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Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 1
Disability Paradigms and Models and
Rehabilitation Practice Lesley Jordan
School of Health and Social Sciences
Middlesex University
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 2
Issue and AimsIssue: Engaging social model with rehabilitation servicesAims:• Provide a framework for analysis (illustrated by
aphasia therapy)• Raise questions about:- - Distinction between ‘individual’ and ‘social’ model services - ‘Social’ aspects of rehabilitation services - Application of social model values within services concerned with impairment
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 3
•Abilities•Valued contribution •People power
•Inabilities•‘Lives not worth living’•Professional control
•Social oppression/barriers
•Society’s failure to meet needs of all
•Intolerance of difference
•Personal tragedy•Individual impairment•‘Special needs’
Social modelIndividual model
Exp
lana
tions
Foc
us
Individual and Social Models of Disability
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 4
Priestley’s Disability Research Paradigms
Cultural values and representations in relation to disabled people
CULTURE
Disabling barriers and material relations of power
SOCIAL STRUCTURE
Beliefs about disability and with disabled people’s identities and roles
PSYCHOLOGY
Functioning of ‘impaired bodies’
BODY
Idealist Modelsconcerned with:-
Materialist Modelsconcerned with:-
Indi
vidu
alS
ocia
l
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 5
Applying disability paradigms to aphasia therapy activities
1. BODY Therapies to improve ‘functional communication’
2. PSYCHOLOGY/IDENTITY Dealing with psychological aspects of aphasia affecting 1 above Self-advocacy courses; Identity projects (Connect website)
3. SOCIAL STRUCTUREAdvocacy/facilitation to enable a man with severe aphasia to give evidence in court (Hovard, 1997)
4. CULTURETraining in strategies/techniques to facilitate interaction for: Care workers (e.g. Jordan, 1998a) Volunteers (e.g. Kagan & Gailey, 1993)
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 6
Applying the paradigms to therapy activities
Activities can be analysed in terms of:
(a) Their specific content
(b) Their meaning/emotional ‘tone’ - messages conveyed to person with
aphasia / others
Both affected by therapist’s underlying values
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 7
Analysis of Relationship between Therapists’ Activities and Values
4s 4i4. Culture
3s (The Social model)
3i3. Social structure
2s2i2. Psychology/ Identity
1s1i (The Medical model)
1. Body
Social modelIndividual model Activity concerning:
Provider Value Systems
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 8
1i: Body activities / Individual model values
• Focus on
(a) Impairment rather than the whole person
OR
(b) Client as a disabled person • Therapist as best assessor of client’s needs• Professional = powerful
Client = subordinate
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 9
1s: Body activities / Social model values
• Client: a person with a life to live and multiple roles
• Professional expertise used to aid clients in achieving their goals
• Problem-solving approach, led by the client • Balanced partnership between therapist and
client
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 10
2i: Psychology activities / Individual model values
• Assist client in accepting their impairment and coming to terms with themselves / their position as a disabled person
• Emphasis on client being realistic about themselves and their limitations
• Sympathetic to carers’ ‘burden’
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 11
2s: Psychology activities / Social Model values
• Assist clients in developing a positive identity as a person with aphasia
• Self-advocacy courses for people with aphasia
• Educating ‘communication partners’ about facilitating communication
• Training volunteers to facilitate communication with specific client
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 12
3i/3s Social structure Therapists’ activities
• Professional opinion / advocacy / facilitation in relation to e.g. benefits / courts / education / employment
• Independent living provisions (adaptations / aids, etc) and information about them
Individual model values• General assumption that the disabled person is
‘the problem’. Rationale: ‘humanitarian’Social model values• Assumption that society is ‘the problem’, so
expectation of adjustments, modifications of procedures, etc. Rationale: ‘citizenship’
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 13
4i/4s Culture Therapists’ Activities
Influencing media representations of people with aphasia
Providing education via publications and mass media
Increasing awareness of aphasia (e.g. Corker & French, eds, 1999; Swain et al, eds, 2004)
Training other service providers and members of general population in facilitation
Provider ValuesContent and delivery likely to reinforce individual model of disability unless explicit exposition of social model at every stage
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 14
Conclusions and Further IssuesPotential for ‘social model’ rehabilitation?• (Possibly) increasing compatibility between
professional values and social model of disability (RCSLT, 1991, 1996)
• Examples of NHS aphasia therapists working in partnership with clients
• Some professional education takes social model on board (e.g. City University; Birmingham University)
• Voluntary sector practice and courses informed by the social model (e.g. ‘Connect’)
• Social model of disability in aphasia therapy literature (Jordan, 1998b; Jordan & Kaiser, 1996; Parr et al, 2003; Pound et al, 2000)
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 15
Conclusions and Further Issues Problems for the social model in rehabilitation
Dominance of individual model of disability in society Possible reinforcement from ‘patients’ and their
families/friends of individual approach Lack of clear distinction between illness and disability NHS culture Scarce resources
Issues How can NHS therapists be encouraged to base their
‘impairment level’ activities on social model values? How to ensure that therapists’ ‘disability level’ activities
are based on social model? Appropriateness of framework for rehabilitation?
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 16
Gearing the Framework to Rehabilitation Activities
Practicalities Meanings
BODY
PSYCHOLOGY
SOCIAL STRUCTURE
CULTURE
Per
son
al
Ch
ang
eE
nvi
ron
men
tal
Ch
ang
e
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 17
References:Connect: The Communication Disability Network www.ukconnect.org
Hovard, L. (1997) ‘The speech therapist’s experience as facilitator’, In Action for Dysphasic Adults Legal/Medical Advocacy Day, Full Transcript, ADA, London
Jordan, L. (1998a) ‘Carers as Conversation Partners: Training for Carers of Communicatively Impaired People’, Care: The Journal of Practice and Development, 6(3), May, 45-59
Jordan, L. (1998b) ‘Diversity in Aphasiology: A Social Science Perspective’ Aphasiology, 12(6), June, 474-480
Jordan, L & Kaiser, W (1996) Aphasia – A Social Approach, Stanley Thornes, Cheltenham
Kagan, A & Gailey, P (1993) ‘Functional is not enough: Training of conversation partners for aphasic adults’, in A L Holland & M M Forbes, eds, Aphasia Treatment: World Perspectives, Chapman Hall, London
Disability Paradigms and Models and Rehabilitation Practice
University of Lancaster 27-July-2004 Slide 18
References continued:
Parr S et al eds (2003) Aphasia Inside Out, Open University Press, Maidenhead
Pound C et al (2000) Beyond Aphasia: Therapies for Living with Communication Disability, Speechmark, Bicester
Priestly, M (1998) ‘Constructions and creations: idealism, materialism and disability theory’, Disability & Society, 13, 75-94
Priestley M (2003) Disability: A Life Course Approach, Polity, Oxford
Royal College of Speech & Language Therapists (1991, 1996) Communicating Quality, RCSLT, London
Thomas, C (1999) Female Forms: Experiencing and Understanding Disability, Open University Press, Buckingham