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Textbook on Social Services and Social Work in Singapore

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Textbook on Social Services and Social Work in Singapore NEEDS AND ISSUES OF PERSONS WITH DISABILITY Rosaleen Ow1 David W. Rothwell2 This is the preprint version of the work. The definitive version was published in Social Work in the Singapore Context as: Ow, R. & Rothwell, D. W. (2011). Needs and issues of persons with disability. In K. Mehta & A. Wee (Eds.), Social Work in the Singapore Context (2nd ed.; pp. 241-270). Singapore: Pearson. 1 Department head, National University of Singapore Department of Social Work, Blk AS3 Level 4, 3 Arts Link, Singapore 117570; [email protected] 2 Assistant Professor, McGill University School of Social Work 3506 University Street, Suite 300, Montreal, Quebec H3A 2A7; [email protected], http://www.mcgill.ca/socialwork/faculty/rothwell Social Work in the Singapore Context 8 Needs and Issues of Persons with Disability Rosaleen Ow and David Rothwell Introduction The collection of comprehensive statistical data on disabled persons is a worldwide problem due to various reasons, including: a) the lack of a universal definition of disability; b) a coherent system for data collection as disability can be social, physical or mental; and c) the tendency to under- report due to stigma and lack of knowledge. Despite these limitations, estimates suggest that 10% of the world’s population lives with a disability, the largest minority (United Nations Programme on Disabilities, 2010). However, measuring disability is not consistent across contexts For example, the incidence of disability in the latest US Census was estimated at 19.3% of the civilian non-institutionalised population, much higher than the UN standard (Waldrop & Stern, 2003). In Singapore, a 10% incidence of disability as proposed by the UN translates into about 490,000 persons based on a population of 4.9 million in 2009 Statistics Singapore, 2010). In 2006, the total number of people with disabilities using government services was about 9,000 (Ministry of Community Development, Youth and Sports , 2007). However, this is not necessarily an accurate measurement of 2 Needs and Issues of Persons with Disability disability in the population because many persons with disabilities who are eligible to receive government services may not be accessing the services. Singapore’s Ministry of Community Development, Youth and Sports (2007) recently acknowledged the need for a rigorous study to determine the incidence of disability in the population because no reliable estimate exists. Therefore, there may be potential for considerable development of services in the disability sector. Definitions A clear and generally accepted definition of disability is important for policy, programme eligibility and mode of service delivery. In Singapore the definition and framework for understanding disability was shaped by the Enabling Masterplan for the Disability Sector (EMDS) that was created by stakeholders and organised by the Ministry for Community Development, Youth and Sports (2007). The purpose of the EMDS was to formulate a vision and identify steps towards ensuring that persons with disabilities are viewed and treated as equal and contributing members of society. The primary objective was to outline a plan to accomplish this goal from 2007 to 2011. According to the EMDS, the definition of disability in Singapore is 'those whose prospects of securing and retaining places and advancing in education and training institutions, employment and recreation as equal members of the community are substantially reduced as a result of physical, sensory, intellectual or developmental impairments' (Ministry for Community Development, youth and Sports, 2007, p. 1). Theoretical Frameworks in the Management of Disability The impact of disability on the individual and the family can be viewed from a life span perspective (Lefrancois, 1993; Hutchinson, 2007; Marshak, Seligman & Prezant, 1999; Ow, 1994), whereas the management and delivery of social services can perhaps be more usefully discussed from a 3 Social Work in the Singapore Context systemic ecological perspective (Bronfenbrenner, 1979; Hartman & Laird, 1983). The Life Span Perspective From the life span perspective, the quality of life of both the individual with the disability and the family members are both important concerns as they progress together through the different life stages. Too often family members are merely perceived as a form of resource for meeting the needs of the person with the disability. Family members also have individual developmental needs in tandem with the developmental needs of the family member(s) with disabilities. The ability of individuals with disabilities to progress developmentally is linked to the ability and extent to which the developmental needs of their family members are met. Family members are interdependent in meeting each other’s physical, emotional, social and spiritual needs. In every family, there are usually four subsystems: 1. The marital subsystem – husband and wife; 2. The parental subsystem – parent and child; 3. The sibling subsystem – child and another child in the family; 4. The extra-familial subsystem – extended family members, friends, care professionals, schools and others in the community. Some impairments such as those arising from Down Syndrome are obvious at birth, but others such as a hearing impairment may take longer to detect. At the discovery of having a child with disability, parents often have to confront one of the most challenging aspects of their own developmental needs. Every parent has high expectations about a major life event such as child birth, and the unanticipated life event of the birth of a child with a disability is a trauma that creates extra demands and will require unanticipated resources from the various subsystems. For example, the marital subsystem has to be able to support rather than blame each 4 Needs and Issues of Persons with Disability other for the birth of a child with an impairment. Older siblings have to recognise and accept the additional time and resources required from the family to help the sibling with a disability achieve appropriate developmental goals while having their own needs met at the same time. As the person with disability grows from childhood to adolescence and adulthood, there are also many other concerns regarding the future care that require long-term permanency planning. The early childhood years can be difficult for the family as the parents have to cope with both looking after the child with disability and ensuring that the developmental needs of every other family member are met. According to the life span perspective, expected developmental tasks at this stage include physical, perceptual and cognitive growth. The child learns motor responses, discriminates the five senses of visual, auditory, kinesthetic, olfactory and gustatory stimuli, develops memory and begins language development. A child with disability may experience delay in achieving some of these developmental tasks depending on the nature of the impairment. For example, a child with a hearing impairment will obviously have major difficulties in discriminating sounds and learning speech, which may result in poor communication skills and social relationships. Unless special facilities are available to help the child minimise the impairment at an early age (e.g., through surgery or from learning an alternative way of communicating, e.g., through sign language), there will be much frustration for both the child with the disability and the family. Delays in achieving developmental milestones, e.g., when a child shows no response when a loud sound such as a hand clap is administered near the ear, are often the first indicators that an impairment may exist. In addition, depending on the nature of the impairment leading to the disability, intensive medical treatment may be required to correct the impairment, and parents have to ensure a certain degree of financial capability to meet medical expenses. While still dealing with their own disappointment, pain and anxiety, parents may also have to spend a lot of 5 Social Work in the Singapore Context time consulting specialists in the hospital about treatment. As a consequence, work and family responsibilities may become major stressors for the marital and parent-child subsystems as the parents cope with the unexpected burden at this stage of their life cycle. Older children in the family may be unintentionally neglected as the parents focus their attention on helping the child with the disability. Entry into the school going age is another experience of disruption in the normal development process of the child and the family. Impairments in the physical and/or intellectual aspects of the child’s development will result in challenges to the degree of fit between the child’s capability and the mainstream education system. The child with a disability may require special education programmes, customised transportation and adapted facilities in the physical environment in order to attend school. For example, the wheelchair-bound individual may require lifts to his or her classrooms, or the school environment will have to be modified to accommodate the child’s needs, e.g., by locating classrooms on ground level for all the lessons that the child attends. Apart from the curriculum, the logistics involved in facilitating full participation remains a major challenge in the integration of a child with disability into mainstream education. As the child grows older, social and emotional adjustments are necessary as the child is confronted with being
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