Disability Paradigms and Models and Rehabilitation Practice

1. Disability Paradigms and Models and Rehabilitation Practice Lesley Jordan School of Health and Social Sciences Middlesex University

2. Issue: Engaging social model with rehabilitation services Aims: 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 Issue and Aims

3. Individual model Social model • Personal tragedy • Individual impairment • ‘Special needs’ • Social oppression/barriers • Society’s failure to meet needs of all • Intolerance of difference Explanations • Inabilities • ‘Lives not worth living’ • Professional control • Abilities • Valued contribution • People power Focus Individual and Social Models of Disability

4. Priestley’s Disability Research Paradigms Materialist Models concerned with:- Idealist Models concerned with:- Functioning of ‘impaired bodies’ BODY Beliefs about disability and with disabled people’s identities and roles PSYCHOLOGY Individual Disabling barriers and material relations of power SOCIAL STRUCTURE Cultural values and representations in relation to disabled people CULTURE Social

5. BODY Therapies to improve ‘functional communication’ PSYCHOLOGY/IDENTITY Dealing with psychological aspects of aphasia affecting 1 above Self-advocacy courses; Identity projects (Connect website) SOCIAL STRUCTUREAdvocacy/facilitation to enable a man with severe aphasia to give evidence in court (Hovard, 1997) CULTURETraining in strategies/techniques to facilitate interaction for: Care workers (e.g. Jordan, 1998a) Volunteers (e.g. Kagan & Gailey, 1993) Applying disability paradigms to aphasia therapy activities

6. 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 Applying the paradigms to therapy activities

7. Analysis of Relationship between Therapists’ Activities and Values Provider Value Systems Activity concerning: Individual model Social model 1. Body 1i (The Medical model) 1s 2. Psychology/ Identity 2i 2s 3. Social structure 3i 3s (The Social model) 4. Culture 4i 4s

8. 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 1i: Body activities / Individual model values

9. 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 1s:Body activities / Social model values

10. 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’ 2i: Psychology activities / Individual model values

11. 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 2s: Psychology activities / Social Model values

12. 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’ 3i/3s Social structure

13. 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 Values Content and delivery likely to reinforce individual model of disability unless explicit exposition of social model at every stage 4i/4s Culture

14. Potential 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

15. 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? Conclusionsand Further Issues

16. Gearing the Framework to Rehabilitation Activities Personal Change Environmental Change

17. 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:

18. 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 References continued: