Trends in Rehabilitation and Disability: Transition from a Medical Model to an Integrative Model (part 2)

The Social Model
The social model is based on knowledge of the experience, views and practices of people with disabilities. The model locates the problem within society, rather than within the individual with a disability. From the perspective of the social model, disability is conceived more as diversity in function or the result of discrimination in policies, practices, research, training, and education. Individuals with disabilities are the authorities. They assume a range of roles-- especially the advocate role--to pursue full expression of educational and employment opportunities and citizenship. Rules are determined within a framework of choice and independent living with strong support from organized disability communities. The biases of the social model include: limiting the causes of disability either exclusively or mainly to social and environmental policies and practices, or advancing perceptions of disability in mainly industrialized countries that emphasize individual rights rather than advancing broader economic rights that may reflect the needs of impoverished developing countries (Albrecht, Seelman, & Bury, 2001; Barnes & Mercer, 2003).

Policies and Practices
While retaining health and welfare policies of the first stage of disability policy, countries are in various stages of transition from the medical model to the social model. International organizations, some industrialized countries, and some developing countries have adopted second and third stage policies and practices of special laws in education, employment, civil rights, and accessibility. The United Nations began adopting disability human rights declarations in the 1970s in support of the principle of normalization of the lives of people with disabilities. Most countries in the second stage of disability policy have adopted special education and employment policies such as Japan's School Education Law of 1947 and the Individuals with Disabilities Education Act of 1975 in the U.S., which involved civil rights and mainstreaming of most children with disabilities {Statistical Abstracts, 2003; Education in Japan, 2001}. Japan and the U.S. are among countries that have adopted special employment-related laws, such as Japan's Human Resources Development Promotion Law of 1969 and the U.S. Rehabilitation Act of 1973 which also involved civil rights (Employment and its Promotion of Disabled Persons in Japan: A Guide to Employment for Employers and Disabled Persons, 1999). Most of these laws provided services which were controlled by professionals. In the third stage, some countries began to move from special needs policies to a civil rights policy such as the Americans with Disabilities Act of 1990 in the United States. Others continued with a health, welfare, special education and special employment approach and often added policies to make buildings and information more accessible (Heyer, 2000; http://www.dinf.ne.jp/doc/japanese/law/etc/z00003.htm; http://www.dinf.ne.jp/doc/japanese/law/etc/100002e/
100002e01.htm).

Measurement Tools
The social model perspective incorporates research that examines problems of quality of life, user satisfaction, participation, and accessibility of various domains of the environment. The perspective also examines problems of participation of people with disabilities in the research process, including survey research. Researchers have explored methods to interview people with disabilities in survey research. Section 508 of the U.S. Rehabilitation Act as amended in 1998 may require federal electronic-based surveys to be accessible to people with disabilities, not only in the collection of survey data, but also in the analysis and reporting stages (Hendershot, 2003). New research tools have emerged to measure quality of life and satisfaction, including the Quebec User Evaluation of Satisfaction with Assistive Technology and the Psychosocial Impact of Assistive Devices Scale (Cook & Hussey, 2002; Scherer, 2002). Researcher David Gray has been involved in the development of measures of the environment (grayda@msnotes.wustl.edu). The following are examples of his work:

In this example, Gray changes the outcome measure from capacity to participation, which focuses on the individual's ability to function in his or her own environment. Although people with disabilities may score low in clinical tests of capacity, they may participate in many life activities including work, education, and family and community life.

In this example, Gray shows the location on the normal curve of people with mobility disabilities without good assistive technology.

In this example, Gray shows the location on the normal curve of people with disabilities with good assistive technology.

In the example above, Gray shows the location of people with disabilities on the normal curve when they have assistive technology, personal assistance and receptive environments.

A number of the Rehabilitation Engineering Research Centers (RERC) of the National Institute on Disability and Research (NIDRR) have developed assistive technologies and universal design products that have increased participation of people with disabilities (http://www.naric.com/search/pd/). For example, the RERC on Universal Design and the Built Environment (http://www.ap.buffalo.edu) has developed a squat toilet and a visitable house as the following graphics show:

Research efforts have also worked toward the development of accessible communication devices. Title IV of the Americans with Disabilities Act charged the telephone companies with provision of interstate and intrastate telephone relay services that will provide deaf, hard-of-hearing and speech-impaired persons with telephone service functionally equivalent to service for hearing persons. The private sector has competed for contracts to develop and mange relay services. The CapTel System shown below is now in the testing stage. (http://www.ultratec.com/infoCapTel.html ) This system can be used by people with some degree of hearing loss because it works like a telephone but also displays every word the caller says during the conversation.

Researchers have also modeled stages of change in organizations as they move towards accessibility. The Center for Rehabilitation Sciences & Technology at the University of Wisconsin at Milwaukee (http://www.uwm.edu/CHS/atoms/) developed a model called A3. The A3 model conceptualizes stages in which organizations meet the needs of people with disabilities, focusing on the physical and virtual environment, consumer products, services and systems. The A3 Model includes three elements: advocacy, accommodation and accessibility. The advocacy stage has the following characteristics:

• Minimal anticipation of needs
• Reactive to "complaints"
• Sometimes the person with the disability advocates
• Other times someone else advocates for the person with the disability
• People with disabilities receive a different "product" than people without disabilities

The next stage is accommodation. Characteristics of accommodation include the following:

• Anticipation of needs
• Prepared to meet needs
• "Complaints" are reduced as there is a system in place
• People with disabilities still receive a different "product" than people without disabilities
• Likely requires additional time, money, effort, etc.

The third stage is accommodation. Characteristics of accommodations are:

• Proactive
• Recognition that better design can reduce the need for individual accommodation
• Everybody receives the same "product"
• People with disabilities do not require additional time, money, effort, etc.

The stages are conceptualized in the following illustration:

Education and Training
The social model is based on a knowledge base of experiences of individuals with disabilities living in society. Adoption of the social model has led to demands to educate and train architects, designers, engineers and lawyers, as well as people with disabilities. Product design curricula may include the following considerations (see figures below):

Engineers have begun to receive clinical training. The University of Pittsburgh School of Health and Rehabilitation Sciences provides training in the Center for Assistive Technology and the University of Pittsburgh School of Law has launched a Disability Law curriculum. (http://www.shrs.pitt.edu/index2.html; http://www.cat.pitt.edu/; http://www.law.pitt.edu/about/index.html). A number of universities, including the University of Pittsburgh, have added a Disability Studies curriculum (http://www.uic.edu/orgs/sds/). The best example of education and training within the social model is illustrated below:

An example of community integration within the social model is illustrated below:

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