Chapter 11: Disability and Social Work Practice

Chapter 11: Disability and Social Work Practice

Outline

• Defining disability

• Theorizing disability

• Categorizing disability

• Prevalence of disability in Canada

• History of disability policy in Canada

• Social work practice with individuals with a disability

Learning Objectives

• To understand how theoretical frameworks inform disability-focused social work practice.

• To understand how disability emerges through the interaction between bodily impairment and the environment.

• To identify complex social, economic, and physical barriers to the inclusion of persons with disabilities from historical and contemporary perspectives.

• To recognize how policies influence the delivery of health and social services to individuals with disabilities and their families.

• To identify the links among theory, research, policy, and practice and to apply these links to addressing issues facing individuals with disabilities.

Defining Disability

• No universal definitions of disability exist in Canada.

• Definitions of disability have significant implications as they shape policies, programs, and services.

• Different government agencies define disability in various ways:

  • Definitions used in surveys (to determine prevalence rates) differ from those used for benefit redistribution (e.g., income tax credits).

Theorizing Disability

The Medical Model of Disability

• Also known as the biomedical model, disease model, clinical model, or individual model.

• Views disability strictly as an individual deficit, as inherently biological.

• Pathology or deviance from normality is diagnosed by “experts” who control access to services.

• Shortcomings of the medical model:

  • Disability is seen as a static, uniform pathological characteristic.

  • It objectifies individuals with disabilities.

  • Does not consider social or environmental factors contributing to disability.

The Social Model of Disability

• Emerged as a critique of the medical model.

• Views people with disabilities as an oppressed group, distinguishing impairment from disability:

  • Impairment: results from physical limitations.

  • Disability: arises from social oppression and exclusion.

• Asserts that disability is constructed by social factors (economy, culture, language).

• Shortcomings of the social model:

  • Risks overlooking individual differences.

  • Assumes all individuals with disabilities experience oppression uniformly.

  • Suggests a barrier-free world is an unrealistic goal.

The WHO’s International Classification of Functioning, Disability and Health

• Defines disability as an umbrella term encompassing impairments, activity limitations, and participation restrictions.

• Definitions:

  • Impairment: Problem in body function or structure.

  • Activity Limitation: Difficulty executing tasks or actions.

  • Participation Restriction: Problems with involvement in life situations.

• Stresses that disability is not just a health issue but a complex phenomenon reflecting interaction between individual health and societal features.

Table 11.1: Applying the WHO’s International Classification

Categorizing Disability

The Categorical or Diagnostic Approach

• Focuses on identifying the causes and effects of deviations from normal bodily function.

• Utilizes assessments and tests to classify these deviations (e.g., scans, tests, assessments).

• Benefits:

  • Standardizes care across contexts.

  • Facilitates medical specialization and clinical research.

  • Allows tracking of public health statistics.

  • Aids community building among individuals with a shared diagnosis.

• Challenges:

  • Risks blurring the differences between individuals with similar diagnoses.

  • Clinical studies may neglect rare disorders due to small sample sizes.

The Non-Categorical or Functional Approach

• Emphasizes level of functioning over diagnostic labels to assess participation and outcomes.

• Considers the interaction of impairments, activity limitations, and environmental factors.

• Benefits:

  • Acknowledges the role of the environment in impairments.

  • Reduces stigma surrounding specific diagnoses.

  • Provides individualized areas for intervention based on daily life.

• Challenges:

  • May complicate classification for medical research.

  • Could be time-intensive in practice, requiring a nuanced understanding of the individual's context.

Table 11.2: Types of Disabilities

Prevalence of Disability in Canada

• Canadian Survey on Disability (CSD):

  • Measures disability considering severity and frequency of activity limitations.

• Statistics from 2017:

  • 22.3% of Canadians aged 15+ reported disabilities (total: 6.2 million).

  • Disability prevalence by gender:

  • 24.3% of women and 20.2% of men aged 15+.

  • Among people aged 65+:

  • 37.8% reported disabilities.

• Most individuals reported family and friends as their primary source of assistance.

Table 11.3: Prevalence of Disability by Age in Canada

History of Disability Policy in Canada

Early Beliefs about Individuals with Disabilities

• Historical views of disabilities are shaped by societal norms.

• Example: Ancient Greeks perceived physical impairments as divine punishment.

• Initial care for individuals with impairments provided by religious entities.

• Common practices involved housing individuals in prisons, workhouses, or almshouses if they appeared different.

• In early 1800s Canada, there was no state support for individuals categorized as “lunatics” or “insane.”

Asylum, Confinement, and Institutionalization

• The Provincial Lunatic Asylum opened in Toronto City Jail in 1841.

  • Commitment could occur through two routes:

  1. Designation by two physicians;

  2. Statement from a justice of peace.

• Institutions served as a catch-all for any undesired population.

• The rise of the eugenics movement in the early 1900s aimed to improve genetic stock.

  • Resulted in sterilization laws passed in Alberta and British Columbia.

Deinstitutionalization

• In the 1970s-80s, changes in care and support practices emerged.

• Patients transitioned from large institutions to hospitals, and then community living arrangements.

• This move led to significant reductions in funding for individuals with disabilities.

• Non-governmental organizations helped mitigate the impact of funding cuts.

• The deinstitutionalization movement recognized the segregation of individuals as oppressive, advocating for better care within communities.

The Independent Living Movement and the Dignity of Risk

• The Independent Living (IL) movement began in North America in the 1970s.

  • It posits that individuals with disabilities have the right to live in communities despite societal barriers.

• Key components of IL philosophy include:

  • Individuals best know their own needs.

  • The need for integrated and community-based services.

  • Enhanced self-representation and self-determination through deprofessionalization of services. - Individualized support services including peer support and direct funding.

• Normalization principle (Bengt Nirje): Access to life patterns similar to typical community conditions.

• Social role valorization (Wolf Wolfensberger): Provides opportunities for dignity, respect, and participation through access to valued social roles.

Progress and Development of Disability Rights in Canada

• 1961: Vocational Rehabilitation of Disabled Persons Act

• 1965: The Canada Pension Plan

• 1976: Council of Canadians with Disabilities

• 1981: International Year of Disabled Persons

• 1982: Canadian Charter of Rights and Freedoms

• 1985: Canadian Human Rights Act

• 1995: Employment Equity Act

• 1998: In Unison Report

• 2010: United Nations Convention on the Rights of Persons with Disabilities

Social Work Practice with Individuals with a Disability

Health and Social Services for Individuals with Disabilities

• Federal and Provincial Resource Allocation:

  • Provinces and territories design their own health care plans with federal funding support.

  • Must include standardized features but may provide additional benefits.

• Universality of Equivalent Care:

  • Specialized services often located in urban centres.

  • Jurisdictional disputes between federal and provincial bodies may delay service.

  • Long waiting lists can impede access to services.

• Income Support:

  • Programs like Canada Pension Plan Disability Benefit require detailed applications.

  • Income support can include specialized housing assistance programs.

Specialized Services

• Publicly-funded programs cater to specific populations (e.g., Ontario Autism Program)

• May offer direct services or funding options for individuals.

Educational Services

• Mainstreaming: Integrates students with disabilities into classrooms based on age, alongside support like aides and individualized education plans (IEPs).

• Non-Governmental Organizations: Vary in scope and may receive government grants, often initiated by specific interest groups.

Promoting Access to Specialized Care: Health, Rehabilitative, and Social Services

• Roles of social workers may include:

  • Administering intake and eligibility assessments.

  • Evaluating the individual's level of functioning and psychosocial needs.

  • Engaging in case management and care coordination.

Promoting Access to Educational Services, Employment, and Independent Living

• Social workers can:

  • Collaborate in educational spaces to implement necessary modifications for students.

  • Support individuals in securing meaningful jobs and ongoing workforce participation through assistance programs.

  • Facilitate independence by involving individuals in critical decision-making and coordinating access to housing and transportation.

Supporting People with Disabilities in Rural or Remote Regions

• As per 2016 Census data, only 17% of Canadians live in rural areas, affecting resource availability for individuals with disabilities.

• Rural residents may face significant barriers in accessing care, education, and transportation.

• Individualized funding models can be beneficial in rural contexts.

• Social workers in these regions should leverage networking and communication technologies with urban peers for ongoing development.

Addressing Poverty: Access to Income Support

• Individuals with disabilities face higher poverty rates compared to those without.

• In 2012, median income for individuals with disabilities was significantly lower (approx. $10,000) than that of non-disabled peers.

• Social workers may assist individuals and their families in applying for eligible income support programs and advocate for policy reforms.

Fostering Quality of Life

• Quality of life is a multifaceted concept, including:

  • Interpersonal relations

  • Social inclusion

  • Personal development

  • Physical, material, and emotional well-being

  • Self-determination and rights

• Social workers address oppression and marginalization, promoting life satisfaction and community participation.

Supporting the Transition to Adulthood

• The transition to adulthood for youth with disabilities encompasses multiple factors (health care, education).

• Institutional settings provide support for effective transitioning while addressing psychosocial goals.

• Social workers assist youth in managing health care, honing independent living skills, and participating in community activities.

Addressing Caregiver Well-Being

• Caregivers often endure:

  • Financial strain

  • Employment difficulties

  • Relationship stress

  • Emotional distress

• Support strategies include:

  • Respite care

  • Counseling and therapy

Social Work Practice Guidelines

• Recognize interaction between impairments and environments.

• Challenge ableism and stereotypes related to disability.

• Foster partnerships with individuals and their families.

• Consider the individual’s entire life course in practice.