Rehabilitation and American Indians with Disabilities: A Handbook for Administrators, Practitioners, and Researchers

Catherine A. Marshall, Ph.D., CRC

The Purpose of this Handbook
My life’s work in rehabilitation has been strongly influenced by culture, whether evidenced through the “required” consumption of warm peach cobbler during “home visits” when I checked on the independent living status of persons with severe and persistent mental illness in Georgia; the lesson a student with paraplegia at the University of Arizona taught me in 1980 when I asked him if he was American Indian and he told me, “No, I’m Hopi”; or the instruction of a Chippewa man in Minneapolis whom I hired as an interviewer, who told me that as a first step in conducting research in the Twin Cities, I needed to read History of the Ojibway Nation(Warren, 1957).

Successful rehabilitation practice and research with American Indians begins with an understanding of and/or relationship to the culture-and more precisely, to the specific culture of a given Nation. In the more than 10 years I have worked with American Indians in research, I have received a few phone calls from doctoral students saying, more or less, “I want to include American Indians in my research and I’m just now starting and I need to be finished in six months-what should I do?” I have to be honest and say, “In my experience, don’t bother.” An American Indian colleague once told me that when he went for counseling, having been depressed over a relationship, the counselor spent the majority of the session asking questions about his tribal customs-understanding his culture should have been a part of her professional training so that she could focus on his needs during the counseling session, and not hers.

Thus, the purpose of this book is to introduce administrators, practitioners and researchers to the context of working with American Indians who have disabilities, provide models of, intervention and training in terms of rehabilitation practice, and to present those cultural factors and ethical concerns which influence models of research. The Handbook, representing over 10 years of the editor’s experience in research, plus the collective experience of several valued colleagues, provides only a beginning. Of the Handbook’s chapters, 6 out of 14 have been published previously in rehabilitation or counseling journals and are included here because they reflect core issues to be addressed and/ or model strategies for dealing with these issues. In some cases, the specific details of a problem or intervention may have changed since an article was first published; for example, the current number of tribal vocational rehabilitation programs. However, the reader is encouraged to further explore the issues presented in this handbook through following the references provided, as well as relevant recommendations. In particular, the reader is encouraged to learn as much as possible about Native peoples in his or her local communities. The American Indian Rehabilitation Research and Training Center (AIRRTC) stands as a resource for those readers who need grounding for further study regarding the needs of American Indians with disabilities.

The Context: Present Realities of American Indians
In “The State of Native American Health” (Chapter 1), Archambault provides the reader with a vision of life as experience by a Lakota boy in a hospital, and, subsequently, for many Native persons in our society who must experience service delivery at the hands of the majority culture. A historical overview of the Native experience, and the consequences of various forms of the “turn White American quick” scheme, provide a context for rehabilitation administrators and practitioners to understand both any reluctance of Native people to engage service delivery driven by majority culture ideation, as well as the need for Native people to involve their history and their traditions in healing and rehabilitation. Schacht provides a summary of the most recent statistics available in terms of disabling conditions facing Native people in “Health Disparities: The American Indian Experience” (Chapter 2).

Sanderson, in “American Indians: An Overview of Factors Influencing Health Care, Disability, and Service Delivery” (Chapter 3) amplifies the historical, cultural, and health factors provided by Archambault and by Schacht and concludes, regarding the importance of this information, that “rehabilitation professionals too often must learn on-the-job the American Indian demographics and factors that influence heath care, disability, and service delivery strategies.” Thomason concludes the first section of the Handbook by giving an overview of psychological issues facing Native people in “Clinical Psychology and American Indians” (Chapter 4) echoing the need for ser- vice providers to be aware of both the history and culture of their Indian clients-in particular, the influence of history and culture in psychological diagnoses and intervention.

Rehabilitation Practice: Models of Intervention and Training
The second section of the Handbook provides a look at both models of intervention and models of training. Disability conditions which are of considerable concern to Native people are addressed, including alcoholism (Chapter 5), and severe disabilities which require specialized services such as provided through independent living and assistive technology (Chapter 6). Marshall, Johnson, and Lonetree provide a historic overview of tribal vocational rehabilitation projects which now number 64; there were only 14 projects when” Acknowledging Our Diversity: Vocational Rehabilitation and American Indians” (Chapter 7) was first published in 1993. Chapter 7 also presents-a model of intervention which can be utilized by state vocational rehabilitation programs in order to serve Indian communities appropriately. Chapter 8 moves the reader from the general to the specific. Questions asked by participants in a professional development workshop are addressed by Johnson and Marshall in “Best Practices for Serving American Indians in Vocational Rehabilitation: A Clinician’s Perspective.”

Pre-service training is addressed by Marshall, Johnson, and Johnson in “Responding to the Needs of American Indians with Disabilities through Rehabilitation Counselor Education” (Chapter 9) where the authors call for “culture-focused training” to occur. Recommendations are given for course content in core rehabilitation courses such as foundations of Rehabilitation Counseling, Assessment and Counseling, Case Management, Vocational and Career Development, and Job Development and Placement. Chapter 10 concludes this section of the Handbook and provides additional recommendations for pre-service training. The chapter builds upon factors associated with educating for appropriate service delivery by addressing the recruitment and retention of American Indian students into the counseling profession.

Models of Research: Cultural Factors and Ethnical Concerns
“Cultural Factors in Conducting Research and Ethical Responsibilities in Serving American Indians with Disabilities” (Chapter 11) provides an overview of factors facing researchers in documenting the needs of American Indians with disabilities and is informed by research conducted through the American Indian Rehabilitation Research and Training Center (AIRRTC). One such specific research experience is documented in “The Rehabilitation Needs of American Indians with Disabilities in an Urban Setting” (Chapter 12), first published in 1992. Subsequently, rehabilitation educators; graduate students; and Indian service providers, both on reservations and in urban areas, have reported using the model of research presented in Chapter 12. Thus while the study reports the needs of Indian people with disabilities in Denver, Colorado, its utility appears to be greater in terms of providing researchers with a guide to research that can be effective not only in documenting need but also in terms of involving local community members in the research process.

The title of Chapter 13, “The Power of Inquiry as Regards American Indian Women with Disabilities: Divisive Manipulation or Clinical Necessity?,” speaks for itself. Finally, a critical factor in research, and one that does not, in the editor’s experience, receive adequate attention in graduate courses in research, is the importance of disseminating research results that are practical and understandable to American Indian communities. This practice is a hallmark of good research practice, one to which AIRRTC re- searchers strive and one which, hopefully, is reflected in the concluding chapter of this section, “Family Voices in Rehabilitation Research” (Chapter 14). Marshall, Sanders, and Hill worked together to conduct the research with family members and worked together to describe the research results, both in this chapter and on video (Marshall, 1995, 1996). It was our hope, as with the Handbook, that the lessons learned and the needs identified would serve to inform administrators, practitioners, and researchers of the best practices for intervention with American Indians who have disabilities.

Marshall, C. A. (Executive Producer). (1995). Family Voices (Video Documentary, 40 minutes).

Marshall, C. A. (Executive Producer). (1996). Vocational Opportunities of Cherokee (Video, 10 minutes).

Warren, W. W. (1957). History of the Ojibway Nation. Minneapolis: Ross & Haines, Inc.