Definitions of disabilities categorized as low-incidence vary in scope. Broadly defined, low-incidence disabilities refer to a visual impairment or hearing loss, deaf-blindness, and significant cognitive impairment. For children, the definition extends to any impairment that requires individualized intervention services provided by professionals with highly specialized skills and knowledge in order for the child to benefit from his or her education. Thus, this definition includes individuals with autism, traumatic brain injuries, orthopedic impairments, or multiple disabilities. Although these classifications may be useful for data collection or communicating potential needs of clients with a particular disability, individuals within each disability category may be more different than they are alike and will likely require highly individualized services.
Even when a very broad definition is used, individuals with low-incidence disabilities compose a small percentage of the population. Nevertheless, it is likely that counselors will encounter clients with low-incidence disabilities in their practice. Individuals with disabilities, like all individuals, may present with a variety of physical, social, and psychological needs that may warrant professional intervention. In keeping with ethical standards, professionals should practice within the scope of their training and recognize when it may be more appropriate to refer to a practitioner with specialized training in the area of the client’s disability.
该条目主要关注与为有视觉障碍,聋哑和听力损失的个人提供服务有关的问题。
Understanding Low-Incidence Disabilities
聋/听力难
Within the medical field, hearing loss is typically defined by one’s ability to perceive sounds of different frequencies and at different intensities. Hearing loss is classified as normal (0-15 decibel [dB] loss), mild (26-10 dB loss), moderate (41-70 dB), severe (71-90 dB), or profound (91dB or greater). In addition, hearing losses may be classified as conductive, sensorineural, mixed, or central auditory processing disorders. Hearing loss can also be defined by functional ability. For example, individuals who are able to communicate using the telephone are often considered “hard of hearing,” while those who primarily receive information visually rather than through auditory pathways are considered “deaf.” These medical and functional definitions do not necessarily correspond with an individual’s cultural identity. Some clients who have a hearing loss may consider themselves culturally Deaf (indicated with the capital D), reflecting their pride in belonging to a community of individuals that share common experiences, a rich cultural heritage, and a shared language—sign language.
The deaf and hard of hearing population is het-erogenous. Factors to consider when working with an individual who is deaf or hard of hearing include the cause, type, severity, and stability of hearing loss; age of onset; type of amplification preferred; preferred communication modality; presence of any additional disabilities; and cultural affiliation. The unique interplay of these factors differentially impacts the individual’s language development, speech intelligibility, academic performance, self-concept, identity, behavior, and social and emotional development.
Visual Impairment/Blindness
Definitions of visual impairment vary but often refer to levels of visual acuity or functioning. Clarity of vision is typically defined in terms of visual acuity, measured on a scale comparing the person’s vision at 20 feet with that of someone who has full acuity. Visual acuity ranges from normal vision (20/20 acuity) to profound low vision acuity (lower than 20/400). Visual acuity that approximates total blindness may also be designated by functional descriptions such as the ability to detect light. The term blindness typically refers to total vision loss, including no light perception, or significant impairment in sight, making it necessary for the individual to rely primarily on senses other than vision to interact with the environment. Legal blindness does not necessarily imply total blindness, and it is defined as corrected distance visual acuity of less than 20/200 or a visual field of 20 degrees or less in the better eye. Individuals with visual impairments demonstrate a wide range of vision functioning that may fluctuate on a daily basis due to a variety of factors.
Factors contributing to the uniqueness of each individual with a vision loss include the type, severity, etiology, age of onset, and stability of the vision impairment as well as the presence of one or more developmental disabilities.
失聪失明
Individuals who are considered deaf-blind have co-occurring vision and hearing losses. The vision and hearing loss both may have been present from birth, or one may precede the other. Often, vision and/or hearing may decline throughout the individual’s lifetime. Clients fitting this classification likely have significant impairments in vision and hearing, requiring specialized services that are not adequately defined by typical services for individuals who are either deaf or blind. Vision and hearing functioning vary considerably within this population, resulting in varied communication preferences and use of assistive devices. Thus, factors contributing to the uniqueness of individuals who are deaf-blind include the etiology, age of onset, severity of visual and hearing impairment, communication preferences, and presence of comorbid disabilities.
咨询考虑
Cultural Perspective
The mental health needs of individuals with low-incidence disabilities have been traditionally under-served. Historically, counselors’ misunderstandings about individuals with disabilities often led to erroneous assumptions that clients with significant hearing and/or vision loss lacked the language and cognitive skills necessary to benefit from therapy. Clients with disabilities who continually encounter bias in their everyday lives may be resistant to or distrustful of counselors who they do not feel relate to their experience. Furthermore, limited accessibility to services continues to be influenced by the shortage of professionals trained to meet the unique needs of these clients. In particular, there is a scarcity of practitioners who can communicate directly with clients using sign language.
Communication
由于沟通在治疗中的重要性,辅导员必须尝试匹配客户首选的交流方式。聋哑,听力障碍或聋哑人的客户可能更喜欢使用语音,美国手语或其他手语系统,表达语音,手势,哑剧,哑剧,肢体语言和面部表情,写作或上述组合进行交流。以其首选的交流方式直接与客户沟通可以促进治疗过程。但是,如果无法直接沟通,辅导员可能必须依靠使用口译员。辅导员应意识到间接沟通对与客户治疗关系的影响,包括客户对辅导员的信任和信心水平,沟通不畅的可能性增加以及有效评估客户的语言水平和思维过程的挑战。当必须使用口译员时,最好使用一致的认证解释器。
Developmental Perspective
A developmental perspective is also important when working with clients with low-incidence disabilities. For example, young children with visual impairments will need support to learn how to explore and function independently within their environment. Severe visual impairment may affect children’s social skills. They may need to be directly taught skills for using meaning-hil gestures and appropriate facial expressions, joining in sports and other social activities, assertiveness, and self-advocacy. Children with congenital blindness may also demonstrate behaviors that appear to be autistic (e.g., echolalia, stereotypic behaviors), which may also interfere with socialization.
与听力损失相关的语言延迟也可能会严重影响人们在整个生命周期内的行为调节和社交技能。听力损失的孩子可能会与不使用相同沟通方式的同龄人隔离。适应他们的听力和/或视力丧失可能会对个人发展的身份感和主张独立性的意愿产生重大影响。应对突然或渐进式视力和/或听力损失的个人可能会受益于咨询,以适应导致的变化。即使是那些似乎已经适应视力丧失的影响的人,在面对受视觉障碍影响的特定发展里程碑时,可能会重新体验社交和情感调整困难,例如获得驾驶执照或过渡到大学或工作场所。
Ecological Perspective
When working with clients with low-incidence disabilities, it is important for counselors to consider the match between the client and his or her environment, given each client’s unique characteristics and needs. It may be particularly important to include families in counseling. Much like individuals reacting to progressive vision or hearing loss, parents go through a process similar to grieving in reaction to their child’s diagnosis. Particularly when the diagnosis is made during early childhood, parents’ attachment and parenting skills may be affected. The overwhelming majority of children who are deaf are born to hearing parents. This results in a unique situation in which the child may communicate using a language that differs from his or her parents’ language and may identify with a culture that differs from his or her parents’ hearing culture. Furthermore, an individual’s declining vision and/or hearing functioning also likely has an impact on the family. It may be beneficial to include other family members in treatment to address changes in roles and responsibilities and associated stress on the family unit.
辅导员的角色
Counselors fill a variety of roles working with clients with low-incidence disabilities. Rehabilitation counselors evaluate and address clients’ independent living skills, use of assistive devices, social interaction skills, academic or career skills, and recreation and leisure skills. An assessment of language and communication functioning or orientation and mobility skills may also be warranted.
对低收入残疾人进行评估的专业人员应涉及有关适当评估程序的专业指南。必须仔细选择评估工具,以了解很少有工具可以与其他表现出类似残疾的人进行比较。在与视觉障碍的客户合作时,临床医生应避免对视力提出巨大需求的任务,包括具有相应视觉组成部分的口头任务,除非评估的目的是衡量视觉。相反,在与听力损失的客户合作时,非语言,基于绩效的任务可能会产生最佳功能估计。在评估期间提供住宿可能是适当的,以促进客户对任务的访问,而无需大大更改要测量的构造。还应考虑到评估是否反映了由于愿景或听力损失的影响,评估是否反映了客户曲目之外的经验。最后,在解释结果时,应仔细考虑视力或听力损失对处理速度,注意力,注意力和疲劳的影响。
References:
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- Ingraham,C。L.,Carey,A.,Vernon,M。,&Berry,P。(1994)。聋哑客户和职业康复:辅导员的实用指南。视觉障碍与失明杂志,88(2),117-127。
- Leigh, I. W. (Ed.). (1999). Psychotherapy with deaf clients from diverse groups. Washington, DC: Gallaudet University Press.
- Moore,J。E.,Graves,W。H.和Patterson,J。B.(编辑)。(1997)。与盲人或视力障碍者的康复咨询基础。纽约:AFB。