Social model or medical model? How to implement one or the other in a group home setting

Graduate social work students at Salem State University were asked to reflect on the ways in which they approach their work with clients with disabilities. Specifically, they were asked to reflect on what aspects of their practice were “under” the medical model of disability and which were “under” the social model of disability. Students were first introduced to the medical model of disability, in which the person’s impairment was the focus. Then, students were introduced to the social model of disability, in which society is seen as the disabling factor as opposed to the part of the person with the impairment. In order to begin to re-visualize what social work practice with a client with a disability would look like, students were asked to answer the following question:

“How can social workers approach the needs of people with disabilities without perpetuating the negative impacts associated with the medical model of disability? Provide a case example and then describe how you could/do/would engage in medical model-informed practice and social model-informed practice with that client.”

By Daniel Fraser, MSW Candidate

Salem State University

Where I work at a group home for people with intellectual disabilities, we have a client, who for the purposes of this discussion, will be referred to as H.I. Several years ago, H.I. began to feel uncomfortable standing or walking on her own, or with a walker. She feared she will fall and hurt herself.  A wheelchair was provided for her, as a way to make her feel more comfortable with her mobility.  However, staff were encouraged to get H.I. to stand up and walk with assistance of a walker, instead of allowing her to remain in the wheelchair on a full-time basis.  Each time a staff member would attempt to encourage her to stand up and walk with assistance of a walker, H.I. would become upset, and refuse to attempt to stand up. It is noteworthy that H.I. is able to transfer herself from her wheelchair to other locations, such as a recliner, her bed, or even the toilet, but that is the extent to which she feels comfortable enough to stand on her own.

When I first started working at the home, the director tried to implement a plan where H.I. was supposed to transfer herself from the toilet seat to the shower seat, each time she went to take a shower (she needs full assistance in taking a shower).  Each time staff went to implement this protocol, it caused a great deal of stress for H.I., and she would refuse to take a shower.

Taking the social model approach, it would have been better for all of the staff members, the director included, to talk to H.I., and find out whether she would rather use her wheelchair to get around, or if she would rather try walking with the walker.  By doing this, we would effectively eliminate the barrier of using a walker or walking on her own, that separates H.I. from the mobility which she chooses (Shakespeare, 2006).  Allowing H.I. to choose the way that she would prefer to move around would also give her more of a sense of independence, and make her feel the power of being able to make her own decisions.  Discussing her option of mobility would also likely take away any behavioral consequences that resulted from staff trying to implement the protocol of having her stand up and walk when she does not feel comfortable doing so.

By taking the approach that was implemented by the director, we were taking part in medical model thinking.  I believe that according to disability studies writer Tom Shakespeare, by not giving H.I. the choice of using the wheelchair to move around, and also by trying to get her to walk from the toilet seat to the shower seat, we were in essence, trying to eliminate an aspect of her disability, in order to fit in with what we wanted for her instead (2006).  By taking this approach, we also encouraged the behavioral consequence that resulted, along with adding more stress to an already stressful situation for H.I.

It is argued that one of the main limitations of the social model is that it essentially further disables someone who is already disabled, by not properly identifying the disability (Shakespeare, 2006).  By doing this, we are taking away part of the person’s identity, and more or less telling the person that even though they may have a disability, they should not recognize that disability.  In the case of H.I., if we do not encourage her to at least attempt to stand up and walk on her own, or with the assistance of the walker, it could lead to much less leg functioning, which could further impair her functioning.  So essentially, by not encouraging H.I. to move around without the assistance of a walker, and just continue to use the wheelchair, we could potentially be further disabling her.

It is a complicated situation, but it helps to look at H.I.’s situation through several lenses!

Shakespeare, T. (2013). The social model of disability. In Ed., Davis, L. (2013). The Disability Studies Reader, Fourth Edition. New York: Routledge.

Daniel Fraser is a candidate for the degree of Masters in Social Work at Salem State University’s School of Social Work. He holds a B.A. in Social Work from Salem State University. He hopes to do clinical work with students who have varying degrees of cognitive and intellectual disabilities with his career. Mr. Fraser has always enjoyed helping people out, and since joining his current place of employment, has really found his niche, where he can help people, and advocate for independence within the disability community. Mr. Fraser can be reached at d_fraser2@salemstate.edu.

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