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Important Context for Counselling People With Disabilities and Disorders

Statistics Canada’s Survey on Disability says disability is “the result of the interaction between a person’s functional limitations and barriers in the environment, including social and physical barriers that make it harder to function day-to-day.”

Disability is a label. Labels can help experts talk to each other and create treatment plans. They can help people with disabilities feel validated and give them access to programs, funding, or accommodations.

But labels can also box a person in. Other people might see only the few things the person can’t do instead of the many things they can. Or they might assume everyone with that label is the same. But disabilities are as unique as people are.

Use labels in ways that help you to help your clients. Remember to work with the person, not the label.

Classifying disabilities, disorders, and diseases

There has been some debate over the terms “disability,” “disorder,” and “disease.” Some people use them interchangeably. It’s increasingly common to make a distinction where:

  • Condition is used as an umbrella term to encompass a variety of disabilities, disorders, and diseases.
  • Disability is a disadvantage that restricts a person’s functions or movement. It usually refers to body parts.
  • Disorder is a condition that disrupts a person’s normal functions. It usually refers to mental, developmental, or neurological phenomena.
  • Disease is a pathological process with specific symptoms that are distinct and measurable. It can be communicable or non-communicable.

This article provides general context for most disabilities and disorders, and a few non-communicable diseases. Although the lists of examples are not comprehensive, the article explores context specific to 4 groups of disabilities, disorders, and diseases:

  1. Developmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD).
  2. Learning disorders include problems with reading, writing, mathematics, and non-verbal learning disorders (NVLD).
  3. Mental health disorders include anxiety disorders, trauma- and stressor-related disorders, eating disorders, mood disorders, personality disorders, schizophrenia, and substance abuse and gambling disorders.
  4. Physical and neurological conditions. Physical disabilities include issues with vision, hearing, mobility, chronic pain, and autoimmune diseases. Neurological disorders and diseases include vascular diseases such as stroke; infections such as meningitis; structural disorders such as acquired brain injury; functional diseases such as epilepsy; degenerative diseases such as Parkinson’s disease; and autoimmune diseases such as multiple sclerosis.

It is common for more than one type of disability to coexist with others in the same or different groups. When mental health and substance use disorders coexist, for example, they are called co-occurring disorders (formerly referred to as dual diagnosis).

History and early legislation

We’ve come a long way in our view and treatment of people with disabling conditions since 1876. That was when Ontario opened the doors of Canada’s first institution for people with developmental issues. The name of that institution is now considered offensive.

Less than a century later, the call to allow polio survivors to leave hospitals and live in the community sparked the community living movement. This led to calls to deinstitutionalize people with all types of disabling conditions.

Since the mid-20th century, many international agreements and national and provincial laws have been passed. These safeguard the rights of people with disabling conditions and strive to help them participate equally in society.

Evolving models of disability

Early models

Models for managing disability, and terms describing disabling conditions, have changed along with social attitudes:

  • The charity/tragedy model views disability as unfortunate happenstance. It prevailed well into the 20th century. It sees people with disabling conditions as objects of pity. When individuals achieve things despite their limitations, they are seen as inspiring. But the disability is always considered the individual’s problem.
  • The medical model dominated the 20th century. It views disability as a biological or health issue. Defining medical criteria for disabling issues helps some individuals qualify for treatment and resources, or perhaps legal compensation for injury. But it can also exclude people whose disabling issues don’t fit narrow guidelines. The medical model sees disability as the individual’s problem. It treats people with disabling conditions as passive recipients of expert care.
  • The economic model defines disability as an inability to work. Disability advocates see this as similar to the charity model, but with public funding rather than private donation. It uses the medical model to determine who receives help.
  • The functional model is closely related to the medical model. It depends on medical diagnoses to define the disabling condition and then provides technology solutions. The focus remains on individuals as passive recipients of expert care.

Social, citizenship, and human rights models

In the latter half of the 20th century, the focus began to shift. Until then, disability was seen through a “care or cure” lens—care for the person, cure the disabling condition. Increasingly, social, citizenship, and human rights models emerged.

In these models, disability only exists because of physical and attitudinal barriers. At one or more points in their life cycle, all humans experience disability. Disability is not an individual problem to be addressed by experts, but a social issue. The solution lies in building accessible environments and passing laws to protect the rights of people with disabling conditions. This, advocates say, would eliminate stigma and honour the right to participate in society.

Enacted in 1982, the Canadian Charter of Rights and Freedoms, and specifically Section 15, guarantees equality rights and freedom from discrimination for people with disabling conditions. Resulting court decisions led to a duty to accommodate. This legally obligates employers, and others, to ensure rules, practices, or barriers do not bar people with disabling conditions from employment. People and organizations must accommodate people with disabilities up to the point where they would suffer undue hardship. Undue hardship is typically interpreted to mean high financial costs or other serious disruptions to business.

In 1986, Canada passed the Employment Equity Act. This defines people with disabling conditions as those who have a long-term or recurring physical, mental, sensory, psychiatric, or learning impairments. Individuals must believe the impairment is a disadvantage to them in gaining employment or that an employer will believe it to be a disadvantage to hire the person. This Act applies only to federally regulated industries.

In 2006, the United Nations adopted the Convention on the Rights of Persons With Disabilities. Rather than viewing people with disabilities through the lens of charity, medical treatment, and social protection, the convention called for them to be treated as full and equal members of society with the same civil, political, economic, social, and cultural rights as all others.

The biopsychosocial model

An important shortcoming of early models of disability was their focus on the disabling condition as the individual’s problem. Social and human rights models shifted the focus to society’s duty to eliminate barriers that prevented people with disabilities from fully participating in society. These barriers could be physical or attitudinal.

The downside of social models is that they overlook people’s lived experience of their disability. In this way, they fail to honour disability as a vital facet of a person’s identity. For example, chronic pain can have a profound effect on a person’s experience of life. No accommodations can erase the experience of pain or its impact on a person’s life. It shapes the way people think and behave, always considering the least painful way to do things and what to avoid doing entirely. At best, the person can learn to manage their pain so it doesn’t define them.

The biopsychosocial model, also known as the social adapted model, takes multiple factors into account. It views disability as a combination of biological limitations and social barriers, both physical and attitudinal, to full participation. It is broader than any earlier models for managing the experience of disability.

Employment counselling practice today takes this broad approach to helping people with disabling conditions find work. They work with people with disabilities more often and across a wider spectrum of disabling conditions than ever before. Medical and other experts still recommend individual therapies to help manage personal issues. Employment counsellors help clients prepare for careers and find employment that suits their skills and abilities. They also advocate for barrier-free and accessible workplaces.

Barriers and challenges

Clients’ financial concerns

Clients may receive public financial supports, such as a pension plan, a long-term disability pension, or income support. They may fear losing these benefits if they take a full-time job. What if they earn less than they receive in financial assistance? What if they lose financial benefits and the job doesn’t work out?

Many clients especially fear losing medical benefits. Private medical benefits can be costly. They may not cover as much as a publicly funded plan. And it may be hard to get the benefits back if the job does not last.

Albertans who receive financial assistance are encouraged to be as self-sufficient as possible. For some clients, this means working. Working while receiving financial assistance can provide an important supplement to earnings.

To ensure they do not lose income because they start work, a portion of the client’s earnings may be exempt from consideration in determining the size of benefit they receive. And even if clients leave income assistance for full-time jobs, they may continue to receive public health benefits for themselves and their children.

Familiarize yourself with available financial assistance programs. Encourage clients to get more information about income exemptions and health coverage. No Albertan should suffer financially because they have a disabling condition. Neither should they have to decide against getting a job because they and their families will be better off if they don’t work.

Environmental barriers

Common environmental barriers include:

  • Inaccessibility of workplace, restrooms, water fountains, and parking
  • Lack of elevators, suitable floor surfaces, and furniture
  • Lack of transportation
  • Limited financial support
  • Lack of support services, such as technical aids or assistants
  • Lack of money for adapting workplaces

Systemic barriers

Common systemic barriers include:

  • Others focusing on the disability rather than on the ability
  • Inflexibility of employers in adapting the demands of the job to the employee
  • Misinterpretation of an employer’s legal duty to accommodate
  • Challenges in co-ordination of available services
  • Low income
  • Lack of personal care assistance in the workplace
  • Irrelevant job requirements

Social challenges

Common social challenges include:

  • Lack of understanding due to fear
  • Lack of awareness of abilities of persons with disabilities
  • Stereotypes about poor workmanship, poor health, and poor attendance
  • Unfair treatment because of differences
  • Exclusion from work-related and social activities

Personal challenges

Common personal challenges include:

  • Low level of education and training
  • Minimal work experience
  • Lack of self-awareness
  • Low self-confidence
  • Low self-esteem
  • Underdeveloped social, interpersonal, and self-management skills
  • Lack of transportation resources
  • Communication difficulties
  • Fear of loss of medical benefits upon gaining employment
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