No abstract

Persons with disabilities constitute the largest minority population within the United States, yet only recently has psychology entered the dialogue of treatment issues for this population beyond the traditional medical model. In this article the authors provide an overview of considerations for psychologists who work with clients presenting with disabilities. Specifically, we address conceptual models of disability and considerations for cultural competence for working with persons with disabilities. Within the cultural competence discussion, we include critical awareness and knowledge, skills development, and practice/applications; such as accessibility, consent forms and other handouts, the psychotherapy milieu, testing accommodations, and the importance of resources, which are provided in the Appendix.

Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.

Using data from the Job Accommodation Network Information System (JANIS), the utility of self-reported functional limitations was examined in relationship to job maintenance for individuals with traumatic brain injury (TBI) who had returned to work. It was found that memory loss and attention/concentration concerns were the most common functional limitations reported. To further establish which limitations were associated with job maintenance, a binary logistic regression was applied. Results suggested that the presence of medical symptoms and emotional dysregulation were reliably and inversely associated with job maintenance. Implications are provided for further research as well as the practice of rehabilitation counseling.