Pam Thomas responded to our request (see bottom of page following XXXXXX) -
thanks Pam. You raise some very interesting and valid points which call for
an answer from the research team at UCL.
First, in attempting to be succinct, we clearly provided insufficient
information about our project. Social barriers - and social facilitators
- are indeed the main focus of our research. In this reply, we will
concentrate on barriers.
The focus groups identified many 'employer agency' barriers (e.g. access
problems, lack of adaptations, negative attitudes, inflexibility over hours
of work, etc.). They also identified a wide range of other social
barriers to employment, including barriers related to the benefits system,
competition within the job market, transport, general training
opportunities, and barriers within the rehabilitation system. The latter
included, for example, negative attitudes of health professionals, and
rehabilitation insufficient in duration, scope and/or aims to equip people
for work. It was clear that they felt strongly that services addressing
their individual impairments were important in relation to work following
stroke. It is because of this that impairment is one of the factors that
we'll be considering further in the next stages of the project. We also
recognise that notions of 'impairment' are socially constructed.
You argued that we should be attempting to influence employers rather than
medical professionals. We would like to influence both. We have placed
more emphasis on employers in that the final stage of our research will
involve interviewing a small number of employers, hopefully employers of
stroke survivors we will have interviewed, in order to raise issues for
employers from the earlier stages of our study.
Our rationale for wishing to influence rehabilitation workers is to
encourage them to see their 'patients' as people with lives to live, and
hence to be more constructive in relation to work issues, in particular
getting back to work. The focus groups suggested that doctors etc can
have an important role here, e.g. in advising about timing and legitimising
/ facilitating a staged return to work.
We recognised from the start that there is an incongruity in attempting to
use a social model approach in relation to a particular medical category.
The reason for this is that we have taken our lead from an organisation of
stroke survivors, which is the grant holder. We hope most of our findings
will be applicable to disabled people more generally.
To conclude, it seems appropriate to return to the initial question we
raised, which was about possible ways of eliciting the type of information
which appears to be a prerequisite for serious consideration by many health
professionals (or is it medical / rehabilitation journals?). We realise
that this can easily be construed as 'selling out' to the medical model.
However, our intention here would be to place such material alongside our
findings on social barriers so as to nudge medically orientated
rehabilitation workers away from the medical model frame of reference and
towards a broader perspective more in keeping with social model ideas. The
issue we are grappling with is whether social model thinkers should simply
'write off' health service professionals or see them as potential allies.
To our minds, the former would be to hand impairment over to the medical
model. (Hughes & Paterson discuss this at a more theoretical level in an
article in Disability & Society, 1997.) Furthermore, it would be
tantamount to constructing health professionals as ciphers, denying them
any 'agency' to think about and possibly change the ways they work. We
have no illusions about the difficulties or the limits to what one project
can achieve.
There is much evidence that many disabled people value treatment they
receive from health service rehabilitation workers, and that demand for
such provision greatly exceeds supply. Some rehabilitation workers are
already attempting to work in partnership with disabled people. More
generally, rehabilitation specialists need to be encouraged to adopt values
and practices compatible with the social model, and to be supported in
doing so.
Sarah Lock, on behalf of the WAS team: Lesley Jordan, Karen Bryan and Jane
Maxim.
XXXXXXXXXXXXXXXXXXX
>Sarah asked for views and ideas on a research project.
>
>I think this project in City College (London) does not just result in
>tensions with the social model of disability but is incompatible with the
>social model of disability.
>
>If the research is based in the social model of disability I do not
>understand why it is medical professionals that need to be influenced -
>rather than employers. The clinical tests referred to are of no use to
>employers - indeed I would suggest they could use them as an excuse for not
>employing someone.
>
>Unfortunately the project is focussing on one cause of impairment and the
>medical and individual implications of this. This is a distraction from the
>socially constructed institutionalised and systematic barriers which also
>affect other people with other causes of impairment. If this research is to
>be conducted within the social model of disability it would have to be more
>inclusive (of people with other causes of impairment) and focus on socially
>disabling barriers rather than individual functioning or performance.
>
>There has been quite a lot written about conducting research with disabled
>people within the social model of disability, details of which I think is
>probably available from the Centre for Disability Studies website. I am
>posting Sarah a report by Breakthrough UK in Manchester on "Common Barriers
>and their Removal" it considers Barriers to employment and training faced
>by disabled people and their employers and training providers, it reports on
>work carried our within the social model of disability. (Breakthrough UK
>Fax: 0161 274 4053).
>
>I'm not sure that this is the sort of views and ideas you were hoping for
>but there is a big difference between operating the social model of
>disability and the more traditional medical / individualised approach which
>takes social limitation as essentially coming from an individuals functional
>limitation.
>
>Pam.
>
>
>
>
>
>
>-----Original Message-----
>From: The Disability-Research Discussion List
>[mailto:[log in to unmask]]On Behalf Of Sarah Lock
>Sent: 02 March 2001 11:47
>To: [log in to unmask]
>Subject: Work After Stroke
>
>
>Dear list members
>
>We are a team from University College London who, in collaboration with an
>organization of stroke survivors called Different Strokes, are undertaking a
>three-year research project about return to work after stroke. The aim of
>the project is to explore barriers to employment and factors facilitating
>employment after stroke for people with and without communication
>difficulties (aphasia), taking a social model approach.
>
>The project involves several stages:
>
>1: Focus groups with Different Strokes members to inform design of
>questionnaire
>2: Questionnaire sent to every stroke survivor on Different Strokes mailing
>list
>
>These two stages have been achieved and questionnaire results are now being
>analysed.
>
>3: In-depth interviews with a cross section of 24 questionnaire respondents.
>These interviews are currently being planned. Our aim is to understand
>individuals' experiences of barriers and enablers to work, to provide detail
>about the factors identified in the focus group and questionnaire data and
>the interactions which may exist between them. This includes the impact of
>early care and rehabilitation, medical and social services offered, and
>factors related to employers, family/friends, transport, job opportunities,
>training, and individuals' impairments and emotional status.
>
>We also recognise a need to consider the interviewees' impairments/mood
>state in a formal way. One (rather pragmatic) reason for this is that we
>feel that medical professionals, whom we want to influence through this
>work, will not fully 'trust' the interview data alone, and will call for
>what they see as more objective evidence about people's impairments, or at
>least have it reported in a way they are used to. We have therefore
>considered using an outcome measure such as SF-36, Barthel Index, Hospital
>Anxiety and Depression Scale, FIM/FAM etc. There is of course a tension in u
>sing such measures in a social-model project, and we wonder if any published
>measures exist which would enable us to access similar information but from
>a perspective that is more in keeping with our project's overall philosophy?
>
>Views and ideas greatly appreciated.
>
>Sarah Lock,
>Research Fellow
>Department of Human Communication Science
>University College London
>
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___________________________________________________________________________S
arah Lock e-mail:
Research Fellow [log in to unmask]
Department of Human
Communication Science
University College London Chandler House
Tel: 020 7679 4214 2 Wakefield Street,
Fax: 020 7713 0861 London WC1N 1PF
____________________________________________________________________________
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