1. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 1 Disability Paradigms and Models and Rehabilitation Practice Lesley Jordan School of Health and Social Sciences Middlesex University

2. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 2 Issue and Aims 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

3. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 3 Abilities Valued contribution People power Inabilities Lives not worth living Professional control Social oppression/barriers Societys failure to meet needs of all Intolerance of difference Personal tragedy Individual impairment Special needs Social modelIndividual model Explanations Focus Individual and Social Models of Disability

4. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 4 Priestleys 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 peoples identities and roles PSYCHOLOGY Functioning of impaired bodies BODY Idealist Models concerned with:- Materialist Models concerned with:- Individual Social

5. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 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 STRUCTURE Advocacy/facilitation to enable a man with severe aphasia to give evidence in court (Hovard, 1997) 4.CULTURE Training in strategies/techniques to facilitate interaction for: Care workers (e.g. Jordan, 1998a) Volunteers (e.g. Kagan & Gailey, 1993)

6. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 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 therapists underlying values

7. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 7 Analysis of Relationship between Therapists Activities and Values 4s4i4. 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

8. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 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 clients needs Professional = powerful Client = subordinate

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

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

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

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

13. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 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 Values Content and delivery likely to reinforce individual model of disability unless explicit exposition of social model at every stage

14. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 14 Conclusions and Further Issues 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)

15. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 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 I ssues 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?

16. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 16 Gearing the Framework to Rehabilitation Activities PracticalitiesMeanings BODY PSYCHOLOGY SOCIAL STRUCTURE CULTURE Personal Change Environmental Change

17. Disability Paradigms and Models and Rehabilitation Practice University of Lancaster 27-July-2004Slide 17 References: Connect: The Communication Disability Network www.ukconnect.org www.ukconnect.org Hovard, L. (1997) The speech therapists 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

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