Attitudes are important to understand as attitudes impact what we do and what we don’t do, how we treat others, what we expect of ourselves and what we view as important. Exploring attitudes is a form of metacognition as it means getting beneath the thinking processes and finding out what people think and why. If we can understand this much, we can then set about to create positive attitudes where negative ones lie. Attitudes do not start and finish as “what we think”. Health research stresses the importance of positive attitudes by health professionals working with people with a disability (Byron, Cockshott, Brownett & Ramkalawan, 2005; Thistlethwaite & Ewart, 2003; Tervo, Azuma, Palmer and Redinius, 2002; Battacharya & Sidebotham, 2000; Eberhardt & Mayberry, 1995; Kaplan, 1984). Negative attitudes towards people with a disability are “a product of individual beliefs and societal and organizational practices… and… attitudes towards persons with disability can be influenced by demographic variables such as age, gender, nationality, marital status, education level, socio-economic status, place of residence (rural vs urban), experience with disability” (Tervo et al., p.1537). Negative attitudes exhibited by occupational therapists are likely to have adverse consequences for persons with disabilities (Eberhardt & Mayberry).
The following slides outline the descriptive statistics derived from a survey conducted with first year students in semester 1, 2006. The question here was: “Do you, or anyone in your household, have difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities? 67.2 percent of students replied: “No” they do not know someone or have difficulty themselves” and therefore 32.8 percent of students studying occupational therapy in 2006 do know someone with a disability. Implications: Eberhardt and Mayberry (1995, p. 630) state that several factors can be instrumental in the formation of attitudes towards people with a disability Frequency of contact with a person with a disability (eg: friend at school) Setting in which contact occurs (eg: health setting (less positive) versus sports or community setting (more positive)) Amount of friendly cooperative behaviour involved (eg: person with a disability is a member of your sporting team) Direct and personal quality of the contact (you know the person because of your similar interests, not your role as their “helper”) If occupational therapy students commence their studies with limited exposure to a persons with a disability the implications are that the amount of exposure (frequency) the quality of the exposure (setting and role) and the relationship (direct and personal quality of the contact) are very important considerations in curriculum design and development.
Students “perception” that a person has a disability is influenced by whether or not the person uses an aid. Aids might include a “wheelchair” or a “cane”. Students perceive a person who uses a wheelchair as having a disability more than a person who has limited vision. The range for the response was: 1= always consider this indicates having a disability 4 = never consider that this indicates having a disability As the responses here are all between 1 and 2.5 it is evident that each of these categories of limitation where an aid is required equate to “having a disability” for this group of students. Implications: Inclusion in curriculum how having an “Aid” is a visible cue to the existence of a limitation however it does not imply “disability” in all aspects of that person’s life.
Students “perception” that a person has a disability is less clear when a visible aid is not used. 1= always consider this limitation as a disability 4 = never consider this limitation as a disability As the responses here are all between 2 and 3.2 out of a potential ‘4’ it is evident that these categories of limitation do not equate to ‘disability’ in the same manner as when the person uses an aid. Within the list of categories of limitations that do not have a visual aid, limitation in “verbal communication” was perceived as more of a disability than “homelessness”. Implications: Verbal communication is perceived as the biggest limitation and as causing “disability” by this group of students. As students will undertake HDS101 Communication and Diversity it is important to address this perception in this Unit as well as through the Foundations of Occupational Science and Therapy Unit.
The question asked here was “when you encounter someone you don’t know well, who has an obvious disability, have you ever felt…” Interested in finding out about the disability Afraid of the person Sorry for the person Indifferent towards the person Awkward Admiration for the person 1 = Often and 4 = Never These results indicate that this group of students tend to want to find out about the disability , feel sorry for the person , and expressed that they feel admiration for the person. Most did not feel afraid, awkward or indifferent. Implications: Needing to find out about the disability, eg: a name or a label is quite different from finding out how this person’s limitations prevents them being able to participate in what they want to do. An OT’s role is not to diagnose or label, it is to understand the functional implications. Therefore a knowledge of the type of issues that could limit participation in an activity is useful, however it is not the only information an OT uses when working with a person.
Students were asked about how they felt people with a disability able to participate in society compared with people who do not have a disability. The “spike” here shows that this group of students feel that people with a disability are “somewhat included” in participating in society. In the next two slides we will look at aspects of where people participate in society, which sheds some light on the result “somewhat”.
Students were asked about participation in employment, education, transport and health care. Students perceive employment and transport as more difficult aspects of society for a person with a disability to access. Healthcare is perceived by this group of students as the easiest to access. Perhaps this contributes to the perception that people with a disability Implications: Students are highlighting some key areas that OTs work with people with a disability: Access to employment and transport.
In this question students were asked about participation in recreation, financial security, social life and raising a family. These results indicate that the students perceive “social life” as the most accessible aspect of social participation and raising a family as the most difficult within these categories. Putting this information together with the previous slide, raising a family and engaging in employment are seen as the two most difficult aspects of social participation for a person with a disability. Implications: Students are highlighting raising a family as the biggest issue here. OT’s often work in collaboration with Social Work around this topic. In curriculum this is a topic that could be integrated into a multi-disciplinary Unit.
This graph represents the question “ Do people with a disability face discrimination?” the “spike” indicates that the majority of students believe that people with a disability face “some discrimination”. Implications: OT’s often work with people around the issue of “disclosure”. When and how to disclose that you have a disability in the areas of social life and employment require careful deliberation around the issues of safety versus opening up to discrimination.
Students were asked if they had ever witnessed discrimination against a person with a disability. Fifty eight percent of students had witnessed a person with a disability being discriminated against. If we compare the results of slide three with these results Where it was stated that 32.8 percent of students studying occupational therapy in 2006 know someone with a disability, it is evident that students have witnessed discrimination and in many cases it was discrimination against a person they did not know. Implications: How does an occupational therapist advocate on behalf of a person who is not directly known to them? How do occupational therapists encourage advocacy BY people with a disability?
So far we have looked at how first year OT students perceive disability and we have briefly looked at the implications in curriculum. One key implication for teaching is through the use of MODELS . Models are sometimes confusing for students until they have enough life and educational experience to integrate the model into their way of thinking. In this presentation we will look at two models. One model is the Person, Environment, Occupation, Performance model (PEOP) and the other is the International Classification of Functioning Disability and Health (ICF). These two models have been selected as one is a global model (the ICF) and the other is OT specific (PEOP). Students in occupational Therapy at Deakin University are exposed to these and other models throughout their four-year degree. Through these models I will illustrate how attitude is very important. The following slides will look at the models and then discuss where “attitudes” can be examined, discussed and potentially improved through curriculum in the occupational therapy program. Finally, a proposal for formal research into the impact of this curriculum initiative will be detailed. A copy of the ethics application is also attached.
The domains are classified from body, individual and societal perspectives. Since an individual's functioning and disability occurs in a context, ICF also includes a list of environmental factors . ICF is useful to understand and measure health outcomes. It can be used in clinical settings, health services or surveys at the individual or population level . Thus ICF complements ICD-10 , The International Statistical Classification of Diseases and Related Health Problems and therefore is looking beyond mortality and disease. (http://www.who.int/classifications/icf/en/) Therefore an occupational therapist is interested in knowing how a disorder or disease effects a person at three levels: Body structure and function The activities they can perform Their level of participation in life These are considered in CONTEXT of personal and environmental factors
A professional model used in OT is the Person, Environment, Occupation, Performance model (PEOP)
Occupational therapy is one of the allied health professions whose aim is to enable people to engage in activities of their choice, when limitations or impairments lead to an inability to complete these tasks independently. The occupational therapist aims to enable their client’s function by improving client’s skills, or by modifying their environment or the task (Crepeau, Cohn, & Schell, 2003) The attitude that the occupational therapist has towards their client’s occupation will impact their ability to assist the person to improve occupational performance and participation. Here is a very simple vignette to describe how attitudes can be far reaching Client A, an 86 year old woman complains that meal preparation is getting more difficult. Therapist B suggests that client A could get meals on wheels instead of cooking dinner each day. Client A does not feel that she can discuss the importance of cooking and it’s subsequent role of “nurturer” to herself and her partner, she believes that the “OT probably knows best” and agrees to accept the OT’s advice and starts getting meals on wheels. The therapist’s attitude that “meals on wheels is easier” has profound implications. Client A no longer uses her kitchen environment the way she used to, she also starts to reduce dexterity in her hands due to decreased use through cooking tasks, her ability to plan and sequence tasks was well practiced through meal preparation but now that she does not have to think through such tasks her “cognitive dexterity” is also reduced. Meals on wheels is delivered to her home, so client A no longer needs to shop for as many items, thus causing some level of social isolation, reduced physical stamina and again reduced “cognitive dexterity”. Therapist B developed this attitude in a cultural context. Attitudes such as : “When you’re old you don’t have to cook”, “older people have accidents when cooking, so it’s safer not to” and “meal preparation is just a menial task and does not hold value in our society”, “shopping, budgeting, meal planning and meal preparation are tiresome and we can all do without that kind of fuss!” What other attitudes can you think right now that effect what choices people can make? (Put this question to the audience and write responses on whiteboard) Leave the whiteboard in clear view so that we can use these examples throughout the remainder of the presentation. Eg: “ People with serious mental illness don’t need to work, they have enough on their plate!” “ Mothers with young children should not be in the paid workforce” “ Mothers with school aged children should be in the paid workforce” (just watch government policy to get an idea of current attitudes!) “ People with serious physical injuries cannot have a quality life” “ Consumer organisations are merely lip-service to people with a disability”
Attitudes are pervasive. Coming back to the discussion of the PEOP model: The central terms in this model are “occupation” and “performance” and “Occupational performance~ participation” these components are directly affected by the person and the environment : occupations: Goal-directed pursuits that typically extend over time, have meaning to the performer, and involve multiple tasks (Christiansen & Baum, 1997, as cited in Baum and Christiansen, 2005). performance: Performance is supported by a complex interaction of biological, psychological, and social phenomena that requires a satisfactory match between person, task, and situational characteristics (Engel, 1977; Meyer, 1922; Mosey, 1974; Reilly, 1962, as cited in Baum and Christiansen, 2005). occupational performance: Occupational performance is central to the development of occupational therapy models. It operates as a means of connecting the individual to roles and to the socio-cultural environment (Reed and Sanderson, 1999, as cited in Baum and Christiansen, 2005). The terms surrounding occupation and occupational performance, namely person and environment, will be expanded upon in the following slides.
Environment Consider the environment client A working is in with therapist B? social environment: Social support is an experienced rather than an observed phenomenon and is essential to maintain health. There are three types of social support that enable people to do what they need and want to do. These include practical support, informational support, and emotional support (Dunkel- Schetter & Bennett, 1990; McColl, 1997; Orth-Gomer, Rosengren, & Wilhelmsen, 1993; Pierce, Sarason, & Sarason, 1990; Thoits, 1997, as cited in Baum and Christiansen, 2005). Discuss the three aspects of social support and relate it to Therapist B and her suggestion to start getting meals on wheels. Practical support Informational support Emotional support
Environment cultural environment: Culture refers to values, beliefs, customs, and behaviors that are transmitted from one generation to the next. Culture affects performance by prescribing norms for the use of time and space and influencing beliefs regarding the importance of activities, work, and play . It also influences choices in what people do, how they do it, and how important it is to them (Altman & Chelmers, 1984; Hall, 1973, as cited in Baum and Christiansen, 2005). Describe the cultural environment of client A and therapist B…
Environment Built environment: Physical environments can be built for accessibility , manageability, safety, aesthetics, comfort, and enjoyment. The suitability of the space to accommodate an individual’s needs is central to physical or built environments. Built environments also include tools that support engagement in tasks and occupations. Tools that are usable within the person’s capabilities are grouped under the category of assistive technology. Natural environment: The natural environment includes geographical features such as terrain, hours of sunlight, climate, and air quality. The natural environment can be a significant factor in determining whether or not an individual’s physical limitations are disabling (Brandt & Pope, 1997, as cited in Baum and Christiansen, 2005). Societal environment: The standing of an individual within the group shapes behavior and attitudes toward self. Social rejection and isolation can have devastating psychological consequences. Societal policies govern the availability of resources which controls access to services and work (Baum & Christiansen, 2005). What aspects of the Built, Natural and societal environments could the occupational therapist use to enable her client to continue preparing meals? Options may include: layout of kitchen, task simplification in meal preparation, using pre-prepared meals from the supermarket etc…
Person cognitive factors: Cognition involves the mechanism of language comprehension and production, pattern recognition, task organization, reasoning, attention, and memory (Duchek, 1991, as cited in Baum and Christiansen, 2005). What aspects of cognition are effected by the decision to accept meals on wheels? Answers may include: planning, memory, problem solving How could cognitive factors be maintained? Answers may include: include other activities in Client A’s daily routine that maintain these aspects of cognition
Person spirituality: Everyday places, occupations, and interactions are filled with meaning that is interpreted by the person based on his or her goals, values, and experiences. Spirituality is socially and culturally influenced but become internal to the individual through personal interpretation. As meanings contribute to personal understanding about self and one's place in the world, they are described as spiritual. People develop a self-identity and serve a sense of fulfillment as they master and accomplish goals that have personal meaning (Christiansen, 1997, as cited in Baum and Christiansen, 2005). How is “cooking” a spiritual activity? (consider its meaning in client A’s life) How has the OT’s attitude effected this aspect of the person?
Person psychological factors: Psychological factors describe the personality traits, motivational influences, and internal processes used by an individual to influence what they do, how events are interpreted, and how they contribute to a sense of self. Self-efficacy is an important psychological factor as it allows people to view themselves as competent. Persons who view themselves as competent view their overall well-being more favorably and continue working on tasks despite setbacks (Bandura, 1977, 1982; Baum & Christiansen, 2005; Gage & Polatajko, 1994, as cited in Baum and Christiansen, 2005). Self efficacy is an important aspect of psychological well-being, how has the attitude of the therapist impacted on client A’s self-efficacy? Answers may include: Client A’s belief in own ability to plan and prepare meals, Client A’s belief in own ability to care for husband, Client A’s belief in her worth
Often these two areas “Physiological” and neurobehavioural” are managed under a medical framework (diagnosis and treatment). Occupational therapists also work directly with people both physiological and neurobehavioral issues : physiological factors: Endurance, flexibility, movement and strength are necessary requirements for occupations requiring moderate or sustained effort. People who are physically active are healthier and live longer than those who are sedentary (Minor, 1997, as cited in Baum and Christiansen, 2005). neurobehavioral factors: The sensory (olfactory, gustatory, visual, auditory, somatosensory, proprioceptive, and vestibular) and motor systems (somatic, cerebellum, basal ganglia network, and thalamic integration) underlie all neuromotor performance (Baum & Christiansen, 2005). How has accepting meals on wheels (which was a recommendation based on attitudes) effected this person physiologically? Answers may include: reduced physical stamina, potentially reduced nutritionally sound food intake … & neurobehaviorally? Answers may include reduced ability to plan, problem solve and sequence tasks.
It has been demonstrated that attitudes pervade all areas of interaction between a client and a therapist. The OT works from a person, environment and occupational performance perspective and attitudes are fundamentally important. Where did attitude NOT impact client A? Answer: where DIDN”T attitudes impact!!! Ultimately, ONE single recommendation pervaded all areas of client A’s person and environment, affecting her occupations and occupational performance.
Students in OT also learn about global models, such as the ICF and profession specific models such as the PEOP. These two models will now be discussed together to demonstrate that they use similar language and can be used in very similar ways.
Person The attitude towards a person with a disability and the attitude BY the person with a disability heavily influences participation. Personal factors include physiological, psychological, cognitive, neurobehavioral and spiritual aspects of the person in the PEOP model while in the ICF these are translated as which include gender, age, coping styles, social background, education, profession, past and current experience, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual.
Environment In the ICF, environment refers to social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain etc. In the PEOP environment refers to the Built environment, Natural environment, Societal environment (all discussed earlier)
Activity and Occupation “Occupation” in the PEOP model equates to Activity in the ICF Attitudes towards what activities or occupations a person can or cannot do greatly influence what occupations or activities a person will try. In our vignette we have illustrated how a simple suggestion “How about getting meals on wheels” can cause major impact on the occupation or activity of an individual
Participation Satisfactory performance and participation are influenced by attitudes towards what the person can try, the environment and the person’s physical and cognitive ability. How has meals on wheels effected Client A’s participation from the perspective of the ICF? Answers might include: reduced participation in shopping, walking, social interaction etc What key area did the OT address when recommending meals on wheels? Answer might be: Body structure and function (ie: adequate nutrition) and health condition.
In the presentation so far we have looked at the findings of a survey conducted with first year students in 2006 around “attitudes towards people with a disability”, we have then discussed (using a simple vignette) importance of recognising attitudes, and the pervasive impact of attitudes by others in another person’s life. So: if people who have a physical or mental limitation that causes disability, report that negative attitudes further reduce their capacity for participation, particularly when they are negative attitudes held by health care workers (Tervo et al., 2002) and health professionals actually contribute to the development of negative attitudes towards people with a disability by reducing the person to the symptoms of the illness or disability, creating “myths which enable the health professional to create stereotypical views of the person with a disability” (Holmes & Karst,1990 cited in Gething, 1993, p.292), what can we do in the occupational therapy curriculum to circumvent this? Looking at this slide, let’s briefly reflect on attitudes that exist in our own minds…
Current state of play: In the TWO first year foundation of occupational science and therapy units the focus is on enabling students to quickly grasp the core beliefs and goals of the profession while seeing the breadth of the areas professional practice. With this in mind, HSO102, “Foundations of Occupational Science and Therapy A”, endeavours to teach fundamental models and skills for practice, while also examining the current attitudes of students towards people with a disability. The unit consists of one one-hour lecture and one one-hour tutorial each week of the thirteen-week semester. Not a lot of time to influence future occupational therapists so what we cover needs to have high impact and allow the students to start to decide if Occupational Therapy is the right profession for them and if they are right for the profession. In addition to the lecture and tute students attend 6 hours of fieldwork each week. The students go to a range of fieldwork locations and the learning experience is not the same for each student. Some students report that their fieldwork has little relevance to their developing knowledge of occupational therapy.
Therefore, in 2007 we are proposing to change the focus of fieldwork to development of skills and knowledge around the topic of disability. As discussed earlier in the presentation, Eberhardt and Mayberry (1995, p. 630) state that several factors can be instrumental in the formation of attitudes towards people with a disability. These will be expanded upon here: Frequency of contact Medical and allied health students who either have a disability or have regular close contact with someone who has a disability tend to have more positive attitudes about rehabilitation outcomes and the individual’s capacity to participate in daily life (Aulangier et al., 2005; Eberhardt & Mayberry, 1995). Setting in which contact occurs The setting in which medical and allied health students have exposure to people with a disability influences how they view that person, how they see that person’s capacity and what they see as their role with them. Contact with a person with a person with a disability in helper-caregiver role may not be conducive to the development of positive attitudes (Eberhardt & Mayberry, 1995). Typically medical settings such as hospitals use a helper-caregiver role under a disability model, which leads to the professionals focusing only on functional limitations (Eberhardt & Mayberry; Gething, 1993) rather than strengths thereby facilitating the development of negative attitudes. In non-clinical settings (Lyons, 1991, cited in Eberhardt & Mayberry) or community settings such as schools, employment and vocational training, and social settings, health professionals are employed to facilitate achievement of goals using a strengths or wellness model (Eberhardt & Mayberry; Gething, 1993) and this facilitates the development of more positive attitudes. Amount of friendly cooperative behaviour involved Clients and therapists who create dependency within their working relationship can severely restrict the opportunities for the individual to learn and grow through the development of new behaviours and new roles (Bener, 1981 cited in Eberhardt & Mayberry, 1995). Students who are able to identify the strengths of the person with a disability and then have a friendly and cooperative approach to their role, not an expert stance, find they are able to create a better working relationship with their clients. The direct and personal quality of the contact Equal status contact where the person with a disability is a team member or a colleague enhances positive attitudes (Amsel and Fichten, 1988; Bender, 1981 cited in Eberhardt & Mayberry, 1995, p.634). Eberhardt and Mayberry report that occupational therapy students who had a positive social contact with a person with a disability, such as a close friend, co-worker or a team-mate, exhibited more positive attitudes than those who only met a person with a disability in a caring role or who had no contact at all. Exposure to a person with a disability who has successfully adjusted to their disability, and is not in a dependent relationship with a therapist, enables the student to see the individual as someone from whom they can learn (Eberhardt & Mayberry).
So, from the literature we are confident to say that positive attitudes towards people with a disability are crucial in developing a beneficial therapeutic relationship. The survey tells us that students come to occupational therapy from a range of backgrounds and have a range of experiences of people with a disability and their attitudes have been formed prior to commencing their occupational therapy education. The literature also informs us that positive well designed learning activities are ones that create the environment where the person with a disability is a teacher, on an equal level to the student or where they are not placed in a dependent relationship with the student therapist. It is possible to facilitate this type of teaching activity in the occupational therapy program at Deakin University due to the flexible teaching approaches by the teaching staff and the potential to use the 6 hours per week formerly used in fieldwork across a range of settings.
Further development of the curriculum is planned in 2007 using the 6-hour per week fieldwork timeslot: Person-centered/ Strengths-based assessment techniques. Two visits to the Independent Living Centre (one more than 2006) to look at adaptive equipment and to learn how to use, disassemble and transport manual wheelchairs A range of field visits to settings where students are taught how to get around physical, mental and social barriers so that disbaility is not the outcome and PARTICIPATION is the outcome! A visit to the Cunnigham Dax art collection (Art created by people with a serious mental illness)
The change in curriculum will be researched and reported: It is important to know if changes to curriculum are effective in creating positive attitudes in first year occupational therapy students towards people with a disability. This research project aims to test this.
The important issue being addressed by this research includes: Why is this data being collected? To ascertain the current attitudes of first year students towards people with a disability. To see if changes occur during the course of first year. How will the information be used? To provide a “snap shot” of attitudes by first year students. To assess if current teaching practices and curriculum in first year the occupational therapy program at Deakin University enhance positive attitudes towards people with a disability. How will this knowledge improve student learning? Enhanced knowledge of what works and does not work in curriculum will enable better curriculum design Better curriculum will enhance student learning outcomes How will this knowledge improve knowledge and attitudes towards people with a disability? Enhanced student learning outcomes in this specific topic areas will lead to more positive attitudes towards people with a disability
Investigating the impact of curriculum on attitudes by first year occupational therapy students towards people with a disability
Are attitudes important? Investigating the impact of curriculum on attitudes by first year occupational therapy students towards people with a disability Photo used with permission: Tamer / World Health Organization (WHO)
<ul><li>Photograph used with permission from the World Health Organisation (WHO). The photo "Shadow of Disability" by Tamer is one of 33 awarded photographs from the WHO photo contest "Images of Health and Disability 2005". The contest has been organized in order to promote the understanding and use of the International Classification of Functioning, Disability and Health (ICF) </li></ul><ul><li>Visit http://www3.who.int/icf/icftemplate.cfm to view more photos. </li></ul>Photo on title slide
Direct experience by OT students with persons with a disability Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues.
Conceptions of disability: person using a visible aid Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. Closer to 1 means student view person with this aid as having a “disability”
Conceptions of disability: person without visible aid Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. Closer to 0 means student view person with this limitation as having a “disability”
Students’ level of comfort being with a person with a disability Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. 1 = Often and 4 = Never
Perception of how included people with a disability in participating in society Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues .
Perception of barriers to participation in society Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. The higher the bar = the more difficulty a person with a disability has participating in this aspect of society. (Range 1-4)
Perception of barriers to participation in society Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. The higher the bar = the more difficulty a person with a disability has participating in this aspect of society. (Range 1-4)
Do people with a disability face discrimination? Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues.
Witnessed discrimination Survey adapted from: Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues.
Using models to explain how attitudes affect participation <ul><li>A World Health Organization model </li></ul><ul><ul><li>The ICF </li></ul></ul><ul><li>An occupational therapy model </li></ul><ul><ul><li>PEOP </li></ul></ul>
What is the ICF? <ul><li>ICF is WHO's framework for health and disability. </li></ul><ul><li>It provides a standard language and framework for the description of health and health-related states </li></ul><ul><li>Its focus is on health and functioning NOT disability (an important attitudinal shift) </li></ul>
Model of ICF http://www3.who.int/icf/beginners/bg.pdf
What is the PEOP model? <ul><li>An occupational therapy model </li></ul><ul><li>Describes the interaction between person, environment, occupation and performance </li></ul><ul><li>Describes how these factors can support/enable or restrict performance of activities, roles of the individual/organization/community. </li></ul><ul><li>(Baum & Christiansen, 2005) </li></ul>
The Person-Environment-Occupation-Performance (PEOP) model
The Person-Environment-Occupation-Performance (PEOP) model ATTITUDES ATTITUDES ATTITUDES ATTITUDES
Critical Analysis of Occupational Issues HSO414 (Honours stream) Occupation: Enabling Action & Outcomes HSO412 (Honours stream) Honours Research Project HSO410 (Honours stream) OR OR Elective (Pass stream) Elective (Pass stream) Critical Analysis of Occupational Issues HSO404 (Pass stream) Occupation: Enabling Action & Outcomes HSO402 (Pass stream) SEM 2 Occupational Therapy Practice, Knowledge & Reasoning HSO411 (Honours stream) OR OST Practicum: B HSO405 (2 credit points) (Pass and Honours streams) Occupational Environments and Technology HSO403 (Pass and Honours streams) Occupational Therapy Practice, Knowledge & Reasoning HSO401 (Pass stream) SEM 1 YEAR 4 OST Practicum: A HSO304 (2 credit points) Occupational Performance: Evaluation & Intervention: 2 HSO306 OT Evaluation & Evidence HSO303 SEM 2 Elective Elective Occupational Performance Evaluation & Intervention: 1 HSO305 Researching Occupational Performance HSO302 SEM 1 YEAR 3 Occupational Development, Disability and Adaptation: B HSO206 Sociology of Health ASC206 Occupational Dysfunction HSO202 Health Information & Data HBS108 SEM 2 Occupational Development, Disability and Adaptation: A HSO205 Elective Elective Neuroscience HSO207 SEM 1 YEAR 2 Integrated Human Physiology HSE208 Functional Human Anatomy HSE102 Health Behaviour HBS110 Foundations of Occupational Science and Therapy: B SEM 2 Understanding Health HBS107 Communication & Diversity HDS101 Human Structure & Function HBS109 Foundations of Occupational Science and Therapy: A SEM 1 YEAR 1
First year, First Semester Curriculum strategy 2006 <ul><li>Snakes and Ladders </li></ul><ul><ul><li>Facilitated by two people who have a visible physical disability, the disability has no impact on their ability to perform their role as facilitator </li></ul></ul><ul><li>OT: what a great job! </li></ul><ul><ul><li>Students are taught by a man who has spastic quadriplegic cerebral palsy about OT’s in his life and their role in helping him to be as independent as possible. </li></ul></ul>Student playing Snakes and Ladders
<ul><li>Initial interviewing </li></ul><ul><li>Students will see therapists in action, undertaking initial interviews, building rapport and designing OT treatment plans from a person-centered, strengths based perspective </li></ul><ul><li>Independent Living Centre Visit </li></ul><ul><li>Students will visit the ILC and learn about environmental adaptations and equipment that allow people with a disability to complete tasks more independently </li></ul><ul><li>A range of field visits: </li></ul><ul><li>Seeing OT and other health professionals in action, asking the “patient/client” what makes a good therapist? </li></ul>First year, First Semester Curriculum strategy 2007
Research Proposal <ul><li>This research aims to measure student attitudes towards people with a disability at the commencement of their studies in occupational therapy. Comparative data will then be used to measure if change in attitudes occurred and qualitative data collection will analyse where changes occurred or did not occur. </li></ul>
Timeline for research project <ul><li>Honours project in 2007 </li></ul><ul><li>Ethics application submitted November 6 2006 </li></ul><ul><li>Baseline data on attitudes to be collected using The Measurement of Attitudes toward people with disabilities (Antonak & Livneh, 1988) in Febrauary 2007 </li></ul><ul><li>In-depth interviews with randomly selected participants from the first year cohort in July 2007 </li></ul><ul><li>Comparative data to be collected using The Measurement of Attitudes toward people with disabilities (Antonak & Livneh) in August 2007 </li></ul><ul><li>Data analysis and thesis writing September/October </li></ul><ul><li>Completion by November 2007 </li></ul>
<ul><li>Antonak, R.F. & Livneh, H. (1988). The measurement of attitudes towards people with disabilities: Methods, psychometrics and scales. Springfield, Illinois: Charles Thomas Publisher. </li></ul><ul><li>Baum, C. M, & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation-based framework for practice. In C. H. Christiansen, C. M. Baum, and J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated. </li></ul><ul><li>Bhattacharya, M. & Sidebotham, P. (2000). Parental and professional perceptions of the levels of disability in children with Down's syndrome. Ambulatory Child Health 6 , 153-163. </li></ul><ul><li>Bruhn, J. G. (1991). Nouns that cut: The negative effects of labelling by allied health professionals. Journal of Allied Health (Fall), 229-231. </li></ul><ul><li>Byron, M., Cockshott, Z., Brownett, H. & Ramkalawan, T. (2005). What does 'disability' mean for medical students? An exploration of the words medical students associate with the term 'disability'. Medical Education 39 , 176-183. </li></ul><ul><li>Crepeau, E. B., Cohn, E. S., & Schell, B. A. B. (2003). Willard and Spackman's occupational therapy (10th ed.). Baltimore, Md.: Lippincott. </li></ul><ul><li>Gething, L. (1993). Attitudes toward people with disabilities of physiotherapists and members of the general population. Australian Journal of Physiotherapy 39 (4), 291-296 </li></ul>References
<ul><li>Gething, L. (ND). Interactions with disabled persons scale: Scale and manual. Sydney: University of Sydney. </li></ul><ul><li>Human Resources and Social Development Canada. (2001). Canadian Attitudes Towards Disability Issues. http://www.sdc.gc.ca/en/hip/odi/documents/attitudesPoll/qualitativeStudy/qualitativeStudy.pdf#search=%22Canadian%20Attitudes%20Towards%20Disability%20Issues%20Environics%20Research%20Group%22. Accessed 3 February 2006. </li></ul><ul><li>Nosek, M.A., Howland, B.A., Rintala, D.H., Young, M.E. Chanpong, G.F. (2001). National Study of Women with Physical Disabilities: Final Report. Sexuality and Disability 19 (1), 5-39. </li></ul><ul><li>Tervo, R.C., Azuma, S. Palmer, G. & Redinius, P. (2002). Medical students' attitudes toward persons with a disability: a comparative study. Archives of Physical Medicine and Rehabilitation 83 (11), 1537-1542. </li></ul><ul><li>Thistlethwaite, J.E. & Ewart, B.R. (2003). Valuing diversity: Helping medical students explore their attitudes and beliefs. Medical Teacher 25 (3), 227-281. </li></ul><ul><li>World Health Organization. ICF Photo contest winners 2005. Accessed November 1 2006. http://www3.who.int/icf/photocontest2005/index.htm </li></ul><ul><li>World Health Organization. (2002). Towards a common language for functioning, disability and health ICF. Geneva: Author. </li></ul>References