Effects of cultural identification and disability status on perceived community rehabilitation needs of American Indians

Journal of Rehabilitation,  Oct-Dec, 1997  by Eugene F. Pichette,  Norman L. Berven,  Fredrick E. Menz,  Teresa D. La Fromboise

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Native American groups include American Indians, Eskimos, and Aleuts. Most empirically based counseling literature on Native Americans has focused on American Indians (Ponterotto & Casas, 1991). American Indians are culturally diverse and geographically dispersed throughout the United States. LaFromboise (1988) discussed the heterogeneity existing among American Indians, citing the work of Manson and Trimble (1982) who identified 511 federally recognized Native entities and an additional 365 state-recognized American Indian tribes. In addition, American Indians are becoming increasingly urbanized, moving to cities for subsistence and gainful employment. Nearly 200 distinct tribal languages are spoken among this diverse population. Given the enormous diversity among American Indian people, it is not possible to describe a "typical" or "generic" American Indian.

American Indians have been the object of continuing oppression, discrimination, prejudice, violence, misunderstanding, and stereotyping (Markides & Mindel, 1987). They typically have little educational, economic, and political power and, more often than not, have little influence over events occurring in the broader society or even those that occur in their own individual lives (Ponterotto & Casas, 1991). Further, the prevalence of disabilities differs between American Indians and non-Indians (Hodge & Weinmann, 1987). For example, American Indians experience visual impairments three times more frequently and hearing losses four times more frequently than the general population (Northern Arizona University & University of Arizona, 1987). American Indians are also more likely to experience disabilities that are caused by accidents, violence, and trauma. Motor vehicle accidents, which frequently result in orthopedic and/or brain injuries, are nearly 4.4 times more prevalent among American Indians than among the general population (May, 1982). The leading cause of death among American Indians is accidents, and 75% of all accidents are related to alcohol (Indian Health Service, 1985). As a result of these various factors, the rehabilitation and mental health needs of American Indians are likely to be substantial, compared to other segments of the U. S. population.

Nearly one-fourth of American Indian people reside in "identified areas" or reservations, and they remain within state and federal jurisdiction and service delivery, continuing to be served by agencies such as the state vocational rehabilitation agencies within the state-federal rehabilitation system. However, O'Connell (1987) reported that the rate at which the state-federal vocational rehabilitation system provides rehabilitation services to American Indians with disabilities was substantially lower than for other people with disabilities, even though American Indians were 1.5 times more likely than the general population to have a disability affecting their employability. Further, the rate of successful closure of American Indians with disabilities who were served within the state-federal rehabilitation system was found to be substantially lower than for other clientele served.

Services are provided to American Indians through a complex, multiple-government system, including the Bureau of Indian Affairs (BIA), Indian Health Service (IHS), and a variety of local tribal agencies, as well as many nontribal agencies, including the state-federal rehabilitation system. Many American Indian people with disabilities may simply be unaware of service agencies that exist on and off the reservations. In terms of accessing services, many American Indians have experienced economic dependency, psychological depression, and poverty, which may result in passive resistance or hopelessness (Johnson, Joe, Locust, Miller, & Frank, 1987). White (1987) found that cultural differences become barriers to service unless rehabilitation agencies make a concerted effort to understand cultural differences and to provide services within the context of those differences. White also noted that many American Indians are reluctant to seek services from the state-federal rehabilitation system, pointing out that relationships to the BIA and IHS are often characterized by dependency, while the state-federal vocational rehabilitation program requires self initiative and a commitment to long-term planning.

Cultural identification of American Indians with disabilities may be one factor influencing service delivery. In a study conducted within the state-federal rehabilitation system, White (1987) found that administrators did not perceive language differences to be a barrier to service delivery, leading White to conclude that administrators may lack sensitivity to the importance of cultural factors. Clark and Kelley (1992), citing work by Trimble (1981) and Matheson (1986), indicated that an understanding of tribal and individual cultural variations is important for effective counseling. Clark and Kelley went on to emphasize the importance of appropriate commUnication styles in counseling with American Indians in order to establish rapport and effective working relationships. Further, the lack of family or culturally appropriate support systems has been cited as a factor that often affects rehabilitation service delivery. These and other cultural elements can play a significant role in the entire rehabilitation process.