues that may be present, especially when the disability is less apparent, such as an intellectual or psychological disability. Often, acute medical needs overshadow pre-hospitalization disability concerns; however, as a person stabilizes medically, understanding of the individual’s unique characteristics is important in order to facilitate the recovery process. For example, routine mental status checks assessing the person’s orientation and alertness after a motor vehicle crash need to be tailored for someone with a pre-existing visual or hearing impairment. The psychologist in the acute care setting can provide an important role in helping staff adapt assessments and interventions appropriately, as well as obtain collateral history from family regarding pre-existing or less obvious disabilities.
Some individuals who sustain injury or illness may subsequently develop an acquired disability and can benefit from education and resources to learn how to adjust to an unexpected change. Psychologists can begin to work with the individual on psychological adjustment even in the acute care setting. Additionally, psychologists can utilize their knowledge about adjustment and individual differences to support individual patients who may adjust differently than expected by care providers. For example, it is not uncommon after a high level spinal cord injury that the medical staff become concerned an individual is not “grieving” or they seem somehow too well adjusted. Psychologists understand that adaptation and adjustment after injury is a complex and multifaceted process, and that individuals differ in their responses to injury and disability based on a number of factors. As such, psychologists have an important role in helping reduce individual pathologizing that can occur after an acute injury which results in significant functional change.
Psychologists who have the opportunity to work with newly injured individuals in the trauma unit or during acute hospitalization are often asked to provide support to family members as well. In this role, psychologists should consider potential changes that may occur in the family or environment after hospital discharge. Role changes following injury and illness are common, during the acute hospitalization and throughout rehabilitation (if needed) and return home. Therefore, psychologists can begin to help families openly discuss this and engage in problem solving. For example, if an individual sustains an injury in which modifications to increase accessibility will be required to return home, psychologists can help families begin an early conversation about universal design issues within the home setting.
Although inpatient rehabilitation is an option for some individuals following acute injury or illness, many individuals do not have the opportunity for inpatient rehabilitation either due to financial limitations or medical appropriateness. Because of this, the acute care setting may be the only place where individuals can be exposed to resources for support post injury or illness. Psychologists can play a role in both advocacy and education regarding disability resources in this critical setting.
Most importantly, all psychologists, whether or not in the acute care setting, need to consider disability and ensure that they are educated when working with clients who have disabilities. The Disability Issues Office of the American Psychological Association and the Committee on Disability Issues in Psychology (CDIP) provide information for psychologists to improve the health and well-being of persons with disabilities. Resources for psychologists such as the Disability Resources Toolbox provide a wealth of information including legal issues, reasonable accommodations and issues related to training students with disabilities in testing and assessment. The Spotlight on Disability Newsletter also provides timely information for psychologists on a variety of issues from parenting to universal design. Links are also provided on the webpage for resources ranging from assisting people with disabilities during a disaster to resources for those engaged in disability research. Ultimately, psychologists have a responsibility to continue education and awareness on disability issues to be effective in supporting and fostering health after acute injury or illness.