Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers.

Purpose of Review: Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns. Recent Findings: While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life. Summary: Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.

A Primary Care Provider's Guide to Sexual Health for Individuals With Spinal Cord Injury.

The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting. This article provides guidance for practitioners in primary care settings who are caring for persons with spinal cord injury. Clinicians should seize the opportunity during the encounter to reframe the experience of disability as a social construct status, moving away from the narrow view of medical condition and "find it, fix it" to a broader understanding that provides increased access to care for sexual health and sexual pleasure.

The COVID-19 pandemic, stress, and trauma in the disability community: A call to action.

PURPOSE: To inform the field of rehabilitation psychology about the impacts of the 2019 novel coronavirus (COVID-19) on the disability community in the United States and the additional sources of stress and trauma disabled people face during these times. METHOD: A review of the literature on disability and COVID-19 is provided, with an emphasis on sources of trauma and stress that disproportionately impact the disability community and the ways in which disability intersects with other marginalized identities in the context of trauma and the pandemic. We also reflect on the potential impacts on the field of psychology and the ways in which psychologists, led by rehabilitation psychologists, can support disabled clients and the broader disability community at both the individual client and systemic levels. RESULTS: The COVID-19 pandemic introduces unique potential sources of trauma and stress within the disability community, including concerns about health care rationing and ableism in health care, isolation, and the deaths and illnesses of loved ones and community members. CONCLUSIONS/IMPLICATIONS: Rehabilitation psychologists and other professionals should be aware of the potential for trauma and stress among disabled clients and work with them to mitigate its effects. Additionally, psychologists should also work with the disability community and disabled colleagues to address systemic and institutional ableism and its intersections with other forms of oppression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

#SaytheWord: A disability culture commentary on the erasure of "disability".

PURPOSE: To inform the field of rehabilitation psychology about the sociocultural implications of the term "disability," and explain the rationale behind the #SaytheWord movement, a social media call to embrace disability identity. METHOD: Review of the literature on disability terminology, the history of language use, and the relationship between attitudes toward disability and language. We reflect on the role of disability within the field of psychology and within the American Psychological Association (APA), including the underrepresentation of disabled psychologists and trainees with disabilities and the lack of mentorship opportunities available in the field. IMPLICATIONS: The authors argue that erasure of the word "disability" can have unintended and adverse consequences. We describe how erasure of disability identity in the context of current sociopolitical efforts to reduce and eliminate public services and supports for people with disabilities is especially threatening to members of the disability community. To move forward, the authors postulate that the disability movement must reconcile its own history of exclusion and adopt a disability justice framework. CONCLUSION: The field of psychology has a rich tradition of appreciation of cultural diversity and individual difference; yet, disability has largely been left out of these efforts. The disability movement is moving toward the status of a diverse cultural group with a social justice agenda parallel to those of other marginalized communities. The authors posit that psychology must play a stronger role in advancing the human rights of people with disabilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Disability culturally competent sexual healthcare.

Though cultural competence and inclusion of diverse identities are increasingly emphasized in psychological training and practice, sexual health and well-being among people with disabilities (PWD) continue to be underrecognized areas in which disability cultural competence is needed. The experience of disability is best conceptualized as an interaction between physical, sensory, or cognitive differences and environmental and sociocultural contexts that facilitate or impede adaptive functioning; these complex interactions, coupled with an individual's age, gender, ethnicity, religious background, and sexual orientation, often inform one's sexual health and well-being. Disability can be thought of as a minority cultural status-a marginalized and stigmatized identity. Given the imperative that psychologists must be culturally competent and self-aware, as well as the centrality of sexual health and well-being to quality of life including among PWD, assessment of sexuality as a facet of overall well-being among individuals with physical disabilities should be part of routine clinical practice. A discussion of disability cultural competence is offered as a foundation to explore disability sexual health and wellness competence in clinical assessment. The disability and sexuality health care competency model is introduced to address the need for evidence-based sexual health and wellness assessment of PWD. Specific conceptual and behavioral sexuality and disability competencies that correspond to the provision and facilitation of these services are delineated. (PsycINFO Database Record

Sex-Positive Assessment and Treatment Among Female Trauma Survivors.

Sexuality and intimacy difficulties are often a part of the aftermath of sexual trauma. We argue that combining techniques from evidence-based, trauma-focused treatment with sex-positive techniques used in sex therapy can best help survivors reduce trauma-related symptoms and develop or regain comfort with their sexuality. In this article, we illustrate this approach by describing the case of a survivor of sexual assault, who completed 20 sessions of treatment that combined modules of trauma-focused therapies, Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) with sensate focus therapy, a technique often used in sex therapy. The outcome of this case suggests that clinicians who work with sexual trauma survivors may want to consider a sex-positive approach to conceptualizing and planning the course of treatment, to achieve optimal results.

Personal assistance, disability, and intimate partner violence: A guide for healthcare providers.

PURPOSE/OBJECTIVE: Our objective was to provide evidence-based guidance for health care providers to engage in brief and extensive assessment of intimate partner violence (IPV) and to initiate appropriate safety precautions and referrals, all within the context of disability. Research Method/Design: This article is a review of the literature on prevalence and risk factors for IPV in nondisabled couples and in couples where a partner has a disability, on various assessment tools, and on the impact of personal assistance on relationships. RESULTS: When an individual has a disability, it is often her or his partner who provides personal assistance. While providing this assistance can produce individual and/or interrelational benefits, it is also associated with a number of mental and physical health problems, including anxiety, depression, anger, drug abuse, and relationship discord and dissatisfaction. In addition, IPV is not uncommon among couples, and risk for partner violence may include depression, drug abuse, and relationship dissatisfaction, among others. CONCLUSIONS/IMPLICATIONS: It is likely that health care providers will encounter individuals with disabilities who are both receiving care from their partners and who are also the victims of partner violence. Thus, they will need to be prepared to assess and triage patients who are in or may be at risk for abusive relationships and to ensure patient safety in the context of these relationships. However, it is also critically important that this assessment occurs within a culturally inclusive and disability-affirming context. (PsycINFO Database Record

Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists.

OBJECTIVE: The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. CONCLUSIONS: Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life.

Sexual expression following spinal cord injury.

Sexual adjustment, defined within this study as post-injury sexual views of the self, among 109 men and 86 women with spinal cord injury (SCI) was explored through cognitive adaptation theory [30]. It was predicted that cognitive adaptation constructs (i.e., personal control, optimism, meaning, and self-esteem) and sexual self-esteem would be predictive of sexual adjustment. It was also hypothesized that sexual self-esteem would be predictive of sexual adjustment over and above cognitive adaptation constructs. A series of hierarchical regression models were performed with results being consistent with proposed hypotheses. Implications for rehabilitation professionals are discussed and clinical suggestions are provided.