Addressing and Enhancing Addressing and Enhancing Diversity in Academic Diversity in Academic

Programs: Faculty, Students Programs: Faculty, Students and Clients with Disabilitiesand Clients with Disabilities

Katherine D. Seelman, Ph.D.Katherine D. Seelman, Ph.D.School of Health and Rehabilitation, University of PittsburghSchool of Health and Rehabilitation, University of Pittsburgh

The Council of Academic Programs in Communication Sciences and DisordersThe Council of Academic Programs in Communication Sciences and Disorders2002 Conference, April 252002 Conference, April 25

Palm Springs, CAPalm Springs, CA

Two Windows on DisabilityTwo Windows on Disability

Rehabilitation Sciences lack knowledge Rehabilitation Sciences lack knowledge that is subjective and social, sufficient to that is subjective and social, sufficient to explain the experience of the disabled explain the experience of the disabled person.person.

Disability Studies lacks knowledge that Disability Studies lacks knowledge that is objective, sufficient to support a is objective, sufficient to support a scientific base for medical treatment. scientific base for medical treatment.

Two Windows on Disability: Two Windows on Disability: Professional and Patient/ClientProfessional and Patient/Client

Health professionals can develop a view Health professionals can develop a view

of disability that is at substantial variance of disability that is at substantial variance from its reality for many disabled people.from its reality for many disabled people.

Disabled people can develop a view of Disabled people can develop a view of health care that is at substantial variance health care that is at substantial variance to its value for them.to its value for them.

Different Roles: Health Care Different Roles: Health Care ProfessionalsProfessionals

The role of health care professionals is The role of health care professionals is associated with knowledge that is objective, associated with knowledge that is objective, scientific.scientific.

Health care professionals make decisions Health care professionals make decisions important to disabled people, including decisions important to disabled people, including decisions about life and death and for long term care about life and death and for long term care interventions such as assistive technology , interventions such as assistive technology , including hearing aids, assistive listening including hearing aids, assistive listening devices and augmentative communication.devices and augmentative communication.

Different Roles: Different Roles: Patient/ClientPatient/Client

The role of the patient/client is associated The role of the patient/client is associated with subjectivity, emotion and personal with subjectivity, emotion and personal experience and is related to Disability experience and is related to Disability Studies.Studies.

Experientially-based knowledge is often Experientially-based knowledge is often under valued.under valued.

. .

Example: M.D. and Disabled Example: M.D. and Disabled PatientPatient::

<I began> to examine his nervous <I began> to examine his nervous system…felt a sense of horror come over system…felt a sense of horror come over me. You can’t feel anything here on your me. You can’t feel anything here on your shoulder? You can’t move your legs.”shoulder? You can’t move your legs.”

M.D. as a Disabled PatientM.D. as a Disabled Patient

““I next met this man in a spinal cord unit in I next met this man in a spinal cord unit in 1985 as I was pushed to the computer 1985 as I was pushed to the computer next to him in occupational therapy. A few next to him in occupational therapy. A few months earlier, I had severed my cervical months earlier, I had severed my cervical spinal cord playing rugby and I was a spinal cord playing rugby and I was a quadriplegic—slightly more impaired than quadriplegic—slightly more impaired than was my former patient.” was my former patient.”

M.D. as a Disabled PersonM.D. as a Disabled Person

““Now, 15 years after becoming Now, 15 years after becoming disabled, I find myself completely at disabled, I find myself completely at home with the concept of…being me.”home with the concept of…being me.”

““Now I know that my assessment of the Now I know that my assessment of the potential quality of life of severely potential quality of life of severely disabled people was clearly flawed.”disabled people was clearly flawed.”

Studies of Quality of LifeStudies of Quality of Life

Neurologists were significantly more Neurologists were significantly more likely to believe that physical likely to believe that physical impairment was an important impairment was an important determinant of quality of life than were determinant of quality of life than were disabled people.disabled people.

92 per cent of people with quadriplegia 92 per cent of people with quadriplegia reported being glad to be alive while reported being glad to be alive while only 18 per cent of emergency service only 18 per cent of emergency service personnel believed they would be glad personnel believed they would be glad to be alive. to be alive.

Disabilities do not have the same social Disabilities do not have the same social consequences as illnesses.consequences as illnesses.

Social Consequences of Social Consequences of Illness and Disability: Are Illness and Disability: Are

They Different?They Different?

Social Consequences of Social Consequences of Disability and IllnessDisability and Illness

People with illnesses People with illnesses are usually cured.are usually cured.

People with People with disabilities frequently disabilities frequently live with disabilities live with disabilities for life.for life.

Social Consequences of Social Consequences of Disability and Illness: Are Disability and Illness: Are

They Different?They Different?

People who are ill People who are ill are patients who try are patients who try to get well.to get well.

People who are ill People who are ill may be temporarily may be temporarily relieved of their relieved of their family and work family and work roles.roles.

People with long-People with long-term disability are term disability are often not ill.often not ill.

People with People with disabilities cannot disabilities cannot be permanent be permanent patients who forfeit patients who forfeit their family and work their family and work roles.roles.

Social Consequences of Social Consequences of Disability and Illness: Are Disability and Illness: Are

They Different?They Different? People who are ill People who are ill

rarely have to rarely have to radically change radically change their lifestyles, i.e., their lifestyles, i.e., where they live, their where they live, their friends, their job.friends, their job.

People who have People who have acquired disabilities acquired disabilities may find they need may find they need support to learn how support to learn how to live a new life.to live a new life.

Implications for Attitudes, Implications for Attitudes, Research, Training and Research, Training and

PracticePractice Identify holistic paradigms and models that Identify holistic paradigms and models that

inform attitudes, research, education and training inform attitudes, research, education and training and practice.and practice.

Incorporate into training and practice, disabled Incorporate into training and practice, disabled people and Disability Studies.people and Disability Studies.

Identify and incorporate into research, problems Identify and incorporate into research, problems that are important to disabled people.that are important to disabled people.

Paradigms and ModelsParadigms and Models

Biophysical modelBiophysical model

Social modelSocial model

Integrative modelIntegrative model

Integrative Model: Important Integrative Model: Important Reports and StudiesReports and Studies

World Health Organization: ICFWorld Health Organization: ICF

Institute of Medicine: Enabling AmericaInstitute of Medicine: Enabling America

National Institute on Disability and Rehabilitation National Institute on Disability and Rehabilitation Research: Long Range PlanResearch: Long Range Plan

Centers for Disease Control: Healthy People Centers for Disease Control: Healthy People 20102010

Training for Whom?Training for Whom?

Medical students, practitionersMedical students, practitioners

Allied health care students and practitioners, Allied health care students and practitioners, including nurses, pharmacists, physical including nurses, pharmacists, physical therapists, occupational therapists, therapists, occupational therapists, audiologists, speech pathologists and audiologists, speech pathologists and rehabilitation engineersrehabilitation engineers

Disabled peopleDisabled people

Training InitiativesTraining Initiatives

Incorporation of Rehabilitation Science Incorporation of Rehabilitation Science and Disability Studies into curricula and Disability Studies into curricula development:development: Primary CarePrimary Care Clinical PreventionClinical Prevention Long Term Care and RehabilitationLong Term Care and Rehabilitation Emergency ServicesEmergency Services

TrainingTraining

At the level of the individual faculty At the level of the individual faculty member, student or client/patientmember, student or client/patient

At the Health Care System levelAt the Health Care System level

At the Public Policy LevelAt the Public Policy Level

Integrative Framework for Integrative Framework for Research, Teaching and Learning Research, Teaching and Learning about Disability in Medicine and about Disability in Medicine and

the Health Sciencesthe Health Sciences Knowledge based in Rehabilitation Science and Knowledge based in Rehabilitation Science and

Disability Studies, especially Development of Disability Studies, especially Development of Integrative paradigm and models, especially the Integrative paradigm and models, especially the ICFICF

Development of curricula, internships and Development of curricula, internships and practicumpracticum

Scenario: A Hard of Hearing Student in Scenario: A Hard of Hearing Student in an Audiology AU. D.Programan Audiology AU. D.Program

Enter a student with bilateral moderate-Enter a student with bilateral moderate-severe hearing losssevere hearing loss

Completed very successfully Completed very successfully undergraduate degree using an FM systemundergraduate degree using an FM system

Must engage in new communications Must engage in new communications situations, involving group projects and situations, involving group projects and presentations presentations

Scenario: A Hard of Hearing Student in Scenario: A Hard of Hearing Student in an Audiology Masters Program an Audiology Masters Program (continued)(continued)

Participates in clinical practicum that Participates in clinical practicum that requires:requires: monitoring the sounds generated by an monitoring the sounds generated by an

audiometeraudiometer Troubleshooting hearing aids via a listening Troubleshooting hearing aids via a listening

stethoscope, recording speech responses of stethoscope, recording speech responses of young children during language testing….young children during language testing….

Questions that Arise for the FacultyQuestions that Arise for the Faculty (continued)(continued)

Must the student “self-identify” herself as a Must the student “self-identify” herself as a disabled individual to the clinical sites to disabled individual to the clinical sites to which she is assigned?which she is assigned?

Which “hat” does a faculty member wear Which “hat” does a faculty member wear when the student experiences a when the student experiences a communications failure in class? In communications failure in class? In clinical practicum? Instructor? clinical practicum? Instructor? Audiologist? Advocate?Audiologist? Advocate?

Questions that Arise for the Faculty Questions that Arise for the Faculty (continued)(continued)

If an FM system breaks down in class, is it If an FM system breaks down in class, is it the instructor’s (audiologist) role to fix it?the instructor’s (audiologist) role to fix it?

In clinic, if the instructor notices that the In clinic, if the instructor notices that the student is unable to accurately hear student is unable to accurately hear children’s responses to test stimuli, does children’s responses to test stimuli, does she/he recommend or prescribe an she/he recommend or prescribe an accommodation?accommodation?

Questions that Arise for the Faculty Questions that Arise for the Faculty (continued)(continued)

Who is responsible for the provision of Who is responsible for the provision of accommodations at outplacement clinical accommodations at outplacement clinical practicum sites?practicum sites? Example: A student needs to have the Example: A student needs to have the

audiometer monitor output patched in directly audiometer monitor output patched in directly to her hearing aids in order to score to her hearing aids in order to score audiometric tests accurately. audiometric tests accurately.

Questions that Arise for the Faculty Questions that Arise for the Faculty (continued)(continued)

What constitutes ‘reasonable What constitutes ‘reasonable accommodations’ so that a student may accommodations’ so that a student may satisfy requirements for clinical contact satisfy requirements for clinical contact hours and face to face contact?hours and face to face contact?

Questions that Arise for the Faculty Questions that Arise for the Faculty (continued)(continued)

Can the profession provide alternative Can the profession provide alternative career paths for students who, with career paths for students who, with reasonable accommodations, cannot hear reasonable accommodations, cannot hear a hearing aid signal, score audiometric a hearing aid signal, score audiometric tests…tests… Example: A non clinical track such as hearing Example: A non clinical track such as hearing

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