Pediatric SCI: Educating Students with Spinal Cord Injuries—The Professional School Counselor’s Role
Susan Schaming McNiff, EdD, LPC, NBCC
The incidence of spinal cord injuries (SCI) continues to rise, particularly with elementary, middle, and high school aged students. This article provides a foundation of knowledge and information for parents and educators, most especially the school counselor, in ascertaining that the most appropriate and beneficial opportunity for education and related services are provided for spinal cord injured students. In addition, this article defines the roles of the school counselor; for social workers assuming this role, and for social workers and psychologists in the rehabilitation setting; to foster optimal transition for children from the physical rehabilitation context to the school reentry.
As recently as the mid 1970s, the special needs of over eight million children with disabilities went unmet! Astoundingly, close to one million exceptional students were excluded entirely from elementary, middle, and high schools; sadly, many others were failing in regular education classrooms because they were not being identified as requiring additional services. As a result, Public Law 94-142, the Education For All Handicapped Children Act, was passed. This act initiated a succession of legislation directed at exceptional children and their right to education. PL 94-142 stipulates that exceptional students must be provided with an education that is appropriate to their unique learning needs in as close proximity as possible to their normally developing peers. The student’s life should “be as normal as possible, and the intervention should be consistent with individual needs and not interfere with individual freedom any more than is absolutely necessary” (Hallahan & Kauffman, 1999, p.15). A least restrictive environment may vary from full inclusion to a residential school depending on the nature and severity of the individual’s disability.
PL 94-142 also demands that students be evaluated in all areas of their suspected disability, that parents have the right to due process, and that an Individualized Education Program (IEP) be constructed to enumerate what services will be provided to meet the child’s needs. The law expounds a zero reject policy, which emphasizes that regardless of the severity of one’s disability, a public school cannot exclude an exceptional or disabled student. Although the student does not have to be educated in the actual school building, nevertheless, wherever the student is educated, the district will pay the cost (Hallahan & Kauffman, 1999).
The Individuals with Disabilities Education Act (IDEA), in 1990 and again in 1997, reauthorized PL 94-142 with certain amendments. Most significantly, it changed the language of the original legislation from “children” to “individuals,” signifying that all children and adolescents with disabilities have the right to a free and appropriate education (Hallahan & Kauffman, 1999). The term “handicap” was replaced with “disability,” perhaps in recognition of the distinction between a disability and a handicap––a disability being an “inability to do something” and a handicap being a “disadvantage imposed upon an individual.” Subsequently, IDEA is inclusive of individuals with spinal cord injuries, mental retardation, traumatic brain injuries and autism, as well as speech, hearing, and visual impairments.
With the aforementioned foundation of knowledge and information, one can better understand the rights of students suffering a spinal cord injury (SCI), as well as the responsibilities of educational personnel, most especially the school counselor, in ascertaining that the most appropriate and beneficial course of education and related services are provided for spinal cord injured students. Despite this critical role of the school counselor, many psychologists and social workers in the rehabilitation setting may be less aware of the progressive development of school counselors’ roles in reintegration to the school setting. The American School Counselor Association (ASCA) issued a position statement regarding school counselor involvement and students with disabilities in 1993 that suggested the following school counselor roles in working with students: “(a) advocacy, (b) transition planning, (c) behavior modification, (d) counseling parents, (e) making referrals to specialists, (f) improving self-esteem, (g) working as part of the school multi-disciplinary team, (h) teaching social skills, and (i) serving as consultants to parents and school staff.”
Despite the recommendations of the ASCA, Myers (2005) reports that very few school counselors have extensive training to provide services for physically disabled students, including those with SCI. With the high expectations set by PL 94-142, IDEA, and the ASCA, in conjunction with the increase of physical disabilities resulting from SCI, a patent need exists for counselors to collectively develop their understanding and counseling competencies related to students that sustain SCI.
As reported by Daniel Lustig (2005), between 183,000 and 230,000 individuals with SCI exist in the United States; approximately 11,000 new cases present each year. The majority of these injuries are sustained by males and females between the ages of 16 and 30, although there are numerous cases of school aged individuals that are forced to adjust to their world following such traumatic spinal cord injuries.
As social workers and psychologists in the physical rehabilitation setting know, a variety of psychosocial reactions may occur as a result of SCI. Many of these may pose barriers for the child in the educational setting that are different than in the rehabilitation setting. Perceptions of body image, for instance, are altered following such an event. For children and adolescents, the onset of such physical disabilities often results in a negative, self-defeating image of the body at the point in one’s life when a “tremendous need for approval from others and a major emphasis on physical appearance” exists, states Antle (2004, p. 169). Social detachment is often the situation for elementary and secondary school aged children who sustain SCI, since rejection or aversion by peers are common occurrences, report Coster and Haltiwanger (2004).
Implications for children and adolescents with this type of injury include their need for an appropriate education. As the previously discussed legislation—IDEA and PL 95-142—reveals, these individuals have the right to a course of education appropriate for their specific learning, physical, emotional, and social needs in as least restricted an environment as possible. The school counselor, in coordination with students, families, faculty members, school administrators, and therapeutic personnel from the medical and rehabilitation services, is a critical agent in constructing and implementing a plan for the student’s assimilation and re-integration into the school setting. Accordingly, it is essential for the school counselor to be knowledgeable as how to best achieve a successful, seamless assimilation for the student.
To ensure a successful transition, the school counselor must respond appropriately from the initial point of contact with the student, as “attitudes can be quite influential in the individual’s response,” states Hayes (1995, p. 20). Grippingly, Hayes reports:
Helpers who work with clients with SCI go through an identical adaptation sequence to that [of their] client . . . Constant exposure to physical disability can be emotionally overwhelming for the helpers as well, threatening their own sense of intactness. An optimal response seems to be a level of empathy that allows understanding and closeness without actually rescuing the client. (p. 25)
Alas, accessing one’s feelings of empathy is often difficult, especially for school counselors who are inexperienced in dealing with students afflicted with SCI, since the school counselor’s emotions are frequently confounded by reactions of shock, helplessness, anger, and guilt, claims Hayes (1995). To effectively assist students with SCI, school counselors must recognize and address their own responses and feelings. In a clinical setting, supervision is an ideal forum for addressing such concerns; regrettably, most school systems do not provide “supervision” for professional school counselors. Close collaboration between school counselors and the social workers and psychologists in the SCI rehabilitation setting may offer optimal team support, and provide school counselors with helpful contact from those who face the emotional challenges of working consistently with children with SCI.
A multi-disciplinary team approach is critical, in lieu of assigning the school counselor as the sole individual charged with reacquainting a student to the school setting. Myers (2005) conducted a study to discern the ways in which an elementary school counselor might meet the needs of students with physical disabilities. The gestalt of her study’s results emphasized a collaborative partnership among regular and special education teachers, parents, school counselors, student assistance counselors, social workers, behavior specialists, speech and language therapists, physical therapists, and school psychologists. Myers purports that collaboration elevates the extent to which the physical and social needs of the student with the SCI are met. Additionally, the multi-disciplinary team approach fosters shared knowledge and expertise in the development of strategies and techniques to be employed. Extending these findings, greater collaboration between the social workers and psychologists in the rehabilitation setting as the child returns to school, may prove the optimal arrangement of resources.
In addition to collaboration, as emphasized by Myers (2005), the ASCA accentuates the importance of advocacy when working with students with SCI. Advocacy is best exemplified when school counselors identify the individual needs of students with SCI and subsequently use particularized planning to create personal goals to meet the individual students’ needs. When acting as an ‘advocate’ for students with SCI, it is critical that the school counselor provide the regular education and special education teachers with all the relevant information, including the student’s IEP, as well as identifying effective strategies that might be pursued in the classroom setting, suggest Coster & Haltiwanger (2004). Allocating continued attention to support the student as he or she migrates the changing academic, social, physical, and behavioral landscape is a top priority for school counselors working with students with SCI.
School counselors may emerge as leaders by assisting educational staff, even the students’ peers, on ways to work with the spinal cord injured students throughout the school day. Realization of the ASCA’s standards of collaboration and advocacy lead the school counselor to concurrently achieve the organization’s ideal of professional school counselors serving as leaders, contends Myers (2005).
Undoubtedly, various needs will arise as the spinal cord injured student pursues her educational plan. According to Livneh, Wilson, and Pullo (2004), such concerns and needs are classified into eight major categories: physical, psychological, social, vocational, financial, and recreational needs, as well as environmental and attitudinal barriers. As a result, school counselors must vary their techniques depending on the individual’s needs. Group counseling— for either support or educational purposes—may be an effective strategy to provide individuals with the ability to exchange their feelings and concerns with others afflicted by the same or similar disabilities, suggest Livneh et al. (2004). Conversely, individual counseling lends itself toward skills training, self-esteem enhancement, and behavior management. Not surprisingly, the school counselors in Myer’s (2005) study reported utilizing various counseling theories when facilitating both group and individual counseling sessions.
Understandably, when school counselors work with physically disabled students, especially those students with SCI, general dilemmas are often reported. For example, school counselors grapple with how to devote equal attention to the academic, social, psychological, and physical needs of the student. Securing time for recommended related services can be a struggle, as the spinal cord injured student has a tendency to be pulled out of class by a variety of medical, therapeutic, or educational specialists throughout the school day. Arguably, the need for strengthened collaborative partnerships and prudent planning among the interdisciplinary team members exists (Dunn, Wood, & Baker, 2002).
Nonetheless, as the rates of SCI continue to escalate, professional school counselors must be prepared to embrace the responsibility of meeting the academic, personal, psychological, social, and physical needs of students with SCI and other physical disabilities. In doing so, it is unquestionably essential to collaborate and team up with other individuals who are fundamental to the student’s re-acclamation to school. With such support in place, the adept, professional school counselor is thus able to confront the challenge, whilst emerging as an advocate for the spinal cord injured student so he or she may reach her individual potential for success.
References
American School Counselor Association. (1993). Position statement: Students with disabilities. Alexandria, VA: Author.
American School Counselor Association. (2003). The ASCA national model: A framework for school counseling programs. Alexandria, VA: Author.
Antle, B. J. (2004). Factors associated with self-worth in young people with physical disabilities. Health and Social Work, 29(9), 167—176.
Coster, W. J. & Haltiwanger, J.T. (2004). Social-behavioral skills of elementary school students with physical disabilities included in general education classrooms. Remedial and Special Education, 25(2), 95—103.
Dunn, N., Wood, A., & Baker, S. A. (2002). Readiness to serve students with disabilities: A survey of elementary school counselors. Professional School Counseling, 5, 277–284.
Hallahan, D. P. & Kauffman, J. M. (1999). Exceptional learners: Introduction to special education (8th ed.). Needham Heights, MA: Pearson Education Company.
Hayes, R. (1995). Counseling the client on wheels: A primer for mental health counselors new to spinal cord injury. Journal of Mental Health Counseling, 17(1), 18–30.
Livneh, H., Wilson, L., & Pullo, R. (2004). Group counseling for people with physical Disabilities. Focus on Exceptional Children, 36(6), 1—15.
Lusting, D. (2005). The adjustment process for individuals with spinal cord injury: The effect of perceived premorbid sense of coherence. Rehabilitation Counseling Bulletin, 38(3), 198—206.
Myers, H. N. F. (2005). How elementary school counselors can meet the needs of students with disabilities. Professional School Counseling, 8(5), 442—451.
Dr. McNiff is a Licensed Professional Counselor and facilitates the Elementary and Secondary School Counseling Programs at Widener University, Chester, PA. She is also Coordinator of the Undergraduate Education Programs in the Center for Education.