Balancing the medical and social models of disability in an education setting

Graduate social work students working with Dr. Elspeth Slayter at Salem State University were asked to reflect on the ways in which they approach their work with clients with disabilities. Specifically, they were asked to reflect on what aspects of their practice were “under” the medical model of disability and which were “under” the social model of disability. Students were first introduced to the medical model of disability, in which the person’s impairment was the focus. Then, students were introduced to the social model of disability, in which society is seen as the disabling factor as opposed to the part of the person with the impairment. In order to begin to re-visualize what social work practice with a client with a disability would look like, students were asked to answer the following question:

“How can social workers approach the needs of people with disabilities without perpetuating the negative impacts associated with the medical model of disability? Provide a case example and then describe how you could/do/would engage in medical model-informed practice and social model-informed practice with that client.”

By Colleen Dalton, MSW Candidate

Salem State University

My case example is that of a student with diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) and a psychiatric disability who attends the school where I am doing my internship, a Kindergarten through -8^th grade inclusion school. This student’s treatment involved medical model-informed practice as he engaged in psychological testing, which compared his functioning to that of students with “normal” learning capacities. This student was placed on medication, either to attempt to “cure” him or get him to a place where he would behave “acceptably” in the school system (Mackelprang & Salsgiver, 2015, p. 105).

However, before this student’s educational plan was implemented along the lines of the medical model, there were a number of steps taken under a social model-informed practice approach.  For example, a functional behavior plan was created as was a behavior plan that was centered on his own interests as incentives. This student was also given the option of using a sensory tool during class time as well as scheduled movement breaks and cues to help with transitions.

I was lucky for the opportunity to work in a placement that devoted a great deal of time, effort, and funds towards trying to create the most inclusive setting possible. A large driving force for the school was the disproportionately high number of students with disabilities and socio-emotional troubles within the learning community. The school’s administrators recognized that the prevailing medical model played a major role in disempowering their students within the larger society.

As Mackelprang & Salsgiver (2015) discuss,  “the medical model’s emphasis on normality as defined by the dominant society results in enormous emotional, psychological, and social costs for people with disabilities” (Mackelprang & Salsgiver, 2015, p. 105). The school set out to normalize the use of sensory tools, movement breaks, and inclusive classrooms.  These actions were taken so that their students could graduate and head on to high school with the confidence and tools they needed to succeed. At the same time, the school also recognized that sometimes testing and medication were needed to keep students safe and promote the best educational opportunities for everyone in the classroom.

As Shakespeare (2006) points out, “the social model so strongly disowns individual and medical approaches that it risks implying that impairment is not a problem” (p. 217-218). Finding the balance between the social and medical models of practice can be tough but is definitely essential in terms of keeping people safe in my opinion.

Mackelprang, R. & Salsgiver, R. (1999). Disability: A diversity model approach in human service practice, 3rd edition. New York: Lyceum Books.

Shakespeare, T. (2013). The social model of disability. In Ed., Davis, L. (2013). The Disability Studies Reader, Fourth Edition. New York: Routledge.

Colleen Dalton, MSW Candidate at Salem State University. (For screenreader: Young white woman with reddish-brown hair sitting at a table next to a window looking out onto the sea)

Colleen Dalton is a candidate for the degree of Masters in Social Work at Salem State University’s School of Social Work.  She holds a B.A. in Human Services from the University of Massachusetts Boston. She hopes to work with children and families after graduation. Dalton can be reached at Colleen.Dalton001@gmail.com.

 

 

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Social work practice with a child with ADHD: Applying the medical and social models of disability

Graduate social work students working with Dr. Elspeth Slayter were asked to reflect on the ways in which they do their work with clients with disabilities. Specifically, they were asked to reflect on what aspects of their practice were “under” the medical model of disability and which were “under” the social model of disability. Students were first introduced to the medical model of disability, in which the person’s impairment was the focus of the model. Then, students were introduced to the social model of disability, in which society is seen as the disabling factor as opposed to the person with the impairment. In order to begin to re-visualize what social work practice with a client with a disability would look like, students were asked to answer the following question:

“How can social workers approach the needs of people with disabilities without perpetuating the negative impacts associated with the medical model of disability?  Provide a case example and then describe how you would engage in medical model-informed practice and social model-informed practice with that client.”

By Erica Chepulis, MSW Candidate

Salem State University

For my consideration of the medical and social models of disability as they relate to social work practice, I will describe a summer camp member who I worked with last summer, who I will call Nicholas. Nicholas is a 9-year-old boy who is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). For Nicholas, his ADHD manifests as having a short attention span during activities, great fluctuations in emotions, and heightened sensitivity to loud noises or crowds.

The medical model views disabilities as “biological dysfunction[s]” and suggests that service professionals utilize interventions to try to “fix” the disability (Mackelprang & Salsgiver, 2015, p.103). In contrast, the social model views disability as a result of the social and physical world that isolates and is not built to accommodate people with disabilities (Shakespeare, 2013). While there are many criticisms of the medical model due to its deficit-based perspective of people with disabilities, there are also criticisms of the social model. Weaknesses of the social model include its simplicity and its establishment by mainly white, heterosexual men with physical disabilities and spinal cord injuries, a group whose perspectives are not representative of collective population of people with disabilities (Shakespeare, 2013). Criticisms of the social model also include its lack of acknowledgement that disability can be an important part of people’s lives and identities, its definition of disability as inherent oppression, and its ideal vision of a barrier-free world which does not consider natural environmental barriers (Shakespeare, 2013).

The social model would be helpful in working with Nicholas by allowing me to understand that the routine and activities of our summer camp were designed with a bias toward non-disabled children. The social model would suggest that I adjust Nicholas’s schedule as well as plan more inclusive activities that would be safer for him and give him equal opportunity to succeed.

While the social model is more strengths-based and does not ask that Nicholas change something about himself, the medical model may be more helpful in a few ways. The social model suggests that the ideal world is one in which people with disabilities do not experience barriers in their daily lives; however, this model does not take into account non-human constructed barriers (Shakespeare, 2013). For instance, Nicholas has difficulty with sensory processing, so loud noises such as thunderstorms are stressful and upsetting to him. We were able to follow the social model and accommodate Nicholas by providing him with warning when we knew there would be loud sounds, making sure there was an exit nearby and a designated room he could sit in if the noises were overwhelming, and creating a safety plan regarding who would accompany him and what activities could be done to help him feel calm. However, the noise could still be bothersome to Nicholas and impact his functioning regardless of our plans. In this case, the medical model may be helpful in providing interventions that can be used to help him through this environmental barrier. If I were Nicholas’s clinician, I might suggest listening therapy or psychotherapy to help him in ways that he could not otherwise be accommodated by the physical and social world around him. The social model is certainly more strengths-based, but it may be helpful to supplement it with the medical model to ensure that all of the client’s needs are met.

Mackelprang, R.W. & Salsgiver, R.O. (2015). Disability: A diversity model approach in human service practice (3^rd ed.). Chicago, IL: Lyceum Books.

Shakespeare, T. (2013). The social model of disability. In Ed., Davis, L. (2013). The Disability Studies Reader, Fourth Edition. New York: Routledge

Erica Chepulis is a candidate for the degree of Masters in Social Work at Salem State University’s School of Social Work. She holds a B.A. in Social Work from Wheelock College. She hopes to continue her career in working with youth in programs that support their educational, social, and emotional growth and encourage them to reach their full potential. Ms. Chepulis chose to study social work practice with people with disabilities to learn how to most effectively and respectfully advocate for youth with disabilities and their families. Ms. Chepulis can be reached at e_chepulis@salemstate.edu.