The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61092

Thilo Kroll, PhD¹, Samuel Gordon, PhD², Phillip W. Beatty, MA¹, Kianda Bell, MA¹, and Marcus Bell¹. (1) National Rehabilitation Hospital Center for Health and Disability Research, 1016 16th Street, NW Suite 400, Washington, DC 21403, 202-466-1915, thilo.kroll@medstar.net, (2) National Rehabilitation Hospital, 102 Irving Street, Washington, DC 20010

Background. Coping with the consequences of gun violence and traumatic spinal cord injuries has received scant attention from rehabilitation professionals. This paper presents findings from a qualitative study with urban survivors and rehabilitation professionals on the psychosocial coping challenges that follow discharge from inpatient rehabilitation.

Methods. Multi-informant, exploratory qualitative study, using semi-structured, in-depth interviews with 25 mostly male African American VASCI survivors (Mdn age: 25 years) and 10 rehabilitation professionals (physicians, therapists, vocational rehab counselor, nurses, psychologists, and social workers). Major themes were identified using content analysis based on grounded theory.

Results. Clinicians and survivors identified facilitators of and barriers to short- and long-term coping with the sequelae of violence and injury. Social integration before the injury, social support, sense of personal control, education, employment, and family involvement are facilitators; significant barriers are the lack of health insurance, inaccessible and non-supportive living environments, transportation difficulties, and lack of access to vocational rehabilitation. Despite the challenges they may pose in the interaction with rehabilitation staff, anger and denial may be functional coping mechanisms in the first weeks of treatment. Sustained denial may jeopardize successful rehabilitation and community reintegration, especially when adequate family and social support are not present. A complex interplay of individual, social, economic, and environmental variables determines psychosocial adjustment.

Conclusions. The study has produced an inductively generated multidimensional coping model that can serve as a framework for hypothesis-driven research on psychosocial coping, community reintegration, and rehabilitation outcomes. Implications for comprehensive, community-based psychosocial and rehabilitative support services will be discussed.

Learning Objectives:

• To discuss the complex and multilayered consequences of violently acquired spinal cord injury and implications for the rehabilitation process
• To identify protective and risk factors in the psychosocial adjustment and social integration processes following inpatient rehabilitation
• To identify the hospital, and community-based support needs of VASCI survivors and clinicians alike
• To apply the inductively generated coping framework to future quantitative and qualitative research studies

Keywords: Urban Health, Disability

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Handout (.ppt format, 963.5 kb)