Disability, culture and the U.N. convention

Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps

The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use.

Impact of transition to an individualised funding model on allied health support of participation opportunities

Introduction: The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts.Materials and methods: Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding.Results and discussion: Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding.IMPLICATIONS FOR REHABILITATIONThe introduction of individualised funding has removed barriers to participation for many National Disability Insurance Scheme recipients.Efforts must be made to build the trust of stakeholders involved in National Disability Insurance Scheme service provision regarding how fee-for-service funding can lead to good participation outcomes for scheme recipients.Transparency around the shared processes of clinical governance and equitable service access operating in Australia's individualized disability funding scheme are suggested to build trust.A visible commitment to maintaining a broad range of services is also indicated to build trust for stakeholders involved in the scheme.

The influence of social context on the perception of assistive technology: using a semantic differential scale to compare young adults' views from the United Kingdom and Pakistan

Background and aim: A Society's view of disability may influence the perception and use of Assistive Technology (AT) products. Semantic cues or cultural coding provide the viewer with a series of visual stimuli to be given or ascribed meaning. Previous research has shown cognitive approaches to visual perception and assignment of meaning vary between diverse cultures. This study reviews the influence of contextual settings on perception, to provide the basis for a debate on the societal perception of communicative content (semantic/meaning) of an AT product; and, the relevance of different cultural cognitive styles. The paper explores, from a cultural viewpoint, the overall understanding of disability internationally.Method: A Semantic Differential (SD) scale was used to obtain views on the image of an attendant wheelchair from nine hundred and ninety-one (991) young adults from the United Kingdom (UK) and Pakistan (PAK), reflecting the individualist and collectivist societies, respectively. This survey follows a previous paper-based study using the same image and protocol. Comparing the two surveys, a consensus of views from the two groups was achieved.Results and conclusion: The responses from the UK group were skewed towards a negative view of disability compared to the Pakistan group. This inferred greater social stigma associated with this AT product in the UK. The combined findings from both surveys provide insights into societal perception of AT products and disability. Areas for future research are suggested, including what visual components of an AT product (graphemes) appear to be associated with positive or negative responses for collectivist and individual societal groups.Implications for rehabilitationAssistive Technology (AT) product designers, academics, professionals and stakeholders need to be aware of challenges which are originated from one's socio-cultural environment. AT products convey certain meanings, semantics, which are interpreted by the society and are subjective to a specific cultural setting.•For the effective communication of meanings and values an AT product relies on the visual clues and design features embedded within the design. However, there have been a limited number of studies reviewing this aspect of product semantics.•The survey and associated testing has highlighted the differences in cultural perception towards AT products and demonstrated the importance of effectively designing the semantic attributes of an AT product as well as its function.•The demonstration of the efficacy of methods within the study for exploring the interpretation of semantic attributes of AT products will help designers and developers better understand the perceptions of individual cultures and societal groups.•A better understanding of different cultures and societies will enable designers and clinicians who specify AT products to reduce AT product abandonment; and, the associated stigma around disability.

The Perception of Disability Among Mothers Living With a Child With Cerebral Palsy in Saudi Arabia

The purpose of this study was to explore the perceptions of disability among Saudi mothers and to understand the implication of the meaning for the mothers of children with disability. A critical ethnographic approach was employed using focus groups and follow-up interviews with the mothers. Three primary themes were identified that specifically influenced and affected the mothers’ experiences: (a) culture and religion, (b) motherhood and disability, and (c) community stigma and discrimination. The study reveals much-needed knowledge and sheds light on a topic, the details of which are rarely available in research literature from the Middle East. The findings further endorse the need for clinicians to listen to the mothers to consider their beliefs and the impact of these beliefs on their experiences. This, in turn, may provide a valuable conceptual lens for health care practitioners to use the family-centered model when working with cerebral palsy children.

Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada

BACKGROUND

Persons with psychosocial disabilities face disparate access to healthcare and social services worldwide, along with systemic discrimination, structural inequalities, and widespread human rights abuses. Accordingly, many people have looked to international human rights law to help address mental health challenges. On December 13, 2006, the United Nations formally adopted the Convention on the Rights of Persons with Disabilities (CRPD) - the first human rights treaty of the 21st century and the fastest ever negotiated.

METHODS

This study assesses the CRPD's potential impact on mental health systems and presents a legal and public policy analysis of its implementation in one high-income country: Canada. As part of this analysis, a critical review was undertaken of the CRPD's implementation in Canadian legislation, public policy, and jurisprudence related to mental health.

RESULTS

While the Convention is clearly an important step forward, there remains a divide, even in Canada, between the Convention's goals and the experiences of Canadians with disabilities. Its implementation is perhaps hindered most by Canada's reservations to Article 12 of the CRPD on legal capacity for persons with psychosocial disabilities. The overseeing CRPD Committee has stated that Article 12 only permits "supported decision-making" regimes, yet most Canadian jurisdictions maintain their "substitute decision-making" regimes. This means that many Canadians with mental health challenges continue to be denied legal capacity to make decisions related to their healthcare, housing, and finances. But changes are afoot: new legislation has been introduced in different jurisdictions across the country, and recent court decisions have started to push policymakers in this direction.

CONCLUSION

Despite the lack of explicit implementation, the CRPD has helped to facilitate a larger shift in social and cultural paradigms of mental health and disability in Canada. But ratification and passive implementation are not enough. Further efforts are needed to implement the CRPD's provisions and promote the equal enjoyment of human rights by all Canadian citizens - and presumably for all other people too, from the poorest to the wealthiest countries.

Adolescents with Hearing Loss and the International Classification of Functioning, Health, and Disability: Children & Youth Version

In 2007, the World Health Organization published a set of International Classification of Functioning, Disability and Health (ICF) codes designed for children and youth (ICF-CY version). The ICF-CY considers typical developmental changes associated with childhood while describing health status and the effects of intervention. In this article we will describe how a specific intervention (transition planning for adolescents) can be documented with the ICF-CY. Transition planning in health care prepares adolescents and their families for the transfer from pediatric to adult health services and has been demonstrated to be an effective practice for adolescents with many types of chronic health conditions (e.g., cystic fibrosis, epilepsy, diabetes). Audiology has not yet addressed transition planning for adolescents with hearing loss; therefore, we propose using the ICF-CY to design a pathway of care. The ICF-CY can standardize transition planning to the benefit of both teen patients and audiologists: teens and their families would gradually acquire necessary knowledge and skills, and audiologists would develop a meaningful data set to help further inform our pediatric practices, as well as give more structure, depth, and accountability to our role in rehabilitation.

Environmental factors influencing participation of stroke survivors in a Western Cape setting

Background

Environmental factors compound or diminish the effects of impairments; therefore they have a direct influence on participation of stroke survivors.

Objectives

To determine environmental barriers and facilitators to participation experienced by a group of stroke survivors in the Western Cape province of South Africa.

Methods

A descriptive, mixed methods study was conducted in 2011. Quantitative data was collected with the International Classification for Functioning, Disability and Health core set for stroke (environmental factors), from 53 stroke survivors, sampled through proportional, stratified, random sampling. Data is presented through graphs and tables. Qualitative data was collected from five purposively sampled participants and thematically analysed.

Results

Under products and technology, participants regarded assets, food, products and technology for daily living, transportation, mobility and communication, and access to buildings as barriers. The physical geography and attitudes of friends and society created further barriers. With regard to services, systems and policies - housing, communication, transport and social services created barriers. Health services, as well as support from health care service providers and family were considered facilitators.

Conclusion

A lack of assets compounded barriers with regard to food, products for daily use, communication and transport. Barriers to participation were exacerbated by a lack of services, systems and implementation of policies focused on the inclusion of people with disabilities, as well as minimal access to assistive devices. Recommendations include provision of assistive devices, structural changes to houses, yards, roads and buildings, lobbying for accessible, affordable public transport, access audits of public buildings, and inclusion of non-governmental organisations and home-based care services in a seamless network of care.

A macro perspective for client-centred practice in curricula: Critique and teaching methods

BACKGROUND

Client-centred practice is often eclipsed by social, economic, and political inequities. Ignoring these realities obstructs clients' goal attainment.

OBJECTIVES

The author advocates for the integration of a macro perspective inclusive of participation barriers and supports in occupational therapy curricula and seeks to motivate educators to adopt teaching approaches that develop students' abilities to address the complexities of client-centred practice.

METHOD

This article integrates a critical analysis of the literature on client-centred practice with reflexivity on disability studies and autoethnography.

FINDINGS

Educational standards require students to learn about the social, economic, and political contexts that impact on client-centred practice and the need for advocacy to enable participation. Theoretical support of a macro perspective for client-centred practice is strongly evident in the literature. Information on methods for teaching students how to actualize these concepts in practice is scant. Thus, strategies to inform the integration of a macro perspective into curricula and concrete activities to develop students' competencies for empowered client-centred practice are required.

CONCLUSION

Educators have an ethical responsibility to critique their pedagogy to determine whether they are adequately preparing students for client-centred practice. The focus must move from teaching a micro perspective of client-centred practice to a macro perspective that enables occupational justice and empowerment.

The Convention on the Rights of Persons with Disabilities: a foundation for ethical disability and health research in developing countries

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has foregrounded disability as a human rights and equity issue, elevating it to a priority global research area. Academics from Western universities are likely to play an increasing role in disability health research in developing countries. In such contexts, there is a need to bridge the gap between procedural ethics and the realities of disability research in cross-cultural contexts. We provide guidance on engaging in ethical disability health research that intersects with and upholds the CRPD. We highlight challenges and tensions in doing so, underscoring the need to be sensitive to the sociocultural and political context of disability that determines how ethical research should proceed. We conclude with 5 recommendations.

Universally design social policy: when disability disappears?

PURPOSE

The aim of this paper is to review and evaluate the legal and policy feasibility of applying the principles of Universal Design (UD) to create a "universalised disability policy" that targets the needs and circumstances of persons with disabilities in light of universal human rights, conscious of individual differences.

METHODS

Applying modified versions of the principles of UD to disability social policy and using core interpretative strategies for human rights implementation (used in the United Nations' Convention on the Rights of Persons with Disabilities) to illuminate, by analogy, ways to resolve the dilemma between seeking equality and respecting difference.

RESULTS

The aspirations of UD in architecture and planning - namely to design buildings and cities to accommodate the needs of the widest spectrum of abilities as possible - can successfully be applied to social policy that focuses on the needs and circumstances of persons with disabilities, and which underwrites a blueprint for reform in the delivery of social services.

CONCLUSIONS

"Universal social policy", and UD, are feasible and desirable approaches to their respective domains, if we adopt a strategy derived from the legal interpretation of human rights implementation. The consequence, however, may be a policy that begins a process of social disappearance of disability. Implications for Rehabilitation The well-recognised principles of Universal Design (UD) have analogs for social policy that focuses on the needs of persons with disabilities. Universal social policy is consistent with the rights and aspirations of the UN Convention on the Rights of Persons with Disabilities. Universalising social policy may lead eventually to the disappearance of "disability" as a policy category.

All talk, no action?: the global diffusion and clinical implementation of the international classification of functioning, disability, and health

OBJECTIVE

We aimed to review the global diffusion and clinical implementation of the International Classification of Functioning, Disability, and Health (ICF) endorsed by the World Health Assembly in 2001.

DESIGN

First, we analyzed the diffusion process of the ICF, with a special focus on clinical rehabilitation. This was done by researching the spread of ICF-related terms in Pubmed and Google from 2001 to 2010. Second, we examined the clinical implementation of the ICF in rehabilitation settings by a systematic review of the literature in the databases Pubmed and Embase. Eligible were studies evaluating the current application and impact of the ICF in the daily practice of clinical rehabilitation.

RESULTS

We found that the diffusion of the ICF as a mere term and concept in the area of rehabilitation is successful. However, the implementation in clinical rehabilitation practice is highly idiosyncratic and rarely evaluated appropriately. The question arises whether this idiosyncratic implementation can be regarded as a process toward standardization at all. Evidence of concrete benefits of a clinical ICF implementation for team members or even patients is at best weak.

CONCLUSIONS

We suggest more comprehensive and comparable multicenter studies to solve the urgent need for best practice recommendations on ICF implementation in clinical rehabilitation.

Ethics, disability and the International Classification of Functioning, Disability and Health

This article offers preliminary reflections on the potential application of the International Classification of Functioning, Disability, and Health (ICF) to the developing literature on disability ethics. As an epidemiologic tool--an international standard language of functioning and disability--the ICF has instrumental ethical significance as its application is governed by standard bioethical concerns of informed consent, confidentiality, and respect for persons. However, the ICF also has an intrinsic ethical significance, so far untapped, arising from three conceptual features of its model of functioning and disability, namely universalism, the interactional model, and etiologic neutrality. The future of the ethical dimension of ICF is briefly explored.

Disability, human rights, and the International Classification of Functioning, Disability, and Health: systematic review

This literature review focuses on the literature on disability from the ethical and human rights perspective in the light of the International Classification of Functioning, Disability, and Health in the period from January 1, 2008, to June 30, 2010. This article identifies and examines studies that deal with the subject of disability with reference to rights, ethical issues, and justice. A total of 42 articles and 33 books were selected. The subject most frequently dealt with in studies on disability is that of human rights (76% of the articles and 79% of the books examined), followed by topics relating to welfare (52% of articles and 64% of books), International Classification of Functioning, Disability, and Health (38% of articles and 45% of books), justice (24% of articles and 48% of books), education (21% of articles and 61% of books), and work (19% of articles and 39% of books). The subject of disability is dealt with in various fields of study and various disciplines. Most of the studies are based on the legal approach. It is to be hoped that there will be an increase in the philosophical and ethical study of disability, which has only recently entered the European debate.

Development of an ICF-based eligibility procedure for education in Switzerland

Starting in January 2011, Switzerland will implement a multidimensional, context-sensitive procedure to establish eligibility in education systems. This paper provides a brief overview of the different eligibility-related practices with a special focus on children with disabilities. The paper then outlines the philosophical and conceptual framework of the eligibility procedure based on the International Classification of Functioning, Disability and Health, and the UN Convention on the Rights of Persons with Disability. The different components and methodology applied to organise information in the process towards establishing eligibility are also presented. Finally, some observations are made regarding transparent and just applications of the eligibility procedure, and the implementation of this new eligibility procedure.

Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems

A common framework for describing functional status information is needed in order to make this information comparable and of value. The World Health Organization's International Classification of Functioning, Disability and Health (ICF), which has been approved by all its member states, provides this common language and framework. The article provides an overview of ICF taxonomy, introduces the conceptual model which underpins ICF and elaborates on how ICF is used at population and clinical level. Furthermore, the article presents key features of the ICF tooling environment and outlines current and future developments of the classification.

Monitoring the United Nation's Convention on the Rights of Persons with Disabilities: data and the International Classification of Functioning, Disability and Health

This paper approaches the general issue of the complex challenges in the relationship between those who generate data -- researchers, scientists, and state statistical offices -- and those who use data -- researchers and policy-makers -- in light of the more specific policy challenges created by the monitoring requirement of the United Nation’s Convention on the Rights of Persons with Disabilities (CRPD: Article 33). International Conventions and Treaties standardly suffer from being persistently ineffectual primarily because of the absence of implementation mechanisms. The CRPD, by contrast, explicitly requires State Parties who have ratified it to institute data generation and monitoring mechanisms for its implementation. This paper argues that WHO’s International Classification of Functioning, Disability and Health (ICF) can be brought into the service of the CRPD data generation and monitoring mandate, both in the shaping of relevant data streams and in the creation of relevant indicators, and concludes by reviewing the challenges that remain.

Towards a common disability assessment framework: theoretical and methodological issues for providing public services and benefits using ICF

PURPOSE

To report on the preliminary results of an Italian project on the implementation of an ICF-based protocol for providing public services and benefits for persons with disabilities.

METHODS

The UN Convention on the Rights of persons with disabilities (UNC) was mapped to the ICF, and core elements were implemented in an ICF-based evaluation protocol. A person-environment interaction classification (PEIC) tree was also developed for defining evaluation outputs.

RESULTS

The PEIC and the ICF-based protocol are the guideline and the data interpretation source, respectively, for providing public services and benefits. They enable to assign persons to different services, from surveillance and monitoring to facilitator provision or sustain over time, to barrier removal or to the reorganisation of environmental factors provision. A detailed description of the target intervention is made available through the implementation of a protocol, which points out the effect of personal support and other environmental factors.

CONCLUSIONS

The detailed description of functioning and disability provided by our methodology can help policy makers and administrators in decision making, on the basis of a description of real needs, and in targeting person-tailored interventions.