Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 1 Disability Paradigms and Models and Rehabilitation

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



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



•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



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



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)



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



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



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



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



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’



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



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’



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



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)



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?



Gearing the Framework to Rehabilitation Activities

Practicalities Meanings

BODY

PSYCHOLOGY

SOCIAL STRUCTURE

CULTURE

Per

son

al

Ch

ang

eE

nvi

ron

men

tal

Ch

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e



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



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

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Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 1 Disability Paradigms and Models and Rehabilitation