1. Disability
OCT 4109
Week 1.
Disability as a social,
cultural and political
phenomenon.
1

2. Important that you take
responsibility for your own
learning.
Ask questions during lectures
and labs
Answer questions during
teaching sessions
Do the reading
I don‟t know what you don‟t
understand unless you let me
know
We are helping you to
learn, enquire, and use clinical
reasoning.

3. Contents.
3
• Welcome to unit
• Definition of disability
and content of unit
• Models and concepts
of disability
• Difference and
diversity

5. • http://www.youtube.com/watch?v=nwBzb7
m2n64
• Mia‟s story

6. Definition..
• Disabilities can result in a person having
a substantially reduced capacity for
communication, social interaction,
learning or mobility and a need for
continuing support services in daily life.
• With the assistance of appropriate aids
and services, the restrictions
experienced by many people with a
disability may be overcome.
• www.disability.wa.gov.au6

7. • The main categories of disability are physical,
sensory, physiological and intellectual.
• A physical disability is the most common,
followed by mental/behavioural and sensory.
Many people with disabilities have multiple
disabilities.
• Physical disabilities generally relate to
disorders of the musculoskeletal, circulatory,
respiratory and nervous systems.
• www.disability.wa.gov.au
7

8. • Sensory disabilities involve impairments in
hearing and vision.
• Mental/behavioural disorders include
intellectual and developmental disabilities
which relate to difficulties with thought
processes, learning, communicating,
remembering information and using it
appropriately, making judgements and
problem solving. They also include anxiety
disorders, phobias or depression
• www.disability.wa.gov.au
8

9. Definition and inclusions
• Disabled people do not enjoy the
biological luxury of recovery.
• They are usually medically well.
• Not equated with any degree of „suffering‟
• Disability exists when „people experience
discrimination on the basis of perceived
functional limitations‟.
9

10. Construct and language
• Developmental disabilities – language used in UK.
• Definition – set of abilities and characteristics that
vary from the norm in the limitations they impose
on independent participation and acceptance in
society
• Developmental in sense that delays, disorders or
impairments that exist within traditionally
conceived developmental domains such as
cognitive, communication, social , or motor
abilities appear in the „developmental period‟
characterised before 22 months of age.
• Low IQ is typically associated with DD
(developmental disability). Odom et al
10

11. Disability as a social construct
Classifying difference
• Classification and clarification of deviations
from the norm
• Including physical, cognitive and mental
disabilities
• “Far from being mere differences of
interpretation, these issues concern the way
in which disabled people are perceived, the
allocation of healthcare resources and, in
some instances, survival itself.‟ (p 17,
Hammell 2006. )
11

12. • “Increasing contact with social differences will likely
bring both conflict and gradual recognition that
„differences‟ are part of the long-term social fabric
of society.” p 10 Odom et al
• Developmental disabilities are handicaps when
they create barriers to personal and social
development of an individual within expectations,
constraints, and supports available.
• As perceptions of social „difference‟ shifts, so will
perceptions of developmental disabilities.
12

13. Language and labelling
13
Desirable language Undesirable language
• People with disabilities • The handicapped or the
when referring to an disabled.
individual person; gives a • He‟s mentally retarded.
focus on the person not the
disability • She‟s autistic.
• He has a cognitive disability • He‟s Down‟s.
(diagnosis). • She‟s learning disabled.
• She has autism (or an
autism diagnosis). • He‟s a quadriplegic
• She uses a wheelchair. • She‟s a cripple.
• Disabled people is the • She‟s a dwarf/midget.
acceptable language in the
social/political model
referring to group/s.

14. They are people, first.
• People do not suffer from a disability
• They are Mums and Dads. . . Sons and
Daughters . . …Employees and Employers
• Friends and Neighbours . . . Students and
Teachers. . …Leaders and Followers
• Scientists, Doctors, Actors, Presidents,
and More
• They are people.
• They are people, first. 14

15. International classification of
functioning, disability and Health ICF
(WHO, 2001)
• Attempts to acknowledge that people
interact with their environments,
– Identifying „impairment‟ (perceived problems
in body function or structure)
– „Activity limitations‟ (difficulties in executing a
task or action)
– „Participation restrictions‟ (problems in
functioning at the social level)
15

16. ICF
• ICF provides a common language and
framework for description of health and
health related states, outcomes and
determinants. The ICF emphasises health
and functioning in society regardless of the
reason for the individual’s impairments. The
ICF focuses on person’s level of health rather
than on disability.
• Important because diagnosis alone does not
predict service needs, level of care, or
functional outcomes
16

17. ICF – International classification
of function

18. ICF
• ICF considers personal factors that impact an
individual‟s ability to act and to participate
and also considers environmental factors.
• These include physical contexts, social and
cultural contexts (attitudes, values), economic
contexts (social systems and services),
political contexts (policies, rules) and legal
contexts in which impairments are
considered.
18

19. • In ICF model, disability and
functioning/participation are seen as the
outcome of the interaction between health
conditions (diseases, disorders and
injuries) and contextual factors
19

20. ICF and issues for disabled
people
• ICF makes no capacity for coding the
discriminatory dimensions of society, performance
of governments or the effect of their policies.
• Explores environment only in how it impacts on
individual lives.
• ICF fosters a view of disabled people as
catalogues of deficits and deprivations father than
as people with various abilities and resources.
20

21. • No other group of minority people has been
the focus of such in depth classification!
• Classification of individual differences, is
seen as necessary for analysis of status,
provision of health or community services or
the implementation of policies to assure their
rights. This would not be acceptable for other
minorities including ethnic minorities, women
or other.
21

22. • Although many potential benefits are
ascribed to the ICIDH and later to the ICF,
the primary use of these classifications is
for compiling statistics, filing and retrieving
case records, (according to the specified
categories), assessing deviations from
„normality‟ and determining eligibility for
services and programmes.
• Clearly such tool „assist professionals and
bureaucrats in their work, they do not have
any inherent benefit for those being coded
and classified” Hammel p25
22

23. • It will be interesting to observe whether, and
how, use of the ICF classification will actually
shift the focus of policy makers and
researchers from individuals to environments
(physical, social, cultural, economic, political
and legal) to enable the coding, classification
and change both of social policies and the
distribution of resources and opportunities
within societies.
23

24. • Disability writers see the ICF classifies
disabled people not as different, but as
– defective,
– deviant,
– sub normal, and
– inferior. (Hammel p21)
24

25. Historical models
• Why
• Help new practitioners understand that
some of the individuals with whom they
work will have experienced very different
services to those on offer today.
25

26. Models of disability
• religious/ moral
• Individual /medical
• social/inclusive
26

27. Models
• Ideas inform and shape behaviour, and
ideas about impairment, shape the
response of individuals and societies to
people who have various forms of
impairment.
27

28. Frameworks
• A model is a framework that is used to make
sense of information, a model is both shaped
by ideas and serves to shape ideas.
• A model may shape ideas so successfully
that it is eventually regarded as the natural or
„right‟ way of thinking about an issue
• 3 models, all emerged at very different times,
they are all evident today
28

29. Moral/religious model
• Oldest and most pervasive framework
• Embraced by most cultures and religions
• Attributes impairment to the consequences
of possession by evil spirits, punishment
for wrong doing, or committed sins by the
individual or the parents.
29

30. Consequences of the
Moral/religious model
• The idea that impairment are deserved led to
derision, ostracism, abuse, ridicule and pity.
• Pity underpins the concepts of charity and
alms-giving
• „Moral obligation‟ is action directed to help
others „less fortunate than ourselves‟
• Leads to people feeling shame, guilt,
30

31. Consequences of the
Moral/religious model
• Disabled people may be hidden from
view.
• Historically lived in institutions, asylums.
• Partially responsible for influencing and
justifying the widespread discrimination
against disabled people.
31

32. • Male dormitory at the Claremont hospital
for the insane.
32

33. Individual / medical model
• Underpinned by rehabilitation professions
• Belief that science can solve all problems
• Sees disability as an individual deficit
amenable to „expert‟ solutions.
• Sees restriction of activity as a tragic
consequence of their impairment
• Assumes that there is an optimal level of
human functioning to which all humans
should aspire.
33

34. Individual / medical model
• Treatments directed to enabling
individuals to overcome functional deficits
and appear as normal as possible.
• Talk of „blame‟ or „non-compliance‟ if
disabled people fail to achieve the
rehabilitation goals established by their
therapists.
34

35. Consequences of
individual/medical model
• Disability theorists view attempts to
normalise individuals as inherently
repressive
• Challenge models in which powerful
„experts‟ determine treatment plans for
powerless „patients‟
• Rehabilitation is the process of enabling
individuals to live with an impairment in the
context of their environments.
35

36. Social/political model
• Arose from the declaration “In our view it is
society which disables physically impaired
people. Disability is something imposed on
top of our impairments by the way we are
unnecessarily isolated and excluded from full
participation in society .. Disability is therefore
a particular form of social oppression”. British
Union of Physically Impaired Against
Segregation (UPIAS 1976 p 3-4)
36

37. Social/political model
• Distinguish impairments (perceived bodily
differences) and disability (the social
experience of having an impairment)
• Social model – impairment refers to
perceived abnormalities of the body/mind,
disability refers to loss or limitations of
opportunities to take part in normal
community life on an equal level with
others due to physical or social barriers.
• Therefore disability refers to something
wrong with society, not with the person. 37

38. Social/political model
• Disability is all things which impose
restrictions on disabled people.
• Includes
– individual prejudices,
– institutional discrimination,
– inaccessible public buildings,
– unusable public transport systems,
– segregated education,
– excluding work arrangements.
38

39. Social/political model;
disability as oppression
• Unequal distribution of resources and power
relations and opportunities to participate in
everyday life.
• Studies of people with spinal injuries
demonstrate dissatisfaction results for the
social disadvantages such as confinement to
residential institution, unemployment and
reduced community access. – is support
social model of disability.
• Environment includes economic, cultural,
social. Legal and political 39

40. Critiques of social/political model
• Model should act as a lens to sharpen one‟s
thinking, not as a set of blinkers to restrict
ideas.
• Social model ignores impact of pain, fatigue,
paralysis and reduced life expectancy.
• Although the medical model has ignored
socio-cultural issues, it cannot simply be
replaced by a socio-cultural model which
ignores medicine.
40

41. • Is the social/political model relevant in the
majority of the world? i.e. in third world
countries?
• Does the social/political model focus on
the impairment rather that the person?
• Is the social/political model an urban
model?
41

42. Consequences of the
social/political model.
• Had major global impact
• Influence for social model is evident in
– international declarations and conventions,
– national legislation,
– global expansion of Community-Based
Rehabilitation programs,
– growing number of Disability Studies university
programs
– Push for inclusive education and
– research literature.
42

43. Rehabilitation and social/political
model
• Rehabilitation can change the skills of people to
increase their ability to functions in the pre existing
environment
• In addition to teaching mobility skills ,
professionals must ensure that clients have
somewhere they can go and something they can
do.
• Acknowledging the social dimensions of
disablement does not require that therapists
neglect the individual physical or psychological
issues of impairment.
• Instead it requires a more holistic focus
43

44. • Requires therapists to expand their focus
of their interventions from modifying
individuals ( ie developing skills)
– to also modifying environments (ie actively
lobbying for accessible transport),
– and modifying attitudes
• Demands a level of commitment and
engagement that supports social inclusion,
and community education
44

45. “Normalisation” and “Social Role
Valorisation” (SRV)
• SRV formulated in 1983 by Wolf
Wolfensberger out of „normalisation‟
• Disability services were still emerging
from the medical model and embracing
the individual model
45

46. Social role valorisation
• SRV is a description of how societally
differentiated people are devalued,
unvalued and often treated poorly
• Focus was to make people with disabilities
more „normal‟
• Helped staff to value people with
disabilities
• SRV works against self-advocacy efforts
46

47. SRV and normalisation
• During 1970‟s and 1980 accepted guiding
principle
• Had tremendous positive impact on people
lives
• Did much to eliminate
– deprivations from purposeful activities,
– overcrowding,
– lack of individualisation,
– isolation from other people or ordinary places.
47

48. • Significantly contributed to increases in
• community residential alternatives,
• development of community based
employment programs,
• rise of self advocacy movement and
• trend towards inclusive, integrated
educational opportunities.
• Wolfe, Kregel and Wehman, 1996
48

49. • Universal acceptance of normalisation led
to misunderstandings, misapplication of
principle
• Service has been paternalistic,
• Wolfe, Kregel and Wehman, 1996
49

50. SRV
• Kielhofner‟s view of SRV – pressuring
disabled persons to fit in by appearing and
functioning as much like non-disabled
persons as possible.
• Functions of „norms‟ eg normal gait,
normal hand writing, establish the
professionals as the people with power.
• Fit with the medical/expert model
50

51. Self determination
• SRV Replaced by the consumer
empowerment movements;
• Self determination - individuals ability to
express preferences and desires, to make
decision, and to initiate actions based on
those decision.
• Simply refers to choice
• Persons sets goals for oneself the actively
engages in activities designed to achieve
these goals. 51

52. OT‟s and disability today
• Difference and diversity (not deviance and
normalisation)
• Person centred practice
– Or client centred practice
– Family centred practice
• Inclusion
• Self advocacy
52

53. Difference and diversity
• cultural diversity
• Celebrate diversity
and individual
differences
• Different ability
53

54. OT models
54
CMOP

55. PEOP Model
physiological Social
support
occupation Social & economic
cognitive
support
Person Environment
Occupational
(intrinsic factors) performance & (extrinsic factors)
participation
spiritual
Culture &
neurobehavioural values Built
environment
performance Natural
& technology
psychological environment
Wellbeing Quality of life

56. Historical perspective in WA
• In Australia at the turn of the century
before there were formal services for
people with disabilities, it was left to
families to care for their children with
disabilities without assistance. Children
with disabilities were viewed as
ineducable, and parents were often
advised to "put their children away and get
on with their lives".
56

57. Parent lead support groups
• 1940‟s and 1950‟s
• Organisations such as Spastic Welfare
association and Slow Learning Children‟s
Group.
• Day care, school, therapies and residential
facilities
57

58. A shift to a training model
• 1964 a new separate State Government
service the Mental Deficiency division
• Separated mental health and intellectual
disability
• Children transferred from Claremont
Mental Hospital to Pyrton in December
1966
• 1970 and 1980 focus on training and skills
developments
58

59. A policy framework
• 1981 the International Year of Disabled
Persons raised the profile
• Commonwealth Disability Services Act (1986)
• 1992 Disability discrimination Act
• Authority for Intellectually Handicapped
persons (AIH) began in WA in 1986 charged
with advancing the rights, responsibilities,
dignity, development and community
participation of people with intellectual
disabilities in WA.
• Disability Services Commission in 1991 59

60. • Information on www.disability.wa.gov.au
• The history of services in WA reflects
history in world.
60

61. Summary
• Exams questions – models of disability,
how they impact your clients, your beliefs
and your services.

62. References
• Conway, M. (2008). Occupational therapy and inclusive design:
Principles and practice. Oxford: Blackwell Publishing.(Ch 2 & 3)
• Disability Services Commission WA. www.disability.wa.gov.au
accessed 8.10.08
• Hammell, K. (2006) Perspectives on disability and rehabilitation.
Sydney: Churchill Livingstone Elsevier.
• Kielhofner, G. (2005). Rethinking disability and what to do about it:
disability studies and its implications for occupational therapy. The
American Journal of Occupational Therapy, 59(5), 487-496.
• Masala, C., & Petretto, D. R. (2008). From disablement to
enablement: conceptual models of disability in the 20th century.
Disability and Rehabilitation, 30(17), 1233-1244.
• Social Role Valorisation
http://www.socialrolevalorization.com/resource/resource.html
accessed 8.10.08
• Wolfe, P., Kregel, J., & Wehman, P. (1996). Mental Retardation and
Developmental Disabilities. In P. J. McLauchlin & P. Wehman 62
(Eds.), (2nd ed.). Austin, Texas Pro-ed.