medical model of disability – #CrippingSocialWork

My sons, my ableism, my social work practice: Lessons learned

Social workers are deeply influenced by their home life. In order to be a reflective practitioner, I feel it is vital to take a look at myself and how my home life influences my social work practice. As part of my course on social work practice with people with disabilities, I was asked to consider my own ableism. I am sad to admit that within my own personal life, I have engaged in ableism. Ableism is defined by Mackelprang and Salsgiver (2015) as “the belief that because persons with disabilities are not typical of the non-disabled majority, they are inferior” (Mackelprang & Salsgiver, 2015, p.105). Upon reflection, I realize that I tend to engage in ableism when I protect my children from the harsh realities of the world, even though I am not. For example, I tend to think that because my son has Autism, or that my other son has an intellectual disability, that they may not be able to handle life’s challenges. Actually, they are quite competent in handling many situations without my added help or support.

I realize that I tend to view my children and other people with disabilities with a ‘containment’ lens. Namely, I always feel that I am limiting the choices of those with a disability be it about going to a party, or getting part time employment. I tend to not let my child with intellectual disabilities go to the mall with his friends, fearing that he might not pay for an item, or might get treated unfairly by a store employee if he doesn’t understand a price. I also view my son with Autism as a child for whom college is not an option. Honestly, I don’t know why I make these assumptions. I now understand that they are wrong, and I am actively working on ending my ‘containment’ mothering approach. I’m now striving to provide equal opportunities to each of my children, and hoping to push them towards their highest potential.

Ableism is closely linked to the lens of the medical model of disability in which the impairment is seen as the problem, versus the social environment. Sometimes, for example, I see my children through this lens, and that is unfair to their development and self-esteem. Specifically, when any family member hears that there is something ‘wrong’ with my child, the first thought that comes into my head relates to how I am going to ‘fix’ the problem. In these moments, I am reacting in fear – of the unknown and of the future. Lately, I have gotten farther away from the medical model and ableist views. Realizing my children, and that other people living with disabilities are great the way they are, and don’t need to be fixed, is a very freeing feeling. I no longer feel as if I am on a race to the finish, but rather on a journey of discovery.

Learning about the social model of disability has also helped me to reflect on my own ableism. I love the work of disability studies scholar Tom Shakespeare, who describes the challenges of an overly-medicalized view of people with disabilities. He defines disability as “the disadvantage or restriction of activity caused by a contemporary social organization which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream social activities” (Shakespeare, 2002, p. 124). This social model thinking can also be applied to how I view my children. I am quick to blame the schools, for not helping my sons gain their skills, and educational needs fast enough. I am quick to point out that they do not have the best equipment or the resources to help my children be fully integrated into regular classes.

This social model of thinking about disability has its downside, though. Shakespeare notes that the world cannot be a barrier free environment and that it isn’t possible to have a barrier free world for everyone. In this vein, I engaged in ableism with my children when I do not let them explore and challenge environments that I cannot fix for them. School is hard for my son with intellectual disabilities. Sometimes life is just hard. If I continue to blame society, blame the system, or even blame my children for their struggles, then I am doing them a disservice and wasting valuable time not enjoying the uniqueness and abilities of the people around me. All of this has implications for how I practice as a social worker!

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.

Erica Sarro 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 Salem State University. She hopes to continue her career in policy-related macro social work. Mrs. Sarro chose to study social work practice with people with disabilities in order to become a better advocate for equal rights for people with disabilities. Mrs. Sarro can be reached at e_sarro@salemstate.edu. Her blog posts are published at www.disabilitysocialwork and you can Tweet her at @disabilitysw.

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 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.

Weighing the pros & cons of the medical & social model of disability when working with people facing medical complexities

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 Sarro, MSW Candidate

Salem State University

“Sarah” was a five year old girl that was referred to my agency by the school system. Her treatment goals included providing resource allocation and engaging in parental education, as well as supporting Sarah with behavior management assistance. Sarah had a diagnosis of intellectual disability as well as a rare genetic condition, which required the assistance of a walker for mobility and a feeding tube. Sarah was also non-verbal and required assistance with improving her receptive language capacity.

If I took a medical model approach to this case, which is defined as; “the belief that with the correct intervention all human abnormalities could be corrected,” I would focus on encouraging medical interventions (Mackelprang & Salsgiver, 2015; p 103). This would include helping Sarah and her family connect with surgeons and genetic doctors, who might be searching for a cure for her condition. Additionally, I would also have worked with the occupational and physical therapists in both community and school settings, with the goal of helping Sarah to walk like a “normal person”, instead of needing a walker or other device.

While practicing under the social model, I would focus on helping the family and school make the environment a more welcoming and accessible place. For example, I would encourage both the school and the family not to focus on interventions with the goal of curing Sarah’s disabilities. Instead, I would educate the family on the rights of a student with disabilities, coordinate with the school to ensure that the correct services were in place so that the medical needs did not overshadow or define Sarah’s school experience. I believe that even though Sarah’s medical issues, (such as the feeding tube) do need to be addressed, that Sarah is more than her impairments and that the school and family should accommodate her needs in order for her to feel successful and equal.

The social model of disability is important when viewing Sarah’s’ ability to interact with her environment. With respect to the social model, Shakespeare states that “the problems disabled people face are the result of social oppression and exclusion, not their individual deficits. This places the moral responsibility on society to remove the burdens which have been imposed and enable disabled people to participate. (Mackelprang & Salsgiver, 2015). As a social work provider, it is my ethical responsibility to advocate for social justice for people with disabilities, including Sarah. Especially important for Sarah’s well-being would be making her home a clutter-free environment, so that she could access all of the rooms in her home. With respect to her school environment, ensuring that Sarah’s classes were accessible and just as equal in opportunities as all classrooms should be.

I would argue, however, that the social model approach is not the perfect model nor is the medical model. As a social worker, I would realize that the social model is not realistic for all aspects of Sarah’s life. Sarah is going to struggle with frustration, and making her life barrier free is not going to be possible all the time. Sarah’s family has to balance her medical and physical needs along with her emotional and communication needs equally. Some medical intervention is needed and any improvement with eating or walking should be celebrated along with her ability to access her environment and society in the least restrictive way possible. Being knowledgeable in both models will not only enhance the quality of integrative care for people with disabilities, but also the assurance of continued cultural competency in the social work profession.

Mackelprang, R. & Salsgiver, R. (2015). Disability: A diversity model approach in human service practice, 3^rd 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.

Erica Sarro 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 Salem State University. She hopes to continue her career in policy related macro social work. Mrs. Sarro chose to study social work practice with people with disabilities in order to become a better advocate for equal rights for people with disabilities. Mrs. Sarro can be reached at e_sarro@salemstate.edu.

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.

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, 3^rd 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 j_cassola2@salemstate.edu.

Social model or medical model? How to implement one or the other in a group home setting

Graduate social work students 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:

By Daniel Fraser, MSW Candidate

Salem State University

Where I work at a group home for people with intellectual disabilities, we have a client, who for the purposes of this discussion, will be referred to as H.I. Several years ago, H.I. began to feel uncomfortable standing or walking on her own, or with a walker. She feared she will fall and hurt herself. A wheelchair was provided for her, as a way to make her feel more comfortable with her mobility. However, staff were encouraged to get H.I. to stand up and walk with assistance of a walker, instead of allowing her to remain in the wheelchair on a full-time basis. Each time a staff member would attempt to encourage her to stand up and walk with assistance of a walker, H.I. would become upset, and refuse to attempt to stand up. It is noteworthy that H.I. is able to transfer herself from her wheelchair to other locations, such as a recliner, her bed, or even the toilet, but that is the extent to which she feels comfortable enough to stand on her own.

When I first started working at the home, the director tried to implement a plan where H.I. was supposed to transfer herself from the toilet seat to the shower seat, each time she went to take a shower (she needs full assistance in taking a shower). Each time staff went to implement this protocol, it caused a great deal of stress for H.I., and she would refuse to take a shower.

Taking the social model approach, it would have been better for all of the staff members, the director included, to talk to H.I., and find out whether she would rather use her wheelchair to get around, or if she would rather try walking with the walker. By doing this, we would effectively eliminate the barrier of using a walker or walking on her own, that separates H.I. from the mobility which she chooses (Shakespeare, 2006). Allowing H.I. to choose the way that she would prefer to move around would also give her more of a sense of independence, and make her feel the power of being able to make her own decisions. Discussing her option of mobility would also likely take away any behavioral consequences that resulted from staff trying to implement the protocol of having her stand up and walk when she does not feel comfortable doing so.

By taking the approach that was implemented by the director, we were taking part in medical model thinking. I believe that according to disability studies writer Tom Shakespeare, by not giving H.I. the choice of using the wheelchair to move around, and also by trying to get her to walk from the toilet seat to the shower seat, we were in essence, trying to eliminate an aspect of her disability, in order to fit in with what we wanted for her instead (2006). By taking this approach, we also encouraged the behavioral consequence that resulted, along with adding more stress to an already stressful situation for H.I.

It is argued that one of the main limitations of the social model is that it essentially further disables someone who is already disabled, by not properly identifying the disability (Shakespeare, 2006). By doing this, we are taking away part of the person’s identity, and more or less telling the person that even though they may have a disability, they should not recognize that disability. In the case of H.I., if we do not encourage her to at least attempt to stand up and walk on her own, or with the assistance of the walker, it could lead to much less leg functioning, which could further impair her functioning. So essentially, by not encouraging H.I. to move around without the assistance of a walker, and just continue to use the wheelchair, we could potentially be further disabling her.

It is a complicated situation, but it helps to look at H.I.’s situation through several lenses!

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

Daniel Fraser is a candidate for the degree of Masters in Social Work at Salem State University’s School of Social Work. He holds a B.A. in Social Work from Salem State University. He hopes to do clinical work with students who have varying degrees of cognitive and intellectual disabilities with his career. Mr. Fraser has always enjoyed helping people out, and since joining his current place of employment, has really found his niche, where he can help people, and advocate for independence within the disability community. Mr. Fraser can be reached at d_fraser2@salemstate.edu.

Moving beyond “fixing” people: Social work practice with people with disabilities

Graduate social work students in Dr. Elspeth Slayter’s courses 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:

By Ndia Olivier, MSW Candidate

Salem State University

Working on a boarding high-school campus, I have the opportunity to be exposed to different students. During my first year, one student, in particular, stood out. J.M. was a breakout basketball star and had dreams of going to the N.B.A. Unfortunately, in his junior year, he was in a terrible car accident and as a result was paralyzed from the waist down. Everyone on campus was affected by his accident because J.M. was such a bright presence on campus and when he came back, he was a different person. He was less interactive on campus and lost his love for basketball.

The adults who were working with him every day were so fixated on the medical model, they wanted to “fix” him as much as they could so he could be ‘normal’ again. They suggested to his mom to take him to the best doctors who specialize helping people who are paraplegic learn to walk through virtual reality. They were not focused on his direct needs because they did not ask him, and that was detrimental to his recovery.

In using the social-model informed practice, the adults working with J.M. should have discussed with him how he saw his recovery going. By placing the focus on him rather than his disability, J.M.’s confidence in recovering could have been more positive than negative. Disability studies scholar Tom Shakespeare discusses the importance of focusing on the individual and not the impairment in order to create a confident space (Shakespeare, 2016).

One of the limits in the social model approach, however, is the idea that individuals with disabilities should disregard their impairments. More specifically, it is stated that “the social model so strongly disowns individual and medical approaches, that it risks implying that impairment is not a problem (Shakespeare, 2016 p. 218)”.

The medical model is helpful when we are utilizing action practices that are suggested by the person with the disability and not the people around them who are looking at it like a problem that needs to be corrected. As social workers, it will only benefit the clients we are working with if we are their advocates and find a balance between the medical model and the social model.

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

Ndia Olivier 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 Psychology from College of the Holy Cross. She hopes to do create change and be an advocate for the voiceless with this career. She wanted to study social work practice with people with disabilities to learn about a population she was unfamiliar with. She is striving to be a well-rounded social worker and learning about one of the minority groups in our society and becoming more self-aware, is key. Ms. Olivier can be reached at ndia.olivier@gmail.com.

“Letting” people who are non-verbal communicate in their own way: A challenge for social work practice

Graduate social work students in Dr. Elspeth Slayter’s courses 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:

By Kasey Soucy, MSW Candidate
Salem State University

While working at a disability group home agency, I came to know“ Jane,” a person with Rett Syndrome. Jane was non-verbal and was unable to walk independently. She used a specialized walker to move around. In addition, she developed her own sign language in order to communicate. During the day, Jane would attend a day program. That program gave all nonverbal clients computers that had the “Picture Exchange Communication System (PECS)” system on it. Jane was required to use it at the day program and was also encouraged to continue using it at the group home. Jane would take home the computer, but she would leave it in her bedroom. She did this because she didn’t like it, and was comfortable with her own form of communication. The day program became insistent on Jane using the computer at home, so the director asked Jane to use it. Jane refused to use the computer and threw it across the room because she was so upset about being asked to do so. The day program still required Jane to use the computer so she would comply, however once she was in her home she didn’t use it and the staff did not force her to do so.

As a social worker, and using what I know now from this course, I would first ask whether Jane wanted to use the PECS system. When disability studies scholar Tom Shakespeare was discussing the social model of disability, he pointed out the idea of this practice is to make society adapt to people with disabilities. This could include allowing for people’s own communication choice to be honored or it could include providing accommodations like the PECS system for non-verbal clients. One of the barriers of the social model (Shakespeare, 2006, p. 219) is trying to make accommodations for people with disabilities without choice. The PECS system might work well for one client who is non-verbal, but it did not suit Jane and she did not want to use it. Shakespeare described limitations with the social model-informed practice as assuming there could be a “utopia” for people with disabilities as there would be no barriers. People with disabilities do not all function or adapt the same way so it is unrealistic to be able to accommodate everyone and it is insulting to force accommodations on people with disabilities if they do not want to utilize that specific accommodation. If Jane was given the option to use or not use the PECS system then that would still be utilizing the social model-informed practice because society is making the change for her and not expecting her to change. By forcing the PECS system on Jane, it is reverting back to the medical model practice because the program is making Jane adjust instead of learning Jane’s sign language.

Jane also used a specialized walker. I would engage in medical model-informed practice by acknowledging it was Jane’s body part that was impaired, and therefore disabled her. This is another limit of the social model-informed practice. As Shakespeare (2006, p. 218), the social model-informed practice is so focused on society being the barrier that it does not always acknowledge that a person’s body can also be the barrier. The medical model-informed practice is what helped Jane receive the specialized walker because Jane’s body was the barrier and she wanted to walk as independently as she could. The social model-informed practice can also be used by ensuring there are ramps for Jane so she can have easy accessibility.

From the macro level of social work, I believe we are on the right track with the social-model informed practice, however as Shakespeare (2006) pointed out on page 220, this model is not complex enough to include everyone. Intersectionality does not seem to be taken in to consideration with this model, which is a complicating factor. A strong model needs to be developed to acknowledge the complexities of people and their disabilities. A person’s environment, gender, race and other social identities need to be considered when developing models (which was not the case since the group of activists who rallied for this model were white heterosexual men (Shakespeare, 2006, p. 217)). The first step to be taken by every social worker should be to ask the person with the disability “what can be done to support you?” or “what do you believe needs to be changed so you do not continue to feel oppressed or feel like your voice is not being heard?”

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

This is Kasey A Soucy, an MSW candidate at Salem State University’s School of Social Work. (Note for Screenreaders: Image shows a confident White woman in a beige sweater who is smiling and standing in front of a forest)

Kasey Soucy 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 Psychology from Salem State University. She hopes to continue her career with the Department of Children and Families. Ms. Soucy chose to study social work practice with people with disabilities so she can have a better understanding with the clients she works with. She also wants to work with her agency in providing a more inclusive solution for working with people with disabilities. Ms. Soucy can be reached at k_soucy@salemstate.edu.