“Letting” people who are non-verbal communicate in their own way: A challenge for social work practice

Graduate social work students in Dr. Elspeth Slayter’s courses 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 Kasey Soucy, MSW Candidate
Salem State University

While working at a disability group home agency, I came to know“ Jane,” a person with Rett Syndrome. Jane was non-verbal and was unable to walk independently. She used a specialized walker to move around. In addition, she developed her own sign language in order to communicate. During the day, Jane would attend a day program. That program gave all nonverbal clients computers that had the “Picture Exchange Communication System (PECS)” system on it. Jane was required to use it at the day program and was also encouraged to continue using it at the group home. Jane would take home the computer, but she would leave it in her bedroom. She did this because she didn’t like it, and was comfortable with her own form of communication. The day program became insistent on Jane using the computer at home, so the director asked Jane to use it. Jane refused to use the computer and threw it across the room because she was so upset about being asked to do so. The day program still required Jane to use the computer so she would comply, however once she was in her home she didn’t use it and the staff did not force her to do so.

As a social worker, and using what I know now from this course, I would first ask whether Jane wanted to use the PECS system. When disability studies scholar Tom Shakespeare was discussing the social model of disability, he pointed out the idea of this practice is to make society adapt to people with disabilities. This could include allowing for people’s own communication choice to be honored or it could include providing accommodations like the PECS system for non-verbal clients. One of the barriers of the social model (Shakespeare, 2006, p. 219) is trying to make accommodations for people with disabilities without choice. The PECS system might work well for one client who is non-verbal, but it did not suit Jane and she did not want to use it. Shakespeare described limitations with the social model-informed practice as assuming there could be a “utopia” for people with disabilities as there would be no barriers. People with disabilities do not all function or adapt the same way so it is unrealistic to be able to accommodate everyone and it is insulting to force accommodations on people with disabilities if they do not want to utilize that specific accommodation. If Jane was given the option to use or not use the PECS system then that would still be utilizing the social model-informed practice because society is making the change for her and not expecting her to change. By forcing the PECS system on Jane, it is reverting back to the medical model practice because the program is making Jane adjust instead of learning Jane’s sign language.

Jane also used a specialized walker. I would engage in medical model-informed practice by acknowledging it was Jane’s body part that was impaired, and therefore disabled her. This is another limit of the social model-informed practice. As Shakespeare (2006, p. 218), the social model-informed practice is so focused on society being the barrier that it does not always acknowledge that a person’s body can also be the barrier. The medical model-informed practice is what helped Jane receive the specialized walker because Jane’s body was the barrier and she wanted to walk as independently as she could. The social model-informed practice can also be used by ensuring there are ramps for Jane so she can have easy accessibility.

From the macro level of social work, I believe we are on the right track with the social-model informed practice, however as Shakespeare (2006) pointed out on page 220, this model is not complex enough to include everyone. Intersectionality does not seem to be taken in to consideration with this model, which is a complicating factor. A strong model needs to be developed to acknowledge the complexities of people and their disabilities. A person’s environment, gender, race and other social identities need to be considered when developing models (which was not the case since the group of activists who rallied for this model were white heterosexual men (Shakespeare, 2006, p. 217)). The first step to be taken by every social worker should be to ask the person with the disability “what can be done to support you?” or “what do you believe needs to be changed so you do not continue to feel oppressed or feel like your voice is not being heard?”

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

Kasey A Soucy
This is Kasey A Soucy, an MSW candidate at Salem State University’s School of Social Work. (Note for Screenreaders: Image shows a confident White woman in a beige sweater who is smiling and standing in front of a forest)

Kasey Soucy is a candidate for the degree of Masters in Social Work at Salem State University’s School of Social Work. She holds a B.A. in Psychology from Salem State University. She hopes to continue her career with the Department of Children and Families. Ms. Soucy chose to study social work practice with people with disabilities so she can have a better understanding with the clients she works with. She also wants to work with her agency in providing a more inclusive solution for working with people with disabilities. Ms. Soucy can be reached at k_soucy@salemstate.edu.