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Currently, more than 41 million noninstitutionalized Americans live with a disability (American Community Survey, U.S. Census Bureau, 2019). People with disabilities and their advocates have worked for decades to remove attitudinal and physical barriers to ensure full inclusion in all aspects of society and the freedom to choose their own future (Jaeger & Bowman, 2005; Kerkhoff & Hanson, 2015; Krahn et al., 2015; Priestley, 2001; Switzer, 2008). For historical overviews of disability events and legislative progress and setbacks, see two timelines (PAEC, 2018; National Consortium on Leadership and Disability for Youth, 2007). Advocacy helped drive the passage of the Americans with Disabilities Act (ADA) in 1990 and more recently the ADA Amendments Act of 2008 (ADAAA), which expanded the definitions of “disability,” “significant limitation,” and “major life activities.” However, many people with disabilities continue to encounter both overt and subtle discrimination in employment, housing, education, recreation, child care, and health care, including mental health services (Banks & Kaschak, 2003; Basnett, 2001; Kirschbaum & Olkin, 2002; Krahn, et al., 2015; National Council on Disability, 2012; Raphael, 2006; Schriner, 2001; Smart, 2001; Stapleton et al., 2004; Waldrop & Stern, 2003; Woodcock, Rohan, & Campbell, 2007).
Although many people with disabilities experience discrimination, responses to those experiences vary from person to person. Furthermore, each person assigns their own meaning to disability depending on the nature of the disability, the quality of social supports, and the demands of life (Olkin, 2012; Olkin and Taliaferro, 2005; Vash and Crewe, 2004). People with disabilities, like everyone else, have life influences that contribute to their development and experiences, such as culture, religion, family of origin, community, education, sociocultural background, employment, friends, significant others, and coworkers. They are also influenced by system-wide factors, such as government policies, available programs, and associated funding. These shared influences shape an individual’s experience of disability. People with disabilities have unique life experiences beyond their disability experiences, and like everyone else, they have unique personal characteristics, histories, intersecting identities, and life situations that affect their psychological needs. To work effectively with people with disabilities, psychologists should strive to become familiar with how disability and related factors affect their clients’ psychological well-being and functioning. For example, the experience of disability may be influenced by functional ability, energy levels, pain, age of onset, manner of onset (e.g., military trauma), and whether the disability is static, temporary, or progressive. It is also influenced by experiences in the community. People with disabilities who have limited contact with others with disabilities in their families, schools, or workplaces may feel different or even alienated. People with invisible disabilities (e.g., learning disabilities, mental illness, brain injury, chronic pain) may even have difficulty convincing others that they have a disability (Smart, 2001; Taylor & Epstein, 1999). Familiarity with the experience of living with a disability increases empathy and understanding, enhancing assessment and intervention. It is important for psychologists to be aware of how their own attitudes, reactions, conceptions of disability, and prejudices may affect their professional relationships with clients with disabilities. Psychologists can also benefit from learning best “barrier-free” psychological practices when working with clients with disabilities, such as providing reasonable accommodations and appropriately incorporating disability-related issues into assessments and interventions.
Unfortunately, while psychologists receive extensive training in how to address mental health issues, they rarely receive adequate education or training in disability issues (Gibson, 2009; Olkin & Pledger, 2003; Strike, Skovholt, & Hummel, 2004). Few graduate psychology training programs offer courses on disability (Olkin & Pledger, 2003; Weiss, 2010). With limited training and experience, many psychologists may not be prepared to provide professionally and ethically sound services to clients with disabilities. Furthermore, many psychologists seek competency in disability issues after completing their formal training.
The goal of these guidelines on disability assessment and intervention is to assist psychologists, psychology students, and psychology training programs in conceptualizing, designing, and implementing effective, fair, and ethical psychological assessments and interventions for people with disabilities. The guidelines offer suggestions on how psychologists can make their practice more accessible and disability-sensitive and how they can strengthen their working relationships with clients with disabilities. The guidelines include information on how disability-related factors and sociocultural experiences of disability influence assessments and interventions. Throughout the guidelines, resources and suggestions are provided to facilitate education, training, and experience with disability constructs important to effective psychology practice.
It is expected that the guidelines will increase discussion, training, and awareness about disability across the profession and among other health professionals, and that psychology training programs will use the guidelines to consider specific curricular revisions and programmatic changes to address disability issues and ensure access to all training opportunities.
Such interest may also contribute to needed research on disability-related assessments (e.g., test constructs, criteria, and use of accommodations) and interventions (e.g., experiential activities and programs), as well as enhancing culturally appropriate communication and decision-making with clients and health care teams.
The guidelines are based on the core values of the Ethical Principles and Code of Conduct for Psychologists (American Psychological Association, 2017; Smart, 2001). The core values include respecting human dignity and recognizing that individuals with disabilities have the right to self-determination, social participation, and fair access to the benefits of psychological services. Psychologists recognize their role in promoting the health and well-being of individuals. Additionally, the core values recognize that individuals with disabilities are diverse and (like all people) have unique personal characteristics, and that disability is not simply a biological characteristic but is characterized by the interaction of the individual with their physical, psychological, socioeconomic, and political environments. For example, the intersectionality of poverty, disability, and multiple minority identities (e.g., gender, race, ethnicity) is well documented (McAlpine & Alang, 2021) and is included in the discussion of intersectional identities in Guideline 7.
Disability is a broad concept that encompasses a range of functional limitations and barriers to participation in community life (World Health Organization, 2001). Psychologists are known for their strong grasp of impairments resulting from emotional and psychiatric problems. Thus, although the APA guidelines apply to people with all types of disabilities, including psychiatric disorders, they emphasize issues of disability resulting from impairments that are less familiar to many psychologists, such as motor, sensory, communication, and neurological disorders. The guidelines also highlight environmental factors that may affect the experience of disability and limit the validity of the assessment. Suggestions for adjustments that may mitigate these factors are also included.
An extensive literature search was conducted across psychology, medical, rehabilitation, vocational, and educational databases, covering the areas of disability models, professional relationships and communication issues, attitudes and biases, intersectionality, assessment and intervention across the developmental continuum, and regulatory and legal resources. The scope of the literature review was broad, encompassing both quantitative and qualitative traditions relevant to various specialties of disability research (e.g., clinical rehabilitation, neuropsychology, rehabilitation psychology, disability studies, education, vocational rehabilitation, forensic medicine, etc.). The literature identified represents theoretical, professional, and clinical literature focused on specific disorders as well as disorders more broadly conceptualized. Together with the original guidelines, this literature serves as the basis for the guidance provided in this document.
Guidelines are not standards. Standards are generally mandatory and may be enforceable. Guidelines are intended to promote the continuing systematic development of the profession and to enable psychologists to maintain a high level of professional practice. Guidelines are not exhaustive and do not apply to all professional and clinical situations. Guidelines are not definitive and do not supersede the informed judgment of psychologists. Applicable federal and state laws also supersede these guidelines.
The guidelines are intended primarily for psychologists and psychology trainees who work with clients with disabilities in a variety of settings. Examples of settings include hospital, rehabilitation, and community service settings, outpatient care, education, religious, and correctional facilities, employment settings, and business settings that address legal, insurance, and compensation issues. The guidelines are designed to facilitate psychologists’ work with clients with disabilities and do not limit or exclude psychologists from serving clients with disabilities or require professional certification for this work. The guidelines also recognize that psychologists who specialize in working with clients with disabilities may seek more extensive disability training to align with their professional practice. There are many avenues through which psychologists and their students can gain expertise and training to work ethically and competently with individuals with disabilities. The guidelines are not intended to be prescriptive, but rather provide recommendations regarding knowledge areas and clinical skills that may be applicable to this work.