Viewing Disability as Diversity When Providing Physical Therapy Combined Sections Meeting 2015 February 4‐7, 2015 Indianapolis, IN www.aptahpa.org HPA The Catalyst is the Section on Health Policy & Administration of the American Physical Therapy Association Speaker(s): Susan Magasi, PhD, OT Marilyn Moffat, PT, DPT, PhD, DSc (hon), GCS, CSCS, CEEAA, FAPTA Susan Roush, PhD, PT Nancy Sharby, DPT Session Type: Educational Sessions Session Level: Multiple Level This information is the property of the author(s) and should not be copied or otherwise used without the express written permission of the author(s). Page 1 of 17 total pages
Transcript
Viewing Disability as Diversity When Providing Physical Therapy
CombinedSectionsMeeting2015
February 4‐7, 2015
Indianapolis, IN
www.aptahpa.org HPA The Catalyst is the Section on Health Policy & Administration
This information is the property of the author(s) and should not be copied or otherwise used without the
express written permission of the author(s).
Page 1 of 17 total pages
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American Physical Therapy Association Combined Sections Meeting Indianapolis; February 2015
Viewing Disability as Diversity When Providing Physical Therapy
Disability as Diversity
Susan E. Roush, PhD, PT; University of Rhode Island Nancy Sharby, DPT Northeastern University (Boston) Susan Magasi, PhD; University of Illinois at Chicago Marilyn. Moffat, PT; New York University & WCPT
APTA CSM 2015 Indianapolis
Disability as Diversity: Overview Introduction
Models of disabilities ICF – focus on Function, Independence and
Participation ICF Case analyses
Applying Disability Studies to Physical Therapy Global Research
Final case analysis & wrap-up APTA CSM 2015 Indianapolis
Disability as Diversity
APTA CSM 2015 Indianapolis
Understanding what is important to others… “Golden Rule” vs. “Platinum Rule”
Disability as Diversity
APTA CSM 2015 Indianapolis
Fundamental Negative Bias
Concept from the 1950s and 60s Erving Goffman Beatrice Wright
Stigma Stereotypes Bias
Disability as Diversity
APTA CSM 2015 Indianapolis
Fundamental Negative Bias
Examples
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Disability as Diversity
APTA CSM 2015 Indianapolis
Fundamental Negative Bias
“So, why is it often assumed people with disabilities are unhappy?”
BBC News Magazine
Shakespeare T. A. Point of View: Happiness and Disability. BBC News Magazine. 31 May 2014.
Disability as Diversity
APTA CSM 2015 Indianapolis
Fundamental Negative Bias
Unfortunately, also seen in healthcare, including physical therapy
Disability as Diversity
APTA CSM 2015 Indianapolis
Fundamental Negative Bias
Test results: ‘Positive’ is really negative from patient’s POV ‘Negative’ is really position from patient’s POV Terms such as ‘good’ and ‘bad’ Lack of ‘person-first’ language
Fundamental Negative Bias
Health care professionals consistently rate the quality of life of persons with
disabilities lower than those persons’ self-reported quality of life
Disability as Diversity
APTA CSM 2015 Indianapolis
Models of Disability
None fit perfectly Each has advantages and disadvantages
Disability as Diversity
APTA CSM 2015 Indianapolis
Models of disability
Moral Medical Social Cultural
Olkin R. Could you hold the door for me? Including disability in diversity. Cultural Diversity & Ethnic Minority Psychology, v8 n2 p130-37; May 2002.
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Disability as Diversity – Moral Model
APTA CSM 2015 Indianapolis
Disability = punishment for wrong doing
Caused by moral lapse, sin, failure of faith
Individuals are responsible for their condition Frequently tied to religion
Disability brings shame
Disability as Diversity – Moral Model
APTA CSM 2015 Indianapolis
“God gives us only what we can bear”
“There is a reason I was chosen to have this
disability”
“She didn’t deserve that”
“Why Me?”
“Physical therapists do God’s work”
Disability as Diversity – Moral Model
APTA CSM 2015 Indianapolis
Advantages: • Special relationship with God • Sense of a greater purpose
Disadvantages:
• Shame, stigma & marginalization
Disability as Diversity–Medical Model
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Disability is something to be fixed
AKA Deficit model
Pathology/abnormality is paramount Impairment=disability
Cure or amelioration sought
Lessened but not absent sense of patients being responsible for their conditions
Disability as Diversity–Medical Model
APTA CSM 2015 Indianapolis
Negative consequences for those who do not value and strive for “normal” outcome
e.g. Non-adherence
Uncooperative
Fixing impairment > facilitating function
Disability as Diversity–Medical Model
APTA CSM 2015 Indianapolis
Paternalism:
Services for, but not by, persons with disabilities
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Disability as Diversity–Medical Model
APTA CSM 2015 Indianapolis
Lack of acceptance of people with disabilities as peers
Attitudinal obstacles to accommodation are
typically the most difficult to overcome
Attitudes create the greatest barrier to accommodations and inclusion
Disability as Diversity–Medical Model
APTA CSM 2015 Indianapolis
Physical Therapy But, we are the good guys, right?
Educated to identify differences from ‘normal’ Remediate abnormalities
Goals are often therapist-generated Goals are linked to “normal,” not to function
Disability as Diversity – Social Model
APTA CSM 2015 Indianapolis
Disability = social construct
Society’s lack of accommodation is the cause of disability
Disability Rights Movement
Disability as Diversity – Social Model
APTA CSM 2015 Indianapolis
Change grounded in Civil Rights “Nothing about us, without us”
Reject charity model
E.g. protests against Jerry Lewis telethons*
*McBryde Johnson H. Too old to die young. Henry Holt & Co. 2005
Advantages
❚ Integration/inclusion
❚ Impairments not disabilities
❚ No stigma
Disadvantages
• Broad social & political changes needed
• Cost
Disability as Diversity – Social Model
Disability as Diversity – Social Model
Reliant on:
De-emphasizing impairments and emphasizing social justice
Changing attitudes is essential
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Disability as Diversity–Culture Model
AKA Minority Group model
Disability = rich perspective on the human condition that is celebrated and valued
E.g. Deaf culture
Autism and neuro-typical
Disability as Diversity
Paradox of Physical Therapy
Functioning in the Medical Model while simultaneously respecting
disability as diversity
Disability as Diversity
APTA CSM 2015 Indianapolis
Creating ICF applications that further
function, independence and participation
Dr. Nancy Sharby: 20 minutes
Who Is Disabled?
❚ People with disabilities (PWD) as a minority group
❚ 56.7 million ❙ Number of people in the United States in 2010 with a disability
❚ 19% community dwelling population ❚ A disability can occur at birth or at any point in a
person’s life.
Who is Disabled?
❚ PWD are the largest minority in America ❚ Disability crosses gender, sexual
orientation, income, race/culture ❚ Disability is a heterogeneous group ❙ Physical, intellectual, sensory or psychiatric
❚ Only 8% of PWD are born with a disability ❙ Anybody can “join”
What is an impairment?
An impairment exists when a person has a physical, sensory or intellectual condition that potentially limits full participation in social and/or physical environments. ❙ Impairment is nothing more than a description
of a difference in the body or mind
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❚ Everyone with a disability has an impairment ❙ Change/abnormality that affects how the body works ❙ Anatomically ❙ Physiologically
❚ Does having an impairment always mean you have a disability?
❚ Does having an impairment mean that you must have it “fixed?
❚ Does everyone with an impairment want it fixed?
❚ If impairment means abnormality, what does it says about the person behind the impairment?
Disability Definitions are Based on Social Norms
❚ Norms based on statistical definitions ❚ Social Norms ❙ Based on experiences of non-disabled ❙ Marginalizes the experience of PWD ❙ Oppresses the rights of PWD
❚ What are some common social norms in America in the 21st century?
Americans With Disabilities Act 1990
❚ "an individual must have an impairment that prevents or severely restricts the individual from doing activities that are of central importance to most people's daily lives"
Wikipedia
❚ Disability is the gap between what the person can do and what the person needs or wants to do
❚ A disability (or lack of a given ability, as the "dis" qualifier denotes) ❙ may be physical, cognitive/mental, sensory,
emotional, developmental or some combination of these.
Social Security Administration
❙ Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment…
❙ Or that can result in death ❙ Can be expected to be present for 12 or more
months
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American Medical Association
❚ An alteration of an individual’s capacity to meet personal, social or occupational demands because of an impairment
Medical Model of Disability
❚ Rehabilitation classically defined disability as a personal deficiency or deviation from documented norms ❙ Impairment is undesirable ❙ Having an impairment is a personal tragedy ❙ Goals ❘ “fix”it ❘ To be “normal ❘ Create independence from others
❙ Client is should fully participate
International Classification of Disability, Illness and Function Environmental Factors
❙ Barriers ❘ Architectural/built ❘ We don’t want sympathy, we want ramps
❙ Disability is a social condition ❘ Looks beyond the individual and focuses on
barriers to participation that are imposed by individuals and society ❘ Nothing about us without us
Environmental Factors
“focusing on the client’s impairment as the problem rather than treating environmental (physical, social, political, and economic) barriers as the true problem, rehabilitation reinforces the perception that disability is an individual matter requiring private solutions rather than a matter of socially produced barriers requiring public, political solutions” Gary Keilhoffer
OT, despite what may be the best of intentions on the part of its practitioners, serves to perpetuate the process of disablement of impaired people.”
Personal Factors: Does Everyone Want to be “Normal?”
❚ “We define disability by the meaning the disability carries for the individual. PWD are people in which a disability is part of their lives—not the definition of their lives. Having a disability means difference, not tragedy”
Mackelprang and Salsgiver. Disability: A diversity model approach in human service practice, 1999, p 63
Differences in World View Non-Disabled ❚ Achievement ❚ Independence ❚ Mastery over the
environment ❚ Future oriented ❚ Autonomous/individualistic ❚ Direct communication
PWD ❙ Acceptance of human
differences ❙ Positive orientation toward
helping and being helped ❙ Tolerance for dealing with
the unpredictable ❙ Understanding that needs
are different depending on abilities
❙ Sense of humor about disability
❙ Interdependence (collectivist)
Common Social Norms for PWD
❚ Finely tuned capacity for inter-personal communication
❚ Flexible, adaptive, resourceful approach to tasks and problems ❚ Skill in managing multiple problems ❚ Artifacts
❚ C J Gill, A psychological review of disability culture. Disabilities studies Quarterly, 1995; 15; 16-19
CRPD ❚ νPreamble of Convention states: ❚ •‘Disability is an evolving concept, and that disability
results from the interaction between persons with impairments and attitudinal and environmental barriers that hinders full and effective participation in society on an equal basis with others’
❚ νArticle 1 of the Convention states: ❚ •‘Persons with disabilities include those who have long-
term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others’.
Disability as Diversity
APTA CSM 2015 Indianapolis
Case analyses with the ICF focused on function, independence and participation
All presenters
20 minutes
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Disability as Diversity
APTA CSM 2015 Indianapolis
Describing and applying concepts of Disability Studies to PT education
Dr. Susan Magasi
20 minutes
The Challenge
❚ How can you integrate disability studies thinking into a profession - like physical therapy - aimed at helping, healing and “fixing”?
❚ Through the creation of transformational learning opportunities
❚ Listen to the disability community…
Credo for support
❚ Challenge stereotypes
#@x! people say to people with disabilities *includes a few sexual references
❚ Partner with the disability community ❙ E.g., Knowledge Translation Collaboratives
elective
❚ Know your limits and those of the profession. ❙ Therapy is but a slice of the lives of the people
we serve
Shift you professional lens to:
❚ See beyond the micro to understand the impact the environmental factors have on participation.
Shift you professional lens to:
❚ See beyond the disability but recognize its impact – include physical, mental health, sensory, cognitive
❚ Re-conceptualize the label of expert and see power
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Provide support ❚ Create a safe space for exploration and
integration.
❚ Prepare students for the clinical realities and challenges of culture shift.
Disability as Diversity
APTA CSM 2015 Indianapolis
Global perspectives
Disability in physical therapist education and practice
Dr. Marilyn Moffet
20 minutes
Disability as Diversity
Marilyn Moffat PT, DPT, PhD, DSc (hon), GCS, CSCS, CEEAA, FAPTA President, World Confederation for Physical Therapy
CURRENT GLOBAL RESEARCH ON DISABILITY IN PHYSICAL THERAPIST
EDUCATION AND PRACTICE
WCPT
• 106 Member Organisations (no individual membership)
• Representing 350,000 Physical Therapists
BACKGROUND PREVALENCE OF DISABILITY
• Variation in the reported prevalence of disability depending on the definition (United Nations Fact Sheet on Persons with Disabilities, World Health Organization, 2011)
• Estimates of number of people with disabilities worldwide range from 0.2% to 21% - most frequently quoted figure is 15%
• Persons with moderate or severe levels of disability are estimated to make up 5.5% of the global population
• Based on population and survey data, nearly 70% of this 5.5% live in developing countries
• Because of baby boomers aging, population growth, and medical advances in lifesaving procedures, conservative assessments indicate that number of people with moderate or severe disability is expected to grow to 525 million by 2035 (WHO, 2002)
BACKGROUND DEFINITIONS OF DISABILITY
• In 1999 WHO defined disability as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for human beings” (WHO, 1999)
• 2 years later in 2002, the WHO developed the ICF Model and revised the definition to “a multidimensional phenomenon resulting from the interaction between people and their physical and social environment” (WHO, 2002)
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BACKGROUND WCPT DEFINITION OF DISABILITY (2014)
• The umbrella term for impairments, activity limitations, and participation restrictions that results from the interaction between an individual’s health condition and the personal and environmental contextual factors. Personal factors are the particular background of an individual’s life and living, and comprise features of the individual that are not part of a health condition or health states, such as: gender, race age, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience, overall behavior pattern, character style, individual psychological assets, and other characteristics, all or any of which may play a role in disability in any level. Environmental factors are external factors that make up the physical, social and attitudinal environment in which people live and conduct their lives. Disability can be described at three levels: body (impairment of body function or structure), person (activity limitations), and society (participation restrictions).
BACKGROUND INTERNATIONAL POLICIES ON DISABILITY
• The Convention on the Rights of Persons with Disabilities and the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities laid the foundation for social integration and equalization of opportunities for people with disabilities - accepted policy for UN, WHO, and WCPT for years
• The participation of people with disabilities in education, the work force, and communities has long been a guiding principle for health policy development, planning, implementation, monitoring, and evaluation, even if is not quite a reality worldwide
BACKGROUND INTERNATIONAL POLICIES ON DISABILITY
• The International Classification of Functioning, Disability and Health (ICF) attempts to address disability in a way that minimizes subjective, attitudinal biases and rather than emphasize disability, the model shifts the focus to the abilities of people (WHO, 2002)
• The key aspects of these policies and the ICF model hold true for those people with disabilities who wish to pursue education and employment as physical therapists
BACKGROUND EDUCATION & EMPLOYMENT AS HUMAN RIGHTS
• Equalization of opportunities, and access to education and employment considered basic human rights
• International guidelines and often, national legislation have been developed to ensure that those with disabilities enjoy these human rights
• Extent to which national implementation makes this a practical reality is variable
• Although human rights treaties and documents have significant potential to improve the QoL for those with disabilities, they are often under-utilized
BACKGROUND EDUCATION & EMPLOYMENT AS HUMAN RIGHTS
• Society, health professional educators, and employers struggle with how to reduce the barriers to participation for those with disabilities
• Education and employment of persons with disabilities - specifically physical therapists - must include comprehensive integrated policies and strategies to address an individual’s participation
• Modifying a job position, making physical changes to the work environment, or adjusting the method of task completion are ways to facilitate a qualified individual with disability to participate in professional education, apply for a job, perform work functions, and have equal access to others in the workplace
BACKGROUND EDUCATION
• Although need for PTs continues to grow worldwide, limited progress in maximizing opportunities for persons with disabilities to participate in higher education and in particular PT education
• Internationally, varying interpretations of guidelines for persons with disabilities regarding accommodations for attending college and participation in health professional training
• Some barriers to education for persons with disabilities include: – Under-estimation of potential to achieve – Negative societal attitudes – Discriminatory practices – Absence of urgency – Institutional policy – Lack of knowledge and resources related to reasonable
accommodation – Inability to identify specific professional requirements
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BACKGROUND EDUCATION (cont)
• In higher education several factors influence opportunity and success of persons with disabilities - institutional policy and practice, peers’ attitudes, and faculty attitudes
• Inclusion of - and accommodations for – students in physical therapy and other health professions with disabilities have been explored for both academic and clinical components of education
• One challenge seems to be defining the “essential functions” necessary for students (DeLisa and Thomas, (2005) Ingram, 1997; Losh and Church, 1999; Rangel, Wittry, Boucher and Sanders, 2001)
• Others have explored difficulties and issues related to making accommodations for students (Beckel, 2012; Francis, Salzman, Polomsky and Huffman, 2007; Ward, Ingram and Mirone, 1998)
BACKGROUND EDUCATION (cont)
• Nursing has reported that students with learning disabilities struggle with various aspects of the curriculum (Carol, 2004; Kolanko, 2003)
• In a study that investigated experiences of occupational therapy students with disabilities - revealed that students with disabilities: (1) have a strong desire to "work around it," (2) desire support and understanding both within and outside the academic environment, (3) understand that disability is an essential part of who they are as people, and (4) believe that having a disability will enhance their own practice (Velde, Chapin and Wittman, 2005)
BACKGROUND PEER ATTITUDES TOWARD STUDENTS WITH DISABILITIES
• How people react to someone with a disability based on meaning of disability within their culture
• College students no different than population at large, and therefore bring those attitudes and biases to field of study
• In general, found that college students have more positive attitudes toward persons with physical disabilities than other types of disability (Chan, Hedl, Parker, Lam,
Chan and Yu, 1988; Jaques, Linkowski, Sieka, 1970; Manders, 2006) • Students entering the health professions would be held
to a higher standard related to their attitudes toward persons with disabilities - although, no data to indicate that is the case
BACKGROUND PEER ATTITUDES TOWARD STUDENTS WITH DISABILITIES
• Therefore persons with disabilities entering into health professions education program might face same attitudes and biases that they would from general public (Lyons, 1991; Rosenthal, Chan and Livneh, 2006; Sahin and Akyol, 2010)
• Doctoral dissertation questioned physical therapists’ attitudes toward physical therapists with disabilities in academic and clinical settings (Kowalski, 2004)
• Study indicated that OT students’ attitudes towards persons with disabilities became significantly more positive as they moved through their academic training; however, when they entered college their attitudes were the same as students entering a business program (Estes, Deyer, Hansen and Russel, 1991)
BACKGROUND FACULTY ATTITUDES TOWARD STUDENTS WITH DISABILITIES
• Little is known about faculty attitudes toward students with disabilities in the health professions
• In UK, level and nature of support necessary for nursing and medical students to be successful was studied (Storr, Wray and Draper, 2011; Little, 1999)
• In one study, attitudes, knowledge and concerns of nursing educators toward students with physical disabilities were investigated and found faculty have a reduced level of confidence in: 1) students’ ability to provide safe patient services; 2) ability of institution to make reasonable adjustments for individual situations; and 3) ability to change the persistence of a fundamental negative bias of students and educators (Sowers and Smith, 2001)
• Another study identified benefits of having a person with a disability instructing a cohort of medical students (Tracy and Iacono, 2008)
BACKGROUND EMPLOYMENT AND PRACTICE
• Knowledge about employment of PTs with disabilities very limited
• Research that does exist has focused primarily on employers’ attitudes toward hiring and accommodating persons with disabilities
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BACKGROUND ATTITUDES TOWARD THE HIRING AND ACCOMMODATION OF PERSONS WITH DISABILITIES
• Aside from limited access to educational opportunities, other factors may dissuade persons with disabilities from seeking employment
• Perceptions and attitudes toward employees with disabilities have been: 1) fear of discrimination; and 2) inability or unwillingness of the employer to make accommodations
• Research indicates that hiring and accommodating persons with disabilities benefits employers; however, issues of harassment and alienation by some co-workers exists, which is problematic since inclusion in workplace is commonly what defines a person as dependent or independent (Hartnett, Stuart, Thurman, Loy and Batiste, 2010)
SURVEY FINDINGS • In 2013, WCPT undertook a study to describe the
attitudes of key stakeholders regarding education and practice for physical therapists with disabilities in different international settings
• Survey was distributed to leaders of all 106 WCPT Member Organizations - information was received from twenty-five
• All Regions were represented in the group of 25 - Africa (4), Asia West Pacific (7), Europe (9), North America Caribbean (4), South America (1)
SURVEY FINDINGS FIRST QUESTIONS
• When asked to indicate if various international regulations, guidelines, standards and polices are used to guide formal entry-level education of PT students in their country, data indicated that disability in education is a consideration for many member organizations and that international policies (particularly the WHO and UN) influence standards in practice for nearly one half of survey respondent countries
• When asked to indicate if various international regulations, guidelines, standards and polices are used to guide clinical practice for PTs with disabilities (existing or acquired), data indicated that disability in clinical practice is a consideration for many member countries; however, more than half of survey respondents reported that their countries either do not use, or they do not know if they use, international policies as a guide to influence standards in practice (see next Table)
PT Student Education (25) PT Practice (N=25)
Used Not Used
Don't Know
Used Not Used
Don't Know
ILO Code of Practice on Managing Disability in the Workplace
9 (36%)
13 (52%)
3 (12%)
8 (32%)
10 (40%)
7 (28%)
ILO Vocational Rehabilitation and Employment (Disabled Persons) Convention
8 (32%)
13 (52%)
4 (16%)
9 (36%)
10 (40%)
6 (24%)
UN Convention on the Rights of Persons With Disabilities
14 (56%)
9 (36%)
2 (8%)
12 (48%)
6 (24%)
7 (28%)
UN Standard Rules on the Equalization of Rights of Persons with Disabilities
11 (44%)
10 (40%)
4 (16%)
10 (40%)
7 (28%)
8 (32%)
WHO ICF 18 (72%)
7 (28%)
0 (0%)
16 (64%)
6 (24%)
3 (12%)
INTERNATIONAL REGULATIONS GUIDELINES USED
SURVEY FINDINGS NEXT QUESTIONS
• When asked to indicate if any national, provincial or state regulations, standards, policies or guidelines are used to guide formal entry-level education of PT students in their country, data indicated that for majority of MOs who responded, local agencies strongly influence educational policy for physical therapy students with disabilities
• When asked to indicate if any national, provincial or state regulations, standards, policies or guidelines are used to guide clinical practice for PTs with disabilities (existing or acquired), data indicated that, similar to educational policy, local agencies strongly influence clinical practice guidelines for PT practitioners with disabilities among the majority of member organizations who responded (see next Table)
PT Student Education N=25
PT Practice N=25
Yes No Don't know
Yes No Don't know
Disability Discrimination Legislation
16 (64%)
6 (24%)
3 (12%)
17 (68%)
3 (12%)
5 (20%)
Employment Legislation
18 (72%)
5 (20%)
2 (8%)
18 (72%)
2 (8%)
5 (20%)
Accessibility Guidelines
16 (64%)
5 (20%)
4 (16%)
14 (56%)
3 (12%)
8 (32%)
Other* 4 (16%)
9 (36%)
12 (48%)
4 (16%)
8 (32%)
13 (52%)
NATIONAL, PROVINCIAL OR STATE REGULATIONS, STANDARDS, POLICIES OR GUIDELINES USED
• When asked to indicate nature of impairments among students entering into PT professional entry-level education, data indicated that schools of physical therapy are admitting students with disabilities, however those students tend to have mild levels of disability
• It was much less common for a participant to report that students with severe disability were admitted to educational programs
DISABILITY TYPE AND SEVERITY - STUDENTS
0 5 10 15 20 25 30
Sensory -‐ Hearing
Sensory -‐ Visual
Sensory -‐ Speech
Physical -‐ Musculoskeletal
Physical -‐ Neurological
Physical -‐ Cardiorespiratory
Mul@ Complex Comorbidity
Mental Health
Learning / Intellectual
Infec@ous Disease
Number
Disability Type
Mild
Moderate
Severe
Don't Know
SURVEY FINDINGS PROFESSIONAL PHYSICAL THERAPISTS QUESTION
• When asked to indicate nature of impairments (developed after entry-level education) among physical therapists that have been accommodated in practice to support continued work as a PT, data reflected similar trends to those found in PT professional education
• Employers are accommodating physical therapy practitioners with disability, however, those practitioners tend to have mild levels of disability
• It was much less common for a MO to report accommodations for employees with severe disability
DISABILITY TYPE AND SEVERITY - EMPLOYEES
0 5 10 15 20 25 30
Sensory -‐ Hearing
Sensory -‐ Visual
Sensory -‐ Speech
Physical -‐ Musculoskeletal
Physical -‐ Neurological
Physical -‐ Cardiorespiratory
Mul@ Complex Comorbidity
Mental Health
Learning / Intellectual
Infec@ous Disease
Number
Disability Type
Mild
Moderate
Severe
Don't Know
DISCUSSION • Although survey response rate was low, data can be used
to make some suggestions about how to move forward and make the education and practice of physical therapy more accessible for persons with disabilities
• In the health services delivery environment, the provider-patient relationship strongly influences the success of treatment
• Having a physical therapy workforce that better reflects the general population would enhance the provider-patient/client relationship and serve to alter unfounded attitudes and biases toward persons with disabilities
• Physical therapist educators, employers and the profession at large will benefit from an improved understanding about how access to the profession can be optimized for persons with disabilities
SUPPORTING DISABILITY ACCESSIBILITY • ANTICIPATE ACCESS REQUIREMENTS - Be proactive!
Anticipate the access needs of all learners. Discuss teaching methods with other staff, both informally and during organised staff training sessions. Peer review and reflection on practice will ensure that modification of teaching strategies is ongoing. Encourage regular evaluation and feedback from students and act on it. Take the opportunity to improve the accessibility of the curriculum in all development work and during revalidation procedures.
• WORK IN PARTNERSHIP - Work closely with staff from the university's disability service. Contact external disability organisations or services. Talk with students with disabilities themselves.
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SUPPORTING DISABILITY ACCESS TO WORK • Americans with Disability Act – helpful in this area -
provides a clear and comprehensive national mandate for elimination of discrimination against individuals with disabilities
• Employer has legal duty to comply
SUPPORTING DISABILITY ASSISTIVE TECHNOLOGY & LOW TECH EQUIPMENT • Technology can be used to improve access:
– To make teaching and learning materials more accessible
– To produce materials in a range of accessible formats – As alternative means of producing and accessing text – To improve independent access to information,
particularly electronic information • Technology can be a key factor for students with
disabilities, enabling access to many courses • Provide materials in appropriate formats • Student should have option to see and test out variety of
available equipment (e.g., hardware, software, low vision equipment)
SUPPORTING DISABILITY LANGUAGE & TERMINOLOGY • Language used influences how one thinks of people and
situations • Language of the Medical Model encourages one to see
disability as a ‘problem’ that should be dealt with by the person with a disability
• The Social Model uses language that locates the ‘problem’ within social “attitudes, systems and practices” that act as barriers to full participation
SUPPORTING DISABILITY DISCLOSURE • Term may have significant negative connotations • Implies disability is something to be ashamed of, and to
be kept hidden • Discourages a person with a disability from discussing
the implications of disability and increases the pressure to 'pass' as 'normal’
• Belongs to Medical Model • In contrast, if you ask one to 'tell’ about their impairment,
this indicates that regard disability as just another component of their individuality (such as age, gender or place of birth) and are far more likely to believe that responses will not be negative
• Use language that reflects a positive attitude to difference so communication is on going
SUPPORTING DISABILITY CLINICAL AFFILIATIONS • Develop a culture of awareness and support that will
improve the practice environment for everyone • Discuss disability issues and possible support strategies
in advance • Have specific staff development sessions to raise
awareness of disability issues • Contact with colleagues who have experience of
supporting students/colleagues with disabilities • Management support by providing time and resources for
staff development in this area • Good communication with the universities that send
students • Access to resources, information, advice and guidance
SUPPORTING DISABILITY CLINICAL AFFILIATIONS (cont) • Have an open and non-judgmental approach • Encourage and support the student to establish an
atmosphere of trust and safety • Try to be as patient as possible • Not place undue emphasis on time pressures
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SUPPORTING DISABILITY INCLUSION • Inclusion is based on principle that everyone is valued • Inextricably linked to the concept of equality, it positively
welcomes diversity within society • Disability is regarded as a welcome difference, not as a
deficit or burden • Encourage student involvement in all aspects of program
development and change management
MOVING FORWARD LINKING DISABILITIES AND ACCOMMODATIONS TO PHYSICAL THERAPY EDUCATION AND PRACTICE • A person with a disability must be qualified to perform
the roles and duties of a physical therapist, including essential job functions and job-related requirements
• Because type and severity of disabilities ranges so widely - no way to create objective guidelines that would cover all peoples’ situations
• Accommodations can be made for specific functions of the job; however, physical therapists must be equally educated and qualified thus creating a barrier for those with intellectual disabilities or mental health impairments
• Physical therapists must also have the ability to provide and demonstrate treatment interventions for patients, therefore some physical disabilities may be challenging to accommodate in physical therapy practice
• However, are many disabilities (physical and mental) that could be accommodated with minimal or no difficulty
