Bethan Collins

Can Disability Studies Contribute to Client-Centred Occupational Therapy Practice?:

Occupational therapists frequently cite a ‘client-centred’ approach as a fundamental aspect of their practice. However, there are many examples in the narratives of disabled people that suggest that the health and social care services they experience do not quite meet this aspiration. The authors propose that an understanding of disability from disabled peoples perspectives is elemental to client-centred practice and that knowledge of the academic discipline of disability studies can contribute to authentic client-centred occupational therapy.

“My view that disability is okay sometimes clashes”: experiences of two disabled occupational therapists

Abstract Aims: While disability is the focus of much attention in occupational therapy, there has been little attention paid to disability within the profession. Disabled therapists not only bring valuable perspectives on disability, but also pose important challenges to taken-for-granted assumptions about impairment and disability within the profession. At the same time, their cultural beliefs and values may clash with core assumptions of the profession. Methods: This study analyses interview data from two disabled occupational therapists, part of a larger study with cultural minority therapists. Semi-structured interviews explored their experiences of professional practice in the context of societal belief in the superiority of non-disabled and “normal” ways of doing and being. Major findings: Some cultural values of participants clashed with the values and beliefs of their profession, particularly concerning independence. Negative attitudes of colleagues and managers were the key barriers to practice. The responsibility for bridging the disabled/non-disabled cultural divide rested with the disabled therapists, exacerbating inequity. Nonetheless, these therapists believed their disability experiences had advantages for practice. Conclusions: Disabled therapists may be required to engage in invisible work to communicate across cultural differences, and to educate others. Respectful openness to difference could enhance the practice competence of both disabled therapists and their non-disabled colleagues. This demands critical reflexive attention to ableism within the profession.

Reflections on doctoral supervision: drawing from the experiences of students with additional learning needs in two universities

Supervision is an essential part of doctoral study, consisting of relationship and process aspects, underpinned by a range of values. To date there has been limited research specifically about disabled doctoral students’ experiences of supervision. This paper draws on qualitative, narrative interviews about doctoral supervision with disabled students. The key reflection is that supervisory relationship was more highly valued than process aspects of supervision. A good relationship was characterised by good communication, willingness to listen and flexibility; it enabled students with additional learning needs to navigate the process aspects of the doctoral journey. Flexibility was the most commonly requested support. Promoting a positive relationship that enables flexibility within the pressure for timely completions respresents a key dilemma for supervisors of disabled students

Physically Disabled Adults’ Perceptions of Personal Autonomy Impact on Occupational Engagement

Despite the prominence of the concept of autonomy in the UN Convention on the Rights of Persons With Disabilities and within disability theory, the relevance of autonomy to occupational engagement is unclear. Using a qualitative, narrative approach, eight adults with significant physical disabilities engaged in iterative interviews exploring their life history and perception of autonomy in daily life. Interviews were transcribed verbatim and themed. Key themes that emerged were that participants valued autonomy differently; their perception of their own personal autonomy influenced both occupational choices and the meaning derived from occupational engagement. While some participants actively sought occupations in which they could make decisions, others preferred more supportive environments, yet all participants avoided situations in which their autonomy was undermined. Awareness of an individual’s values regarding autonomy could assist occupational therapists to both select appropriate occupations for intervention and discuss the meaning derived from occupations, thereby enhancing client-centered practice.

The Affirmative Model of Disability: A Means to Include Disability Orientation in Occupational Therapy?

Disability orientation is a missing concept in occupational therapy. Disability orientation describes a persons interpretation of his or her disability experience and his or her perceptions of the meaning of being disabled. One orientation is that of affirmation, which originates in the affirmative model. This takes a non-tragic view of disability and impairment, and rejects the assumption that disability is necessarily negative. Instead, those with an affirmative orientation view disability as difference that can be celebrated and can enrich life. Since occupational therapists may work with people with an affirmative disability orientation, understanding and acceptance of this orientation could support client-centred practice.

First- and second-generation design and engineering students: experience, attainment and factors influencing them to attend university

ABSTRACT Challenges for students who are ‘first-in-family’ to attend university have been discussed within widening participation discourse. However, in the UK, ‘first-in-family’ or first-generation students have frequently been conflated with those experiencing poverty or from lower socio-economic groups. This research integrated survey data with assessment data from final-year design and engineering students in a UK university to examine students’ attainment, the influences on why students decide to attend university and students’ experiences during their degree programmes. Analysis of the data showed variations in the reasons for first- and second-generation students wanting to go to university, particularly a significant difference in the influence of parents. First-generation students described significantly less parental influence on the decision to attend university than second- or subsequent-generation students. Smaller differences in students’ experiences and attainment in university were also noted. Whilst first-generation students reported differences in study habits, their attainment was, on average, marginally higher than that of their peers. Building on others’ theoretical work, which suggests the importance of social capital within higher education (HE), this research highlights the difference in social influences on both university application and expectations of university for those with and without a family history of tertiary education. Further research is needed to explore, in larger samples, whether the social influences on individuals’ perception of HE are in turn shaped by whether or not their parents attended university, and further, what impact this may have, not only on degree outcomes but also on the broader benefits typically associated with graduate experience.

Troubling ideas for widening participation: how higher education institutions in England engage with research in their access agreements

This article explores how higher education institutions in England engage with research in their access agreements. Through an analysis of access agreements from 2014-15 to 2016-17, a picture of how research is understood, undertaken and documented emerges. A lexical analysis of the texts was used to establish the different ways research is being referred to or funded as part of the access agreement process. The analysis shows a productive relationship between national policy and institutional activity. But there appears to be a lack of infrastructure at an institutional and sector level to join up sustained and rigorous research with widening participation activity and policy. This means that, even after ten years of access agreements, widening participation is not fully embedded into the academic practice of higher education. We argue that research undertaken as part of the access agreement process can provide much needed evidence of impact and situate activity within an institution-wide context. However, we also suggest that widening participation research has the potential to offer productive troubling ideas to dominant rhetoric and, in so doing, shape new ways of thinking about, and doing, widening participation within institutions and across the sector.

Promoting sexual well-being in social work education and practice

Abstract 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.

Dignity and respect during pregnancy and childbirth: a survey of the experience of disabled women

BackgroundDespite the increasing number of women with disability globally becoming pregnant, there is currently limited research about their experiences. A national survey of women’s experience of dignity and respect during pregnancy and childbirth raised concerns about the possibility of women with disability having unequal care with overall less choice and control. To address this further we conducted a study to explore the experiences of dignity and respect in childbirth of women with disability.MethodsThe study involved a self-selecting, convenience sample of 37 women who had given birth in the United Kingdom and Ireland and had completed an internet-based survey. Women were identified through online networks and groups of and for disabled parents and for people with specific medical conditions. Data were collected using an online survey tool. Survey data were analysed using descriptive statistics. Thematic analysis was used for open questions.ResultsDespite generally positive responses, just over half of the group of women expressed dissatisfaction with care provision. Only 19% thought that reasonable adjustments or accommodations had been made for them (7/37). When reasonable adjustments were not in place, participants’ independence and dignity were undermined. More than a quarter of women felt they were treated less favourably because of their disability (10/37, 27%). At all points in the pregnancy continuum more than a quarter of women felt their rights were either poorly or very poorly respected; however this was greatest in the postnatal period (11/35, 31%). In addition, more than half of the women (20/36, 56%) felt that maternity care providers did not have appropriate awareness of or attitudes to disability.ConclusionsWomen’s experiences of dignity and respect in childbirth revealed that a significant proportion of women felt their rights were poorly respected and that they were treated less favourably because of their disability. This suggests that there is a need to look more closely at individualised care. It was also evident that more consideration is required to improve attitudes of maternity care providers to disability and services need to adapt to provide reasonable adjustments to accommodate disability, including improving continuity of carer.

Interpretative Phenomenological Analysis: A means of exploring aspiration and resilience amongst Widening Participation students

As the Office for Fair Access and the Higher Education Funding Council for England priorities now extend across widened access to success, both the aspirations of young people from widening participation (WP) backgrounds and their existing or developing resilience as students are of concern to Higher Education institutions. In this paper, these positive psychology concepts of aspiration and resilience are used in two different studies each seeking to move away from the prevalent discourse of deficit. This paper thus offers the joint perspective of two researchers exploring the phenomena of a) aspiration in students from low participation neighbourhoods and b) resilience in students from low-income backgrounds. Interpretative Phenomenological Analysis (IPA) is utilised by both to offer a credible, insightful research approach which may enable educators, researchers and policy-makers to appreciate the nature and significance of WP students’ experiences in a previously unseen way, thus enabling effective interventions and methods of support. Through in-depth exploration of the cognitions and emotions of young people from WP backgrounds, the researchers discuss how listening to individual stories can provide rich data that may enhance future support for students. Important methodological challenges and the implications of applying IPA to both studies are debated; including use of language to convey meaning, the role of researcher reflexivity and the difficulties in achieving a truly interpretative account of the phenomenon. Whilst often a challenging methodology, IPA can provide rich, contextualised accounts which contribute to the limited extant qualitative literature on WP student aspiration and resilience.