Social workers, especially those in health care and rehabilitation systems, must consider practice changes necessitated by recent legislation and the growing activism of disability rights groups. The authors review essential elements of the emerging sense of both oppression and empowerment that is occurring for many people with disabilities and groups; consider key aspects of ADA and other perti nent legislation that place new emphases on the self-determination of people with disabilities; and discuss what implications changing practice roles might have for social workers' relationships and patterns of interaction with other professionals in medical, health care and rehabilitation settings. The authors outline a beginning effort at designing a conceptual framework that promotes practice that: (1) maximizes clients' involvement in exploring an expanded range of options and choices; (2) prepares clients to be more effective in dealings with professionals, bureaucrats and agencies that often do not understand nor appreciate their need for self-determination; and (3) at the organizing level, mobilizes and helps to empower groups of people with disabilities to consider policy and program alternatives that can improve their situation. This framework may also be useful in work with people who have other long term care needs, chronic conditions.