Running head: SOWK802 Conceptual Model

SOWK802 Conceptual Model David Hall University of South Carolina

SOWK802 Conceptual Model

Introduction The goal of professional service provision to persons with disabilities is to facilitate and enhance service recipients capacity and agency to achieve personal, social and economic independence (ACA, 2005; NASW, 2008). Services intended to advance these aims have historically been guided by medical model principles, and have produced equivocal and even unintended negative results, and may in fact undermine routes to independence. This manuscript presents a theoretically sound conceptual model that identifies advocacy-centered service provision as an effective means of promoting personal agency among persons with disabilities. In order that personal, social and economic independence is enhanced, the development of agentic capacities is particularly salient for persons with disabilities given the constraints and limitations that they face in their social environments. Drawing upon the extant research, it is argued that these constraints, which include devaluation of social status, disabilityrelated stigma, stereotypic beliefs, paternalistic practices, and medical model rehabilitation approaches result in disproportionate representation among persons with disabilities on several important life satisfaction indicators, and affect the development of personal agency needed to effect change on their own behalf The following sections will present several working definitions of the notion of disability, and will provide pertinent descriptive data that establishes the importance of generating research that may inform the means by which to reduce disparities in health and well being for this population. Next, a description of the 802 Conceptual Model, which situates persons with disabilities in an ablest environmental context that may impede the development of agentic traits in individuals with disabilities, is introduced and described. The conceptual model illustrates the hypothesis that participation by persons with disabilities in organizations that

SOWK802 Conceptual Model utilize an advocacy-orientation to service delivery will result in the promotion of personal agency, mediated by the development of emancipatory values orientation and subsequent agency-promoting strategies. Concurrently, the model suggests that participation of persons with disabilities in an advocacy-centered service organization will interrupt a stagnation-trajectory of adaptation mechanisms (Welzel & Inglehart, 2010) predictive of groups afforded low status and restricted opportunity within the social structure. The manuscript concludes with a discussion of the potential utility of the conceptual model, its limitations and challenges in ultimately yielding empirical findings, and areas for future study related to the model.

Conceptualizing and Defining Disability Collectively, persons with disabilities constitute the largest single minority group in the United States, totaling approximately 36 million individuals that comprise 20% of the total population (Drum, McClaine, Horner-Johnson & Taitano, 2011). Persons with disabilities constitute a highly diverse population inclusive of physical, psychiatric/emotional, cognitive and behavioral conditions, and which span racial, gender, class, ethnic, sexual orientation and age dimensions. The shear the size and expansive spectrum of this population, in addition to discipline and interest-group-specific orientations to the notion of disability, underlie why a universally agreed upon definition of disability remains elusive. While there does exist a continuum of perspectives that inform how disability is understood and subsequently approached by professional service providers working with this population, two foundational perspectives, the medical model and the social model of disability, prevail as polar conceptualizations of disability.

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The Medical Model Perspective of Disability The medical community has traditionally defined disability as a medical condition or illness that results in dependency that deviates from biological and social norms (Scullion, 2010). A medical model definition of disability views the impairment and its resulting functional deficits as the defining consideration, situating the cause or source of disability within an objectified individual (Hughes, 2010). The corresponding approach to service provision is characterized by service providers acting in the role of experts who seek to treat impairmentrelated deficits in a way that fosters adaptation to the impairment/condition, and optimal normalization to conventional social expectations (Scullion, 2010; italics added for emphasis). The medical model perception of disability as deficit is perhaps most clearly evidenced in the utilization of Disability Adjusted Life Years (DALY) as a mechanism for cost effectiveness analysis and epidemiological studies (Jelsma, De Weerdt, & De Cock, 2002). While the DALY intended use is to promote preventive public health initiatives, its formulaic calculation of the depreciation of a persons value of life given a particular disability status is premised on the assumption that a life with disability is of less value than a life without disability. The Americans with Disabilities Act (ADA), enacted in 1990 and most recently amended in 2008, constituted an initial challenge to the predominant biomedical conceptualization of disability in its regulatory provisions, yet retains a medicalized orientation in its oft-cited definition of a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more major life activities; or (2) has a record of such an impairment; or (3) is regarded as having such an impairment (ADAAA, 2008).

SOWK802 Conceptual Model The Social Model The social model of disability (Oliver, 1983), a perspective developed and championed by persons with disabilities in reaction to the medical model (Barton, 2009 as cited in Oliver & Barnes, 2010), distinguishes between impairment a long-term characteristic of an individual that affects the body, mind or senses - and disability exclusion resulting from the barriers imposed by, or ignored by, society. Proponents of the social model do not deny the reality or related functional challenges resulting from the impairment, but argue that it is the environmental barriers (social, physical, educational, economic, and attitudinal structures constructed in and by society) encountered by persons with disabilities that constitute the primary source of limiations (Iezzoni & Freedman, 2008; Hughes, 2010; Oliver, 1983; Oliver & Barnes, 2010; Scullion, 2010). The social model defines disability as occurring between the person and his/her environment, and looks to the physical, social, political and economic structures of society as the primary target for change. Aligning closely with a Freirean (1970/1993) perspective on the dynamics of oppression, proponents of the social model contend that if disability exists, there must also exist a disabler and a disabled (Scullion, 2010); the oppressor and the oppressed. The World Health Organizations International Classification of Functioning, Disability and Health (ICF) incorporates the social model perspective in its distinction between impairment understood as the organic manifestation itself, disability the restrictions in performing developmentally-expected activities that result from an organic condition, and handicap - the social consequences of deficient ability (WHO, 2001). This conceptual paper adheres to the ICF definition, defining disability as an umbrella term for impairments, activity limitations and participation restrictions [and] denotes the negative aspects of the interaction between an individual and contextual factors (environmental and personal factors) (WHO 2001, 213).

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Persons With Disabilities as an At-Risk Population While establishing a universally accepted definition of what constitutes and/or causes disability remains a work in progress, evidence that the life experiences of persons with disabilities are characterized by discriminatory practices, limited access to physical, social, economic, and political resources and opportunities, and negative belief systems all serving to restrict opportunity for mobility within the socio-environmental structure across employment, educational and health domains (Drum et al., 2011; Scullion, 2010) - is well supported in the literature (Balcazar & Taylor-Ritzler, 2009; Brault, 2010; Chima, 2003; Drum et al, 2011; Nosek & Simmons, 2010). Employment Current research suggests that employment opportunities are disproportionately denied to persons with disabilities (Balcazar & Taylor-Ritzler, 2009; Brault, 2010; Drum et al, 2011), placing them at risk for both economic and social marginalization. Several studies (e.g., Brault, 2010; Drum, et al., 2011; Nosek & Simmons, 2010) report that only 1/3 of all persons with disabilities find sustained employment, as compared to 72-75 percent of people without a disability; a proportion that is essentially the same as it was in 1990 prior to the enactment of the ADA (Chima, 2003). Similar to trends within the non-disabled population, persons of color and women with disabilities experience greater barriers to employment. Balcazar & Taylor-Ritzler (2009) report that persons of color with disabilities are less likely to be employed than are whites with disabilities, while Parish, Rose and Andrews (2009) found that, among all subgroup populations explored, women with disabilities experienced the lowest employment rates and highest reliance on Supplemental Security Income (SSI).

SOWK802 Conceptual Model Poverty and Economic Well-being Related, individuals with disabilities are reported to be nearly twice as likely to live in poverty than are those without disabilities (Nosek & Simmons, 2007), with some studies as high as a 27% poverty rate (Erickson and Lee, 2008). Women with disabilities are more likely than men to live below the poverty level (Nosek & Simmons, 2007), and are reported to experience hardships including food and housing instability, inadequate health care, and loss of phone service at higher rates than non-disabled women (Parish,Rose & Andrews, 2009). Data suggests that persons with cognitive/intellectual (Mercier & Picard, 2011) and psychiatric/mental disabilities (Cook, 2006) suffer disproportionately more chronic and severe levels of poverty relative to the non-disabled population as well as compared to persons with non-intellectual and non-psychiatric disabilities. Soffer, McDonald & Blanck (2010) point out that the economic disparities experienced by persons with disabilities are in part associated with the higher costs related to living with a disability (e.g. assistive technology, physical and behavioral health care, accessible housing and transportation). Not surprisingly, a majority of persons with disabilities fall within what is considered to be the asset poor, meaning that their access to economic resources is insufficient to sustain themselves for a limited period of time (Oliver & Shapiro, 1995; Havemann & Wolff, 2004).

Health Disparities While persons with disabilities are not formally acknowledged or included as a population at risk by Federal health disparity efforts (Nosek & Simmon, 2007), research suggests that this population is in fact over represented across numerous health conditions, and constitute a highly vulnerable group. Drum and colleagues (2011) used data from the Behavioral Risk Factor Surveillance System (BRFSS), a public health survey established by the Centers for

SOWK802 Conceptual Model Disease Control and Prevention (CDC), to compare self-reported prevalence rates of various health indicators among working aged (18-64) persons with disabilities with those of other minority populations in the United States. The authors report that persons with disabilities are in fact at greatest risk relative to other marginalized groups in regard to prevalence rates on ten of fourteen health indicators as reported in the Health Disparities Disability and Rehabilitation Research Project database. Relative to other minority populations, persons with disabilities have experience a higher prevalence rate of obesity, diabetes, heart disease, and stroke, and experience the greatest financial barriers to health care (Drum et al, 2011). Persons with disabilities are also at risk for secondary emotional/psychiatric conditions that result from intra-psychic and/or socio-environmental responses to the organic condition. Several studies (Brown & Turner, 2010; Mirowsky & Ross, 1999; Turner, Lloyd & Taylor, 2006; Turner & Noh, 1988; Turner & Turner, 2004) have explored the relationship between disability and depression, and report up to a three-fold increase in depressive symptoms among persons with a physical disability. Brown and Turner (2010) report that low level of mastery and self esteem were the strongest predictors of depression levels. deRoon-Cassini, de St. Aubin, & Valvano (2009) explored the factors that contribute to perceived quality of life following spinal cord injury, and report that it is the perception and internalized beliefs related to perceived loss of physical resources rather than the severity of the impairment itself that was most predictive of self-reports of psychological well-being. Of significant relevance to the current study, wellbeing was partially mediated by the nature and level of global meaning making, a concept whose defined as clear and personally valued, coherent goals/aims in life, and a sense that these goals had been achieved (deRoon-Cassini, de St. Aubin, & Valvano, 2009), parallels the construct of agency, defined later in this manuscript.

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Effectiveness of Service Provision in Advancing Well-Being In addition to concurring with the social model perspective that would argue that the descriptive statistics pertaining to the plight of persons with disabilities presented above are in large part the result of an ablest social structure that restricts the range of life opportunities for this population, it is further contended that the nature and effectiveness of medical modeloriented service organizations which dominate service options for persons with disabilities (Beauchamp-Pryor, 2011; Marini & Chacon, 2002; Oliver & Barnes, 2010; Patchner, 2005; Scullion, 2010; Tilsen & Nylund, 2008) are also complicit in the generation of these data. Medical model-oriented services place the client/patient in the role of passive participant who defers to the expert counselor, whose rehabilitative goals center on curing, fixing or facilitating adaptation of the person to better fit in an ablest society (Patchner, 2005; Rothman, 2008). In placing the person with a disability in a passive role in regard to his/her own treatment, the dominance of the medical model across service options for persons with disabilities may well serve to reify a deference orientation (Welzel, Inglehart and Klingemann, 2003), a key consideration that predicts low individual agency in the 802 conceptual model presented later in this manuscript. Considerable literature (e.g. Barnes, 2007; Bircher, 2000; Gallagher, 2001; Hughs, 2000; Oliver, 1983; Oliver & Barnes, 2010; Tilsen & Nylund, 2008) refers to the rejection of the medical model by persons with disabilities. Tilsen & Nylund (2008), for example, in arguing in favor of greater counselor-client collaboration in the rehabilitation counseling process, report that the medical model of care has engendered service recipients with a sense of hopelessness and voicelessness (pp. 340). Other studies reviewed (e.g. Barnes, 2007; Bircher, 2000; Gallagher, 2001; Hughs, 2000; Oliver, 1983; Oliver & Barnes, 2010; Tilsen & Nylund, 2008) relate that the

SOWK802 Conceptual Model historical dominance of a medical model orientation in service delivery has served to invalidate bodies and minds that do not conform to social norms, confer lower status upon persons with disabilities, and shape both intrapersonal and societal perceptions and expectations about disability. Social model proponents maintain that the dominance of the medical model has, in this sense, contributed to societys restriction of opportunities and exacerbation of stereotypes and belief systems that impede inclusion of persons with disabilities participation in mainstream social, economic and political activities (Oliver & Barnes, 2010). Concern regarding the efficacy of medical model service provision, and the impetus for exploring the efficacy of an advocacy-centered approach to service, is further motivated by the fact that medical model treatments have been shown to yield ambiguous outcomes. While literally hundreds of studies investigating the effects of specific clinical treatment approaches are found in the professional literature, their overall impact on well-being, as evidenced in part by the data described in the Persons With Disabilities as an At-Risk Population section of this manuscript, is equivocal. A good example of these indefinite findings is reflected in Wampolds (2001) study of the effect of therapy on persons with mental health diagnoses. Wampold reports that, despite therapy-centered treatment having an overall positive effect size of between .7 and .8 on advancing desired outcomes, it is client-related factors (e.g., optimism, persistence, resources, environmental context) rather than the expertise of the clinician or the effectiveness of the clinical approach, that account for 87% of improvement observed in the course of therapy. Thus, only 13% of desired change is associated with the medical-model rehabilitation approach employed. While the fore-mentioned research begins to indicate the shortfalls of medical model services in advancing well-being among persons with disabilities, empirical investigation of the effects of an alternative model of advocacy-centered service is lacking. Multiple searches across

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SOWK802 Conceptual Model social science, social work, psychology, and medical databases uncovered no empirical investigations that examined the effects on participation in an advocacy-centered service programs on well-being at the individual level of analysis.

Introduction of the Conceptual Model As indicated in the previous section, medical model rehabilitative approaches to service provision with persons with disabilities has provoked strong criticism from consumers and advocates within the disability-service field, while concurrently yielding unconvincing outcomes in regard to intrapersonal and social justice needs of this population. The following section presents the 802 Conceptual Model, represented in Figure One, that identifies advocacy-centered service provision, characterized by Freirean and social model principles, as an alternative to medical model-oriented rehabilitation for persons with disabilities. Specifically, this model is intended to provide a foundation for further exploration of the question: what is the effect of participation in advocacy-centered service programs on the development of individual agency among persons with disabilities? The model visually and conceptually illustrates the hypothesis that participation by persons with disabilities in organizations that utilize an advocacyorientation to service delivery will result in the promotion of personal agency, mediated by the development of emancipatory values orientation and subsequent agency-promoting strategies. Concurrently, the model suggests that participation of persons with disabilities in an advocacycentered service organization will interrupt a stagnation-trajectory of adaptation mechanisms (Welzel & Inglehart, 2010) predictive of groups afforded low status and restricted opportunity within the social structure. The models components as well as the propositional relationships are explained in detail below.

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SOWK802 Conceptual Model Explanation of the Conceptual Model This section provides an overview of the 802 Conceptual Model; each component, designated by the boxed shapes, and proposed relationships indicated by letter/numbered arrows between components is explained, with supporting relevant literature provided. The model situates persons with disabilities in an ablest social structure that often places limits on the range and quality of opportunities for persons with disabilities. These limitations may be evidenced in paternalistic attitudes, manifest in formal and informal policies, observable in interpersonal and social relations, and/or experienced in the physical structure in which persons with disabilities interact on a daily basis. The conceptual model draws heavily upon two theoretical frameworks; the Evolutionary Human Development model, developed by Welzel, Inglehart and Klingemann (2003) and Welzel & Inglehart (2010)1, and Freires (1970/1993) conceptualization of conscientization, to explain the relationship between participation in advocacy-oriented service programs and the development of individual agency among persons with disabilities.
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It should be noted here that the original Human Development model as designed by the Welzel, Inglehart & Klingemann was used to describe collective changes in human development at the international/societal level. The authors viewed the process of societal human development as unfolding in evolutionary fashion in response to changing macro level contexts (e.g., globalization, regime change, technological advances). Welzel, Inglehart and Klingemann (2003) and Welzel & Inglehart (2010) attribute societal change in large part to an emerging citizenlevel emancipatory orientation, resulting from the benefits of socio-economic development that result from these contextual changes. An emancipatory orientation is founded on increased freedom of choice and access to new opportunities that become available within the social, economic and political structure. Societies and populations within them who begin to experience greater opportunity, according to the authors, eventually shed their deference orientation that resulted from a survival/basic needs focus, as legitimate freedoms for opportunity pursuits emerge.An orientation of possibility promotes appraisal of existing opportunities, goal setting, and engagement in strategies (e.g. skill building) that increase the likelihood of goal attainment.

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SOWK802 Conceptual Model In the section below, I first introduce the consequent variable, human agency, identified in the model as the purple box, situated on the far right. Next, using Welzel et als (2003; 2010) framework of Evolutionary Human Development as a foundation, the relationships between the environmental structure (situated far left in model, maroon box), which is understood to include physical, social, economic, cultural and political domains, and two human development trajectories, one that promotes thriving and optimal agentic development (trajectory A(1-4), green arrows/boxes), and one characterized by a stagnation (trajectory B(1-4), brown arrow/boxes) are explained. Finally, a third potential trajectory (C(2-4), red arrows) emerging as a result of participation in an advocacy-oriented service organization (the intervening variable) is described.

The Consequent Variable: Human Agency I begin by defining the desired end-result, the development of human agency. Among the

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SOWK802 Conceptual Model publications reviewed (Alkire, 2005; Bandura, 1989, 1997; Frost & Hoggett, 2008; Kotan, 2010; Ryan & Deci, 2000; Schwartz, 1992; Sen, 1999; Welzel & Inglehart, 2010) several closely related definitions, often employing unique terminology, were uncovered. Kotan (2010), for example, describes an agentic individual or group as one who demonstrates the ability to exert power so as to influence the state of the world, and to do so in a purposeful way that advances self-established objectives. Similarly, Sen (1999) defines a human agent as someone who acts and brings about change, and whose achievements can be judged in terms of her own values and objectives (p12). Central to each of these definitions is the notion of self-directed action intended to advance a self-determined objective. Sens reference to the relationship between agency and values is an important one that is echoed in much of the literature. Schwartz (1992) defines values as desirable trans-situational goals, varying in importances, that serve as guiding principles in the life of a person or other social entity (p. 37). Values, in this sense, serve to motivate human choice and direction central components of agentic behavior (Welzel, Inglehart & Klingemann, 2003). Schwartz identifies the value of self-direction, the agentic capacity for independent thought and action that advances valued objectives, as one of ten universal values that apply across cultures. Similarly, Ryan & Deci (2000) contend that autonomy ones self-determined, willing behavior that is congruent with the individuals interests, values and desires- is one of three basic psychological needs that determines psychological growth, integrity and well-being. Alkire (2005), like Ryan & Deci, elaborates on the relationship between agency and wellbeing, arguing that well-reasoned self-direction, a characteristic she relates to the exercise of agency, may also, to the degree that it fosters intrinsic satisfaction, serve as one of several dimensions that enhance or inform well-being. She adds that agency can also cause well-being

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SOWK802 Conceptual Model as individuals exercise agentic capacities to advance other dimensions of their lives that contribute to overall life satisfaction. Welzel and Inglehart (2010) analyzed the effects of agency on well-being at both a societal and individual levels of analysis. On both a collective and individual level, a positive and significant relationship was demonstrated between level of perceived agency and well-being. While the studies reviewed offer different lenses in defining the term, the importance of agency as a vital aspect of human development and well-being is widely espoused across these studies, positioning it as a meaningful focus of investigation in this and future studies. Welzel and Inglehart (2010) for example, describe agency as the primary human trait, suggesting that human development itself is best understood as the maturation of a persons agentic traits (44). The authors argue that it is agency that allows for instrumental adaptation to changing social, political, economic and environmental conditions, and which explain both individual and societal change over time. Agency, according to Welzel and Inglehart (2010), is the primary mechanism by which humans adapt to their environmental contexts in order to meet both the demands and needs for survival and to take advantage of opportunities that allow us to thrive. As suggested earlier in this manuscript, several studies (e.g., Barnes, 2007; Bircher, 2000; Gallagher, 2001; Hughs, 2000; Oliver, 1983; Oliver & Barnes, 2010; Tilsen & Nylund, 2008) suggest that the medical model approach has served to impede the development of agency among persons with disabilities by instilling a sense of deference, voicelessness, and diminished social status in recipients of services. By contrast, advocacy centered service organizations are by design oriented toward engagement with its members in a transformative process that raise critical consciousness regarding status quo practices that limit inclusion of persons with disabilities; develop skills of advocacy; promote leadership capacities; enhance perceived self-

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SOWK802 Conceptual Model efficacy; and develop the collective capital across its membership (Pyles, 2009). These domains of individual capacity derived through the experience of advocacy initiatives, are in turn hypothesized to cultivate the development of personal agency.

Socio-Environmental Structure The Evolutionary Human Development Model, with particular attention to the relationship between status-dependent opportunities and restrictions inherent in the environmental structure, and the Welzel et al. conceptualization of sequential adaptive mechanisms (Welzel & Inglehart, 2010; Welzel, Inglehart and Klingemann, 2003), provides sound contextual framework for explaining the moderating effect of ones environmental structure on agency development. The 802 Conceptual Framework situates the environmental context as a moderating variable in that an individuals status and experience within the environment is assumed to, in most cases, affect the strength and direction (positive or negative) of the real and/or perceived access to opportunities for thriving. In modifying the Welzel et al. (2003; 2010) Evolutionary Human Development model from an international/societal perspective of the socio-political-economic structure to a community level frame of reference, the 802 Conceptual Model draws upon Germain and Gittermans (1995) conceptualization of ecological systems framework (ESF) (also referred to as person-in-environment (PIE) in the social work literature). ESF offers a perspective by which we can examine the reciprocal relationships and interactions between a person and environmental domains within which s/he interacts, makes choices, acts, and develops. Welzel and Inglehart (2010) refer to the physical, social, economic, political and cultural domains of the environment and - the practices that occur within them - as existential conditions, and argue that they define the availability of opportunities to thrive. It is argued here that the employment,

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SOWK802 Conceptual Model economic, and health disparities experienced by persons with disabilities described earlier in this manuscript serve as sound evidence that the existential conditions and the essential resources and opportunities provided through them are disproportionately denied to this population. Individual and Group Fit Within the Social Structure and Agency Both Welzel and Inglehart (2010) and Germain and Gittelman (1995) highlight the importance of a persons status in gaining access to these opportunities, associating resource access with the persons environmental fit (817). Environmental fit describes how a given person or groups needs, rights, goals and capacities are perceived to contribute to - and be supported by - the operations of the environment. Favorable fit suggests adequate adaptation between the environment and the person, and promotes continued development and satisfying social functioning, while poor fit impairs or impedes individual and group development, health and social functioning ( Germain & Gitterman, 817). The notion of environmental fit is further informed by Welzel & Inglehart (2010) who posit that the processes of stratification and socialization serve to legitimize ideologies, beliefs, and practices that benefit the elite and maintain a stratified status quo. A legitimized status quo defines a persons fit within the social environment, and dictates what is and is not viable within a given social group. Central to our study is Germain and Gittermans (1995) contention that status and fit within the community directly impact a persons capacity to act in a self-directed, agentic way (818). Germain and Gitterman (1995), who in referring to low status populations relationship to environmental fit, write: [P]eoples life circumstances may be such that few options exist in their environment, so personal choice and decisions are meaningless. If people have no control over undesirable life events or financial security, then self-direction is threatened (818). Several studies (Balcazar & Taylor-Ritzler, 2009; Chima, 2005; Turner & Turner, 2010) concur

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SOWK802 Conceptual Model with the premise forwarded in the 802 Conceptual model that environmental constraints, notably negative societal attitudes and valuation about persons with disabilities among the general public, prospective employers and even rehabilitation professionals, undermine social and economic opportunities across the social structure for persons with disabilities. Welzel and Inglehart (2010) succinctly summarize, characterizing stratification and socialization processes as potentially caging human agentic capacities (p. 47).

Effect of Environmental Fit on Intrapersonal Perceptions Ones the environmental context, including the socialization received within that context, also serves to influence intrapersonal perceptions and beliefs about oneself and ones referent group(s) in relation to the larger society (Chima, 2005) which also affects the development of agentic capacities (Welzel, Inglehart and Klingemann, 2003). Chima (2005) found that persons with disabilities interpreted interactions with persons without disabilities to terminate sooner, entail greater physical distancing during engagement, to be generally more negative, and to produce greater levels of distress than did interactions with others with disabilities. Chima (2005) suggests that consistent interactions of this nature may negatively influence self-concept, leading to self-doubt fear of taking risks, fear of making mistakes, feeling inadequate, and concerns about what others think (48). The environmental context is thus understood for its biased utility in providing and dispersing resources and opportunities as well as for its effect on individual and group psyche. Livingston & Boyds (2010) meta-analysis investigated the relationship between internalized stigma related to mental illness and its various correlates and consequences. Internalized stigma is defined by the authors as a subjective process, embedded within a socio-cultural context, which may be characterized by negative feelings (about self), maladaptive behavior, identity

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SOWK802 Conceptual Model transformation, or stereotype endorsement resulting from an individuals experiences, perceptions, or anticipation of negative social reactions on the basis of their mental illness (2151). The authors report that higher levels of internalized stigma was negatively and robustly (r-values range from -.28 to -.58) related to lower reported measures of hope, empowerment, self-esteem, self-efficacy, quality of life, and social support. Welzel and Inglehart (2010) further suggest that existential conditions shape intrapersonal perceptions about if and how a given opportunity makes sense given the socio-economic environmental considerations, including ones likelihood of capitalizing on an opportunity given his/her socio-cultural status. As a point of example, we might consider the utility of a woman receiving professional training for work outside the home if she is situated in a highly patriarchal society in which cultural values and practices heavily endorse the male breadwinner, female motherhood paradigm. Under these environmental conditions, even if the opportunity for such training became accessible, the slim likelihood of applying those skills in a way that might foster thriving, significantly reduces the trainings utility. Accordingly, it is not just access to opportunities, but also the calculation of the degree to which the opportunity holds utility to advance thriving, given ones station in the social strata, that contributes to ones overall outlook. The authors refer to the association between existential conditions and real or perceived opportunities as the environment-utility link. The underlying theory advanced by Welzel et al. (2003; 2010) suggests that the degree of access or barriers and value of opportunities that exist within the social environment for a given individual/group set in motion a sequence of adaptive beliefs and behaviors that reflect and predict thriving or stagnating trajectories, which in turn predict the level and nature of agency

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SOWK802 Conceptual Model developed. These sequences are described in the section below.

Sequence of Adaptive Mechanisms: Thriving Trajectory The 802 Conceptual Model illustrates two general trajectories of human agency development; the thriving and the stagnating sequence of adaptive mechanisms. The thrive trajectory is situated at the top of the 802 model, and is identified by green boxes and arrows designated A1-A4; the stagnation trajectory is situated at the bottom of the model, and is identified by brown boxes and arrows designated B1-B4. A third trajectory emerging from the blue box labeled Advocacy Oriented Service Provision, this studys predictor variable, is explained later in this manuscript.

Thrive Perception: As discussed earlier, each trajectory is in large part determined by the environmental conditions (opportunities/restrictions, socialization patterns) afforded a given person or group in a stratified social structure. The model illustrates that individuals and groups afforded high levels of opportunity and access due to their social positioning, privileges of race, gender, and non-oppressed status, are more likely to have developed an optimistic perception of the life options available to them. Welzel and Inglehart (2010) term this a thrive perception.

Emancipation Orientation: Bountiful opportunities, permissive conditions for choice, and importantly, the existence of either formal protections (e.g., rights, laws) or informal norms of acceptance, connectedness (e.g., social capital) that ensure equitable access to opportunities, in turn, nourish the perception of possibility and vision for an autonomous, self-directed life (arrow A2), referred to as an emancipation orientation (green box, top center) in the 802 model. Welzel, Inglehart and Klingemann (2003) maintain that as opportunities for individual wellbeing increase in an environmental structure, greater valuation on the development of individual

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SOWK802 Conceptual Model and horizontal social capital emerges, while reliance on vertical authority relations that restrict human autonomy (341), diminishes.

Promotion Strategies: An orientation that views the world as offering a range of viable opportunities leads to (arrow A3) a prioritization of those opportunities, and the promotion of strategies (green box, top right) that enrich human capital considered necessary to maximize the successful attainment of valued goals. The process of establishing objectives and exercising ones capacity and power in the attainment of those objectives enhances human agency (arrow +A4) (Welzel, Inglehart and Klingemann, 2003; Welzel and Inglehart, 2010). Higher levels of human agency generally creates a yet wider range of options for thriving, offering further opportunity for development, and thus establishing a self-perpetuating cycle.

Sequence of Adaptive Mechanisms: Stagnating Trajectory Threat Perception: Conversely, groups experiencing historic and contemporary oppression and pressing existential conditions that restrict opportunities for thriving and impose conditions that orient attention to survival/basic needs satisfaction are predicted to promote the development of threat perceptions (arrow B1) among persons embedded in these environmental conditions. Perceived threats may include concerns that are of economic, physical, social and/or political nature. Mpofu and Wilson (2004) argued that a communitys opportunity structure, understood as the mix of opportunities and related resources within a setting that are differentially distributed relative to status (e.g. social class, ethnicity/race, physical/mental state), orients each person to viable goals and strategies available to attain a desired end (e.g., employment). In considering the effect of environmental structure on students with disabilities, the authors add that that both real and perceived adverse societal attitudes, barriers to inclusion, and paternalist

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SOWK802 Conceptual Model perspectives pose threats that negatively influence the students internalized belief systems about disability, which serve to further narrow the scope of perceived opportunities within this oppressed population (Mpofu & Wilson, 2004). Deference Orientation: Viewing ones world through a lens that primarily focuses on threats to survival and limitations for mobility advances a self-protective orientation and a valuation of deference (arrow B 2) to the status quo, authority, and compliance with within-group norms (Welzel & Inglehart, 2010; Welzel, Inglehart & Klingemann, 2003). Welzel, Inglehart and Klingemann (2003) argue that the publics prevailing value orientations reflect the constraints imposed upon human autonomy by greater or lesser pressing social conditions (347). The authors contend that the social structure, the degree of opportunity afforded a particular group, and that groups perception of access to opportunities for thriving shapes value orientation (Welzel, Inglehart & Klingemann). Specifically, the authors contend that pressing social conditions and the resulting threat perception that prevails serve to restrict the range of human choice, and in doing so, reduce the expression and valuation of emancipatory ideals in favor of a deference and conformity oriented perspective. A deference value orientation, in this sense, may be manifest acceptance of ones position and life circumstance, foreclosure on opportunities that are perceived to be out of reach, and centering of attention on complying with authoritative entities (e.g. county, state social welfare providers) who possess the power to grant or impede access to resources needed for basic survival needs satisfaction. Such a response is well understood through the lens of Maslowian (1988) theory, which suggests that, in the light of pressing survival needs, people will adjust their aspirations to focus thinking and actions on meeting the most basic needs first, rationally choosing to forego energy expenditure on goals that, in the present context, appear unattainable

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SOWK802 Conceptual Model or of secondary importance (Maslow, 1988). Deference may also occur in relation to ones primary reference group. This is reflected in the findings reported Quane and Rankin (1998) who found that African American males residing in impoverished environmental contexts characterized by low employment, low parental educational attainment, and high levels public welfare utilization report homogenous peer group orientation in regard to skepticism related to the utility of academic attainment as well as low expectations pertaining to acquiring employment.

Prevention Strategies: Adaptation under restrictive environmental conditions dispose individuals to engage in the development of what Wenzel and Inglehart (2010) refer to as prevention strategies (arrow B3). Prevention strategies, which flow directly from ones orientation regarding what is possible and viable given environmental opportunities and constraints, refer to a focal interest in avoiding failure, and are characterized by downward aspiration and action adjustment (Costa, McCrae & Zonderman, 1987) and implementation of survival-centered strategies (Maslow, 1988). As indicated by the negative symbol associated with propositional arrow B4, it is contended (Wenzel & Inglehart, 2003) that while prevention strategies may well serve to alleviate perceptions of threat, they do not promote a valuation of emancipation that leads to strategies to enhance human agency (arrow -B4). Several studies have reported on the impact of the social environment and ones position within it on expectations for the future. For example, Turley, Santos and Ceja (2007) effectively argued that the colleges to which a student applies suggests what that student believes to be realistic and expected, rather than what is aspired to, given their individual academic performance as well as their social origin and status. The authors found that high levels of parental education and family assets were associated with applications to prestigious schools,

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SOWK802 Conceptual Model while lower family SES, as well as female gender, was associated with applications to less prestigious colleges (Turley, Santos & Ceja, 2007). Turley et als (2007) study reflects how relative perceived status in the environment shapes intrapersonal perceptions and expectations regarding what is possible and viable within the environmental opportunity structure.

The Intervening Variable: Participation in Advocacy-Oriented Service Organization By itself, Welzel and Ingleharts (2003) evolutionary model of human development might be interpreted as highly deterministic in nature; that once a trajectory has been embarked upon, the outcome is a fait accompli, at least in the relative short term. It is suggested here that there is nothing inherent in the Welzel et al. (2003; 2010) theoretical or conceptual framework that precludes the introduction of a catalytic mechanism, such as participation in an advocacycentered service organization, to determine its effect on redirecting an individuals trajectory and consequent development of human agency. As indicated in the 802 Conceptual Model, it is argued that participation in a Freirean-informed advocacy program (positioned in the center of the model, blue box) that incorporates a social model orientation may interrupt a presently experienced deference trajectory (arrow C 1 -), and promote an emancipatory perspective and value orientation (arrow C 2 +). As an explanation of process, it is suggested here that an advocacy program that incorporates a social model perspective and a Freirean (1970/1993) approach that emphasizes the development of critical consciousness and praxis, termed conscientization (67), will promote the insight, motivation, skill development and action necessary to redress social inequities experienced within the social environment. Freires (1970/1993) conceptualization of conscientization, which is itself grounded in Marxist critical theory, is comprised of two central processes. The first entails a sequential process by which subjugated groups develop an increased

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SOWK802 Conceptual Model level of critical consciousness through reflective discourse. This has been termed a transformational process (e.g. Pyles, 2009). Horizontal, non-hierarchical dialogue is purported to promote (1) enhanced awareness of shared conditions and consequences among members of an oppressed group, (2) the identification of the structural causes that undergird these conditions, (3) a vision of an alternative, more just arrangement of conditions, and (4) an individual and collective inclination to confront the oppressive structure in the pursuit of the alternative vision (Freire, 1970/1993). The second component of Freires (1970/1993) process of conscientization is praxis reflective action brought about as a result discourse (Freire, 1970/1993, p. 88) that is intended to advance the process of changing the structural conditions that undergird the oppression encountered by the group. An important tenet of Freires (1970/1993) model is that discourse and reflective action must both occur if transformation is to be realized; while sacrifice of discourse results in unreflective re-action that serves to divert subsequent dialogue (and thereby impede deeper levels of critical consciousness), sacrifice of action following reflective discourse amounts merely to empty verbalism. Applied to the 802 Model, an individuals active participation in collective consciousnessraising and advocacy-related actions are expected to: transform prior held beliefs and behaviors that reflected, prior to participation, a deference orientation; facilitate the development of individual and group objectives related to their shared experience of injustice; and reorient the individual to opportunities to improve ones experience in the social environment that were not evident prior. The process by which reorientation of perspective changes from deference to emancipatory, the identification of group and individual objectives to address injustice, and participation in advocacy-oriented action steps parallel the very definition of agency (Kotan,

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SOWK802 Conceptual Model 2010; Sen, 1999 ). These processes serve to catalyze the transformation of participants from that of objects that unreflectively adapt to the conditions imposed upon them by the structures and practices of a society, to more fully humanized subjects capable of envisioning and potentially acting to advance the transformation of themselves and the world in which they coexist.

Discussion The 802 Conceptual Model constitutes an initial effort to address a definitive gap in the literature pertaining to the efficacy of participation in advocacy-centered services on the development of individual agency among persons with disabilities. Several explanations, including the relative deprivation theory (RDT) and the social identity theory (SIT) have been forwarded to explain why people join in advocacy initiatives in the first place. The RDT posits that people engage in collective advocacy in response to beliefs that their group has been treated unjustly, or is deprived of certain rights and resources relative other groups (Runciman, 1966). Similary , the SIT describes the effect of oppressive inter-group dynamics that influence intragroup coalescence and advocacy-oriented behavior (Tajfel, H., & Turner, J.C., 1979). While the literature includes a body of work that has empirically investigated these and other theories pertaining to the social, psychological and pragmatic motivations underlying why individuals engage in advocacy-related actions, lacking are conceptual and empirical accounts that describe the effect of participation on individual outcomes such as improved agency, self-efficacy, social capital and general health and well-being. Exploration of the relationship between participation in advocacy-centered services on the development of agency is intended to produce knowledge that may be of practical value in the design and orientation of services made available to persons with disabilities. Service strategies

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SOWK802 Conceptual Model that employ Freirean processes of conscientization and a social model orientation of disability may be more consciously and consistently incorporated into existing service models, including those that currently reflect a medical model perspective. Such a transition in service orientation may be viewed as a continuation of a slowly-developing paradigmatic shift away from strict adherence to medical model tenets and top-down, expert-guided practices. This transition has been evidenced by a growing recognition of the ethical significance and efficacy of clientcentered service, respect for consumer self-determination, and the ubiquitously-cited if at times poorly defined goal of enhancing client empowerment. Advocacy, as understood through a Freirean and social model lens, extends the notion of empowerment from that which is bestowed upon a marginalized group (e.g., see Narayan, 2002) to that which humanizes and legitimizes marginalized individuals and groups (Friere, 1970/1993) as a result of their own conviction and action; their own agency. Alternatively, advocacy-centered service strategies, if demonstrated to generate optimal outcomes, may be incorporated as the primary technology of a service organization, resurrecting Gibelman and Krafts (1996) contention that advocacy should be institutionalized and strengthened as a program of service(43), rather than appended as a peripheral afterthought. All this being said, there exists a selection bias limitation in regard to translating the 802 Conceptual Model into an empirically-testable framework. As indicated earlier, relative deprivation and social identity theories each suggest that conditions of oppression and marginalization promote involvement in advocacy-related initiatives, largely fueled by anger and a sense of solidarity resulting from common experience. This premise, which is well supported in the literature, runs counter to Welzel and Inglehart (2010) proposition that low social status and limited access of environmental resources and opportunities promote an orientation of

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SOWK802 Conceptual Model deference. Clearly, there exists a range of responses to oppressive conditions and practices. Some individuals will be predisposed toward traditional rehabilitation and counseling services that position them in a more passive client role, and others that inspire a person toward a service technology that seeks to redress the oppression. Pre-existing emancipatory predispositions make it difficult to determine the unique impact of participation in an advocacy organization. Given the lack of empirical investigation in this area, the potential focus of future research is rich with opportunity. While the 802 Conceptual Framework is, by design, highly inclusive across types of disabilities and levels of severity, gender, age and ethnicity/race, it stands to reason that each of these factors may well moderate the effectiveness of participation in advocacy-centered organizations. Of particular interest will be the intersectionality of these factors, as it is expected that such cross sections will differentially define status, and thus perspectives and decisions about choice and mobility in the social environment.

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SOWK802 Conceptual Model

References American Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: Author. ADA Amendments Act (ADAAA) of 2008, Public Law 110325, Section 9021b, (2008).

Alkire, S. (2005). Subjective quantitative studies of human agency. Social Indicators Research, 74, pp 217-260. Balcazar, FE & Taylor-Ritzler, T. (2009). Perspectives of vocational rehabilititation counselors on the factors related to employment outcomes of racial and ethnic minorities with disabilities. Journal of Social Work in Disability & Rehabilitation, 8, pp 340-354. Bandura, A. (1997). Self-efficacy: The Exercise of Control. NY: Freeman.

Bandura, A. (2004). Health promotion by social cognitive means. Health Education and Behavior, 31, pp. 143-164. Barnes, C. (2007). Disability activism and the struggle for change: Disability, policy and politics in the UK. Education, Citizenship and Social Justice, 2(3), 203-221. Barton, L. (2009). Transcript of audio interview with Professor Len Barton.www.informaworld.com/smpp/educationarena_interviewonline_interview5~db= educ. Beauchamp-Pryor, K. (2011) Impairment, cure and identity: where do I fit in?. Disability & Society, 26(1), 5-17. Brown, R.L. & Turner, R.J. (2010). Physical disability and depression: Clarifying racial/ethnic contrasts. Journal of Aging and Health, 22(7), 977-1000. Cook, J. A. (2006). Employment barriers for persons with psychiatric disabilities: Update

29

SOWK802 Conceptual Model of a report for the President's Commission. Psychiatric Services, 57(10), 13911405. doi:10.1176/appi.ps.57.10.1391 Costa, P.T., McCrae, R.R. & Zonderman, A.B. (1987). Environmental and dispositional influences on well-being. British Journal of Psychology, 78; 299-306. deRoon-Cassini, T.A., de St. Aubin, E., & Valvano, A. (2009). Psychological well being after spinal cord injury: Perception of loss and meaning making. Rehabilitation Psychology, 54(3), 306-314. Drum, C., McClaine, M.R., Horner-Johnson, W., Taitano, G. (2011). Health Disparities Chart Book on Disability and Racial and Ethnic Status in the United States. Institute on Disability, University of New Hampshire. Erickson, W., & Lee, C. (2008). 2007 Disability status report: United States. Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics. Freire, P. (1970/1993). Pedagogy of the Oppressed. New York: Continuum International Publishing Group, Inc. Gallagher, H. (2001). What the Nazi Euthanasia Program can tell us about disability oppression. Journal of Disability Policy Studies, 12(2), 96-99. Germain, C.B. & Gitterman, A. (1995). Ecological perspective. In Encyclopedia of Social Work (19th edition), 816-824. Haveman, R., & WolfF, E. (2005). Who are the asset poor: Levels, trends and composition, 1983-1998. In M. Sherraden (E.), Inclusion in the American dream: Assets, poverty, and public policy (pp. 6186). New York: Oxford University Press. Hughes, B. (2000). Medicine and the aesthetic invalidation of disabled people. Disability &

30

SOWK802 Conceptual Model Society, 15(4), 555-568.

Hughes, R. (2010). The social model of disability. British Journal of Healthcare Assistants, 4(10), 508-511. Iezzoni LI, Freedman VA. (2008). Turning the disability tide: the importance of definitions. JAMA, 299: 332-334. Jans, L., Stoddard, S. & Kraus, L. (2004). Chartbook on Mental Health and Disability in the United States. An InfoUse Report. Washington, D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research. Jelsma, J., De Weerdt, W., & De Cock, P. (2002). Disability Adjusted Life Years (DALYs) and rehabilitation. Disability & Rehabilitation, 24(7), 378-382. Kotan, M. (2010). Freedom or happiness? Agency and subjective well-being in the capability approach. The Journal of Socio-Economics, 39(3), 369-375. Lopez-Turley, R.N., Santos, M., & Ceja, C. Social origin and college opportunity expectations across cohorts. Social Science Research, 36, 1200-1218. Marini, I., & Chacon, M. (2002). The Implications of Positive Psychology and Wellness for Rehabilitation Counselor Education. Rehabilitation Education, 16(2), 149-163. Mirowski, J. & Ross, C.E. (1999). Well-being across the life course. In A.V. Horwitz & T.L. Scheid (Eds.), Handbook for the study of mental health: Social contexts, thories, and systems (pp. 328-347). Cambridge, UK: Cambridge University Press. Mpofu, E. & Wilson, K. (2004). Opportunity structure and transition practices with students with disabilities: the role of family, culture and community. Journal of Applied Rehabilitation Counseling, 35(2), 9-16. Murray CJL, Salomon JA, Mathers CD, Lopez AD, editors. Summary measures of

31

SOWK802 Conceptual Model population health: Concepts, ethics, measurement and applications. Geneva: WHO; 2002 National Association of Social Workers. (2008). Preamble to the Code of Ethics. Retrieved November 30, 2011, from http://www.socialworkers.org/pubs/Code/code.asp Nosek, M.A. & Simmons, D.K. (2007). People with Disabilities as a Health Disparities Population: The Case of Sexual and Reproductive Health Disparities. Californian Journal of Health Promotion 5(Special Issue:Health Disparities & Social Justice), 68-81. Oliver, M.L. (1983). Social Work with Disabled People. Basingstoke, MacMillan.

Oliver, M. L., & Shapiro, T. M. (1995). Black wealth/white wealth: A new perspective on racial inequality. New York, NY: Routledge Press. Parish, S.L., Rose, R.A., Andrews, M.E. (2009). Income poverty and material hardship among U.S. women with disabilities. Social Service Review, 83(1), 33-52. Patchner, LS. (2005). Social work practice and people with disabilities: Our future serves. Advances in Social Work, 6, pp. 109-120. Pyles, L. (2009). Progressive community organizing: a critical approach for a globalizing world. New York: Routledge. Quane, J. M., & Rankin, B. H. (1998). Neighborhood poverty, family characteristics, and commitment to mainstream goals: the case of African American adolescents in the inner city. Journal Of Family Issues, 19(6), 769-794. Rothman, JC. (2010). The challenge of disability and access; Reconceptualizing the role of the medical model. Journal of Social Work Disability & Rehabilitation, 9, 194-222. Ryan, R.M. & Deci, E.L. (2000). Self-Determination theory and the facilitation of intrinsic and extrinsic motivation, social development, and well being. American Psychologist, 55(1), 68-78.

32

SOWK802 Conceptual Model

Sen, A.K. (1985). Well-being agency and freedom: The Dewey Lectures 1984. Journal of Philosophy, 82(4), 169-221. Sen, A.,K. 1999. [2001]. Development as Freedom. Oxford University Press, Oxford.

Soffer, M., McDonald, K.E., Blanck, P. (2010). Poverty among adults with disabilities: Barriers to promoting asset accumulation in individual development accounts. American Journal of Community Psychology, 46, 376-385. Tajfel, H. & Turner, J.C. (1979). An integrative theory of intergroup conflict. In W.G. Austin & S. Worchel (Eds.), The social psychology of intergroup relations (pp.3348). Monteray, CA: Brooks/Cole. Tausch, N., Becker, J., Spears, R., Christ, O., Saaab, R., Singh, P., Siddiqui, R. (2011). Explaining radical group behavior: Developing emotion and efficacy routes to normative and nonnormative collective action. Journal of Personality and Social Psychology, 101(1), 129-148. Tilsen, J & Nylund, D. (2008). Psychotherapy research, the recovery movement and practice-based evidence in psychiatric rehabilitation. Journal of Social Work in Disability & Rehabilitation, 7(3-4), pp340-354. Turner, J.B. & Turner, R.J. (2004). Physical disability, unemployment and mental health. Rehabilitation Psychology, 49, 241-249. Turner, R.J., Lloyd, D.A., & Taylor, J. (2006). Physical disability and mental health: An epidemiology of psychiatric and substance disorders. Rehabilitation Psychology, 51, 2 223. Turner, R.J. & Noh, S. (1988). Physical disability and depression: A longitudinal analysis. Journal of Health and Social Behavior, 29, 23-37.

33

SOWK802 Conceptual Model

Welzel, C. & Inglehart, R. (2010). Agency, values, and well-being: A human development model. Social Indicators Research, 97(1), 43-63. doi:10.1007/s11205-0099557-z. Welzel, C., Inglehart, R., & Klingemann, H. D. (2003). The theory of human development: A cross-cultural analysis. European Journal of Political Research, 42, 341 379. Wompold, B.E., Ahn, H.A., & Coleman, H.L.K. (2001). Medical model as a metaphor: Old habits die hard. Journal of Counseling Psychology, 48(3), 268-273 Wompold, B.E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum. World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization. Wright, S.C., Tahylor, D.M., Moghaddam, F.M. (1990). Responding to membership in a disadvantaged group: From acceptance to collective protest. Journal of Personality and Social Psychology, 58, 994-1003.

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