Sources of Double Disadvantage for People with Disabilities Living in Remote and Rural Areas of New South Wales, Australia

This study demonstrates how people with disabilities living in remote and rural areas experience double disadvantage in regard to receipt of services. They tend to experience similar disadvantages to other remote and rural dwellers (as compared with their urban counterparts), but these disadvantages are compounded by those associated with living in an environment which does not cater for the needs of people with disabilities. Findings display how geographical, physical, cultural, social and psychological factors within the external environment create disadvantages for the individual. The project involved data collection from people with disabilities, disability groups, service providers, families and carers through consultations and field trips. Major issues emerging from consultations were concerned with: transport and distance, isolation, the need for more consumer involvement, the nature of service provision (appropriateness, flexibility, co-ordination and location), the need for community and professional disability awareness education, protection of rights, carers and respite care, accommodation and housing, education, employment, information dissemination and access to specialised equipment. Comparison with overseas studies indicates that findings from this Australian study have applicability in other countries which have large remote and rural areas.     

Interviewing victims of sexual abuse with an intellectual disability: a dutch single case study

The approaching to use with people with an intellectual disability who are (suspected) victims of sexual abuse is a challenge for social professionals. Being at the mercy of professional facilities, the victims are in a vulnerable position. They have limited capacities to defend themselves against the intimidations of perpetrators and to deal with the consequences of the terrifying happenings. Finally, sexual abuse is a criminal offence. Much depends on the quality of the interviews. In the Dutch practice of forensic reactions to (suspected) sexual abuse of people with an intellectual disability, experience has been acquired with different types of interviewing.

With the help of a single case study between a health professional and a victim, these forms of interviewing are demonstrated. The professional pursuit is to let the client disclose what has happened in their own words. The study shows that in social health and welfare practices the professional task is to navigate between, on the one hand, the communicative space for the client to provide free recall and, on the other hand, the need to provide help to clients with an intellectual disability to verbalize inner cognitions and emotions.     

Austerity and the lives of people with learning disabilities. A thematic synthesis of current literature

Abstract

The Financial Crisis of 2008 resulted in many western economies implementing cuts in health and social care. This systematic review provides a holistic picture of the impact of austerity policy on the lives of people with learning disabilities (LD) and the collateral effects on the people who support them. Our review suggests that in the current climate of economic austerity, available funding to support people with LD is no longer aligned to their care needs. Cuts in disability services have adversely affected the well-being both of people with LD and their informal carers. Individuals with LD have lost social support and are experiencing increased social isolation. Heightened demands on family carers’ time have negatively influenced their wider roles, including parental functioning, and labour market participation. Our review provides the foundations for further discourse and research on the effects of austerity on people with LD and their family carers.     

Sustaining an intimate and sexually fulfilled marriage or partnership in older adulthood with a disability: Perspectives of social workers

ABSTRACT

The American portrayal of sex is often left for only the young, attractive, and able-bodied. In contrast many studies have found that older adults with disabilities in marriages and intimate partnerships have sexual desire and sexually active lives. Social workers are often burdened with balancing the sexual intimacy desires of their older adult clients with disabilities, alongside the need to protect them from sexual abuse and exploitation, particularly among those who may lack the capacity to consent due to cognitive impairment. This phenomenological study aimed to understand the lived professional experience of social workers (N = 5) in supporting married and intimately partnered couples in which at least one person was an older adult with a disability to understand the clients’ needs and common social work practice methods used to address their needs. Inductive coding was used to identify themes and subthemes. Their role included helping their clients to learn about their ability to have sex, consenting to sex, negotiating accommodations for intimacy and sex with their spouses, and counseling those who took on caregiver roles for their spouses. Social workers reported that individual diagnosis, such as dementia, should not alone determine one’s ability to consent to sex.     

精神残疾群体的社会保障需求与供给:现状、问题与发展建议

精神残疾人多生活困难,构成社会最为弱势的群体。本文采用实地研究与文献研究的方法,对精神残疾人的社会保障需求与供给进行专门考察。研究发现,精神残疾群体的主要需求包括治疗、基本生活支持、康复、长期照护与监管以及社会参与。对此,我国政府已通过多项社会保障制度安排予以回应,基本满足了精神残疾人的基本生活与治疗需求,但还存在社区康复服务匮乏、替代性照护服务供给不足、就学、就业难等问题。基于以上发现,本文认为精神残疾人的基本生存权虽得到较好保障,但是对其发展权和参与权依然关注不足。原因在于当前精神残疾人社会保障存在三个不平衡:经济保障与服务保障发展的不平衡,医疗服务与社会服务发展的不平衡,以及卫健、民政、残联不同部门能力与投入的不平衡。针对这些问题,笔者对未来政策的完善提出了参考建议。     

Examining More Inclusive Approaches to Social Work,Physical Disability,and Sexuality

People with disabilities often experience the idea that those with disabilities are not, or should not be, sexual beings. This article examines how people with physical disabilities define sexual activity, their levels of sexual satisfaction, group differences in how people define different acts as sexual activities, and the differences in levels of sexual satisfaction. Additionally, this study (N?=?450) looks at the correlations between levels of independence in multiple contexts. Levels of independence are also assessed in relationship to severity of disability and sexual satisfaction. Implications for social work and social service practice, education, and policy are discussed.     

How is participation related to well-being of homeless people? An explorative qualitative study in a Dutch homeless shelter facility

The majority of homeless people is socially excluded which negatively affects their well-being. Therefore, participation-based programs are needed. The current research is conducted within a Dutch homeless shelter facility that offers educational, recreational, and labor activities to clients in an environment which is designed to feel safe (an enabling niche). The main aim of these activities is to facilitate social participation. We conducted two qualitative studies consisting of 16 semi-structured interviews, to explore clients’ experiences with participation in activities in relation to their well-being. The findings showed that clients experienced that participation had led to an improvement of physical, social, and mental well-being. In general, clients reported that due to participation in activities they have strengthened their social support network, improved their (mental and physical) health, self-esteem and personal growth. We concluded that in order to facilitate long-term positive outcomes of participation in practice, it is necessary to focus on group cohesion, and on the social worker’s behavior and attitude.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

Promoting sexual well-being in social work education and practice

This paper explores the importance of including sexual well-being within social work practice and education. Social workers often work with individuals for whom opportunities for sexual expression are limited and who face discriminatory attitudes. Sexual well-being is a global concern, and is particularly relevant considering international interest in the influence of notions of well-being on mental and physical health. Implementation of new social care policy in England, underpinned by the well-being principle, provides practitioners with the opportunity to explore what is meaningful to individual’s well-being through person-centred approaches to practice. There is currently little coverage of sexual well-being within social work education, this means students and practitioners lack the knowledge and skills to challenge barriers. Promotion of the concept of sexual citizenship, with its associated rights and responsibilities, enables social workers to engage in rights focused practice. Sexual well-being is a sensitive subject and the social and personal barriers practitioners may experience in addressing this topic are explored.     

Disablism in the lives of people living with a chronic illness in England and Portugal

This article is based on research about the daily lives of people living with chronic illnesses in England and Portugal. Through the first-person narratives of participants, I argue that the lives of people living with debilitating chronic illnesses are affected by disablism, discrimination and exclusion. These aspects affect them in several important realms of life such as lack of or poor social support, difficulties in obtaining reasonable adjustments or the inability to obtain any kind of state support at all. These aspects are also widespread and compound and greatly influence their lives, beyond or in addition to the physical experience of the illness itself. I conclude that it is fundamental to change these structural and policy aspects and that people should have access to what I have termed a paradigm of sustained well-being, despite the illness.     

Living on a knife edge: the responses of people with physical health conditions to changes in disability benefits

Abstract

This article documents the experiences of people with a physical health condition or disability who have experienced a loss of or change in disability benefits under the welfare reform programme in the United Kingdom. A theoretical model was constructed using in-depth interviews and grounded theory methods. The findings show that participants experienced the benefits system as dehumanising, and felt that they lived in a judgemental and invalidating society, where they were perceived as ‘scroungers’ and faced discrimination from others. These experiences negatively affected their mental and physical health and well-being. They also negatively affected participants’ identity, leading to experiences of shame, hopelessness and social isolation. However, many participants attempted to resist these negative impacts (e.g. through seeking support or taking political action). The findings demonstrate the significant impact of benefit changes on well-being and identity, thus highlighting important implications for claimants, and staff in healthcare, the benefits system and government.     

We did it together: a participatory action research study on poverty and disability

This article presents the perspective of both non-disabled and developmentally disabled people working together in a research project on poverty and disability. Our study used a participatory action research approach that challenges the norm of exclusion in the research process. Control of the research agenda has been inclusive and shared to varying degrees in accordance with the needs and desires of the members of an advisory committee of developmentally disabled people living with low income. We reflect on our process of working together according to four principles of participatory action research with disabled people. We discuss our successes and challenges enacting these principles in the hopes that future researchers can build upon our experience to be more inclusive of developmentally disabled people in their work.     

‘Now I’d like to sleep with Rachael’ – researching sexuality support in a service agency group home

Many intellectually disabled people living in agency services require significant forms of support to live safe and satisfying sexual lives. Research reveals that despite support personnel working in service systems now holding largely positive attitudes towards sexuality assistance, proactive practice is rarely initiated. This article probes what might lie within this attitude/assistance gap. This investigation reveals a complex picture of practices that rely on intellectually disabled people showing conformation to a ‘couple doing normal’ ideal, so as to be judged capable of being supported. It examines how wider social locations of meaning related to ‘intellectual disability’ and ‘sexuality’ might substantiate these judgement calls. The degree to which it can be said that worker’s own attitudes and values underpin their reluctance to provide support is then explored. Finally, why researchers and practitioners might need to reappraise the complex interactions that shape worker’s practice in this area is discussed.     

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.     

The accommodation and support needs of people with a mental illness: A process and framework for action

Abstract

This paper reports the results of a consumer-focused assessment of the accommodation and support needs of people with a mental illness living in a regional city. The study utilises a 'pathway to stability' approach to assess the phase-contingent accommodation and support needs of mental health consumers through interviews and focus groups with consumers, carers and service providers. The study identifies five broad phases of the life course impacted by mental illness—beginnings, long-term needs become clearer, instability as needs evolve, finding stability and ongoing. Five key issues—information, self-competence, comorbidity, coordination and flexibility were expanded upon in focus groups. Principles for planning future service delivery are identified. The implications of the findings and research methodology for social work practice and research are discussed.     

Identity challenges and social experiences of higher education students with disabilities in Slovenia

This article focuses on the experiences and experiencing of disability, policies of self-understanding, and the life plans and aspirations of students with disabilities. The article draws on the results of a qualitative survey of students with disabilities taking courses in various faculties of the University of Ljubljana. The results show that students with disabilities are able to reshape their identities in a way that does not consist of the disability experienced, but is independent of it, and they are able to accept their disability as the reality of life without losing their own purpose of living and life plans. This experience is a significant part of the identity formation of people with disabilities, and the social experience of people with disabilities strengthens their selfhood while also producing new responses and challenges to contemporary issues of identity formation and identity policies.     

The sexual side of physical disability

This article describes the format and evaluation of a study day on the sexual side of physical disability. Many staff, such as social workers, occupational therapists, doctors and nurses, who work with disabled people, feel that there is a need to discuss with them how their disability may affect sexual and emotional relationships and what can be done to overcome any problems which might arise. They are, however, reluctant to raise the subject of sexuality, first because they have insufficient information, so have no positive suggestions to offer, and second because of feelings of embarrassment and other, perhaps unexplored, feelings about sexuality and disability. The study day was designed to help social workers and other staff to feel comfortable enough to raise this important topic with their clients.     

Health of Carers of Young People with Early Psychosis: A Biopsychosocial Approach

Despite widespread recognition of the usefulness of a biopsychosocial approach in social work, there are limited studies exploring how social workers can use this approach to support the health and wellbeing of carers of young people with first episode psychosis (FEP). Validated questionnaires and anthropometric measures were used to assess the physical health and wellbeing of 42 carers of young people with FEP. Carers had moderate levels of negative caregiving consequences, quality of life, and health status. More than half (52.4%) of carers were experiencing social isolation. Many carers were overweight (78.6%), had a high risk for type 2 diabetes (39.0%), and had hypertension (33.3%). Practical implications of a biopsychosocial approach to social work that supports both clients and their carers are discussed.     

Dementia,disability rights and disablism: understanding the social position of people living with dementia

This article considers the recent history and consequences of positioning people living with dementia in the realms of disability, disablism and disability rights. The geo-political focus is the United Kingdom and neighbouring resource-rich nations in the Global North. The first section examines the growing trend of identifying ‘dementia’ with ‘disability’, a trend fuelled by the expansion of dementia-related activism and research. The second section focuses on how researchers who have published in Disability & Society and other journals have applied the social model of disability to individuals living with dementia. The third section discusses three conceptual challenges that lie ahead for those who choose to research and theorise the dementia/disability connection. These challenges concern: theorising dementia as disability; understanding intersectionality in dementia contexts; and understanding ‘abuse’ in dementia contexts.     

Applying a social model of disability across the life span

With an estimated 21.3% of persons aged 15 and older experiencing disability in the USA, social workers will see clients present with disabilities across all practice settings and stages of human development. Yet, the training and terminology of social workers—which often closely aligns with medical professionals—may seem to occur in isolating silos or disciplinary theories. Social work education often views the needs of older adults and people with disabilities as two distinct populations, despite the fact that many of these individuals share similar needs for access, resources, and support. Furthermore, when discussing human development, the focus may skew to individual affective, behavioral, and cognitive processes and indicators of abnormal development and frailty. Thus, by clarifying terminology and applying a social model of disability across the life span, we identify how educational efforts related to human behavior and the social environment can promote intersectional and inclusive social work related to aging and disability.