Health Services Social Workers' Activities with People with Disabilities: Predicters of Community Practice

Article excerpt

The purpose of this study was to explore the extent to which hospital based social workers were actively involved in community practice on behalf of disabled people. The study attempted to identify what variables influence social workers in health settings to engage in community practice. A sample of 286 social workers employed in 57 different hospital and rehabilitation settings participated in a survey that focused on advocacy and related topics. A questionnaire explored participants' perspectives and the levels and kinds of practice activities they engaged in relation to the needs of people with disabilities. Most respondents indicated that community practice was part of their professional responsibility and that disabled clients needed such assistance. Regression analyses showed that self-reports of community practice activities were nevertheless highly related to self-reported advocacy activities. However, their reports of their actual advocacy activities consistently fell below their recognition of need.

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A major tenet of the Americans with Disabilities Act (ADA) is that people with disabilities frequently encounter institutional, social and physical barriers as they try to establish and maintain lives in mainstream communities. This view is held by a great many disability rights advocates and authors who suggest that many of the problems encountered by disabled people are neither psychological nor medical (Mackelprang & Salsgiver, 1999; Tower, 1994). Rather, they contend that disabled people encounter problems in their contacts and interactions with communities, organizations and mainstream health and rehabilitation organizations that for one reason or another limit full participation by people with disabilities (Beaulaurier & Taylor, 2001b; Hahn, 1984; Kailes, 1988; Roberts, 1989).

Although people with disabilities are becoming more militant about demanding new types of services, there is reason to believe that the health organizations that serve them may actually be working to limit their options. As managed care becomes more prevalent in health services, administrators can be expected to seek to limit the discretion and flexibility of practitioners, particularly when it comes to prescribing more costly services and options whose costs are unknown or not supported by third-party payers (Herbert & Levin, 1996; Sunley, 1997, pp. 88-89). Grass roots advocates in the disability rights movement, however, increasingly favor programs and services that support "independent living" approaches that maximize the clients' ability to live and work in mainstream communities (Crewe & Zola, 1983; Herbert & Levin, 1996; Kailes, 1988; Mackelprang & Salsgiver, 1996; Sunley, 1997; Tower, 1994). This may create a situation in which administrative pressures may conflict with increasingly articulate and well-organized disability rights groups, not to mention other consumer and patient movements. What people with disabilities increasingly say they need are alternatives to the services provided by mainstream rehabilitation and health organizations (Beaulaurier & Taylor, 2001a; Tower, 1994).

The notion that people with disabilities need assistance and services that lie outside the traditional framework of mainstream health and rehabilitation organizations is well established in the disability rights community (Kailes & Weil, 1985; Mackelprang & Salsgiver, 1996; Renz-Beaulaurier, 1998; Tower, 1994). For a substantial number of disabled people, however, there is also a need for services and other forms of assistance, in order to facilitate community-based living (Mackelprang & Salsgiver, 1999; Mathews, 1990; McAweeney, Forchheimer, & Tate, 1996). In order to obtain both rights and services, many disability activists have had to organize and mobilize their constituencies (Varela, 1983).

In an environment where organizational and environmental priorities appear to be at odds, social workers in health care settings increasingly feel the need for better community practice skills in addition to more familiar direct-practice skills. …