Crossing a Canyon: Identifying and Remediating Service Delivery Gaps for Individuals with Cognitive Disabilities in Rural British Columbia, Canada

Crossing a Canyon: Identifying and Remediating Service Delivery Gaps for
Individuals with Cognitive Disabilities in Rural British Columbia, Canada
SOWK 799
Abstract
This paper explores the service delivery gaps for individuals living with cognitive disabilities in rural British Columbia, Canada. It covers the difficulties faced by people living with cognitive disabilities in the rural areas of British Columbia and indicates solutions for their problems. It goes beyond by providing concrete recommendations on what needs to be done to ensure that every individual living with cognitive disabilities has access to the required care and support from their caregivers and society as a whole.
The topic is introduced with a concise statement of the research problem. The researcher consulted several peer-reviewed scholarly sources to obtain relevant information regarding the service delivery gaps for people living with cognitive disabilities. The literature review section focused on five questions which were;
What are the key themes within the literature?
What are the research outcomes?
What is the SW knowledge as it relates to the topic?
What are the gaps in the Literature / SW Knowledge?
What areas need more research?
The research concluded that identifying and remediating service delivery gaps for individuals with cognitive disabilities in rural British Columbia, Canada required a multifaceted approach. The following recommendations were drawn from the study: -
The study recommended that discrimination and the interpersonal conflicts that are frequently faced by people living with cognitive disabilities must be minimized.
It is also essential for healthcare providers and the care givers living and interacting people with cognitive abilities to have positive attitudes towards helping these individuals.
Because individuals living with cognitive disabilities are often involved in interpersonal conflicts, it is recommended that their care providers should receive training on the appropriate means of handling such conflicts.
Additionally, healthcare professionals should receive proper training on how to identify and treat various cognitive disorders.
Introduction
The Study Population
There is a growing population of people living with cognitive disabilities (CD) around the world, and that number continues to rise as the total population of the Earth grows (Chinn, Levitan, & Murrells, 2017). Some of these disabilities are age-related, while in some cases, children are born with disabilities, otherwise known as congenital disorders. According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM–V) by the American Psychiatric Association (2013) regarding cognitive disabilities, dementia is one of the most common illnesses that affect people around the world. Additional examples of cognitive disabilities include Down syndrome, Fetal Alcohol Spectrum Disorder (FASD), and Autism Spectrum Disorder (ASD). Both developing regions and developed countries record-high numbers of people living with cognitive disabilities. It is not a phenomenon that is exclusive to one area of the world as in a regional-based infection or disorder (American Psychiatric Association, 2013).
A person is said to have a cognitive disability if he or she has limitations in cognitive functioning. Most of the common symptoms displayed by people with these disabilities include problems in communication, difficulties in comprehension, socializing, and challenges in basic self-care (Chinn et al., 2017). The named challenges may cause both children or adults with such disabilities to have problems in learning, hence slow and sometimes a complete lack of comprehension of learned information. They might also perceive their environment in a completely different manner compared to their neurotypical peers who lack such cognitive disabilities.
Research Summary and Components
The research entails recommended approaches through which service delivery gaps faced by people living with cognitive disabilities in rural British Columbia, Canada, can be mended. Based on current research, people living with cognitive disabilities in British Columbia face challenges such as discrimination, marginalization, and exploitation. These challenges result from the traditional service delivery models of health, education, and criminal justice are not designed with the needs of people with cognitive disabilities in mind (Ribet, 2011).
This paper is, therefore, a comprehensive study that explores what needs to be done to ensure that service delivery gaps for individuals with cognitive disabilities are identified and remediated. The research states that crossing such a “canyon” requires a multidisciplinary collaborative approach towards interventions. The life of each person matters, including those cognitive disabilities. These people form crucial parts of our society, and all of them form essential components of their families. Whether young or old, their health and well-being mean a lot to those who love them.
The study goes beyond describing the challenges faced by these people but also provides recommendations on what needs to be done to ensure that every individual living with a cognitive disability has access to the required care and support from their caregivers, and society as a whole. It is the hope of the researcher that this study will form a basic foundation upon which future research regarding the same topic can be based.
Neglect From Families and Society
Presently, individuals living with cognitive disabilities run into many obstacles when trying to access services in British Columbia. Some of these challenges include neglect from their families. Unfortunately, many families place the blame for the financial burdens they experience on the members of their family with cognitive disabilities (Ribet, 2011). As a result, many people living with cognitive disabilities become alienated and lack support from their families. A majority of these people have challenges in communication and, or comprehension. They, therefore, require assistance from family members in almost everything they do. However, the latest research studies indicate that most of these people with disabilities experience discrimination from their families (Ribet, 2011; Mcconkey et al. 2004).
Ribet (2011) articulates that the majority of people living with disabilities experience discrimination from society at large. This discrimination is two-fold when a person also comes from a visible minority group, particularly if they are Indigenous. Stigmatization in rural areas is still rampant, as it is in society as a whole. Based on the latest research, the majority of the people living with these disabilities are considered burdens on society. Such stigmatization, therefore, prevents families of these people from seeking the required supports that they need. They fear that should they become open regarding the challenges of their children or elderly family members, then other society members would look down upon them.
Purpose of Research
This research paper, therefore, aims to fill the gaps as mentioned above by studying and comparing several kinds of literature. The recommendations included in this research study will further inform and benefit the social service professionals who work with people with these disabilities. Furthermore, this research should prove to be of benefit to the family members of people living with cognitive disabilities. This research can also be useful for researchers who are interested in knowing how to identify and remediate the care gaps faced by people living with cognitive disabilities, and the entire matrix of interdisciplinary professionals concerned with people living with these disorders. It is, therefore, a comprehensive research study that aims at satisfying various stakeholders in society.

Thematic Findings From Literature
Current scholarly sources to obtain relevant information regarding the service delivery gaps for people living with cognitive disabilities. Peer-reviewed journal articles within the last 5-7 years were used as resource material, but there are several older scholarly sources included as well, as they were deemed relevant to the present research. ResearchGate and PubMed internet databases were used, and the search terms were cognitive disabilities, as well as a comprehensive search of phrases such as “cognitive disabilities in Canada,” “service delivery gaps for people living with cognitive disabilities,” and “appropriate means to close the service delivery gaps among people living cognitive disabilities.” Using this approach helped in narrowing down the scholarly resources into a few out of the thousands of articles that were retrieved in the internet search. Additionally, condensing such research articles into a small number helped in selecting the most appropriate scholarly sources used in this research article.
After identifying several sources regarding the topic based on the search terms, the researcher started screening the source articles based on the dates of publications. The researcher was interested in the latest research studies, especially those published within the last 5 to 7 years. The main reason for such precision is that recent articles have relevant outcomes compared to those published many years ago. One challenge faced in trying to exclusively use current journal articles is that older research articles obtained from the databases contained far more detail. This research paper aimed at incorporating the most comprehensive, relevant information, so the researcher considered incorporating the older articles into the study. The researcher narrowed in on the geographical focus of research articles, and articles that focused on the rural areas of British Columbia and Canada, in general, were given more priority. Many articles were reviewed, which focused on other geographical regions, such as the United States and other developing countries. Most of these articles were not included in this study because they were not geographically related.
Theoretical Underpinnings Explaining the Research
Several theories explain the subject considered in this study. There are similarities and differences, and the researcher included these theories to understand cognitive disabilities better. The findings of these theories are, therefore, included.
Piaget’s Theory
The first underpinning theory used in this research is called Piaget’s theory of cognitive development (Chowdhury & Benson, 2011). The theory helped in understanding the cognitive development of a child. Before identifying the service delivery gaps for people living with cognitive disabilities, it is first crucial to understand how cognitive development occurs among children. The researcher considered this move as the best route of determining the growth and development of cognitive abilities. According to Piaget, children move through four different mental stages before they reach adulthood; the theory focuses not only on the means of acquiring information but also explains in detail the nature of such intelligence.
Sensorimotor stage: According to Piaget, the first cognitive development stage is the sensorimotor stage (Chowdhury & Benson, 2011). This stage of cognitive development encompasses children aged between birth and two years. One key characteristic of this stage is that infants understand the world through movements and sensations because they do not necessarily understand everything yet but can suck the milk from the breast, grasp using their fingers, listen to their parents talk, and lastly, look at the basic things that surround him or her (Chowdhury & Benson, 2011). At this particular juncture, children understand that there are a lot of basic ideas that exist, though they cannot see all of them. Another important feature of children who are in this category is their ability to separate human beings from other objects. For example, at this stage, children can already isolate the voices of their parents, and when one speaks, they know their tone and can differentiate it from the movements of pets like cats and dogs. Lastly, children who are at the sensorimotor stage understand that their actions can have a sensory response from objects in their surroundings.
Preoperational stage: According to Piaget’s theory, the second stage of cognitive development is called the preoperational stage. At this stage, children start learning symbols and can differentiate objects based on the words attached to them, and they may distinguish between a father and siblings just by looking at an image of them. It is worth noting that children who are in this stage often struggle to see things, not in their perspectives, but the perspectives of other people. Empathy is still not yet formed (Lunsky, Garcin, Morin, Cobigo, & Bradley, 2007). At this stage, children learn the pretend play, and can still differentiate between real-life occurrences and fantasy that is only occurring in their minds. At this level, the child still does not know how to differentiate sizes. For instance, when given two lumps of clay, one rolled into a cylindrical shape, and the other flattened, he or she may choose the flattened one, thinking that it is bigger compared to the cylindrical clay. Even though they are in a position to master an oral language and develop progressively in their thinking, their thinking is still based on concrete terms.
The concrete operational stage: The third stage is called the concrete operational stage. In this kind of cognitive development strategy, children tend to think logically about specific events. For example, they start thinking of what life is and where people go after death (Morrow, Dagg, & Pederson, 2008). They are more egocentric at this stage and become open to conversations. Additionally, at this stage, they begin to master sizes and are capable of understanding that an equal amount of water poured into a sizeable short cylinder will still be the same as the amount of water poured into a tall thin bottle of the same size.
Children who fall into this category are often between 7 and 11 years of age and have not yet become organized in their communication (Mcconkey, R. & Truesdale-Kennedy & Conliffe, 2004). This timeframe is a crucial age category among children because it is the same age when children take part in primary education. They are required to have proper mastery of age-related curriculum and to start practicing on how to read and write. They, therefore, require good teachers who understand their learning needs (Lunsky et al., 2017). In the same class, there might be a child who has a much slower speed in learning compared to the rest. They should, however, be accommodated in the learning environment, because they are still growing and have a chance of fully developing their brain into the expected capacity (Mcconkey et al., 2004). Educators of these children should, therefore, become considerate and support the struggling young ones in all the activities that they do. In the same stage, children are so keen on the kind of approach given to them by the teachers, guardians, and all adults in their lives. Failure to show them appreciation would, therefore, break their hearts and lead to potentially permanent disappointments.
Formal operational stage: The fourth and last stage is called the formal operational stage. It refers to the stage where children have reached the adolescent age of 12 years and above. At this level, children tend to reason logically on conditional statements. For them, abstract reason emerges at this point. It is at this very moment that children begin to think of morality and become organized in life. It is worth mentioning that at this juncture, children need more direction from their parents and the utmost care because they have reached one of the most vulnerable points in their lives, puberty (Morrow et al., 2008). It is worth noting that Piaget viewed intellectual development as a qualitative approach, not a quantitative increase in piles of information. Piaget’s theory of cognitive development, therefore, informs the public of a qualitative change in their children’s thinking and reasoning capacities. It is a fundamental theory to focus on when tackling the service gaps that people with cognitive development face (Morrow et al., 2008). The method educates mental health professionals on the appropriate means of handling people with cognitive disabilities. In theory, older individuals require different approaches toward their care due to the differences in their reasoning based on their ages.
Importance of the Theoretical Framework
The theoretical framework of cognitive development is appropriate for this field as it informs of the mental development progress of human beings. The theory indicates what parents /guardians of newborn babies should expect in terms of their development. Additionally, the theory has well-defined stages of cognitive development. As a result, a caregiver to an individual with a cognitive disability would easily trace the cognitive development of the child as he/she grows. Having this foreknowledge is crucial as any deviations in the expected cognitive development would require urgent medical interventions. Tracing of cognitive disorders is also accessible through the use of this theoretical framework. From birth, children born with FASD can easily be located and given the required care, such as help with the movement and appropriate treatment. Furthermore, cognitive disabilities that originate from old age, such as dementia, would easily be assessed and proper care delivered.
Underdiagnosis of many cognitive disabilities has led to huge gaps in service delivery for people living with cognitive disabilities (Lach et al., 2009). According to the British Columbia Medical Association (2019), all cognitive disabilities require appropriate diagnostic interventions. However, the latest research indicates that most people living with cognitive disabilities do not receive the necessary medical and social support due to misdiagnosis or outright missed diagnosis of their health conditions. These people end up receiving wrong and untimely treatments. It is, therefore, crucial for medical practitioners to understand the various signs of cognitive development in healthy people so that they can treat individuals with intellectual impairments (British Columbia Medical Association, 2019). Little information is known on the exact signs and symptoms of the vast array of cognitive disabilities. Each year there are many new diagnoses and disorders discovered
In most cases, these disabilities have similarities, such as lack of skills to perform required daily activities. Hence healthcare providers face many challenges in identifying the specific cognitive disability and appropriate treatments (British Columbia Medical Association, 2019). It is, however, crucial to note that as researchers become better acquainted with the various concepts outlined in the theories of cognitive responses, they are in a more suitable position to determine the appropriate treatment for their patients. It might take considerable time to diagnose specific disabilities, but with more efforts and comparisons of various literature, an individual is capable of knowing the development of multiple disabilities such as ASD, FASD, and many more.
Vygotsky’s Sociocultural Theory
The next theory, which helped in the understanding of the research topic, is the Vygotsky’s Sociocultural Theory. This theory proposes that an individual’s social network plays a vital role in the way they think and relate to objects surrounding them. According to this theory, an individual’s interaction with culture plays a crucial role in defining whom the person becomes and what the person needs to do (Ouellette-Kuntz, 2005). Vygotsky, therefore, believed that a person would first learn from their surroundings and use that learned information from society to initiate how he or she thinks (Morrow et al., 2008). Communities where people with mental illnesses are discriminated against, young people would first learn such unethical behaviors from their parents or caregivers, and finally, internalize such actions before they display them in public. Unlike Piaget, who believes that cognitive development is a universal process, Vygotsky argued that different cultures greatly influence cognitive events, so they are different from one society to another.
Bandura’s Observational Learning
Another theoretical approach that assisted in understanding this concept is called Bandura’s Observational Learning. According to Bandura, children rely on people (models) and select appropriate behaviors from such people to determine their life path. These actions are called coding, and while so doing, the children tend to focus on activities that relate to their gender (Mansell & Ericsson, 1996). As mentioned by Piaget, such children tend to choose factors that are following their cultures. As a result, young people tend to follow the practices that are performed by their peer groups. Primarily, observational learning occurs through observation. This theoretical approach argues that children and adults learn through observing their given environments. According to Mansell & Ericsson (1996), some concepts must be learned through observations, in which case, there may be no theoretical approaches that apply. According to Bandura, people best learn in an environment where things are physically arranged and demonstrated. In such situations, children grasp ideas and retain them long-term.
What children observe in their environment when they are young children affect their overall life in later years. According to Emerson (2003), children are imitators, and they do all they can to learn from their surrounding environments. As a result, they take most of their time learning by observing what older people do. In circumstances when the demonstrator misbehaves or misguides the young people, such children would also be misled. The consequence of every action that children encounter is a crucial feature of Bandura’s principle.
Emerson (2003) mentions that people living with cognitive disabilities require appropriate education so that they can fit well into society. However, most of these people have difficulties in comprehending the information that is available to them in their environment. According to Emerson (2003), introducing a learning approach that allows people living with such disabilities to learn and participate actively is essential. The collaborative learning environment would also reduce the chances of discrimination or diminished self-esteem among people living with such disabilities (Emerson, 2003). It is, therefore, essential for teachers to become well versed in the varying emotional swings of the individuals living with intellectual disabilities. It is imperative that individuals with cognitive disabilities learn emotional regulation as early and to the fullest extent possible.
Challenges that Indigenous People in Canada Face
Matthew (2017) noted that Indigenous People in Canada encounter multiple challenges that emanate from the disparities that exist in Canada’s healthcare and disability services delivery models. Indigenous people in Canada, by virtue of colonization, are marginalized. They are subjugated through legislation such as the Indian Act, and this is especially true for those Indigenous people who also have cognitive disabilities (Matthews, 2017). The resultant determinants of health caused by this oppressive legislation, such as poverty, education, and social status, have historically had a racially stereotyped response from the healthcare system as if Indigenous people have brought poverty, addiction, and intergenerational trauma upon themselves (Matthews, 2017). Systemic racism that exists within Canada’s healthcare system requires a route forward to increase anti-oppressive practice amongst those working within the healthcare system in Canada (Matthews, 2017).
According to Matthews (2017), the lived experiences of Indigenous people in Canada have a high probability of lowering their health outcomes. This aspect is heightened by the inadequacies of access to quality medical services and their lower socio-economic statuses within Canadian society. Furthermore, Browne et al. (2016) explain that Indigenous Canadian people living in remote areas of the country also experience deficiencies in their ability to access satisfactory medical services and infrastructure. These deficiencies are especially correct for Indigenous people with cognitive disabilities, for even when an Indigenous community has adequate healthcare services on reserves, services such as group homes and community inclusion programs are often non-existent (Browne et al., 2016).
The Canadian healthcare system lacks equal care access and medical facilities for remote communities, which also affects people with cognitive disabilities (Martin, Miller, Quesnel-Vallйe, Caron, Vissandjйe, & Marchildon, 2017). McDonnell et al. (2017) reiterate that the country’s healthcare management system experiences failures in ensuring that the existing regulations, strategies, and policies guiding the healthcare of people living with cognitive disabilities are implemented. Canada has a long history of legislation and policy enactment that has altruistic aims in principle but fails in execution.
An example of this is the findings of the Canadian Human Rights Tribunal, which found that child welfare services for Indigenous children in Canada were not equitably funded. After four years, the recommendations from that tribunal are still being implemented on a minimal basis. Rahaman, Holmes, and Chartrand (2017) explain that issues of racism, such as systemic prejudice in the Canadian medical system, have acted as noteworthy contributors to the lower health outcomes seen in Canada’s Indigenous population and particularly, among people living with cognitive disabilities.
Rousseau et al. (2017) reveal that racial prejudices in the Canadian healthcare system are not only tied to interpersonal relationships of Indigenous People when interfacing with individual medical practitioners but also in the organizational and administrative dimensions that these people practice within. Services to adults with developmental disabilities are no different. Community Living BC policies are not inherently racist, but provisions for the delivery of CLBC funded services in Indigenous communities has only been in place since 2014 (CLBC, 2018). Goodman et al. (2017) explain that structural discrimination against Indigenous people is evident in the regulatory frameworks, policies, and practice, an aspect that imposes profound adverse effects on the ability of this populace to access critical services. According to McNally and Martin (2017), the issues of colonization and racial discrimination in Canada are related and do play a crucial role in imposing detrimental effects on the health status of the Indigenous population in Canada.
Rousseau et al. (2017) reveal that colonization is considered one of the most critical determinants of health outcomes of the Indigenous populations living with cognitive disabilities around the world. For instance, the government of Canada puts considerable emphasis on the role played by issues such as social segregation, inadequacies in the levels of self-determination, racist ideologies, and colonization in fostering the current state of health disparities experienced by the Indigenous population.
Donna Baines (2017) reveals that for well over 100 years, Canada’s Indigenous people living with cognitive disabilities have been managing prejudice and its associated effects in their personal, family, as well as social lives. They are continually demonst...