In this essay I will be looking at models of disability, focusing mainly on the social model of disability and drawing upon the academic writing of disabled people and others as well as looking at a case study of David; a fifty five year old male who was admitted to hospital six months ago from having being diagnosed with a mild stroke. I will then go on to discuss the social model's relevance to the practice of therapists.
Disability is a major issue faced by our society. An attempt to describe the term disability can be very challenging. At present, there is no legal definition of disability as described in the social model of disability. Under the Equality Act, (2010) a disabled person is described as someone with "a physical or mental impairment that has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities". This also covers people with progressive conditions such as HIV, cancer or Multiple Sclerosis, and those with hidden disabilities like dyslexia. There are two main models of disability, the medical model and the social model. The medical model of disability, sees disabled people's inability to join in society as a direct result of having an impairment and not as the result of features of our society which can be changed (Swain, French, and Cameron, 2003).The World Health Organisation (1980) categorises disability into three main groups; Impairment, Disability and Handicap. They state impairment is different to disability, from this it is easy to see how people with disabilities might become stigmatised as lacking or abnormal. The medical model of disability, assumes that the first step solution is to find a cure or, using the World Health Organisation Classification (1980) to make disabled people more "normal" (cited in Reynolds,2005). When policy makers think about disability in this individual way they tend to focus on compensating people with impairments, for example, targeting specific benefits such as the Disability Living Allowance (1992) for those individuals and providing segregated 'special' services for them.
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This model of disability has been criticised as it does not offer a realistic perspective from the viewpoint of disabled people themselves, disabled people can be led to believe that their impairments automatically prevent them from participating in social activities. This view was rejected by disabled people who then advocated a different way of looking at disability (Oliver, 1983).
In 1983 lecturer Mike Oliver, proposed the social model of disability. He adapted the model from the Fundamental Principles of Disability published by the Union of Physically Impaired Against Segregation (1975), where an impairment is defined as "lacking all or part of a limb, or having a defective limb, organ or mechanism of the body" and disability as "the disadvantage or restriction of activity caused by contemporary social organisation which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities."(Swain and Cameron,1999, p.69).
Central to this model is the belief that individuals with disabilities have a right to access, belong to, contribute to, and to be valued in society. The social model focuses on the strengths, abilities, and experiences of people with disabilities. Supporting individuals with disabilities in this model does not mean helping them to become "normal," but instead focuses on tackling the social or physical barriers the individual faces in daily living (Oliver, 1983).
In contrast to other models of disability, the social model is based on knowledge of the experiences, views, and practices of people with disabilities. The model understands individuals with disabilities as experts on their own lives and as experts on disability; it does not necessarily see difference as problematic or necessarily negative. Oliver (2004) goes on to argue that people with disabilities have faced prejudice and discrimination, therefore those who support this model believe that attention should be focused on restructuring society, not treating the individual.
The social model views disability as a consequence of structural, environmental and attitudinal barriers that prevent people with a disability or impairment from maximum participation in society (Oliver, 2004, cited In Swain, French, Barnes and Thomas, 2004). For example, short-sighted people living in the United Kingdom are not classified as disabled. Eye-tests and visual aids, which are available means that this impairment does not prevent them participating fully in life. If, however, they live in a third world country where such eye care is not available they are severely disabled. The inability to read, subsequently learn, and gather information would be considered as a severe impairment in any society.
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If we apply the social model to the case study of David: "Adapting to life after stroke", we are able to identify hidden attitudinal barriers that may exist in support of the social model, in the way society may view individuals with disabilities as being dependant and an inability to function fully due to their impairment. An example of this is when David states "sometimes in shops, if I struggle to find the right money or to put away change, I feel really patronised", he may also experience these as hidden barriers from family members, this is indicated when David states "At times I think they get annoyed with me being slower than before".
In addition to these barriers, David may also encounter structural barriers; this may prevent him from being able to continue drive after his stroke due to legislations in place whereby you are not allowed to drive for one month following the event. This is a legal requirement even if your symptoms have fully resolved. The Driving Vehicles Licensing Authority would need to be contacted if "one month after the stroke you are still suffering from weakness of the arm or legs, visual disturbance, or problems with co-ordination, memory or understanding." (Driver and Vehicle Licensing Authority, 2011). Other structural barriers in insurance policies mean David may also have to pay more for his car insurance due to suffering a stroke, this can be viewed as society penalising him for having a disability. Environmental barriers may also exist which prevent David using public transport to get to work.
Oliver (1990) argues that the removal of these structural, environmental and attitudinal barriers will improve the lives of disabled people, giving them the same opportunities as others. For example in the case study, David was able to return to his job as a Health and Safety Advisor on a part time basis under the Employers and the Equality Act (2010) employers are required to make reasonable adjustments to their policies or practices. By making adjustments, employers are removing the barriers that disable according to the social model, they are effectively removing the disability.
The strength of this model lies in its placing the responsibility upon society and not the individual. At the same time, it focuses on the needs of the individual whereas the medical model uses diagnoses to produce categories of disability, and assumes that people with the same impairment have identical needs and abilities. It also offers positive solutions that have been proven in the United Kingdom (Reynolds, 2005).
The social model however has limitations. Firstly, Crow (1992) criticises the model for its failure to emphasize certain aspects of disability such as the pain of impairment, both physical and psychological. In other words, the struggle may be over for disabled people in terms of obtaining human rights but the personal struggle of just getting out of bed in the morning remains. This struggle means that no matter how accommodating society is for disabled people, disabled people will always be disabled people.
Morris (1991, p.10) then goes on to argue "While environmental barriers and social attitudes are a crucial part of our experience of disability - and do indeed disable us - to suggest that this is all there is, is to deny the personal experience of physical and intellectual restrictions, of illness of the fear of dying". Further criticisms made of the social model, is its failure to take into account that as the population gets older the numbers of people with impairments will rise and making it harder for society to adjust. Lastly, the model's concepts can be difficult to understand, particularly by professionals in rehabilitation. These professionals have to be persuaded that their role must change from that of "cure or care" to a less obtrusive one of helping disabled people take control of their own lives (Morris,2004).
If we look at the relevance of the social model in the practice of therapists;
Occupational therapists and Physiotherapists working with people with disabilities would be able to align themselves to the model, by identifying barriers that may exist for the client and implement interventions to overcome these disabling barriers and promote social integration. "Assessments based on the social model of disability do not ask 'What is wrong with this person?' but instead ask 'What is wrong for this person?' At the core of an assessment based on the social model of disability." (Morris, 2004, p.24).
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In the case study of David, he identifies fatigue and mobility as key areas he wishes to address with the help of therapists. A therapist may assess the client in their own environment whether that is in their home or work and then suggest adaptations such walking aids or assistive aids to help enable the client to carry out occupations while removing barriers in order to live a more independent life.
In the case of Speech and Language Therapists they may work towards bringing about changes in the individual's environment in order to maximise the opportunities for communication. This might, for example, involve teaching carers how to adjust their language to suit the client's level of understanding, or use gesture in addition to verbal communication when conveying their message (Coles, 2001).
The social model of disability is a key mechanism for ensuring that Social Care services and resources work in partnership with people who need support. Assessments should identify the barriers, external to the individual, which are getting in the way of human rights. The planning and delivery of services should be focused on tackling these disabling barriers. All of this opens up exciting possibilities of using public resources in ways, which really make a difference to people's lives (Morris, 2005).
To conclude, models of disability are tools for defining impairment and disability, and ultimately for providing a basis upon which government and society can devise strategies for meeting the needs of disabled people. They are a useful framework in which to gain an understanding of disability issues, and of the perspective held by those creating and applying the models.
Previous models of disability were essentially devised by people about other people, however the social model of disability provides an alternative perspective from those who experience disability.
The social model proposed by Oliver (1990) has played a key part in promoting ways of overcoming disabling barriers for disabled people and a move forward to empower those individuals to be apart society.One of the major criticisms that have made of the social model is its detachment with having to deal with of impairment and its experiences. It is important to acknowledge that therapists play an important role in overcoming disabling barriers and adopting a holistic approach to enable individuals to carry out everyday meaningful activities as well promoting social inclusion, through adaptations to their environment.
Models of disability provide us with a continuum on changing social attitudes to disability and where they are at a given time. Models change as society changes; therefore, we should develop and implement various models, which will empower people with disabilities, giving them full and equal rights as others within their society.
Coles, J. (2001) The Social Model of Disability: what does it mean for practice in services for people with learning difficulties? Disability and Society, 16(4), pp. 501-510.
Crow, L. (1992). Renewing the Social Model of Disability. Coalition pp.5-9.
HM Government (2011) Directgov: Driver and Vehicle Licensing Authority (2011) Available at: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/MedicalA-Z/DG_185787 [Accessed on 10 November 2011].
HM Government (2011) Directgov: Employers and the Equality Act (2010) Available at: (http://www.direct.gov.uk/en/DisabledPeople/Employmentsupport/YourEmploymentRights/DG_4001071) [Accessed: 5 November 2011].
HM Government (2011) Directgov: Disability Living Allowance (1992) Available at: http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Disabledpeople/DG_10018702 [Accessed on 10 November 2011].
HM Government (2011) Directgov: Equality Act (2010) Available at: http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRights/DG_4001068 [Accessed: 5 November 2011].
Morris, J.1991: Pride Against Prejudice-Personal Politics of Disability, London: The Women's Press.
Morris, J. (2004) Social Model Assessment Team Pilot Project Essex Social Services: Report of Evaluation. p24 [PDF online].
Available at: www.leeds.ac.uk [Accessed: 5 November 2011].
Oliver M (1983) Social Work with Disabled People. Basingstoke, Macmillan.
Oliver, M. (1990) The individual and social models of disability. Available at: http://www.leeds.ac.uk/disabilitystudies/archiveuk/Oliver/in%20soc%20dis.pdf 4 [Accessed: 5 November 2011].
Oliver, M. (2004) If I had a hammer: The Social Model in action. In Swain, J., French, S., Barnes, C. and Thomas, C. (eds) (2004) Disabling barriers - enabling environments. 2nd ed. Los Angeles, SAGE Publications.
Reynolds, F. (2005) Communication and clinical effectiveness in rehabilitation. Oxford: Butterworth-Heinemann.
Swain, J. and Cameron, C. (1999) Unless otherwise stated: Discourses of labelling and identity in coming out. In Corker, M. and French, S. (eds) Disability Discourse. Buckingham: Open University Press.
Swain, J., French, S. and Cameron, C. (eds) (2003) Controversial issues in a disabling society, London: Sage in Association with the Open University.
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Juvenile Chronic Arthritis (JCA) is a condition, which causes pain and inflammation of the joints and bones. The main symptoms include pain, stiffness, restricted movements of the joints, swelling, and warmth and redness of the skin over the joint. "About 12,000 children in the UK under the age of 16 have a form of Arthritis."(Arthritis care, 2011).
The purpose of this leaflet is to provide information on support services available and coping strategies for Helen, a fourteen-year-old female who suffers from JCA. The leaflet focuses on three main support services which address the identified needs of Helen.The case study of Helen highlights swimming as a meaningful leisure activity, so one of the programmes offered in the leaflet is an Arthritis foundation aquatic programme, there is evidence based research to suggest swimming can help to ease stiffness, improve movement in joints, and strengthen muscles. The program incorporates the buoyancy of water and the soothing warmth of a heated pool to make a safe and ideal environment for relieving pain and stiffness (Arthritis, 2011).
Other Programmes aimed at Helen and her family focus on teaching knowledge and skills to better manage JCA and providing the opportunity to meet others who share similar experiences. This acknowledges the need for support for the whole family, which is strength of the leaflet however a limitation is the lack of in depth information provided.
The use of a case study of a teenager with JCA, is an effective way of providing reassurance and encouraging Helen to remain positive. Coping strategies are also included as a way of offering practical advice on how to manage JCA on a daily basis, and takes into account if reader is not ready join they can still take away some useful tips.
An important factor in whether health information will appeal to this target audience is design (Houts et al 2006). According to Hoffman and Worrall (2004), a health education leaflet should be patient centred and designed with the principles of good health education material design in mind, including layout of both illustration and text. Often leaflets in clinical areas are ignored; however leaflets with pictures draw the attention of patients and encourage attention to the information contained within and as the leaflet selected is vibrant and colourful it catches the eye. There is a blue background for the leaflet, on which the text is placed on; this makes the black of the main body of the text stand out as well as the use of suitable images Helen can relate too.
In terms of content of information, written material should contain accurate content and be written in a simple manner which can be understood easily.
The front cover of a leaflet is particularly important as it is the main device used to initially attract the target audience (NHS,2003).To attract Helen to the leaflet an image of a group of teenagers is used for the cover as she would be able to identify more with as most leaflets on Arthritis have images of older people and can be off putting for a teenager.
A logo is also used so it is clear to the reader who is responsible for producing the leaflets and if she wants to seek additional information then the logo will help her to remember the organisation. The heading "If you are a teenager with Juvenile Chronic Arthritis, you are not alone" is clear and written in a large front so it immediately addresses the target audience and provides reassurance. Bearing in mind that an average person will only look at a leaflet for a few minutes, this is very important as the information and the purpose of the leaflet comes across clearly and immediately on the front cover which is one of the main strengths of the leaflet. However, the contact details on the back of the leaflet with extra support services is not clear enough to the reader in regards to whom to contact if interested in joining the programme.
The language used throughout the leaflet is simple in order to appeal to young teens, but a Flesch test has not been carried out to indicate this, as "Standard" texts should have an FK Grade level of about 7-8 which is similar to a reading age of 13-14 years, therefore suitable for the target audience. (Frances, 2005)
NHS Toolkit for producing patient information (2003) recommends using a 14 point or larger for those with sight difficulties, therefore an Ariel 14 point sized font has been used in the main body of the text so that the leaflet is both clear and easy to read and a more bolder style of font is used for subheadings inside so it is more eye-catching. This takes into account the reader who has JCA may have deterioration in sight as one of the symptoms of their condition.
To conclude, the overall content and presentation of the leaflet successfully addresses the needs of Helen, focusing on providing information on support services. The leaflet has been designed so it is not overly cluttered but provides basic information by including a case study, coping strategies and facts that may encourage her to join. However, Improvements can be made in the design layout and incorporating more depth of information.