Adults with learning disabilities - Essay Example

Introduction A learning disability (LD) is defined as a neurological disorder. It is the result of a difference in wiring in some adults and children. Those who experience a LD may be as intelligent, or even smarter, than their cohorts, although they have difficulty with an activity/s, such as; reading, writing, spelling, recall and reasoning, as well as the organisation of learnt material (Vaughn & Fusch, 2003). Interventions to aid adult learners with LD have changed dramatically over the past century (D'Amato, Crepeau-Hobson, Huang, & Geil, 2005). This paper will critically review the development of the present day approaches to intervention to demonstrate the benefits of the social-model. Firstly, a historical perspective will be given to illustrate the growth of LD service delivery from a medical-model approach, labeling theory to a social-model approach. Secondly, person-centred planning shall be critically discussed. Next issues of anti-oppressive practices with regard to gender will be outlined. Finally, a conclusion shall synthesise the main points of this paper to identify the advantages that social-model based interventions can have. It is anticipated that this paper will inform research to aid adults with LD to be encouraged in their strengths, aware of their weaknesses, and to better understand health and social care systems approaches to providing care. The Medical-Model, Labeling Theory and a Contemporary Social-Model Approach In the early 19th century the leading model of care for adults with a LD was grounded in the broad system of health care (Young, 2006). Following the industrial revolution and the mass migration of the rural population to the cities those with a LD tended to be among those living in poverty and performing enforced labour. In the mid-19th century many concerned citizens debated the humanity of the conditions of those living in poverty, and who were experiencing ways of being such as a LD. The medical-model approach at the time considered the people housed within asylums as 'having a problem' that was not able to be worked with. The patients were often treated as children and robbed of their dignity and seen as not able to make the correct choices for them to ensure good health. According to the medical-model those with a LD were a threat to the 'contamination' of the UK gene pool. Hence, this later medical-modal approach continued with the view of a biological condition alone, that could not be altered in any way by 'nurturing'. And by taking a rigid 'nature' view of LD saw the person experiencing the condition as beyond hope of social interventions, and that wider society (i.e., environment) had no responsibility as to how those with LD experienced life and well being. Dramatic changes came following the Wars, when the atrocities of Nazi experiments highlighted the need for more thought into what it means to be human, issues of dignity, welfare, protection and human rights. The dawn of ethical research and treatment had come. Whilst the medical-model remained focused on diagnosis, treatment and monitoring for effect, the idea that living experiences for those with LD could be improved took hold. The new version of the medical-model emphasised the possibility of treatment by identifying and strengthening cognitive abilities of those with LD (arrowsmithschool.org, 2007). "When the weak areas of the brain are strengthened.the learning disability is reduced or removed." (Steinberg, 2007, p. 1). In 1946 there was the introduction of the National Health Service in the UK and with it came the creation of the term 'mentally handicapped' and the institutions developed into hospitals with a focus on caring for patients. Society had shifted from seeing those who were LD as dangerous and a potential infectious threat, to people in need of interventions and treatment. Labeling theory (Tannenbaum, 1938), grew in popularity as those with LD who adopted deviant behaviors, such as drug use and or crime, were considered to be the 'victims' of social stereotyping, their characters developing directly from social expectations of them (Davenport, 2005). Hence negative labels resulted in a self-fulfilling prophecy for LD persons, in that the labels influenced their behaviors and choices. However, the theory came under scrutiny for being too simplistic, ignoring psychological changes within the individual who is labeled and the affect of such change (Wellford & Triplett, 1993). As social conscious began to emphasise that all people in society had choice, and rights to life and choice, opportunity and respect it was contended that each person was entitled to have the extra support required to meet their needs. The social-model approach of thought contributed to changing the way in which health and social care services were planned, delivered and monitored. Person-Centred Planning The rise of person-centred planning in the late 20th century emphasized a process-focused approach to empower and enable those with a LD. Highlighted were a person's needs and their being able to define and direct their own lives. As such, a greater inclusion within society as valued members who had many aspects of themselves s to contribute to greater social functioning ensued. Person-centred planning enables LD persons to choose from amongst methods and resources to determine their own pathways to achievement, with planners on hand to facilitate and aid, not to direct (O'Brian & Lovett, 1993). Over the past two decades research and discourse have supported that social care be delivered in the UK using the social care model (e.g., Quality Indicators for Learning Disabilities, 2004). The person-centred planning perspective is inclusive of the needs, expectations and rights of the patient to improve their quality of life. In this sense the social-model, "places an emphasis on the [person's] life, rather than their body" (Young, 2006, p. 20). However, Kendrick (2003) notes that a goal of person centredness does not ensure that this will inevitably occur, and that the process will only succeed when facilitators (planners) have cultivated within themselves the acceptance that the person is to be the centre of all thinking, discourse and decision making. This view is supported by an archival investigation by Hehir (2002) defined ableism as "the devaluation of disability" that that "results in societal attitudes that uncritically assert that it is better" (p. 220). He stated that the continuing view of abelist assumptions within the education system reinforces prejudices toward persons with LD, and also likely contributes to the continuing low levels of education and employment experienced by this social group. So that the actual achievement of the goal of person-centred planning will remain dependant on how much society in general provides for those with LD to take direction of their lives (Kendrick, 2003). As social beings, each human is influenced, consciously or not, by community views. Similar to labeling theory is Kendrick's contension that what a person with a disability expects of their life is moderated by what others believe possible of them. The difference being, that Kendrick views the process bi-directionally, with collectivist and individual factors influencing the life of the individual. Anti-Oppressive Practices with Regards to Gender The complex composition of the phenomenon of oppression is evident in the lives of people with a LD who are often marginalized by wider society. Human service workers have the moral, ethical and legal responsibility to advocate for those who disadvantaged and treated unequally within society. Anti-oppressive practices have been found to effectively influence situations of inequality to improve the life chances of those oppressesed. Burke (2002) states that the personal experiences of each individual within society is directly affected by socio-cultural, political and economic relationships that are specific to geography and the historical situation. Currently in the UK society one oppressive situation that remains is gender inequality with regard to access to services in social care. Power relationships and their use and abuse occur on personal, family, community, organizational and structural levels, which are not mutually exclusive, and so shape and construct the social reality of each human service worker. In order to understand how females and males as a group gain differential access to resources and services it is necessary that human service workers be aware of the inter-relationship of the factors that can affect power relationships: For example, a white male social worker brings to the situation a dynamic that will reproduce the patterns of oppression to which black women are subjected in the wider society. In this scenario, Amelia feels she is silenced. Her plea for 'someone to talk to', to be listened to and taken seriously, is neither understood nor acted upon. This is highlighted in the powerlessness expressed in the telling of her storyThe challenge to you, the worker, is to reflect on your social division membership, your personal and professional biography and the impact that this will have on your involvement with Amelia. Are you the right worker for her If the answer is no, the challenge is not only to find a more appropriate worker but to look to ways in which you may minimise the potential for oppressive practice at the point of referral. In and through this process of thinking and reflecting, which should take place in supervision, team discussions and interactions with service users, you will begin to work in an anti-oppressive way (Burke, 2002, p. 134). Hence, one of the most challenging forces of anti-oppressive practices when working with those experiencing a LD is to recognise the obstacles, to be self-aware and to understand one's own social location that affects communication with person-centred planning and implementation: a person centred philosophy; and egalitarian value system concerned with reducing the deleterious effects of structural inequalities upon people's lives; a methodology focusing on both process and outcome; and a way of structuring relationships between individuals that aims to empower users by reducing the negative effects of social hierarchies on their interaction and the work they do together (Dominelli, 1994, p. 3) McDonald, Keys and Balcarazar (2007) undertook a narrative study of low-income African-American women and men with LD to investigate learning disabilities as they co-occur with another sociopolitical minority statuses, that of gender and ethnicity. Their qualitative analysis showed that having a LD detracts from positive gender expectations and increases negative ones; and that gender and ethnic narratives have relevance to persons experiencing a LD. The findings contrast with earlier survey research of Carlsson and Sonnander (2006) which concluded that females and males with LD and intellectual disability were delivered services in a gender-neutral way. As such, they tended to not be treated as women and men with individual preferences and needs. This highlights the need for further research into person-centred planning with regard to gender issues. Conclusion The quality of life on a day-to-day basis for adults who experience a LD has changed dramatically over the past 200 years in the West. The medical-model emphasises the physical experience of a LD and as such focuses on the body and not the actual 'person'. The social-model addresses the marginalization of those with LD, and takes a person-centred approach that seeks to meet their needs, expectations and rights for inclusiveness, quality of life and partners in decision making about their lives and well being. The social-model approach in that the NHS has implemented the healthcare directive Quality Indicators for Learning Disabilities, 2004 that aims to emphasise the critical need for those with LD to be included in decision making, social settings and health and social care partnerships to enhance their learning opportunities and improve their quality of life (Young, 2006). The person-centred approach is stated to be able to deliver real change to people's lives that experience LD by implementing a single, anti-oppressive multi-agency institution to plan, carry out and monitor this outcome. References Arrowsmith School (2007) Retreived April 15th, 2007, from arrowsmithschool.org. Burke, B. & Harrison, P. (2002). 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IDEA and disproportionality: Federal enforcement, effective advocacy, and strategies for change. In D.J. Losen and G. Orfield (Eds.), Racial Inequity in Special Education (pp. 219-238). Cambridge, MA: Harvard Education Press. Kendrick, M.J. (2003). Some predictable cautions concerning the over-reliance and overemphasis on person centred planning. The Frontline Of Learning Disability, 58. McDonald, K.E., Keys, C.B., & Balcazar, F.E. (2007). Disability, race/ethnicity and gender: Themes of cultural oppression, acts of individual resistance. American Journal of Community Psychology, 39(1-2), 145-161. O'Brian, A. & Lovett, H. (1993). Finding a Way toward Everyday Lives: The Contribution of Person Centered Planning. Pennsylvania: State Dept. of Public Welfare, Harrisburg. Steingberg, S. (2007) Retraining the brain. World Jewish Digest (March), 1-4. Tannenbaum, F. (1938). Crime and the Community.New Yor: Columbia University Press. Vaughn, S., & Fuchs, L. S. (2003). Redefining learning disabilities as inadequate response to instruction: The promise and potential problems. Learning Disabilities Research & Practice 18(3), 137-146. Young, A. (2006). Stakeholders' views on measuring outcomes for people with learning disabilities. Health and Social Care in the Community, 14(1), 17-25. Wellford, C.F. & Triplett, R.A. (1993). The future of labeling theory: Foundations and promises. Retrieved April 20, 2007, from http://www.criminology.fsu.edu/crimtheory/blomberg/thefuture.html. Read More