This chapter examines racial and ethnic differences in disability in the United States with a focus on their patterns, trends, and determinants. Disability is responsible for massive social and economic costs to individuals, families, and health care systems. Racial and ethnic differences in health are one of the most widely studied topics in U.S. health disparities research. The risk of disability among older Asians is an understudied area, despite the growth of this population subgroup in recent years due to increased volume of immigration from Asia to the United States. There is an ongoing interest in measuring and understanding the patterns and causes of racial/ethnic differences in disability in the United States. Rising obesity may play an important role in the findings for Hispanic women and for the trend in disability for all race/ethnic groups.

The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.

As diverse student populations gain visibility in colleges and universities across the United States, higher education counselors and student affairs professionals aim to effectively serve and meet the needs of these students. Individuals with disabilities (IWDs) represent one of these previously segregated diverse voices and perspectives that have recently experienced positive developments from inclusive college experiences. College students with disabilities represent an important segment of the growing student population. In 1997, Gill proposed a Disability Identity Integration Model (DIIM) for people with disabilities at the individual and group levels. The DIIM model aims to understand the integration process for people with disabilities into society in a process that involves identity development as part of the disabled minority group. The DIIM offers four types of integration: (a) coming to feel we belong, (b) coming home, (c) coming together, and (d) coming out. This integration process promotes personal empowerment and disability rights.

This chapter focuses on the role that Adult Protective Services (APS) and related service systems play in protecting vulnerable older adults and adults with disabilities from abuse, neglect, and exploitation. It articulates policy issues connected to elder justice. The chapter also explores human rights issues related to elder abuse, aging, and disabilities, particularly how to balance rights to self-determination and safety when working with abused, neglected, and exploited older adults. APS operate within a continuum of services that challenge social workers in their efforts to respond effectively to elder abuse. In addition to knowledge of aging, disabilities, the dynamics of family violence and care giving, and community resources and skills in capacity assessment, working in multidisciplinary teams, advocacy, and systems navigation, social workers need commitment to values of self-determination and empowerment to guide their work in this system.

This chapter explores a paradigm shift in policy and practice related to the delivery of services and supports to older adults or adults of any age with disabilities-the growth of person-centered (PC) and participant-directed (PD) practice initiatives. It discusses new theoretical approaches, particularly the Consumer-Directed Theory of Empowerment (CDTE), which are salient to explaining the growth and impact of PC and PD initiatives as an evolving practice model that represents a paradigm shift from past approaches to working with older adults and persons with disabilities. Research is needed on recent practice and policy changes that have implications for the continued development and examination of theories that support PC and PD care. With both the aging and the increasing diversity of the US population combined with federal policy initiatives related to LTSS, the demand for PC and PD initiatives will continue to grow.

Advocacy is key for the clinical mental health counseling profession. Clinical mental health counselor advocates (CMHCAs) rely on the advocacy competencies to guide their assistance to clients in removing barriers and to secure deserving resources, or to advocate on behalf of clients, groups, or communities. This chapter addresses the importance of advocacy and social justice advocacy, and the strategic positionality of the clinical mental health counselor as an advocate for addressing social and institutional barriers that reduce client access, equity, and success. It identifies the advocacy competencies and approaches to advocate for clients care, and emphasizes the ways that they foster resilience and growth. Specific cases illustrate clients' and professionals' understandings of and access to a variety of community-based resources. The chapter also addresses strategies to advocate for the profession and for clinical mental health counseling professionals.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.