Diversity
Persons with Disabilities: Diversity and competency considerations
Randall J. Cox, Ph.D.
Editor's note:
Congratulations to Randy Cox who has just been elected chair-elect of the APA Committee on Disability Issues in Psychology! The committee is charged with promoting: the psychological welfare of people with disabilities, the development and implementation of psychological service delivery models responsive to the needs of people with disabilities, the awareness of disability issues in psychological research as well as specific research activity in disability areas, and inclusion of knowledge about disabilities and disability issues in education, training programs, and professional development of psychologists.
Phyllis Terry Friedman
There is presently a paucity of information regarding the provision of psychological services to individuals with disabilities relative to the information available regarding similar professional activities with individuals from various ethnic and cultural backgrounds. By focusing on our professional ethics code, I would contend there is justification for extending the growing recognition of the need for ethnic and cultural diversity related competence to include individuals with disabilities. I would like to more broadly address the issue of competency with regards to providing professional services to individuals with disabilities.
Kaslow (2004) defined competence as "an individual's capability and demonstrated ability to understand and do certain tasks in an appropriate and effective manner consistent with the expectations for a person qualified by education and training in a particular profession or specialty thereof (p. 775). As is indicated in the APA Ethics Code (2002), under Principle E: Respect for People's Rights and Dignity, psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and social economic status and consider these factors when working with members of such groups. Further section 201(b) of the APA Ethics Code (2002) states, "Where scientific or professional knowledge of the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in standard 2.02, providing services in emergencies"
While a reasonable amount of focus has been given to multicultural competence, I contend that a much better effort is needed to ensure that competency in individual differences is included in all aspects of graduate training programs. The APA Multicultural Guidelines (2003) noted that "All individuals exist in social, political, historical, and economic contexts, and psychologists are increasingly called upon to understand the influence of these contexts on individuals' behavior" (p. 377). The guidelines further elaborate, "Multiculturalism, in an absolute sense, recognizes the broad scope of dimensions of race, ethnicity, language, sexual orientation, gender, age, disability, class status, education, religious/spiritual orientation, and other cultural dimensions. All of these are critical aspects of an individual's ethnic/racial and personal identity, and psychologists are encouraged to be cognizant of issues related to all of these dimensions of culture" (p. 380).
In other words, graduate students should continually be educated on the way that individual differences (e.g., disability) can impact how clients are perceived as well as the way that clients perceive the clinician (Miller, 1991). Additionally, students in training need to consider how individual and cultural differences influence clients' recognition of a problem as well as potential solutions for a given problem. Dr. Greg Taliaferro (2005) quite appropriately pointed out that even something as seemingly universally applicable as evidenced-based practices (EBPs) may need significant modifications when applied to individuals with disabilities. He asserted that student's limited exposure to training opportunities may leave them prone to biases against and misconceptions of disability. Related to this concern is the survey of psychological services to clients with disabilities by Leigh, Powers, Vash and Nettles (2004) that identified several important barriers to treatment including lack of knowledge, limited training in disability issues and services, and lack of sensitivity.
As an active member of the Association of Directors of Psychology Training Clinics (ADPTC), I'm proud to acknowledge the contributions of many of our members in developing the training competencies document (Hatcher and Lassiter, 2007). Several professional organizations have embarked on a collaborative effort to develop guidelines for identifying, training and evaluating professional competencies for health and human service providers and educators in psychology (2001 American Psychological Association (APA) Education Leadership Conference (ELC), APPIC Competencies Conference: Future Directions In Education And Credentialing In Professional Psychology, held in November 2002 in Scottsdale AZ, ADPTC Midwinter Meeting, Miami FL, February 27, 2004, Council of Chairs of Training Councils (CCTC) Practicum Competencies Workgroup meeting on March 25, 2004 in Washington, DC as well as the November 2004 meeting, Division 29 Executive Committee). One important section of the professional competency document is entitled "Diversity - Individual and Cultural Differences," which includes the following three items: knowledge and understanding of the principles and findings related to individual and cultural differences as they apply to professional psychology.
Understanding of one's own situation (e.g., one's ethnic/racial, socioeconomic, gender, sexual orientation; one's attitudes towards diverse others) relative to the dimensions of individual and cultural differences (e.g., class, race, physical disability etc.). Dr. Greg Taliaferro (2005) stated it very well when he wrote, "it has been my own professional and personal experience that psychologists' attitudes, beliefs and emotional reactions towards clients with disabilities often adversely effects the therapeutic alliance. Without adequate training and examination of one's own experiences and feelings towards disabilities, psychologists may do considerable harm to their clients with disabilities" (p. 15).
Understanding of the need to consider individual and cultural differences issues in all aspects of professional psychology work (e.g., assessment, treatment, research, relationships with colleagues, etc.). It is important to remember that issues of cultural and individual diversity are considered to be relevant to the development of competence in all defined areas of professional competencies (Kaslow, 2004).
Estimates of up to 15% of the population in the United States are reported to have a disability, which greatly increases the likelihood that students and professionals in practice will indeed encounter an individual with a disability who is seeking services not once but multiple times in their career. Therefore I assert that we must continue our efforts toward bringing the issues of individual differences (e.g., disability) to the same level of importance with regards to graduate education and training that has been afforded to the topic of ethnic and multicultural diversity.
References
American Psychological Association Education Leadership Conference. (2001). Re-thinking education in psychology and psychology in education. Retrieved November 21, 2003, from http://www.apa.org/Edielc/elcOl_homepage.html
American Psychological Association (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist. Vol. 58, No. 5 pp. 377-402.
Association of Psychology Postdoctoral, and Internship Centers. (2001, November). Future directions in education and credentialing in professional psychology. Competencies conference2002, Scottsdale, AZ. Retrieved October 20,2006, from http://www.appic.org/news/3_l_news_Competencies.htm
Hatcher, R. L. & Lassiter, K. D. (2007). Initial training in professional psychology: The Practicum Competencies Outline. Training and Education in Professional Psychology, 1, 49-63.
Johnson-Greene, D. (2006). Ethics of testing and assessment of persons with disabilities: Moving towards disability-related competence. Division 22 newsletter: volume 33, No. 3.
Kaslow, N. (2004). Competencies in professional psychology. American Psychologist, 59, 774-781.
Leigh, I., Powers, L., Vash, C. & Nettles, R. (2004). Survey of psychological services to clients with disabilities. Rehabilitation Psychology, 49(1), 49-54.
Taliaferro, G. (2005). Evidenced-based practices and disability. Division 22 newsletter: volume 32, No. 4.
