Social Work Practice with Disability: Moving from the Perpetuation of a Client Category to Human Rights and Social

Justice

Abstract In this article, we propose an alternative stance to the ways in which disability is theoretically and practically approached within the field of social work. We begin with a critical analysis of how contemporary views of disability and response praxis came to be. Building on history and current scholarship from humanities, social sciences, and natural sciences, we then advance a progressive theoretical framework, explanatory legitimacy theory (DePoy & Gilson, 2004, 2007). Explanatory legitimacy theory locates disability within the broad context of human diversity, uncouples diversity and thus disability from the bodies and backgrounds mentality of current diversity thinking, and illuminates an alternative value and philosophical frame to inform and guide social workers concerned with furthering the profession’s mission of social and distributive justice for all people. Over the past several decades, disability and social work have become increasingly strange bed fellows. In this article, we discuss why and then propose a philosophical and theoretical direction for reconciliation. We begin by gazing backwards in time to set the chronological context for current debates about the term “disability.” Building on history and current thinking, we then advance a progressive theoretical framework, explanatory legitimacy theory (DePoy & Gilson, 2004, 2007), which locates disability within the broad context of human diversity, uncouples diversity and thus disability from the bodies and backgrounds mentality of current diversity thinking, and thus illuminates an alternative value stance to inform and guide social workers concerned with advancing the profession’s mission of social and distributive justice for all people. 1. What Came Before Us There is record of concern with “the atypical human” as early as ancient civilizations (Longmore & Umansky, 2001). This history creates an opaque but important window on how civilizations responded to embodied difference. Unfortunately, in this short space, we cannot do justice to the richness of this history, but we can provide a brief chronology that summarizes the critical historical turnings necessary to inform current debates and understand contextual responses to atypical humans in contemporary times. Whereas diverse notions of and approaches to atypical bodies have occurred, the following commonalities can be seen across chronology: (1) in each era there have been many potential and accepted explanations for a single atypical human characteristic, (2) these explanations form the basis for categorization and subsequent response to category members, and

(3) the responses proffered provide an analytic window on the beliefs, values, politics, economics, intellectual trends, and level of technological development of the times. We enter our history through a linguistic portal, as this symbolic element of social and cultural groups is critical in revealing contextually embedded values and meaning (Belsey, 2002; Baudrillard, 1995). First, note that we use the terms typical and atypical to denote a full range of frequency from most to least respectively. We have selected this terminology, rather than normal/abnormal, to circumvent the value judgments that are embedded in the normal/abnormal binary. The term “disability” has only recently become a signifier for the grand category of atypical bodies. Its predecessor, “handicap,” was alleged to have emerged from the cap-in-hand proclamation, in which Henry VII in 1504, recognizing the plight of injured soldiers, formally allowed these worthy citizens to beg in the streets as a means to their own subsistence. More broadly, the recognized use of the term handicap is an equalizing scoring system in which disadvantaged persons are artificially boosted to increase the likelihood of their success when positioned against a superior opponent. In the early part of the 20th century, the term handicap was ascribed to individuals with bodily differences that ostensibly placed them at a disadvantage, and ultimately the word “handicap” in this sense, came to mean a specific embodied condition such as a “physical or mental handicap.” Given the pejorative notion of bodily inferiority, it is no surprise that a euphemistic term to replace “handicap” was sought to describe bodies that did not conform to the “typical.” It is curious that the term “disability” was selected, given that the prefix “dis” emerged from DIS, the name given by ancient civilizations to the ruler of Hades, or the underworld. DIS was portrayed as punishing mortals by extracting their health, wellbeing, and capacity to function in their environments. The use of DIS is consistent with the disdain for atypical bodies in Ancient Greece. While those who were mildly atypical were excluded from community life (with the exception of those who were saluted because they sustained bodily injury in war), extreme deviations from the typical were considered inhuman (Martin & Volkmar, 2007; Braddock & Parish, 2001) and left to die. Thus, myth, symbol, and tolerance in ancient Greece demonstrate the historical common denominator of multiple explanations and responses to atypical bodies on the basis of why the atypical had occurred, rather than on the atypical characteristic or need itself. In the Middle Ages, the typical tapestry against which the atypical emerged was frayed and threadbare, characterized by poverty and deprivation. Human conditions such as blindness, deafness, and lameness that are so often associated with impoverished living conditions were woven into daily life and image (Braddock & Parish, 2001; DePoy & Gilson, 2004; DePoy & MacDuffie, 2004). So rather than embodied phenomena such as blindness or lameness being considered atypical, only extreme deviations were located as marginalia, and in concert with the religious and intellectual trends of the middle ages, were attributed to supernatural causes, followed with responses that were consistent with the degree of worth ascribed to each explanation (Braddock & Parish, 2001; Winzer, 1993). Of particular note in this time period are the historical roots of charity and faith healing responses to disability (DePoy & Gilson, 2004). Whereas people with atypical bodies were devalued themselves, their place on earth was fabled to be a test as well as an opportunity from God, for those who were fortunate, to demonstrate their charity and tolerance. Faith-based care only for those who approximated the low end of worth was born, and serves as the archetype of contemporary secular charities and institutions.

Moving forward in chronology, as the complexity and differences around the globe became known to civilizations, history moved beyond a single story of one’s own people. Because of this vast history, we narrow our discussion to colonial America where our focus will reside on the North American continent for the remainder of our brief but purposive historical expedition. In the fledgling U.S., an amalgam of both enlightenment and religious thinking, peppered with economic prosperity, increasing economic concern, and the juxtaposition of indigenous and immigrant people created a complex backdrop for understanding responses to atypical bodies. The rationale for inclusion and in-home responses to the atypical that were apparent in early colonial America were breaking down and quickly became supplanted by “medical” explanations (Axinn & Levin, 2000), setting the stage for medical and ultimately broader professional colonization and ownership of the “atypical body and mind” (Mink, Solinger & Piven, 2003; DePoy, & MacDuffie, 2004). Of particular historical importance to understanding contemporary disability theory and practice responses were the abstract creations of Quetelet, who invented the mathematical constructs of the normal or bell shaped curve and measures of central tendency. These two ideas form the foundation of contemporary empirical knowledge and fabricated the dissection of humanity into the two categories of “normal” and “abnormal” (DePoy & Gilson, 2007a). Applying the bell shaped curve to human variation, Quetelet extrapolated the concept of “the normal man,” who was considered to be both physically and morally normal. Synthesizing probability theory with the “normal man” construct, normal was not only interpreted as the most frequently occurring phenomenon, but morphed in translation to what “should be.” Observation, therefore, turned to prescription, and anyone with observed phenomena on the tail ends of the curve was categorized as “abnormal.” Fields of study and professions (with medicine in the lead) that espoused and reified these positivist approaches to inquiry as truth (such as normal and abnormal psychology, medicine, special education, social work, and so forth) all distinguished between normal and abnormal and claimed the “abnormal” as their epistemic and ontological property as well as their axiological obligation (DePoy & Gilson, 2007a; 2004). It is curious to note that the term disability in the early 20th century did not include medical diagnostic conditions, as revealed in the1906 edition of the Standard Dictionary of the English Language that proffered the following: lack of ability of some sort, impotence, the state of being disabled, a crippled condition, lack of competent means, inability as, the disabilities of poverty. Legal incapacity or the inability to act; as the disability of lunatics and infants

despite their assertions to look beyond the body. run-down. we highlight what we have named “the tyranny of the opposite. broken down*. Because deficient bodies are the object of disability rights discourses and responses. counted out*. Stein. stalled. silenced. and exclusion. and rights as citizens for those who were members of the disability club (Nussbaum. lame. mutilated. castrated. economic. maimed. limping. Early scholars such as Oliver (1997) and Linton (1998. Rather than accepting themselves as the “work” for the disability industry. halting. identical narratives may produce different meanings. hobbling. mangled. paralyzed. useless. useless 1. weakened) the term disability was adopted by professions and now labels one of the largest industries in the United States (Gill. Moreover. helpless. 1992). banged up*. senile.Note that these definitions are both expansive and progressive in that they do not delimit disability to specific diagnostic explanatory conditions or exclusively embodied phenomena. Although medical explanations remain primary in defining disability even now. learning and mental disabilities. brain damaged. segregation. paraplegic. 2004). done for*. and further exposed by terms such as physical. 2006. laid up*. the history of disability took an important turn in the latter half of the 20th century that has significantly influenced responses to it. Words such as inclusion. palsied. confined to a hospital. injured. decrepit. incapacitated. marginalization. quadriplegic. Demands for equality of opportunity were anchored on theory and research that documented the locus of disability within systems of oppression and discrimination rather than internal to the organic body. impaired. done in*. on one's back*. as the explanation for disability. exclusion. Before we move on to disability in social work. wounded. crippled. physically challenged. 2006. worn-out. since such explanations of permanent deficit were impotent in advancing social justice. marginalization. and theory. 2006) rather than an internal medical condition. 2006) proposed the intolerance and rigidity of social and built institutions rather than medical conditions. With the view of disability explained by external factors such as social. wrecked. out of action*. In an effort to create a politically correct moniker for its current pathologized synonyms (handicapped. language is not simply restricted to . political.” We began this paper with a discussion of language because of its powerful and reciprocal role in reflecting. and abrogation of human rights (Nussbaum. Disability rights scholars and activists eschewed the medical explanation for disability. confined to a nursing home. situate disability within the organic human domain. superannuated. confined to one's bed. this conceptual quagmire reveals the inherent hegemony of medical abnormality in explaining the atypical and locating disability within the body regardless of the narrative indicting systems of oppression rather than bodies as disabling factors. professions. hamstrung. the locus for disability and thus for necessary responses has become a moving and complex target. disabled scholars looked external to the body to explain disability. And as reminded by the post-structuralists and post-modernists. impotent. cognitive. cracked up*. bedridden. but rather approach disability from a broad descriptive stance not entwined with explanation. confined to one's home. participation. equality of opportunity. prejudice. Still. policies. as well as shaping values. 2006. see also hurt. Stein. weakened. DePoy & Gilson. and nondiscrimination were introduced into the disability literature and parlance reflecting the notions that people who did not fit within the central tendencies of Quetelet’s “normal curve” were disabled by stigma. as evidenced by embodied eligibility criteria even for human rights and anti-discrimination legislation.

such as disabled. Cohen. retarded. 1999). Moreover. the foundation of social work’s view of humans as structuralists and cleaved into normal or the tyranny of the opposite (NOT normal) is set into motion before students even engage in practice. May and Raske (2004) and Rothman (2002). and decreasing many of the required disciplinary areas of scholarship beyond social work itself. And while several social work scholars have asserted their espousal of the social construction of disability (Yuen. or what is NOT said. Cohen. is NOT strictly a function of environment. but rather had ministered to “people with disabilities” through the provision of clinical services. contribute to. Murphy & Pardeck. crippled. 1 (a). & Tower. That is to say. remain NOT desirable.” while cobbled by committee so to speak for the purpose of political correctness. rather than being reconceptualized as human diversity. 2002. Murphy and Pardeck (2005). And for the majority of the field. subscribing to developmental theory. 2005. 2007. and thus respond to disability as something other than an embodied phenomenon. By analyzing what is NOT articulated but what is actualized in professional behavior. Inherent and perhaps not effectively shrouded in these linguistic finaglings is the unworthiness of these modifiers and a hierarchy of “worth and NOT worth” on the basis of category membership. 1999). through succumbing to the politicalization of education. Words and phrases such as “person first language. social work education . Moreover. according to the scholarship of Mackelprang and Salsgiver (1999) and endorsed by Yuen. are often opaque in what is NOT spoken. and rather are lexically relocated after “personhood” to obfuscate what is NOT desirable. given the penchant of most schools of social work to equate HBSE with theories of human development. social work had not attended to disability as a category of oppression. mental. The use of person first language. which locates disability within a person no matter where the “heinous” condition is lexically placed. physical. Yet. disability is a pathological condition that immediately catches the social work clinical eye. talk about. Given the social justice mission of social work and its mandate “to {attend to}the environmental forces that create. explicit. but is powerful in its negative spaces or what we refer to as the tyranny of the opposite. and Tower (2007). and so forth. Whatever practice approach is followed to address the category of people with atypical bodies and minds. and articulated. modifiers that are part of human experience. neurological disability and so forth (Rothman. Disability in the House of Social Work The history and current residence of disability within social work is a curious one. one would expect that social work would have taken a progressive lead in disability rights. how to think about. and is in need of repair. the tyranny of the opposite once again exposes the social work view that disability is NOT desirable. 2004). these same authors encounter the conceptual quagmire from which disability rights theorists cannot extricate themselves.what is apparent. 2004) divulge social work values and beliefs even when wellintended claims of disability as constructed are made. Mackelprang & Salsgiver. 1998) the atypical body. and address problems in living” (NASW Code of Ethics. social work joins full tilt in the disability industry (May & Raske. May & Raske. perhaps through improving the world for citizens with disabled bodies and minds and most likely through providing services that “clientize” (Cowger. as well as the subcategorization of disability into types such as learning.

2. the framework is applicable to a broad swath of human categorizations. we also fall prey to the conceptual paradox. noticeable heterogeneity (http://www. and this article is appearing in a special issue devoted to the construct that we wish to eliminate. As you might have noticed. Because we view disability as an important element of human variation. Moreover. multiplicity of differences.com. whereas we apply explanatory legitimacy to the category of disability in this article. and ethics. we acknowledge our own conceptual strugglings and ask that. and examine thinking that challenges well honed beliefs. 2004. explanatory legitimacy theory. as we did and continue to do. 1996). and as one in which members needs “help. and categorization in which we parse and then locate diverse bodies and minds. in that we argue against the usefulness of the category of disability itself. Some prevailing and representative examples of contemporary definitions of diversity are. consider alternatives that have not been articulated. 2002). In the 1906 edition of the Standard Dictionary of the English Language. It examines and predicts what is essential for the assignment of legitimate roles and power positions (Jost & Major. which we refer to as diversity patina (DePoy & Gilson. Legitimacy theory had been advanced as early as ancient civilizations.” Before we suggest how social work and disability can reconcile. in this case assignment to the disability category. and minority group membership (Basson. be reflexive. that invokes and synthesizes diversity and legitimacy theory for thinking about human difference. 2005). the name of the framework depicts the basic tenet that legitimate category assignment and response to category members. which not only describe the essential membership criteria but explain appearance.” What we mean by “flipping your brain” is before dismissing unfamiliar ideas that on the surface may create axiological and ontological tension. ergo the appearance of “explanatory” in the theory name. as we have noted.has perhaps inadvertently reified disability as a category with embodied deficit as the binding and defining element of membership and identity. legitimacy theory informs a complex analysis of what is both gained and relinquished in exchange for membership in legitimate categories. 2004. variation. As it applies to diversity and disability. The term “diversity” has changed significantly over time. racial difference (Shiao. As we discuss later in the paper. and experience of group members because of their . is a value judgment that is made on explanations for human phenomena. “diversity” is defined as: dissimilitude. are typical of current superficial perspectives in which diversity is viewed as a primary characteristic ascribed to groups possessing specified bodies or backgrounds. Moving Forward-Rethinking Disability as Diversity through Explanatory Legitimacy Theory We now introduce a framework. behavior. As we will discuss in more detail. the reader “flips his/her brain. diversity theory is a second critical grounding that comprises our theoretical framework. Healy. 2004). biological difference (Wilson. but we teach and write about it. variety. values. we propose an explanation for disability that transcends the debate about whether disability is explained by embodied conditions or environmental discrimination. 2007). engage the work. 2004).hyperdictionary. These definitions.

Different from less progressive but prevalent contemporary approaches to multicultural equality in which marginalized groups are granted membership to predominant cultures only through assimilation or specialized. women. Healy. Expanding the theoretical paradigm of diversity to include and extend beyond bodies and backgrounds to include the uniqueness of all people provides many opportunities not only to maintain the important theoretical and applied gains that have occurred from civil rights concepts and movements. . special responses to groups who exhibit diversity patina can be diminished and even revoked as we currently are observing with specialized legislation such as the ADA. viewing diversity as a characteristic of “otherness” sets the theoretical foundation for separation and scrutiny of marginalized groups by those who are in the position to marginalize (Shaio. and practice discourse. We refer to this approach as diversity depth. Assuming group homogeneity on the basis of a single bodies and backgrounds diversity patina characteristic has the potential to promote essentialist thinking and identity politics. 1999). 2004. there are many limitations. Fourth. disabled groups (DePoy & Gilson. Bonilla-Silva. bodies and background views of diversity do not account for the expansion of global. In agreement with Shaio (2004) we suggest however. 2004) and more recently. First. but to advance the social justice mission of social work. Rodriguez. Whereas there are essential and warranted benefits to restricting diversity theory and related responses to selected diversity patina subgroups who have experienced discrimination. and virtual environments in which bodies and backgrounds are irrelevant. categories and the theories that fit within them are axiological. 2002. that a major emphasis in this shift was the failure of multicultural efforts to advance axiological symmetry among groups. Numerous historical and political factors have been advanced for this lexical and conceptual recalibration (Parillo. That is to say. The bodies and backgrounds perimeter fails to achieve what Goldberg (1994) has referred to as incorporationist multiculturalism. Moller-Okin et al. 1999) and by positing homogeneity within the very groups that are defined as diverse. incorporationist thinking locates diversity within all groups. 2005. as well. 1999). and to restrict theory application and community responses to assumed nomothetic need. 2005. and thus values the contributions and power of each to beneficially transform the other through interaction. Finally. Note that the tyranny of the opposite implies that people who are NOT members of these predefined groups are NOT diverse. Mackelprang & Salsgiver. affirmative action. categories in themselves are constructions.possession of the criterion that admitted them to the diversity club. Moreover. Third. policy. non-heterosexual groups (Anderson & Middleton. the way in which we carve up our theoretical universe can be as diverse as the phenomena that we seek to describe and explain. Schneider. in much of contemporary literature. group specific strategies that can be eroded or even eliminated. multicultural efforts fail to rise above proscribing the label of diverse to all people and therefore situate diversity within historically devalued groups with certain bodies and backgrounds pedigrees. Tomlinson. 2004. That is to say.. 2004. dynamic. Second. 2003. 2004. technological communication. and other diversity patina-specific responses. the term diversity has been further delimited to a characteristic that belongs to groups perceived as non-dominant and non-privileged such as ethnic and racial minorities. Healy. and change in response to contexts.

. As we have noted. we have posited a third. Explanatory Legitimacy Theory Explanatory legitimacy theory was initially developed in theoretical opposition to vague and debated definitions of disability. abstract. to category members. rehabilitation. whereas explanations that accept constructed reasons as legitimate would guide the response of barrier removal to economic and community participation.2 (a). not because of the atypical description. the binary of disability explained as constructed (which includes the social. or from the binary that explains it as embodied or environmentally imposed. As we noted above. medical explanations. in concert with the explanation. and virtual environments that promote equality of opportunity and human rights. Applied to disability. in which atypical and unexpected description (or what is infrequent in a context) serves as the domain of interest and engenders multiple explanations for its occurrence. minority. Description encompasses the full and diverse range of human appearance. We assert that this explanation has the potential to heal the explanatory cleavage. are the primary passwords to enter. and experience from atypical through typical and expected. to refashion physical. Different from approaches that describe disability as abnormal. Specific to disability. and special accommodation of individuals. the judgments are anchored on the explanations for the atypical. behavior. we suggest that it is simply a set of axiological judgments about the explanatory legitimacy criteria that elucidate and apply membership. not the atypical description itself. political. and to provide an important direction for social work. and a legitimate response. integrative explanation. Of critical importance here is the recognition that the explanatory criterion not only creates the permeability and perimeter of the category but ultimately shapes legitimate responses to its members. whether explicit or shrouded with social justice language. and legitimacy. And in our current climate. disjuncture theory. and creative and significant systems change. which consists of legitimate category assignment on the basis of an acceptable and valued explanation. and cultural models that appear in the literature) or embodied (explained by a medical-diagnostic event) is the current forum for debate. explanation. Explanation is the “why” of description. Just imagine requesting ADA protection because you are disabled by employers’ negative attitudes toward your appearance. Through this theoretical lens. boundaries that only admit those with legitimate medical diagnostic explanations guide responses such as remediation. to expand responses to a full range of human diversity. explanation is the set of reasons that the atypical occurs and forms the foundation for judgment and legitimate category assignment. Because of the false binary and the conceptual quagmire that we discussed above. universal design. thereby obfuscating the primacy of medical/diagnostic explanations as the only acceptable and valued legitimate disability club membership criteria. in which constructed explanations are only applied to those with bona-fide diagnoses. legitimate category membership is determined on the explanation. The third element is legitimacy. There are three elements to the theory: description.

the intersection of bodies and diverse environments (including but not limited to built. and other resources. Bodies that do not conform to prescriptive averages. As an example. This male-centric. economic. to see. professional. Rather. virtual. to behave in an expected manner. to walk with a typical gait. service. to hear. policy. revealed the continued hegemony of DaVinci’s Vitruvian man as both the foundational ideal and basis for estimating average adult body sizes. That is to say. social. and functional design of environments. such as the ability to use both hands for manipulation. 2007). Similarly. products. setting up an environmental binary of juncture and disjuncture (See Figure 1). we mean the ill fit of the body (broadly defined) with the environment. expressive. By accepting the explanation for disability as an ill-fit between embodied phenomena and the environments in which one acts.2 (b). virtual and abstract (social. policy contexts) explains ability and the tyranny of the opposite. Current built. Figure 1 However. Disjuncture explanations serve this professional master. practices. the disjunctures between atypical bodies and their contexts. the opportunities for social workers to expand the . Disjuncture theory By disjuncture. assumptions about typical bodies. cultural. are challenged to participate in environments in which they do not fit. what ability is and is not respectively. professional. therefore. and so forth provide the prevailing data on which environmental design and professional practice are anchored. adult image is the design bedrock for mass produced and standardized building and product design practices (Gilson & DePoy. are not the explanatory locus of disability. to think typically. counter heights and so forth. policy. our recent inquiry into the rationale for and derivation of architectural standards for door sizes. what is theoretically typical and average forms the basis for architectural. natural. We assert that disability is a complex element of human diversity that should be viewed by social workers through pluralistic rather than essentialist lenses. in and of themselves. social. virtual. and so forth) environments are explicitly or implicitly based on standards that hearken back to the enlightenment and in large part continue to be a function of nomothetic thinking.

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with Jamal experiencing numerous hospitalizations and near-death experiences. recently the disease has taken hold again. a child diagnosed with muscular dystrophy who recently acquired a feeding tube. The hospital social worker states that Kathy will be ready for discharge in three days. Sarah. compensated. This is a difficult meeting . Kathy is diagnosed with shaken baby syndrome. I need to find a placement for Kathy as her parents are incarcerated and there are no family members available. 3 months of age and recently removed from her home because of physical abuse. Twelve-year-old Jacob has already had his right leg amputated and is wearing a prosthetic device that he has turned into a "weapon" when his peers tease him. DMin. exhausted physically and emotionally from years of her care as a single mother. Barbara says she is leaving the state and not to look for her. Case Notes: Dated October 24 Phone call received from the Children's Hospital social worker with a referral of baby Kathy. and hospitals. MDiv. I arrive at the multidisciplinary meeting to discuss Jamal's emancipation from the care of Children and Youth Services to the County's Adult Services. he was diagnosed with HIV/AIDS. I have no idea where to look next for a home for him. She is asking for his removal from their home. skilled nursing facilities. Multiple foster homes met his needs as a young child. Jamal had a number of very good years. The history was that no one expected Jamal to live—as an infant. Next month. With new medications and technologies. His most recent years have been spent in group homes. I have worked with Barbara since the birth of her daughter. Jamal turns 21 and this meeting is an attempt to transfer his care to those in adult services. However. LCSW Children With Disabilities in the Child Welfare System Work with this highly vulnerable population requires specially trained. Will I be able to find a foster home equipped to care for baby Kathy's special needs? Phone message left from Jacob's foster mother communicating the doctors' findings that his cancer has returned. learning how best to care for a child with multiple special needs. Both his parents died from the disease and there were no relatives to provide care. Barbara is a good mother. I listen a second time to the next phone message. His foster mother shares that she is pregnant with their first child and fearful for her baby's safety as Jacob continues to act out. her message tells me that she left her daughter in the lobby at the Children's Hospital. I've set up in-home services for her so her child would not require institutionalization.Disabilities – How Social Workers Help: Children With Disabilities in the Child Welfare System By Cynthia Weaver. I have already moved Jacob to seven different homes during his seven years in foster care. and cared-for social workers. Today. as it is difficult to understand because the speaker is crying uncontrollably. I learn that Barbara is crying about her difficult decision. ACSW.

for me as his social worker. A broad definition of a developmental disability is a condition or disorder—physical. therefore. blows to the head in child abuse or shaken baby syndrome may cause central nervous system damage. Special Needs On a continuum of vulnerability. auto accidents. 2002). foster. already established medical and educational services for the child are often put on hold until placement is secured. Mental retardation. and services with new providers are initiated in the geographical area of the placement. When a child or adolescent enters the child welfare system as a result of abuse. neglect. Kaye. and therapeutic services must be provided to this population of children and to their biological. learning. or identified. To maintain children with disabilities in family and community settings. According to Baladerian (1992). Jamal appears to know this because during the last few months. including mental retardation and other forms of learning and cognitive disabilities" (Prevent Child Abuse America. developmental. or acquired prior to the age of 22. and Ratnofsky (1993). In a national study by Crosse. because we know Jamal will not likely have the same level of care we've been able to provide for him as a child. records are gathered. and seizure disorders are possible outcomes of head trauma. a comprehensive assessment needs to be completed to determine appropriate services and interventions to address the child's special needs as a result of this trauma and find an appropriate placement that can best meet the needs of the child/adolescent. children and adolescents with disabilities in the child welfare system are a highly vulnerable population.4 times more likely to be maltreated than were children without disabilities (Sullivan & Knutson. found that children with disabilities were 3. "more than 50% of child victims of neglect sustain permanent disabilities. NE. Children/adolescents who are abused or neglected are at increased risk for developmental delays or disabilities. has a key role in identifying and accessing appropriate services for children/adolescents with disabilities and their families (biological and foster) within the child welfare system and in the medical and educational systems. supportive. the nurses who have provided continuous care. they found that children with disabilities were 1. paralysis. and his personal aide. This condition must be congenital. 2002). and/or abandonment. he has become depressed and has periods of self-mutilating behavior. language. self-direction. 1998). and diving are common causes of injury in children and adolescents. capacity for independent living. cerebral palsy. The child welfare worker. In addition. cognitive. related anomalies in reproductive cell division. and adoptive families (Hughes & Rycus. When a child/adolescent with a preexisting disability is separated from the parent/family and enters the child welfare system. or emotional—that has the potential to significantly affect the typical progress of a child's growth and development or substantially limits three or more major life activities including self-care. mobility. and/or economic self-sufficiency (Federal Developmental Disabilities Act of 1984). There are many providers sitting around the table as we take the next few hours to discuss Jamal's placement and services at the adult state-funded nursing facility. Genetic problems. . traumatic brain injury.7 times more likely to be maltreated than children without disabilities and a study conducted in 1997 in Omaha.

such as the use of apnea monitors. Child welfare workers carrying caseloads of children/adolescents with special needs should have training in areas of medical interventions such as CPR for infants and children for safety and competence when apart from medical providers—transporting children to visits and medical appointments. as well as be more credible and accepting to foster parents and birth parents who are already required to have such expertise to care for the child on a daily basis. Advocacy on behalf of children and adolescents with special needs requires that social workers be skilled and empowered to address areas of discrimination and inadequate resources. and early intervention will better assist the child welfare worker who has the responsibility of finding and supporting appropriate placements for children/adolescents with disabilities. with the same zeal a dedicated parent would seek services for their child. such as limited medical coverage related to insurance coverage or lack thereof. and oxygen. serious emotional and behavioral problems. knowledgeable professionals who can advocate for children and adolescents with disabilities and their families. and HIV/AIDS. lifts. Training and networking with medical. 2000). & Loyek. Often. the social worker will need additional training in specific areas. Dependent on the special needs of the child/adolescent. even if a medical provider is present to intervene or is providing one-on-one care. Such barriers could be physical. prenatal exposure to alcohol and other drugs. these children's special needs remain unmet. such as access to buildings. Keller. Social workers servicing this population will benefit from having the advanced training of a master's degree in social work to most effectively identify and work with the various systems involved. Training must go further than traditional competency training for child welfare workers. mental health/retardation. A 1997 study by the Child Welfare League of America (1999) revealed that 94% of the children placed for adoption in 1996 had special needs as related to physical disabilities. The social worker's knowledge of such equipment and interventions will enable the worker to have a more secure level of competence and comfort in working with the child/adolescent. medical social work. developmental delay. and community resources is a necessary prerequisite for effectively caring for children with disabilities within the child welfare system (Weaver. Additional training in the areas of mental retardation. Child welfare social workers benefit from training in the area of family systems and the dynamic the child/adolescent with special needs creates among the . Trained social workers will understand the challenges that face families of children/adolescents with special needs and assist them in securing resources and in communicating their needs. wheelchairs. 2005). Social workers need a comprehensive understanding of legislation surrounding the Americans with Disabilities Act and how to effectively address barriers that inhibit their clients from services for their special needs. ventilators. Special Training There is an increased need for competent. both prior to and throughout the often lengthy period that they receive care in child welfare agencies (American Humane Association. or medical. 2000).Research indicates that 45% to 50% of children in the child welfare system have a chronic health problem or diagnosed disability (American Humane Association.

The creative use of agency rituals—Arbor Day and planting a tree in memory of a child/adolescent. an agency gazebo as a safe place to retreat to privately grieve apart from the group—can demonstrate to child welfare workers providing direct care the sensitivity administration has to the effect the death of a child on their caseload has to them. and funeral director(s) who can provide financially reasonable and sensitive services for marginalized populations. 1999. but the much-needed emotional bonding and unconditional love that is often taken from them when removed from their biological families (Weaver. Death and Dying Social workers benefit from having an education and a level of comfortability surrounding the emotional and spiritual underpinnings of death and dying. . etc. Social workers benefit from having an understanding of various religious/spiritual and cultural beliefs. 2003). and interventions provides children/adolescents in the child welfare system with not only physical assistance. administration must understand the impact the dying process and possible death of a child/adolescent has on the caseworker. 1999). and extended family members. mental health time off surrounding the death of a child/adolescent. the names of competent religious leaders to perform services. Nontraditional Techniques Creativity can enhance the work surrounding children with special needs as one works outside the box of traditional child welfare. such as a knowledge of available funding streams for funeral and burial. sensitivity. The availability and funding for outside. Delta Society. an area often encountered when working with children and adolescents with disabilities. an area often encountered at the time of death. prisoners) has proved insightful to their specific needs (Fine. before working with such populations to avoid countertransference. 1996). Internal agency support through competent supervision. siblings. therapies. Child welfare workers should have resources to meet the family's needs should a child die while in care. disabled. a memory wall of names to be remembered. Connecting children/adolescents with special needs to animal-assisted activities. quality-of-life issues. mental retardation. Working with the child/adolescent with special needs involves the understanding. If they want to retain competent social workers in their agency. The use of animals with populations identified as "special needs" (elderly. living wills. confidential counseling to support social workers in the area of bereavement will help identify possible areas of countertransference and address the social worker's own grief and loss after providing support to children and their families (Weaver. mental health. and agency group process are successful administration interventions for the longevity of social work staff. Social workers benefit from the ability to explore their own moral/religious/spiritual beliefs surrounding medical ethics. and interventions with the "whole" family.parent(s).

Keller. Retrieved May 23. N. from http://www. the number of children surviving many diseases and illnesses has greatly increased because of the advancement of medical technology and new medications. ARCH National Respite Network and Resource Center. During the past 20 years. References American Humane Association (2000). This is something about which we. The fragility and vulnerability of this population of children/adolescents require the utmost of our sensitivity. Retrieved June 24. Baladerian. are proud.org. (1994). and community resources is a necessary prerequisite for effectively caring for children/adolescents with disabilities within the child welfare system. Fact sheet Number 36. 2004. as an industrialized society. 2003. & Loyek.org/archfs36. we also need to understand the implications for the longevity of life for children/adolescents with disabilities that find themselves growing up in the child welfare system. from http://www. often separate from a consistent. and/or replacements. advocacy. especially during times of medical emergency. child welfare workers carrying cases of children/adolescents with special needs should be afforded the highest level of legal support should litigation be directed towards them during the review of the death of a child while in care. Likewise. 1997. . competent parent/caregiver. Abuse and neglect of children with disabilities. and creativity (Weaver. The consistency and competency of the child welfare social worker is as critical as the advanced medical technology and new medications for the quality of care for this vulnerable population. with an increased level of financial compensation to equal the level of special training secured and level of risk taken in providing services to this vulnerable population. 2005).htm.americanhumane. Social workers caring for vulnerable populations often themselves become vulnerable in a highly litigious society and will frequently decline such a sensitive caseload for fear of long-term ramifications to their professional career. Child Welfare League of America. Meeting the needs of young children in foster care. expertise. However. Child welfare workers carrying caseloads of children/adolescents with special needs should be identified at a higher level than that of an entry-level social worker. hospitalizations.archrespite.Caring for the Caregivers Caseloads containing children/adolescents with disabilities should be smaller for social workers so effective time and energies can be spent in securing additional training and networking with other agency resources. mental health/retardation. Training and networking with medical. J. The time spent on a child/adolescent with special needs can easily triple that of a nonspecial needs case.

. MD. S. E. and Programs. Hughes. Weaver. A report of the maltreatment of children with disabilities. D. Washington. Maryland: The University Press of America. 1275-1288. Weaver. DC: CWLA Press. & Knutson. Supporting the spirituality of children in foster care and their caregivers. B. In: Silver.Crosse. Prevent Child Abuse America. J. Keller. New York: Columbia University Press. Policies. C. Children and adolescences with disabilities in the child welfare system. 24(10). Federal Development Disabilities Act of 1984. Child Welfare for the Twenty-First Century: A Handbook of Children. Pub. Department of Health and Human Services.. Sinclair's Listening Ears: The Journey of a Feline Social Worker. No. A. eds. 2002. C. J. C. New York: Academic Press. Fine. Administration on Children. Maltreatment and disabilities: A population-based epidemiological study. (1993). Youth and Families. Handbook of Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice. P. P. Kaye. DC: National Center on Child Abuse and Neglect. L. Young Children and Foster Care: A Guide for Professionals. Amster. Sullivan. and Family Services: Practices. (1999). (2003). Administration for Children and Families. Brookes Publishing Co. 98-527. G. Child Abuse & Neglect. Youth. Baltimore. J. Lanham. H.. & Haecker.. J. pp. & Rycus. P. Weaver. C. . Washington. ed. (1998). Delta Society (1996). Developmental disabilities in child welfare. (1999).. In: Mallon. R. S. Ann (in press 2005). C.. F. USW: Delta Society. & Hess. A. 139-157. & Ratnofsky. & Loyek. Federal Developmental Disabilities Act of 1984. Standards of practice for animal-assisted activities and animal-assisted therapy. M.. U. (2002). J.S..

When the spirits were perceived as evil. social work has viewed itself as the profession with primary responsibility toward people who are subjected to discrimination and oppression. people with disabilities have had "no legal recourse to redress such discrimination. Finally. Recent developments in the disability movement. Societies treated and responded to people with disabilities based on their cultural belief systems. Congress also acknowledged that unlike other populations who have experienced discrimination. however. people with disabilities have been ostracized. relatively few social workers work with people with disabilities. 1993. abandoned young and old people with disabilities in the countryside to die. and suggestions for integrating both approaches are provided. rejected. a plea is made to the social work profession and the disability movement to combine efforts to enhance the lives of people with disabilities. the profession has been hesitant to become involved with people with disabilities. escape routes were fashioned by drilling holes in the skulls of people who were thought to he possessed (Albrecht. This article examines the history of societal values and attitudes about people with disabilities and the rise of the disability movement. This article addresses historical and contemporary issues concerning disability. Social work and independent living approaches to working with people with disabilities are compared and contrasted. Mackelprang & Santos. a plea is made for social work to re-evaluate its commitment to people with disabilities. The Americans with Disabilities Act (ADA) of 1990 (P. Ancient Beliefs Neolithic tribes perceived people with disabilities as possessed by spirits. the profession has not embraced the causes of people with disabilities as it has other oppressed groups. with their rugged individualism.People with Disabilities and Social Work: Historical and Contemporary Issues Romel W. Consequently. few people with disabilities enter the profession. and discriminated against in society. Salsgiver From the earliest recorded history. Mackelprang and Richard O. 101-336) was a civil rights landmark for people with disabilities. Plato (1991). With the passage of the ADA. The Spartans.000.000 Americans with disabilities have been subjected to serious and pervasive discrimination." From the beginning. 1992). archaeologists have repeatedly uncovered evidence of people with disabilities dating as far back as the Neanderthal Period. to whom Western culture owes much . including independent living.L. 1992). are discussed and compared to social work's approaches to disability. and the profession has done little to promote disability rights (Mackelprang. Finally. History of Treatment of People with Disabilities Throughout the history of humankind people with disabilities have been a part of society. Congress acknowledged that the 43. Although social work has a history rich in advocacy for oppressed people.

Judeo-Christian Beliefs Judeo-Christian tradition. 18th-Century Beliefs . and sexual prowess are temporary. who borrowed the concept of reciprocity from the Greeks. Stone (1984) suggested that the Poor Laws were England's attempt to reconcile this dilemma by creating a "system of categorical exemption' (p. allowing people to deny the eventual loss of physical integrity and ultimately death. With the codification of the Elizabethan Poor Laws in 1601. The Old Testament forbade people who were blind or lame from entering the houses of believers (Wright." or of short stature were forbidden to become priests. prevalent among Europeans during and after the Middle Ages. Judeo-Christian thought. or of the better when they chance to be deformed. (Becker. as they should " (p. Disability signified "sinner" to the ancient Hebrews. 1992). Although Judeo-Christian philosophy did not advocate killing. People who were deformed. The Romans. In the New Testament. It was thought that people with disabilities had them because of their own or their parents' sins. Treatment centered on spiritual redemption (Albrecht. viewed people with disabilities as standing in the way of a perfect world: "the offspring of the inferior. 1960). a denial that generalizes to those with disabilities. Livneh (1980) contended that people with disabilities remind those without disabilities of humankind’s link with the rest of the animal kingdom and of their own fallibility. Livneh also contended that people with disabilities threaten those without disabilities with the knowledge that their limber walk. blind. people with mental disorders were believed to be possessed. 1966). taught that people with disabilities were expressions of God's displeasure (Livneh. 17th-Century Beliefs The rise of capitalism during the Industrial Era presented unprecedented labor needs and social problems. Livneh (1982) believed that the segregation of people with disabilities decreases the chances of association. people with disabilities were ostracized and stereotyped. will be put away in some mysterious. Similarly. England endeavored to deal with the dilemma of caring for needy people while maintaining a labor force for its developing industries. like the Greeks the Romans also abandoned disabled or deformed children to die (Morris. 51) by classifying poor people into deserving and nondeserving categories. and "crippled" people were deemed deserving and received charity less begrudgingly than so-called nondeserving poor people. unknown place. has also taught that bureaus are made in God's image and are different from and superior to the rest of the animal kingdom. However. on which much of Western culture is based.of its ethical framework. and people with disabilities were thought to be demons. gave assistance to adult people with disabilities with the expectation that they would demonstrate thanks by not rioting. 1982). Orphaned. "crippled. 1986). People with serious or terminal illnesses challenge that denial and thus tend to be avoided. strong muscles. Western culture has engaged in a collective denial of aging and death. 183).

Rhodes (1993) concluded. could be molded into assimilated. Professionals lost confidence in their ability to perfect people with disabilities. and they were increasingly isolated and institutionalized. institutions dedicated to perfecting the imperfect sprang up (Rothman. Deutsch (1949) quoted Darwin's cousin Frances Faltin. World War I and World War II marked superficial advancement for people with disabilities.” which included people with disabilities. 1971) with the hope that professional intervention could cure those inadequacies. Roosevelt as a person with a disability. However. less threatening. the ominous philosophy of social Darwinism and eugenics came to prominence. Roosevelt was continually forced to compensate for society's attitudes and to hide his disability from the public. 355). who described eugenics as "the study of the agencies under social control that may improve or impair the racial qualities of future generations either physically or mentally" (p. People with disabilities were to be prevented from marrying or having children for fear of propagating their imperfections. Gallagher (1985) recounted the prevailing attitudes of the time in the experiences of President Franklin D. When a cure was not possible. the stereotype of people with disabilities as nonproductive and socially abject was prominent through the .By the mid 1770s. often on the advice of professionals. 1987a). people with disabilities could at least be trained to become functional enough to “perform socially or vocationally in an acceptable manner” (Longmore. 20th-Century Beliefs Early 20th-century America offered little attitudinal progress. a model of treatment began to emerge that defined people with disabilities by their biological inadequacies. 6). the Enlightenment. making them extremely vulnerable. institutions to deal with the threat and nuisance of people with disabilities increased dramatically. Professionals held great hope that “deviants. 1971). 1987b. sometimes in sub-human conditions. a new perspective on the human situation. concluding that they were innately unproductive and thus endemically without worth. p. Parents. by the end of the 19th century. hid disabled children from society in their homes or in institutions. was making its impact on Europeans and Americans. more acceptable people (Rothman. No intervention could bring about change because the laws of nature deemed people with disabilities unfit (Longmore. As the 19th century progressed. However. People with disabilities were objects of shame and disgrace. Federal rehabilitation legislation produced money for treatment of veterans disabled by war. Eugenics became a convenient explanation for the ills of society and cast people with disabilities in a frightening light. In the United States. Within this environment. 358). 19th-Century Beliefs The 1800s began with the continuing belief that humans could change. "the movement emphasized the dominance of heredity and sought to encourage the reproduction of socially desirable individuals (positive eugenics) and discourage the reproduction of the undesirable (negative eugenics)" (p. Out of the tenets of the era came the idea that perhaps humans could be perfected.

Similarly. analysis. and change. people with disabilities have demanded the right to take control of their lives. 1994). neglecting social. Independent Living and the Minority Model The birth of disability consciousness in the United States arose out of the turbulence of the 1960s. a decade of re-examination. The disability movement matured with the development of the independent living concept in the early 1970s. Judy Heumann. medical evaluations measure pathology and the lack of pathology but rarely measure strengths. Whereas traditional Judeo-Christian culture and traditional models of professional treatment focused on individual pathology (Weick. 1987). In contrast. environmental. Independent living proponents reject traditional treatment approaches as offensive and disenfranchising and demand control over their own lives. challenge. Initially led by people such as Lex Frieden. social workers. The medical model views physicians as treatment directors and nurses. the major diagnostic tool of mental health practitioners. 1987b). Social workers become involved with these individuals only by request. and other health care professionals as assistants who help direct patients' lives. 1989). Patients are passive recipients of treatments that are dispensed by professionals who are experts. 1980). Rapp. The independent living perspective views people with disabilities not as patients or clients but as active and responsible consumers. therapists. and contextual factors that influence people's situations. & Kisthardt. independent living proponents retain their own personal responsibility to hire and fire people who provide attendant care. and Ed Roberts. independent living applied the minority model as the foundation of the political process of gaining the civil rights of people with disabilities (Berkowitz. Mental health practice has focused on individual weakness and pathology. favoring instead attendants who are trained by the individuals with disabilities themselves. . independent living focused on societal responses and discrimination as the primary barriers to civil rights. The DSM-IV (American Psychological Association. For the first time in U. During the second half of the 20th century the ideas of past eras continued to influence professional practice. significant numbers of people with disabilities demanded access to the mainstream of society. perhaps even in Western history.S. Sullivan. Thus. when people with physical disabilities have needed physical assistance with self-care. This dependence forced on people with disabilities by professionals and society as a whole has led to great dissatisfaction. For example. they become vulnerable to the withdrawal of help from providers who do not like having their authority questioned. If people with disabilities who use professional services attempt to become active consumers and control their care. They eschew the need for licensed providers such as registered nurses to provide care. history.1950s (Longmore. is devoted to the diagnosis of pathology. Diagnoses within these settings also focus exclusively on the individuals being diagnosed. that care is primarily provided by licensed professionals assigned through formal agencies. The experts make the decisions and inform patients of those decisions (Trieschmann. in the last decade of the 20th century. with almost no attention given to strengths.

attitudinal." are expected to fill this rote even when they are perfectly healthy. The minority model asserts that discrimination against people with disabilities is rooted in the beliefs and values of the culture. For example. At the same time. they will lose not only their payments but also their medical coverage. whom society assumes are "sick. Also. Stone (1984) stressed that residual benefits of the Elizabethan Poor Laws are the ensured support and services to people with disabilities in the current welfare state. As with those who are sick. self-concept. What Stone and others failed to recognize is that categorizing people with disabilities as deserving of charity creates a dubious benefit wherein they qualify for an ever-eroding baseline of services and are relegated to subsistence-level living. and economic success of people with disabilities can be understood only by viewing people with disabilities as a minority group who are subjected to discrimination found in their social environments (Fine & Asch. As a group--as a minority--these children have been denied their right to education (Meyerson.Traditional medical paradigms define the nature of disability by individual deficiencies and biology. thus subjecting them to a form of benevolent oppression. Independent living encourages people with disabilities to begin to assert their capabilities personally and in the political arena. people with disabilities have been given few opportunities to develop skills associated with independence and self-sufficiency. For example. Independent Living. and Disability . For example. Their only obligation is to be grateful for the help given them (Devore & Schlesinger. they invariably believe those messages and act accordingly. justifications for keeping children with disabilities out of regular public schools have centered on their impairments. The behavior. Social Work. which would be financially devastating and potentially life threatening. 1988). the social welfare system creates pervasive disincentives to work and reinforces the idea that people with disabilities do not need to work. The most fundamental belief is that people with disabilities cannot and should not work or otherwise be productive. When the expectations that people with disabilities should not work and should fulfill the sick role are foisted on people for their lifetimes. 1988). Contributing to the belief that people with disabilities should not work is the role of sick people in Western culture. 1987). educational achievement. Attributions of personal unworthiness based on spiritual beliefs further promulgate oppression and isolation. The minority model views the lack of work options as repressive and decries this discrimination. People with disabilities. if people receiving Social Security Disability and Medicare return to work. Proponents of independent living contend that children with disabilities have not been allowed to attend regular schools because of physical. and legal barriers and not because of individual incapabilities. people with disabilities are to be taken care of and to be provided for.

. In addition. they are viewed with skepticism and distrust. the profession has not shown a consistent commitment to people with disabilities. p. With the emergence and expansion of other trends of thought in recent decades. there are few disabilityrelated articles in the social work literature. 1992). Longmore also offered illustrations of the catastrophic effects of public social policies in the lives of people with disabilities..Social work philosophy shares many similarities with the minority model of viewing people and their environments. thus relegating clients to passive. 64) and help people find the power within themselves (Saleebey. 1993). Empowerment has been a guiding tenet of both social work and independent living. 1991. One reason may be that social workers often practice in organizations such as hospitals and mental health centers in which professionals make the decisions. 354). people with disabilities have not regularly sought social work services (Servoss.. When social workers are identified as the professionals who implement and enforce such policies and regulations. The numbers of' social work students and educators who have a disability are low. Longmore (1987a) recounted the experiences of people with severe physical disabilities attempting to live independently: "severely disabled adults. and social work conferences are nearly bereft of presentations on disability (Mackelprang. However. receiving roles. As social work matured from a person in-environment to an ecological systems approach. Social workers also "empower clients to become active participants and decision makers in all phases of their lives" (Sheafor. & Horejsi. a major method of practice evolved from casework to case management. 153). acknowledging the influences of the environment on personal functioning. 1992). The ecological systems perspective combined with a strengths-based case management approach that uses the principle of empowerment is a departure from the medical model and is a step toward the minority model. 1993). Whereas social . culture. Social workers use a systems perspective. Weick et al. This practice perspective is further reinforced by the strengths-based practice model (Rapp. Ecological systems theory has been a natural outgrowth and synthesis of these trends (Hepworth & Larsen. must spend their lives confined to families' homes or imprisoned in institutions . case' management has a stronger emphasis on professionals interacting with multiple systems that affect clients.. . 1983). independent living views empowerment from a different perspective than social work. however. to achieve independence and productivity in the community become yet another massive hurdle they must repeatedly battle but can never finally defeat" (p. However. case management emphasizes the use of a number of roles from counselor to advocate to educator to mediator. (1989) emphasized that assessment and intervention based on the strengths of individuals is the cornerstone of empowerment: "Focusing on human strengths is one significant strategy for helping people reclaim a measure of personal power in their lives" (p. . . Horejsi. the person-in-environment perspective differs from independent living in that it maintains a heavy emphasis on Freudian and neo-Freudian philosophy (Hepworth & Larsen. The very agencies supposedly designed to enable severely physically handicapped adults . and social supports has become increasingly emphasized. 1993). However. Likewise. Many social work jobs are also located in public sector settings that are bureaucratic and cumbersome. Moore (t990) contended that "case management" is a new name for traditional social work practice. the importance of systems.

she asked the independent living counselor to intervene on her behalf. departing from traditional reliance on professionals used in the medical model. independent living views social workers and other professionals as consultants only. and Sharon also made request for services. The following example illustrates the differences Sharon. while acknowledging the multiple systems that affect people. coerced treatments) are prevented. During Sharon’s hospitalization her social worker facilitated the procurement of Medicaid. often focuses on individual factors that contribute to client problems. ordered medical equipment such as a wheelchair. and worked with Sharon’s family to prepare for her discharge from the hospital. In this manner people's capacities are maximized and abuses of power (for example. shifting control from formal providers to informal providers (DeJong. Although social work has pioneered efforts to encourage tile use of natural helpers in people's environments. inappropriate institutionalization. 1992). Similarly. independent living proponents assert that the informal support model still breeds dependence. social workers and other professionals teach skills and facilitate self-management but do not assume responsibility or control over people. Independent living espouses a philosophy that advocates natural support systems under the direction of the consumer. procured the services of a home health agency for home nursing visits. Social work's tendency to intervene in personal problems without being asked is rejected by independent living proponents as intrusive. the social worker generally informed Sharon of the services she would be providing. Similar case management services were provided for six months after discharge. The independent living movement has more than 20 years of experience developing and refining this approach. Even when individuals have severe disabilities that limit learning and decision-making capabilities. arranged for vocational rehabilitation services. Benefits to Social Work Social work can benefit greatly from a shift in focus from case management in which clients are labeled "cases" to a consumer-driven model of practice that acknowledges self-developed empowerment and not empowerment bestowed from others.work envisions professionals involving clients or patients in prescribed care or treatment plans. Independent living proponents believe that the greatest constraints on people with disabilities are environmental and social. Social Work and Independent Living: Forging a Partnership The lack of social work involvement in the independent living movement is disturbing because both have much to offer each other. received social work case management services after an automobile accident caused a spinal cord injury that resulted in quadriplegia. Batavia. involuntary sterilization. Rather than meet her requests as the social worker had . Social work. age 32. Sharon became involved with a local independent living center for peer counseling and independent living training. she asked the counselor to procure a commode chair. & McKnew. Six months after discharge from the hospital. When Sharon began to have trouble with Medicaid.

He sought assistance with budgeting and financial difficulties at an independent living center. helped Jim develop a budget and strategies to deal with creditors. Therefore. had a traumatic brain injury. Although his family could seek counseling at a mental health center. Sharon was able to greatly enhance her independence in several areas. The social worker cited her close relationship with Sharon and Sharon’s appreciation of her efforts as evidence of the effectiveness of their relationship Although the social worker’s activities helped Sharon. it became apparent that his head injury was also a contributing factor to significant marital and family difficulties. his wife and adolescent daughter were in significant distress. saw her role as facilitating Sharon’s self-determination. However. As time progressed. However. the independent living approach can be criticized as viewing problems too much from an external perspective.done. The social worker always informed Sharon of her plans to assist Sharon. The social worker viewed her interventions on Sharon's behalf as client centered and empowering. and . and Sharon often requested the services the social worker provided. and she did not consider directly intervening in activities Sharon was capable of. Competent counseling was available at the independent living center but was inaccessible unless Jim identified problems and requested help. the independent living counselor taught Sharon to self-advocate with Medicaid and guided her through the process of ordering medical equipment so Sharon could do so in the future. Jim and his wife later separated and divorced. and money management. firing. She took control in the immediate weeks and months after Sharon's accident because "to ask Sharon to do so would be overwhelming because Sharon needed time to adjust to her injury. The independent living counselor. Independent living may be too quick to assume that consumers already have knowledge and abilities rather than recognizing that they may need assistance to develop their strengths. Sharon developed the knowledge and skills to direct her own personal care. no marriage reconciliation services were provided. the counselor informed Sharon how she could gain access to a program in which she could hire and direct her attendants rather than having nurses and aides assigned to her. Jim. the social worker maintained her involvement level because working with so many agencies was "complicated. this center did not employ people who understood the implications of brain injury. The independent living counselor. In addition. the social worker unintentionally encouraged dependence and impeded Sharon’s self-determination.' Her actions empowered Sharon because she was able to access numerous services. the counselor felt constrained from intervening in this area Jim seemed relatively unconcerned by his marital situation (almost certainly because of lack of insight as a result of his head injury). on the other hand. essentially reclaiming control over her life. including hiring. Benefits to the Independent Living Approach If the person-in-environment approach can be criticized for being too intrapsychic. During the sessions with Jim. Through mutual exploration with the counselor. age 28. who was also a MSW student in practicum. because these problems were not problems identified by Jim. The following example illustrates the differences.

B. S. in part because independent living’s narrow view of the consumer does not include the family. New York: Columbia University Press. E. before both can forge a partnership. it was too late to save his marriage. Becker. Social work can contribute decades of experience with the ecology of society and multiple systems. Generations. (1994). the independent living approach resulted in a lack of intervention. and education with disabilities (Mackelprang. disorders (4th ed. (1992). Batavia. DeJong.. (1987). A. The disability movement can help social work enhance approaches to clients. Berkowitz.. Washington. practitioners. and become more involved in disability advocacy work in agencies with activist philosophies. better empower oppressed and devalued groups. a social work approach would have allowed for broader intervention and ultimately may have been more empowering to Jim and his family. In Jim's case. Diagnostic and statistical manual of mental Americans with Disabilities Act of 1990. 1993). re-examine its attitudes and beliefs about people with disabilities (Salsgiver. (1966). 104 Stat 327.Jim’s wife maintained primary responsibility for their child. This case also illustrates the conflict between absolute self-determination and the need to sometimes impose professional intervention. Disabled policy: America’s programs for the handicapped. 16. New York: Free Press.L. 89-95. & Schlesinger. the social work profession must work to increase the low numbers of social work students. The disability business: Rehabilitation in America. G. Although some would argue against any change in Jim’s intervention. E. 1993). It is a partnership that is long overdue. G. (1949). American Psychological Association. The independent living model of personal assistance in long-term-care policy. which ultimately had negative effects on Jim and his family. H. CA: Sage Publications. W. . provide disability-competent education. Ethnic-sensitive social work practice (3rdEd.) Columbus: Merrill. Outsiders: Studies in the sociology of deviance. 1001-336. Newbury Park. D. P.. By the time Jim became responsive to the need for help. A. Conclusion Social work and the disability movement have much to offer each other. Deutsch. References Albrecht. & McKnew. L. Devore.). I. G. and understand the needs of people with disabilities. DC: Author. (1987). However. (1992). The mentally ill in America: A history of their care and treatment from colonial times. London: Cambridge University Press.

H. Livneh. R.Fine. (1988). In M. Review in American History. Nagler (Ed. D. Social Work. assisted suicide and social prejudice. P. K. 15. Nagler (Ed. H. & Larsen. (1992. Saleebey (Ed. W.). March). The republic: The complete and unabridged Jowett translation. The strengths perspective in social work practice (pp. Social work education and persons with disabilities: Are we meeting the challenges? Paper presented at the Annual Program Meeting of the Council of Social Work Education. (1992). (1991).). In M. New York: Vintage Books. 43. J. (1988). L. Disability beyond stigma: Social interaction.. C. (1980).. A.rk Meyerson. (1990). Moore. 35.. CA: Health Markets Research. discrimination. (1985). CA: Health Markets Research. Livneh.New York. & Asch.Faculty Development Institute presented at the Annual Program Meeting of the Council of Social Wo Education. NY: Longman. Plato. Palo Alto. 3. 338-347. W. S. Uncovering the hidden history of people with disabilities. 141-168. (1993. Rehabilitation Literature. Mackelprang. 45-58). march). & Santos. Rethinking social welfare: Why care for the stranger? New York: Longman. (1987a). R. Issues in Law & Medicine. K. L. Perspectives in disability (pp. G. On the origins of negative attitudes toward people with disabilities. Direct social work practice: theory and skills (4th ed. R. (1987b). M. Mackelprang. New York: Dodd. 61-74). In D. The social psychology of physical disability: 1948 and 1988. Rehabilitation Literature. FDR’s splendid deception. . MO. P. Rapp. 444-448. Longmore. 355-364. 13-23). A. A. (1986). and activism. Morris. (1993). Mead. 280283. Longmore. Pacific Groove. Disability and monstrosity: Further comments. The strengths perspective of case management with person suffering from severe mental illness. A social work practice model of case management: The case management grid. Perspectives in disability (pp.). D. (1982). H. 41. Palo Alto. Hepworth. Elizabeth Bouvia. Gallagher. T. Kansas City. CA: Brooks/Cole. Educational strategies for working with persons of disability.). White Plains.

A. W. Weick. Social Work. Salsgiver. Introduction: Power in the people. Needham Heights. (1980). p. NASW California News. MA: Allyn & Bacon. Wright. D. 3-17). G. W. (1992). 34. Spinal cord injuries: Psychological. 58-62. Sheafor. 3(2). (1993). (1971). Mental retardation and sexual expression: An historical perspective. (1984). R. and social work. Mackelprang & D. A physical minority: The disabled and mental health care.).. A strengths perspective for social work practice. (1989). NY: Longman. C. A. .The strengths perspective in social work practice (pp. D. New York: Harper & Row..). The disabled state. (2nd ed. January) The Americans with Disabilities Act. Brown. B. R. Rapp.Rhodes. Horejsi. Sullivan. P. 1-27). Trieschmann. Saleebey (Ed. (1993. Philadelphia: Temple University Press.. American Journal of Social Psychiatry. W. Rothman. NY: Haworth Press. B. Stone.). social and vocational adjusgment. D. New York: Pergamon Press. A. Techniques and guidelines for social work practice. In D... & Horejsi. & Kisthardt. G. White Plains. ableism. Servoss. R. Sexuality and disabilities: A guide for human service practitioners (pp. (1983). C. In R. (1960). Boston: Little. Binghamton. Valentine (Eds. 350-354. R. Salleebey. (1991). B. 4. The discovery of the asylum: Social order and disorder in the new republic. Physical Disability—A psychological approach.

The ASHA inter-alia will take care of the comprehensive services to the persons with disabilities at the grass root level. Since seventy five percent persons with disabilities live in rural areas. The National Rural Health Mission through Accredited Social Health Activist (ASHA) addresses the health needs of rural population. which includes early detection and intervention. surgical correction and intervention. strengthening capacities of persons with disabilities and their families. the services run by professionals will be extended to cover uncovered and un-served areas. Currently. modern aids and appliances of ISI standard that can promote their physical. psychotherapy. vision stimulation. NGOs including associations of parents and persons with disabilities. Early Detection and Intervention Early detection of disability and intervention through drug or non-drug therapies helps in minimization of impact of disability. especially the vulnerable sections of society. local level institutions. vision assessment. Counseling & Medical Rehabilitation Physical rehabilitation measures including counseling. (ii) educational rehabilitation including vocational education and (iii) economic rehabilitation for a dignified life in society. Physical Rehabilitation Strategies a. c. audiological rehabilitation and special education shall be extended to cover all the districts in the country by active involvement and participation of State Governments. and necessary facilities will be created towards this end. Assistive Devices The Government of India has been assisting persons with disabilities in procuring durable and scientifically manufactured. occupational therapy. speech therapy. . Therefore. new District Disability Rehabilitation Centres (DDRCs) will be set up with support from the State Government.National Policy for Persons with Disabilities Rehabilitation Measures Rehabilitation measures can be classified into three distinct groups: (i) physical rehabilitation. social and psychological independence by reducing the effect of disabilities. To expand coverage in rural and unserved areas. there will be emphasis on early detection and early intervention. Government will take measures to disseminate information regarding availability of such facilities to the people especially in rural areas. Privately owned rehabilitation service centres shall be regulated for maintenance of minimum standards which shall be laid down. rehabilitation services are largely available in and around urban areas. counseling & medical interventions and provision of aids & appliances. b. It will also include the development of rehabilitation professionals. physiotherapy.

The availability of devices will be expanded to cover uncovered and under-serviced areas. It has played a significant role in the provisions of services for persons with disabilities. The NGO sector is a vibrant and growing one. State Governments. Development of Rehabilitation Professionals Human resource requirements for rehabilitation of persons with disabilities will be assessed and development plan will be prepared so that the rehabilitation strategies do not suffer from lack of manpower. implementation. low vision aids. family associations and advocacy groups of parents of disabled persons shall also be covered in the directory identifying them separately. monitoring and has been seeking their advice on various issues relating to persons with disabilities. Some of the NGOs are also undertaking human resource development and research activities. Interaction with NGOs will be enhanced on various disability issues regarding planning. their resource position. persons with disabilities are provided with devices such as prostheses and orthoses.Every year through National Institutes. tricycles. wheel chair. learning equipments (Braille writing equipments. DDRCs and NGOs. educational kits. The following programmes will be undertaken: i. For NGOs supported by the Central/State Governments. Government has also been actively involving them in policy formulation. both financial and manpower will also be reported. A Directory of NGOs working in the field of disability will be prepared properly mapping them by geographic regions along with their major activities. public and joint sector enterprises involved in the manufacture of high tech assistive devices for persons with disabilities will be provided financial support by the public sector banks. Private. policy formulation and implementation. d. Disabled persons organizations. exchange of information and sharing of good practices amongst NGOs will be encouraged and facilitated. CD player/ tape recorder). Dictaphone. hearing aids. planning. surgical footwear and devices for activities of daily living. Networking. Promotion of Non-Governmental Organizations (NGOs) The National Policy recognizes the NGO sector as a very important institutional mechanism to provide affordable services to complement the endeavors of the Government. communication aids. assistive & alerting devices and devices suitable for the persons with mental disabilities. . special mobility aids like canes for blind.

early childhood education methodologies. Organizations both in public and private sector will be encouraged to make their websites accessible to the visually impaired using Screen Reading Technologies. NGOs will be trained in resource mobilization. will be strengthened. compilation and analysis of data relating to socio-economic conditions of persons with disabilities. their or their family member or caregiver's consent is mandatory. Collection of regular information on Persons with Disabilities 1. NGOs will be provided opportunities for orientation and training of their human resource. 2. A comprehensive website for persons with disability will be created under the Ministry of Social Justice & Empowerment. The NGOs shall be encouraged to mobilize their own resources to reduce the dependence on grants-in-aid from the Government and also to improve the availability of funds in the sector. There is a need for regular collection. Transparency. The Census has also started collection of information on persons with disabilities from the Census-2001. Research For improving the quality of life of persons with disabilities. cause of disabilities. iii. Wherever persons with disabilities are subjected to research interventions.ii. procedural simplification etc. Steps will be taken to encourage and accord preference to NGOs working in the underserved and inaccessible areas. v. The National Sample Survey Organization will have to collect the information on persons with disabilities at least once in five years. NGOs will be encouraged to develop and adopt minimum standards. Tapering of assistance in a schematic manner will also be considered so that the number of NGOs to be helped within the available resources could be maximized. development of user-friendly aids and appliances and all matters connected with disabilities which will significantly alter the quality of their life and civil society's ability to respond to their concerns. . Towards this end. There are regional/State imbalances in the development of the NGO movement. codes of conduct and ethics. iv. Training in management skill which is already being provided. Reputed NGOs shall also be encouraged to take up projects in such areas. will be guiding factors for improvement in the NGO-Government partnership. research will be supported on their socio-economic and cultural context. accountability. The National Sample Survey Organization has been collecting information on Socio-economic conditions of persons with disabilities on regular basis once in ten years since 1981. The differences in the definitions adopted by the two agencies will be reconciled.

iii.Principal Areas of Intervention Prevention. speech pathology. clinical psychology. health care and sanitation amongst adolescent girls. Attention will be paid towards improving awareness of nutrition. Programmes will be undertaken for screening of children to identify at risk cases. vii. Training modules and facilities in disability prevention. ii. expectant mothers and women in the reproductive period. x. vocational counseling & training and social work are available in adequate numbers. National. physiotherapy. Early Detection and Intervention In order to ensure prevention and early detection of disabilities. iv. The latest research findings in the field of genetics will be utilized appropriately to minimize congenital disability including mental illness. Disability specific manuals for families having persons with disabilities will also be developed and provided free of cost. . regional and local programmes of immunization (for children as well as expectant mothers). vi. Training programmes of postgraduate. viii. early detection and interventions. the following action will be taken: i. occupational therapy. ix. Appropriate plan of action for limiting effects of disability and prevention of secondary disabilities within the existing health delivery system will be evolved. early detection and intervention will be developed for medical and para medical health functionaries and Anganwadi workers. v. undergraduate degree and diploma in medical education will include modules on disability prevention. audiology. Awareness programmes for prevention will be built in at the school level and at the level of teacher's training courses. Medical and para-medical personnel will be adequately trained and equipped for early detection of disability amongst children. public health and sanitation will be expanded. Human resource development institutions will ensure that the personnel needed to provide support services such as special education.