INCLUSIVE CAMPUS
DIVERSIFYING HEALTH AND HUMAN
SERVICES PROFESSIONS
The Experiences of Students with Disabilities in the
Health and Human Service Programs.
Tal Jarus,
Laura Bulk,
Michael Lee and the UBC IC team
Please contact - [email protected]
What do you think the % of students with
disabilities is?
A. 20%
B. 14%
C. 12%
D. 5%
E. 1%
What do you think the % of clinicians with
disabilities is?
A. 20%
B. 14%
C. 12%
D. 4%
E. 1%
Background
• Labor market participation is strongly associated
with education
• for people with various disabilities the connection
between higher education and employment is
even stronger
• There remains a low enrolment and a high firstyear drop-out rate for individuals with disabilities
in spite of
• initial changes in legislation and policy in different
countries worldwide, and
• with the development of access and support
programs within higher education.
Background
•
Health and Human Service (HHS) professions:
•
•
•
•
•
have the potential to facilitate the transition to
employment
academic studies AND fieldwork/practicum
additional barriers
Complex contexts
Tension:
•
•
Accommodations vs. meeting competencies
increasing diversity vs protecting uniformity of the
profession
(Andrew & Manson, 2004; Nolan et al., 2014; Schrewe & Frost, 2012)
•
Underrepresentation of people with disabilities
(Wilcock & Townsend, 2000)
“There’s a lot of sympathy and
empathy and helping for [visible
disabilities]. If there’s something less
visible … then doctors are the least
sympathetic of the bunch. It’s like,
get going, step up. Sink or swim,
kind of mentality around in medical
school.” Sarah (faculty member)
“I’ve had a hard time voicing [my
needs] because the department will
say, ‘Well that’s what we’re about…
That’s our game, and if that doesn’t
fit for you then maybe this isn’t the
right area for you.’ …I know that I
can do this, is just hard to learn that
way.” Pam (student)
Heterogeneity
• Heterogeneity of experience
• Describing disability
• Trajectories & sequelae
• Shared experience: Dimensions of
disability
• Institutionalized essentialism: Cookie
cutter approaches
Heterogeneity of Experience:
Describing disability
Characteristic
Anxiety
Fatigue/loss of energy
Mobility
Pain
Stress
Depression
Difficulty with
focusing/concentration
Communicating
Fainting
#
17
15
13
12
10
8
9
7
1
Characteristic
Memory
Neurological
Reading
Stiffness
Hearing
Weakness
Risk of
infection/sickness
Eyesight
Weight loss
#
7
6
5
4
4
4
3
2
2
Shared Experience:
Dimensions of Disability
Dimension
Diagnosis known
Persistent
Sense of stigma
Specific impacts
#
32
25
24
20
Dimension
Intermittent/unpredictable
Single
Physical
Stress
#
10
10
18
10
Nonvisible
Difficult to diagnose/
diagnosis questioned
Multiple
Mental
Both visible and nonvisible
19 Physical and mental
13 Switching from visible to
non-visible
17 Visible/known
16 Rx refractory
8 Known course
7
5
Treatment positive
11 Global impacts
Diagnosis unknown
4
3
5
5
4
Our Conversations
with Students with
Disabilities
1. Students had to legitimate their ability to
perform (via negotiation, selective
disclosure, and advocacy).
2. Disabled students and clinicians experience
marginalization (via dominant discourses,
discriminatory design, and disempowering
interactions)
3. Stakeholders questioned their citizenship
(challenging students’ rationality, limiting
autonomy, and questioning productivity)
1. Legitimization
• Negotiation of Disability Label:
‘That’s who I’m’
• Selective disclosure
• Advocacy
1.1. Negotiation of Disability Label:
‘That’s who I’m’
• Accepting, rejecting, or renegotiating
“I’ll say, ‘I actually have a disability myself …’, and I’ll say,
‘so, I’m letting you know now and I apologize if I ask you to
maybe repeat some things’, and most of the time… people
respond… oh, that’s just human.” (Julia)
“Just changing the moniker from disabilities to diverse
abilities does a whole lot to change perception. Rather than
viewing it as a weakness or a detractor, it’s just difference
….” (Angela)
“[Hearing impairment is] a really oppressive and negative
term… we don’t look at ourselves as someone with a
disability.” (Emma)
1.2. Selective Disclosure
• Managing perceptions of (real or imagined) others
“I thought if you have a mental illness then that
looks bad if you’re a [practitioner]. … I would
not want employers to know about it for those
reasons [stigmas] ” (Kate)
“My clinical instructor … said, you know, be
very careful who you share with…It’s better to
share with less than more.” (Rose)
“I’ve found in a way that there are less
problems when I just disclose … like if I don’t,
there are a lot of misconceptions and …
[people say] oh you’re lazy or you’re just weird.”
(Sarah)
1.3. Advocacy
• To advocate or not to advocate
“You have to go in knowing that you’re not
going to get everything you need.” (Wendy)
“I had a meeting with my [program]…we
discussed the attendance piece and they
informed me that there is an attendance
policy…there’s not. There is an attendance
expectation…That’s not a policy. That’s an
expectation. I’m sorry I’m not living up to your
expectations. Um (laughs) which I don’t think
they loved but at the end of the day, I’d love to
say that I can go to every class and be that
student, but I can’t.” (Lina)
2. Marginalization
Incongruence
Professional Status
• Competent
• Independent
• Authoritative
• Healthy
• Service-giver
Disabled Status
•
•
•
•
•
•
Defective
Dependent
Helpless
Dangerous
Unwell
Service-recipient
(Erevelles, 2011; Hughes, McKie, Hopkins, & Watson, 2005; Moreno, 2002; Phillips, 1990; Taleporos &
McCabe, 2002; Thomas, 2007; Thomson, 1997)
2. Marginalization
Marginalization is “the process through which margins are
created, defined, and enforced” (Ferguson, 1990, p. 9). This
takes place though:
1. Discourse about disability
2. Structural discrimination
3. Imbalanced Interactions
2.1. Discourse about Disability
Stigma, dehumanization, and permanence
• “there’s this huge stigma attached to people with disability,
like it’s your fault, or that you’re not whole, or you’re not
complete, you're not doing the best job possible.” (Daisy,
faculty member)
• “I’m an entire person. I’m not just that disability…look at
me with all of the different aspects that I bring and look at
me as an entire person.” (Tonia)
• “perceived as being almost deliberate that I had missed
classes…[another student] had missed more class than I
had but she was considered a legitimate absence because
she had appendicitis.” (Kate, student)
2.2. Structural Discrimination
Inflexibility, red tape, assumptions
• “our program is relatively inflexible…it would definitely be
a factor at their admission if there was some sort of
disability which would preclude them from participating in
one particular aspect of the program.” (John, program
manager)
• “[the doctor] would not give a diagnosis unless there was
further testing and all this testing I had to pay for myself
…definitely expensive.” (Alex, student)
• “in the [program], there’s a culture of…we can help
patients but patients aren’t among us.” (Rose, student)
Institutionalized Essentialism:
Cookie Cutter Approaches
“Like just all disabilities are the same, put them in
one group, especially in the past they would do
that.” Trisha
“You don’t get to spell out what accommodation
you need, you get to set out what your limitations
are…And [accommodations are] well established.”
Bruce
Institutionalized Essentialism:
“Do you really have a disability?”
“I phoned up [disabled transportation services) and I
said…I wouldn’t mind getting a ride once in a while…I was
criticized quite badly for that for using that
service…because I wasn’t in a wheelchair or something.”
Layla
“Having a hidden disability is like, it’s just different than a
physical disability…they find out like “Oh, you’re doing
services at the [disability services office]…Do you really
have a disability or are you just like - to get the
services?”…With hidden disabilities people don’t believe
you…because I can hold a conversation, they think that I
don’t really have a disability.” Taylor
2.3. Imbalanced Interactions
Management/control, surveillance, dismissal
• “the [supervisors] knowing up front (that a student has a
disability) were very appreciative that they knew that this is
what was coming and were absolutely keen to
accommodate.” (Cathy, faculty)
• “[students with disabilities] are under a lot of scrutiny,
particularly when they are out on placement and they don’t
want to rock the boat.” (Paul, professional regulator)
• “Just the constant “you shouldn’t be here”. You know, I’ve
been told a number of times, find a new profession…this
isn’t the right program for you.”” (Lina, student)
Review of Policies
Scanned policies of all MD Canadian programs
• All universities provide extensive and varied in-class
didactic accommodations for their students
• No clear description of the process for providing
accommodations for clinical learning contexts (lab,
clinical, OSCE and clerkship)
• Of the 14 schools researched, only 4 have a specific
accommodations office within their Faculty of Medicine
• School mostly deals with students in a case-by-case
manner.
Implications
Short-term:
• Consciousness raising
• Educate faculty, staff, clinical supervisors
• Re-examining assumptions about how training should
occur
• Building supportive community for students with
disabilities (DREAM)
Long-term:
• Combat injustice faced by people with disabilities
• Universal Design Curriculum
• Increase diversity of healthcare providers will result in
improve care (Riddell & Watson, 2003)
Acknowledgements
The IC UBC team
Our participants
TLEF – Teaching and Learning
Enhancement Fund, UBC
CIHR
Teaching Practices
& Student mental
health
[email protected]
http://blogs.ubc.ca/teachingandwellbeing/
What Do You Think?
I have the skills to enhance
student wellbeing through my
teaching practices
 On a scale of 10, where 10 = strongly agree
and 0 = strongly disagree
0 1 2 3 4 5 6 7 8 9 10
What Do You Think?
I believe that faculty
members are responsible for
supporting student wellbeing
 On a scale of 10, where 10 = strongly agree
and 0 = strongly disagree
0 1 2 3 4 5 6 7 8 9 10
What Do You Think?
I am knowledgeable regarding
the impact of mental health and
wellbeing on learning
 On a scale of 10, where 10 = very knowledgeable
and 0 = not knowledgeable
0 1 2 3 4 5 6 7 8 9 10
What Do You Think?
I am knowledgeable about
teaching practices that promote
student well-being
 On a scale of 10, where 10 = very knowledgeable
and 0 = not knowledgeable
0 1 2 3 4 5 6 7 8 9 10
How often do students
experience mental health issues?
What have we done (2012-15)
Student &
stress
Stigma &
campus MH
Faculty &
staff
International
students’ MH
perspectives
needs
on student
MH
• Increase awareness of MH
among students, faculty, &
staff
• Advance on-campus MH
services & resources
• Promote MH resources &
services
• Create a healthier campus
community
• Improve teaching
practices
Teaching Practices & Student
Mental Health (2015-17)
• Undergraduate Experience Survey
Student
perspec • Teaching practices & your MH – focus groups
tive
• Nominations from students
Faculty • Interviews on what have you done to enable
students’ mental wellbeing
voice
KT
activities
• Instructors – tenure & pre-tenure, sessional &
TA
• departmental, faculty & campus wide
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
Student wellbeing is supported
when…
 they feel a sense of connection
and social belonging
 their learning (and motivation to
learn) is supported
 they are holistically supported
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing and learning
are supported when students
feel a sense of connection and
social belonging
 instructor-student relationship
 peer-to-peer relationships
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing and learning
are supported when students
feel a sense of connection and
social belonging
 Share your suggestion / practice
with us
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing is supported when their
learning (and motivation to learn) is supported

structuring the course effectively (e.g. exam and
assignment due dates)

delivering the course material (e.g. syllabus, online
materials) effectively

supporting student learning outside the classroom

helping students find value in the subject matter

helping students find value in the learning process
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing is supported
when their learning (and
motivation to learn) is supported
 Share your suggestion / practice
with us
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing is enhanced
when students are holistically
supported
 recognizing that students have lives
outside academics
 openly discussing wellbeing-related
topics
 creating a safe classroom environment
Findings – Teaching Practices &
Mental Wellbeing (2015-17)
 Student wellbeing is enhanced
when students are holistically
supported
 Share your suggestion / practice
with us
Let’s Revisit Questions Again …
I have the skills to enhance
student wellbeing through my
teaching practices
 In the scale of 10, where 10 = strongly agree
and 1 = strongly disagree
0 1 2 3 4 5 6 7 8 9 10
Let’s Revisit Questions Again …
I believe that faculty members
are responsible for supporting
student wellbeing
 In the scale of 10, where 10 = strongly agree and
1 = strongly disagree
0 1 2 3 4 5 6 7 8 9 10
Let’s Revisit Questions Again..
I am knowledgeable regarding
the impact of mental health and
wellbeing on learning
 In the scale of 10, where 10 = very knowledgeable
and 1 = not knowledgeable
0 1 2 3 4 5 6 7 8 9 10
Let’s Revisit Questions Again…
I am knowledgeable about
teaching practices that promote
student well-being
 In the scale of 10, where 10 = very knowledgeable
and 1 = not knowledgeable
0 1 2 3 4 5 6 7 8 9 10
Acknowledgements
TLEF – Teaching and Learning
Enhancement Fund, UBC
Students, staff and faculty who
contributed to this project
Questions and Comments?
Thank you!
[email protected]
https://blogs.ubc.ca/teachingandwellbeing