Rehabilitation counseling in Appalachian America

Journal of Rehabilitation, July-Sept, 2003 by William Bauer, Bruce M. Growick

Americans who live in Appalachia experience unique and different ways of life than most Americans. Appalachian culture runs from the bottom half of the State of New York through the mountains of West Virginia and Southeast Ohio to the flatlands of Alabama (Appalachian Regional Commission, 1999). This area of the country offers different perspectives and challenges to life. Because of the geographical vastness and uniqueness of the Appalachian culture, many people with disabilities who live in Appalachia are unable to access rehabilitative services and agencies. As verified by Herbert and Cheatham (1998) and Rueda and Martinez (1992), the combination of being a person with a disability and belonging to a minority group, such as living in rural Appalachia, produces a double bias in adjusting to everyday activities. Living in rural Appalachia has its minority features by virtue of geography, unemployment rates, lack of medical services, and limited economic growth.

This paper identifies the geographical area and demographic characteristics of Appalachia, describes the common characteristics that are a part of the Appalachian culture, and provides current statistics of children and adults living in Appalachia who have disabilities. In addition, the authors point out the importance of the impact of the Rural Cultural Diversity Initiative as established by the 1992 Amendments to the Rehabilitation Act of 1973. Finally, the availability of employment opportunities for individuals with disabilities in Appalachia will be discussed, with their implications for rehabilitation services.

Appalachia Geographical Area and Demographics

According to the Appalachian Regional Commission (ARC), Appalachia is defined as a 200,000-square-mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi. It includes all of West Virginia and parts of twelve other states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia (see map). About 22 million people live in the 406 counties of the Appalachian Region, and 42% percent of the Region's population is rural, compared to less than 20% of the national population (ARC, 1999). According to the ARC report, the economic fortunes of Appalachia are still based on the extraction of natural resources and manufacturing. However, these areas are now experiencing a boon from tourism because people who live in the urban area of America want to escape from the city and explore remote areas. Unfortunately though, the unemployment rate remains high, and social and health services are scarce and scattered.

During the fiscal year 2000, the ARC identified nine states consisting of counties that have been labeled "distressed" counties. A distressed county, according to the commission, is one that has been targeted as having four areas of immediate concern: income, unemployment, poverty and infant mortality rate. In Appalachian America, income rates are lower, the unemployment rate is higher, poverty is rampant, and the infant mortality rate in some counties is twice the national average.

The following states and the number of distressed counties within those states are identified as: Alabama (3), Georgia (10), Kentucky (40), Mississippi (13), North Carolina (2), Ohio (9), Pennsylvania (2), Tennessee (10), Virginia (5) and West Virginia (26). See Figure 1.

[FIGURE 1 OMITTED]

According to Rehabilitative Engineering Society of North America (RESNA) in a statement from their Rural Initiatives Project Handbook (1996), people with disabilities live in many rural areas across the United States. Unfortunately, the rehabilitative services that people with disabilities need are usually in large metropolitan areas, and such services are simply not available in rural areas. The availability of rehabilitation services is a necessary component to a successful and healthy lifestyle for individuals with disabilities, and this dearth of services needs to be met. For example, the average distance to quality rehabilitative services can be as much as 200 miles away; the nearest critical care hospital may also be as far for some families. This isolation directly affects timely health care services, and the quality of life that individuals with disabilities in rural America experience.

Appalachian Special Characteristics and Features

The characteristics, which are unique to Americans who live in Appalachia, are indeed startling. The following is a brief list, highlighting many of the items of concern by professionals (Child Defense Fund of Ohio, 2001).

* 1 in 5 Appalachian children live in poverty ($14,630 or less a year for a family of three in 2001).

* Over 28% of Appalachian children receive health care through Medicaid.

* 84% of the children enrolled in Medicaid live with working parents.

* Nearly 40,000 Appalachian children lack health insurance (1998).

* 7.6% of Appalachian children are born at low birth weight in 1999, up from 6.3% in 1990.