Viewing Disability as Diversity When Providing Physical Therapy Combined Sections Meeting 2015 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 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 American Physical Therapy Association Combined Sections Meeting Disability as Diversity Indianapolis; February 2015 Susan E. Roush, PhD, PT; University of Rhode Island Nancy Sharby, DPT Northeastern University (Boston) Susan Magasi, PhD; University of Illinois at Chicago Viewing Disability as Diversity Marilyn. Moffat, PT; New York University & WCPT When Providing Physical Therapy APTA CSM 2015 Indianapolis Disability as Diversity: Overview Disability as Diversity Introduction Models of disabilities Understanding what is important to others… ICF – focus on Function, Independence and Participation “Golden Rule” vs. “Platinum Rule” ICF Case analyses Applying Disability Studies to Physical Therapy Global Research Final case analysis & wrap-up APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis Disability as Diversity Disability as Diversity Fundamental Negative Bias Fundamental Negative Bias Concept from the 1950s and 60s Erving Goffman Beatrice Wright Examples Stigma Stereotypes Bias APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis 1 Disability as Diversity Disability as Diversity Fundamental Negative Bias Fundamental Negative Bias “So, why is it often assumed people with Unfortunately, also seen in healthcare, disabilities are unhappy?” including physical therapy BBC News Magazine Shakespeare T. A. Point of View: Happiness and Disability. BBC News Magazine. 31 May 2014. APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis Disability as Diversity Fundamental Negative Bias Fundamental Negative Bias Test results: Health care professionals consistently rate ‘Positive’ is really negative from patient’s POV the quality of life of persons with ‘Negative’ is really position from patient’s POV disabilities lower than those persons’ self-reported quality of life Terms such as ‘good’ and ‘bad’ Lack of ‘person-first’ language APTA CSM 2015 Indianapolis Disability as Diversity Disability as Diversity Models of Disability Models of disability None fit perfectly Moral Medical Social Cultural Each has advantages and disadvantages Olkin R. Could you hold the door for me? Including disability in diversity. APTA CSM 2015 Indianapolis Cultural Diversity & Ethnic Minority Psychology, v8 n2 p130-37; May 2002. APTA CSM 2015 Indianapolis 2 Disability as Diversity – Moral Model Disability as Diversity – Moral Model Disability = punishment for wrong doing “God gives us only what we can bear” Caused by moral lapse, sin, failure of faith “There is a reason I was chosen to have this Individuals are responsible for their condition disability” Frequently tied to religion “She didn’t deserve that” Disability brings shame “Why Me?” “Physical therapists do God’s work” APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis Disability as Diversity – Moral Model Disability as Diversity–Medical Model Disability is something to be fixed Advantages: Disadvantages: AKA Deficit model • Special • Shame, relationship stigma & Pathology/abnormality is paramount with God marginalization Impairment=disability Cure or amelioration sought • Sense of a greater purpose Lessened but not absent sense of patients APTA CSM 2015 Indianapolis being responsible for their conditionsAPTA CSM 2015 Indianapolis Disability as Diversity–Medical Model Disability as Diversity–Medical Model Paternalism: Negative consequences for those who do not value and strive for “normal” outcome Services for, but not by, persons with disabilities e.g. Non-adherence Uncooperative Fixing impairment > facilitating function APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis 3 Disability as Diversity–Medical Model Disability as Diversity–Medical Model Physical Therapy Lack of acceptance of people with But, we are the good guys, right? disabilities as peers Attitudinal obstacles to accommodation are Educated to identify differences from ‘normal’ typically the most difficult to overcome Remediate abnormalities Goals are often therapist-generated Goals are linked to “normal,” not to function Attitudes create the greatest barrier to accommodations and inclusion APTA CSM 2015 Indianapolis APTA CSM 2015 Indianapolis Disability as Diversity – Social Model Disability as Diversity – Social Model Disability = social construct Change grounded in Civil Rights “Nothing about us, without us” Society’s lack of accommodation is the cause of disability Reject charity model E.g. protests against Jerry Lewis Disability Rights Movement telethons* *McBryde Johnson H. Too old to die young. Henry APTA CSM 2015 Indianapolis Holt & Co. 2005 APTA CSM 2015 Indianapolis Disability as Diversity – Social Model Disability as Diversity – Social Model Advantages Disadvantages Reliant on: • Broad social & De-emphasizing impairments ❚ Integration/ political changes inclusion needed and emphasizing social justice ❚ Impairments not disabilities • Cost Changing attitudes is essential ❚ No stigma 4 Disability as Diversity–Culture Model Disability as Diversity AKA Minority Group model Paradox of Physical Therapy Disability = rich perspective on the Functioning in the Medical Model human condition that is while simultaneously respecting celebrated and valued disability as diversity E.g. Deaf culture Autism and neuro-typical Who Is Disabled? Disability as Diversity ❚ People with disabilities (PWD) as a Creating ICF applications that further minority group function, independence and participation ❚ 56.7 million ❙ Number of people in the United States in 2010 with a disability Dr. Nancy Sharby: 20 minutes ❚ 19% community dwelling population ❚ A disability can occur at birth or at any point in a person’s life. APTA CSM 2015 Indianapolis Who is Disabled? What is an impairment? ❚ PWD are the largest minority in America An impairment exists when a person has a ❚ Disability crosses gender, sexual physical, sensory or intellectual condition orientation, income, race/culture that potentially limits full participation in ❚ Disability is a heterogeneous group social and/or physical environments. ❙ Impairment is nothing more than a description ❙ Physical, intellectual, sensory or psychiatric of a difference in the body or mind ❚ Only 8% of PWD are born with a disability ❙ Anybody can “join” 5 ❚ Everyone with a disability has an impairment ❚ If impairment means abnormality, what ❙ Change/abnormality that affects how the body works ❙ Anatomically does it says about the person behind the ❙ Physiologically impairment? ❚ 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? Disability Definitions are Americans With Based on Social Norms Disabilities Act 1990 ❚ Norms based on statistical definitions ❚ Social Norms ❚ "an individual must have an impairment ❙ Based on experiences of non-disabled that prevents or severely restricts the ❙ Marginalizes the experience of PWD individual from doing activities that are of ❙ Oppresses the rights of PWD central importance to most people's daily ❚ What are some common social norms in lives" America in the 21st century? Social Security Wikipedia Administration ❚ Disability is the gap between what the person ❙ Inability to engage in any substantial gainful can do and what the person needs or wants to activity by reason of any medically do determinable physical or mental impairment… ❚ A disability (or lack of a given ability, as the ❙ Or that can result in death "dis" qualifier denotes) ❙ Can be expected to be present for 12 or more ❙ may be physical, cognitive/mental, sensory, months emotional, developmental or some combination of these. 6 American Medical Association Medical Model of Disability ❚ Rehabilitation classically defined disability as a personal deficiency or deviation from ❚ An alteration of an individual’s capacity to meet documented norms personal, social or occupational demands ❙ Impairment is undesirable because of an impairment ❙ 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 OT, despite what may be the best of (physical, social, political, and economic) intentions on the part of its practitioners, barriers as the true problem, rehabilitation serves to perpetuate the process of reinforces the perception that disability is an disablement of impaired people.” individual matter requiring private solutions rather than a matter of socially produced barriers requiring public, political solutions” Gary Keilhoffer 7 Personal