Guidelines for Assessment of and Intervention with Persons with Disabilities

Approximately one in five Americans or roughly 50 million Americans are currently living with a disability (U.S. Department of Education, 2007). Individuals with disabilities and their advocates have worked for more than 40 years to eliminate attitudinal and physical barriers, to be fully included in all aspects of society, and to secure the freedom to choose their own futures (Jaeger & Bowman, 2005; Priestley, 2001; Switzer, 2008). Their efforts facilitated the passage of the Americans with Disabilities Act (ADA) of 1990. Nonetheless, many people with disabilities continue to encounter both blatant and subtle discrimination in employment, housing, education, recreation, childrearing, health care, and mental health services (e.g., Banks & Kaschak, 2003; Kirschbaum & Olkin, 2002; Raphael, 2006; Schriner, 2001; Smart, 2001; Stapleton, Burkhauser, & Houtenville, 2004; Waldrop & Stern, 2003; Woodcock, Rohan, & Campbell, 2007).

Although many persons who have disabilities have experienced discrimination, each individual reacts differently to those experiences. Moreover, each person assigns a unique meaning to disability, depending on the nature of impairment, the quality of social support and life demands (Olkin, 1999b; Olkin & Taliaferro, 2005; Vash & Crewe, 2004). Above and beyond their disability experiences, persons with disabilities have their own life experiences and, like everyone else, their own personal characteristics, histories, and life contexts.

To work effectively with people who have disabilities, psychologists need to become familiar with how disability influences a client’s psychological well being and functioning. Psychologists should also become aware of how their own attitudes, reactions, conceptions of disability, and possible biases may affect their professional relationships with clients who have disabilities. Further, it is important for psychologists to learn the best “barrier-free” psychological practices for clients with disabilities, including provision of reasonable accommodations, and appropriate integration of disability-related issues into assessment and intervention.

Unfortunately, while psychologists receive extensive training in treating mental health disorders, they rarely receive adequate education or training in disability issues (Leigh, Corbett, Gutman, & Morere, 1996; Olkin & Pledger, 2003; Rubino, 2001; Strike, Skovholt, & Hummel, 2004). Few graduate psychology training programs offer disability coursework (Olkin, 2000; Olkin & Pledger, 2003). This paucity of training is a major barrier to providing effective services to clients with disabilities (Leigh, Powers, Vash, & Nettles, 2004; Olkin, 2002). Limited training and experience may leave many psychologists unprepared to provide clients with disabilities with professionally and ethically sound services, including provision of assessments and interventions.

The goal of these Guidelines for Assessment of and Intervention with Persons with Disabilities is to help psychologists conceptualize and implement more effective, fair and ethical psychological assessments and interventions with persons with disabilities. The Guidelines provide suggestions on ways psychologists can make their practices more accessible and disability-sensitive, and how they might enhance their working relationships with clients with disabilities. Additionally, the Guidelines provide information on how psychologists can obtain more education, training and experience with disability-related matters.

The Task Force hopes that the Guidelines will increase discussion, training and awareness about disability across the profession. Such interest might contribute to needed research on disability-related issues in assessments and interventions. In particular, we encourage the development and use of empirically informed treatments and assessments for clients with disabilities (Olkin & Taliaferro, 2005).

The Task Force based the Guidelines on core values in the Ethical Principles of Psychologists and Code of Conduct (APA, 2002; Smart, 2001; Szymanski & Trueba, 1994) with specific reference to Principle D: Justice and Principle E (Respect for People’s Rights and Dignity). The core values include respect for human dignity, recognition that individuals with disabilities have the right to self determination, participation in society, equitable access to the benefits of psychological services, recognition that people with disabilities are diverse and have unique individual characteristics, and recognition that disability is not solely a biological characteristic, but is also a result of the individual’s interaction with the environment.

Disability is a broad concept that encompasses a wide range of impairments, functional limitations, and barriers to participation in community life (World Health Organization, 2001). The Task Force recognizes that psychologists have a firm grasp on treating impairments that arise from issues of emotional disturbance and mental health disability. Accordingly, although our Guidelines apply to persons with all types of disabilities, including mental health, we emphasize issues of disability arising from the impairments which are less known to psychologists, such as mobility, sensory, communication, and neurological impairments. We also focus on environmental factors that influence all disabilities and accommodations that mitigate them.

The Task Force conducted an extensive literature search of psychological, medical, rehabilitation, vocational and educational databases, searching in the areas of professional relationship and communication issues, attitudes, biases and assessment and treatment of persons with disabilities across the developmental trajectory. The literature reviews were broad in scope, covering quantitative and qualitative traditions tied to various specialty areas in disability research (e.g., clinical rehabilitation, neuropsychology, education, psychometrics, counseling and vocational rehabilitation). Much of the identified literature was theoretical and professional, focusing on specific disabling conditions rather than generic disability. The Task Force used the results of those reviews in developing these guidelines.

This document offers guidance on how psychologists assess and treat people with disabilities in their professional capacity. Guidelines are not standards. Standards are generally mandatory and may have an enforcement mechanism. Guidelines are intended to facilitate the profession’s continued systematic development and to ensure that psychologists maintain a high level of professional practice. Guidelines are not exhaustive and may not apply to every professional and clinical situation. They are not definitive and do not take precedence over a psychologist’s well-informed judgment. Applicable federal and state statutes also supersede these Guidelines.

These Guidelines are intended for psychologists who work in various settings with clients who have disabilities. Settings may include outpatient therapy; educational, religious, or correctional facilities; businesses and employment settings; insurance, compensation and legal contexts, and hospital, rehabilitation and community service settings. They are meant to facilitate a psychologist’s work with clients who have disabilities, not to restrict or exclude any psychologist from serving clients with disabilities or to require specialized certification for this work. The Guidelines also recognize that psychologists who specialize in working with clients who have disabilities may seek more extensive disability training consistent with specialized practice.

There are many methods and ways for psychologists to gain expertise and/or training in working with individuals who have disabilities. The Guidelines do not prescribe following specific training methods, but instead offer recommendations on those areas of knowledge and clinical skills considered applicable to this work.