How the medical and social models of disability play out in adoption social work

social vs. medical model
Image from Bluestockings Magazine (For screenreader: Image shows a cartoon that explains the difference between the medical and social models of disability. Specifically, it shows a person in a wheelchair at the bottom of the steps.  On the right is a caption saying “they should build a ramp” and on the left is a caption saying that the “impairment is the problem”)

Graduate social work students in Dr. Elspeth Slayter’s course on social work practice with people with disabilities 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 Janelle Cassola, MSW Candidate

Salem State University

For my consideration of how the medical and social models of disability play out in my social work practice, I will explore the scenario of a child with a disability, “Sara,” who is receiving services through my current field placement at an adoption agency.  Although the scenario is not a true situation, it is plausible.

Sara is a two-year old girl who was born with a unilateral cleft lip and a cleft palate due to her mother’s substance use during pregnancy.  Sara’s cleft lip was corrected at the age of 3 months and her palate was corrected at the age of 7 months.  The surgeries went well but they were unable to repair the full cleft lip so Sara still has a slight cleft.  Sara was removed from her mother at birth due to a positive toxicology screen at birth.  She was placed in foster care and has remained in care of child welfare services since then.  During this time, Sara’s mother was unable to consistently follow the goals on her family reunification service plan. Eventually, the child welfare authority changed Sara’s goal from permanency through family reunification to permanency through adoption.

Since Sara was born, she has had multiple ear infections that have affected her hearing.  Her first foster home placement did not attend to these ear infections in a timely manner, which had a great effect on Sara’s hearing.  As a result, she has been diagnosed slight hearing loss. Sara also has been diagnosed with a speech delay due to the combination of her hearing loss and cleft palate.  She receives therapeutic services through a speech-language pathologist and an audiologist in addition to her ear, nose, and throat doctor.

Now that Sara’s goal has been changed to adoption, her social worker has started recruiting for an adoptive family for Sara.  Her social worker could approach her recruitment of families and the information she gives them through medical model-informed practice or social model-informed practice. I will play out each scenario below.  If, as Sara’s social worker, I decided to provide information to the prospective family through medical model-informed practice I would focus on the interventions that are currently in place in order to help “heal” Sara.  According the Mackelprang and Salsgiver (2015) the medical model believes that specialists such as speech and occupational therapists are those who should control how people with disabilities are seen.  Therefore, when speaking with the potential adoptive family about Sara, I would inform them about her impairments, and would share that she has multiple different specialists who are working towards making her “normal”. By doing so, it would be the hope of a medical model believer that the family would be more willing to take Sara into their home if they knew she had a chance of “losing” her disability.

On the other hand, as a social worker looking to recruit a home for Sara through social model-informed practice, the focus would be different.  I would still inform the family of Sara’s supports and the specialists that she is currently seeing.  However, since the social model asserts that society is the disabling factor, I would introduce their services as optional (Shakespeare, 2013).  I would focus more on what the family would have to do in order to change their social environment so that Sara would be supported.  This would mean speaking with extending family members and friends and discussing how their views on a person with impairments is really what is disabling to Sara.  Unfortunately, if a child’s medical needs were presented to a family in that way and the family chose to discontinue her services, it could hinder Sara’s development.  Shakespeare (2013) acknowledges this weakness of the social mode in his article “The Social Model of Disability.”

In summary, I would most likely take a mixed approach when working with Sara and her potential adoptive families, drawing on the best of each model.

Mackelprang, R. & Salsgiver, R.  (2015). 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.

Janelle Cassola 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 Urban Studies from Worcester State University. She hopes to continue her career in the field of adoption. Ms. Cassola chose to study social work practice with people with disabilities to become better informed of this community, the barriers that they face, and the practice frameworks regarding people with disabilities. Ms. Cassola can be reached at