Ditchman Research Team

Lee, E. J., Ditchman, N., *Thomas, J., & *Tsen, J. (2019). Microaggressions experienced by people with multiple sclerosis in the workplace: An exploratory study using Sue’s taxonomy. Rehabilitation psychology, 64, 179-193.

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Purpose: Microaggressions are subtle forms of discrimination and include verbal, nonverbal, or environmental slights that convey disparaging messages to people based upon their group membership, such as disability. The purpose of this study was to investigate the experience of microaggressions in the workplace among individuals with multiple sclerosis (MS). Method: This study used a community-based participatory research approach and qualitative design. Adults with MS (N = 29) with current or recent work experience were recruited to participate in a focus group study. Eight focus groups were conducted and transcripts analyzed using qualitative content analysis to generate themes and subthemes. Study protocol, coding, and interpretations underwent a validity check by an external advisory group consisting of researchers in the field and individuals with MS. Results: Almost all of the participants in this study reported experiencing some form of microaggressions in their workplace. Several important themes emerged, including pathologizing, assumption of disability status, second-class, lack of awareness, social distance, and denial. This study also found that perceived stress was associated with microaggressions and that microaggression exacerbated the negative impact of uncertainty related to symptoms and job security. Participants also identified various coping strategies used to deal with microagressions, such as involvement in support groups and meditation. Implications: The themes that emerged from the focus groups further our understanding of microaggressions as a factor impacting the work experiences of people with MS. Findings have implications for rehabilitation practitioners and future research to promote work life, job retention, and well-being of people with MS.

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Ditchman, N., Chan, F., *Haak, C., & Easton, A. B. (2017). Factors impacting sense of community among adults with brain injury. Rehabilitation Psychology, 62, 130-142.

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PURPOSE: Despite increasing interest in examining community outcomes following disability, sense of community (SOC) has received relatively no attention in the rehabilitation literature. SOC refers to feelings of belonging and attachment one has for a community and is of particular relevance for people with brain injury who are at increased risk of social isolation. The aim of this study was to investigate factors contributing to SOC for individuals with brain injury. METHOD: Members from 2 brain injury associations (n = 98) participated in this survey-based study. Hierarchical regression analysis was used to explore demographic, disability-related, community and social participation variables' impact on SOC with regard to one's town or city. Follow-up mediation analyses were conducted to explore relationships among social self-efficacy, support network, neighboring behavior, and SOC. RESULTS: Findings indicated that disability-related and community variables accounted for over 40% of the variance in SOC. Size of social support network was the only significant independent contributor to SOC variance. Follow-up analyses provided support for (a) the partial mediating effect of social support network size on the relationship between social self-efficacy and SOC, and (b) the mediating effect of neighboring behavior on the relationship between social self-efficacy and social support network size. CONCLUSIONS: Findings from this study highlight the particular importance of self-efficacy, social support, and neighboring behaviors in promoting SOC for people with brain injury. Recommendations are provided to advance research efforts and inform intervention approaches to improve the felt experience of community among people with brain injury.

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Ditchman, N., Sung, C., Easton A., *Johnson, K., & *Batchos, E. (2017). Symptom severity and life satisfaction in brain injury: The mediating role of disability acceptance and self- efficacy. NeuroRehabilitation, 40, 531-543.

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BACKGROUND: Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. OBJECTIVE: The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. METHODS: Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with acquired brain injury. RESULTS: Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. CONCLUSIONS: These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed.

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Ditchman, N., Miller, J. L., & Easton, A. (2017). Vocational rehabilitation service patterns: An application of network analysis to examine employment outcomes of transition-age individuals with autism. Rehabilitation Counseling Bulletin. Advance online publication. doi:10.1177/0034355217709455 

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Young adults with autism spectrum disorder (ASD) face poor employment outcomes following transition from school to adult life. Social network analysis is a useful approach for examining service patterns associated with employment success for this population. An advantage of this approach is its focus on the interdependence of variables rather than individual predictors. This study applies network methodology to examine the relations between vocational rehabilitation services and young adults with ASD to predict employment status. Using the Rehabilitation Services Administration (RSA-911) data set, participants included 2,219 individuals with ASD between the ages of 16 and 24 served by the public vocational rehabilitation system and closed as either competitively employed or not employed. A two-mode network was constructed such that a relation was defined for each service an individual received. Results from a core-periphery analysis indicated that of the 22 services available, core services included assessment, counseling/guidance, job placement, on-the-job support, job search support, and transportation services. Follow-up analyses suggested that the greater number of these six core services an individual received, the better the employment outcome. Findings highlight that these services should be viewed as interconnected and suggest a set of six core services that may be particularly beneficial for this population.

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*Batchos, E., Easton, A., *Haak, C., & Ditchman, N. (2017). Social factors predictive of social integration for adults with brain injury. Disability and Rehabilitation.  Advance online publication. doi: 10.1080/09638288.2017.1326175

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INTRODUCTION: Individuals with acquired brain injury (ABI) may not only struggle with physical and cognitive impairments, but may also face challenges reintegrating into the community socially. Research has demonstrated that following ABI, individuals' social networks tend to dwindle, support may decline, and isolation increases. This study examined factors impacting social integration in a community-based sample of 102 individuals with ABI. METHODS: Potential predictors included emotional support, instrumental support, problem solving confidence, and approach-avoidance style (AAS) of problem solving, while controlling for age, gender, education, and time since injury. Hierarchical regression was used to analyze whether these factors were predictive of social integration. RESULTS: The final model accounted for 33% of the variance in social integration outcomes. Results demonstrated that emotional support was initially a significant predictor; however, when controlling for emotional support the variance in social integration was better accounted for by social problem solving - specifically, AAS. A follow-up mediation analysis indicated that the relationship between social problem solving (specifically, AAS) and social integration was partially mediated by emotional support. CONCLUSIONS: This suggests that for individuals with ABI, a tendency to approach rather than avoid social problem solving issues is a significant predictor for social integration both directly and indirectly through its association with emotional social support. Implications for Rehabilitation Both instrumental and emotional social support should be assessed in patients with acquired brain injury (ABI), ensuring that emotional needs are met in addition to the more obvious instrumental needs. Barriers to problem solving for people with ABI may limit optimal social integration; thus, assessment and intervention aimed at increasing AAS are recommended. To enhance the social integration outcomes of people with brain injury, strength-based psychosocial rehabilitation should optimally balance an individual's abilities with areas requiring compensation, focusing on how to approach rather than avoid problems as well as strategies to cultivate emotional social support.

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Ditchman, N., Easton, A., *Batchos, E., *Rafjako, E., & **Shah, N. (2017). The impact of culture on attitudes toward the sexuality of people with intellectual disabilities. Sexuality & Disability, 35, 245-260.

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Although sexuality is a central component of human life, it is often discouraged and inaccessible to many adults with intellectual disabilities (ID). Common misperceptions and stereotypes of people with ID, such as being asexual, childlike, or innocent, impact the provision of sexual education, opportunities, and rights for many people with ID. The aim of this study was to examine the impact of gender, familiarity with ID, and cultural orientation on predicting attitudes towards the sexuality of people with ID. Participants included 227 students from two U.S. universities with a large international student population. Collectively, predictors explained 32% of the variance in attitudes towards sexuality, with cultural orientation variables accounting for the greatest amount (27%). Using Triandis’ four-factor conceptualization of culture, horizontal individualism and horizontal collectivism were associated with more positive attitudes, and vertical individualism was associated with more negative attitudes. Results highlight the impact of individual and societal characteristics on attitudes, suggesting that cultural orientation plays a role in mitigating and perpetuating stigma toward individuals with ID. Implications for research and practice are provided.

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Ditchman, N., Keegan, J., Batchos, E., Haak, C. L., & Johnson, K. S. (2016). Sense of community and its impact on the life satisfaction of adults with brain injury. Rehabilitation Counseling Bulletin. Advance online publication, doi: 10.1177/0034355216661850.

 

 Sense of community (SOC) refers to feelings of belonging and attachment one has for a community. Despite a growing focus on adjustment and community outcomes following disability, this construct has received little attention in the rehabilitation literature. The primary aim of this study was to examine the extent to which SOC and social identification with one’s town contribute to life satisfaction outcomes among adults with brain injury, controlling for demographic, disability, and other related social constructs (e.g., social support and social integration). Members from brain injury associations across the United States (n = 177) participated in a survey-based study. Results from hierarchical regression analysis indicated that the final model accounted for 45% of the variance in life satisfaction, with SOC variables contributing 11%. Symptom severity, perceived emotional support, and the SOC dimension reinforcement of needs were significant independent predictors of life satisfaction. Findings from this study highlight the importance of examining SOC variables among clients with brain injury in order to enhance subjective well-being.

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Ditchman, N., Sheehan, L., Rafajko, S., Haak, C., & Kazukauskas, K. (2016). Predictors of social integration for individuals with brain injury: An application of the ICF model. Brain Injury. Advance online publication, doi: 10.1080/02699052.2016.1199900. 

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Objective: People with brain injury often experience significant challenges to social and community engagement following injury. The purpose of this study was to investigate factors impacting social integration for adults with brain injury using the International Classification and Functioning, Disability, and Health (ICF) as a conceptual model. Methods: Adults with brain injury (n = 103) recruited through two US state brain injury associations participated in a survey study. Hierarchical regression analysis was used to examine the predictive impact of components of the ICF model on social integration outcomes. Specifically, demographic (age, gender, SES), disability (severity of functional limitations), personal (disability acceptance, social self-efficacy), and environmental (neighbourhood climate, stigma, social support network) factors were entered as four conceptual groups of predictors to examine the incremental contribution of the variance in social integration explained by each set. Results: As hypothesised, the inclusion of each block of predictors significantly improved the model. The overall regression model explained 41% of the variance in social integration. Specifically, SES (β = .25), severity of functional limitations (β = .29), and social support network (β = .29) emerged as the strongest independent predictors. Conclusion: Findings from this study highlight the importance of adopting a biopsychosocial approach to understanding social integration for people with brain injury.

 

 

Ditchman, N., Werner, S., Kosyluk, K., Jones, N., Elg, B. & Corrigan, P. W. (2013). Stigma and intellectual disability: Potential application of mental illness research. Rehabilitation Psychology, 58, 206-216. doi:10.1037/a0032466. 

 

Purpose: Individuals with intellectual disabilities (ID) and individuals with mental illness are consistently found to be among the most socially excluded populations and continue to face substantial health, housing, and employment disparities due to stigma. Although this has spurred extensive research efforts and theoretical advancements in the study of stigma toward mental illness, the stigma of ID has received only limited attention. In this paper we explore the application of mental illness stigma research for ID.  Design:  We carefully reviewed the existing research on mental illness stigma as a foundation for a parallel summary of the empirical literature on attitudes and stigma related to ID.  Results: Based on our review, there has not been a systematic approach to the study of stigma toward ID. However, multilevel conceptual models of stigma have received much attention in the mental illness literature. These models have been used to inform targeted interventions and have application to the study of the stigma process for individuals with ID. Nonetheless, there are indeed key differences between—as well as substantial variability within—the ID and mental illness populations that must be considered. Conclusions: Stigma is an issue of social justice impacting the lives of individuals with ID, yet there remains virtually no systematic framework applied to the understanding of the stigma process for this group. Future research can draw on the stigma models developed in the mental illness literature to guide more rigorous research efforts and ultimately the development of effective, multilevel stigma-change strategies for ID.

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