Val's presentation at the University of Calgary -- Social Construction of Disability and Health Course; Paradigms, Policies, Systems and Outcomes

1. Val Lougheed
Northern Lights Canada
Real Work * Real People * Real
Results
Paradigms, Policies,
Systems and Outcomes
The Re-Organization of the
Disability Benefits System
1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca

2. The Medical Model
1600’s – Rene Descartes (philosopher)

3. Disease
“pathology of a part that
is identified by objective
criteria”
(Barbour, 1995, p. 10)

4. Impairment
• “a loss of, or loss of the use
of….any body part, system or
function”
• relates to a specific function
(Zabrodski, 1999, pp. 49 & 52)

5. Disability
• “loss of capacity to meet
personal, social or occupational
demands”
• relates to a specific role
(Zabrodski, 1999, pp. 51 & 52)

6. Handicap
• result of an impairment or
disability that limits or prevents
the fulfillment of one or several
roles regarded as normal
• activity limitation; participation
restriction
(WHO, 1980; ICF, 2001)

7. Impairment
Predicts
Disability

8. Person and their
Disability
Health Care & Rehab
►
Fix The Person

9. Disability Policy Objectives
-Art and Science
• Rehabilitation Services
• Financial
Compensation

10. Disability Policy Objectives
-Art and Science
Rehabilitation Services
“empower and enable
consumers to act effectively in
a spirit of self-reliance”
(Hope, Timmel and Hodzi, 1985)

11. Disability Policy Objectives
-Art and Science
Financial Compensation
…ensures that you continue to
be able to “meet your daily
financial needs”
(Great-West Life, 2010)

12. Combining Art and
Science
“twin but potentially
contradictory goals”
“how to reconcile these twin
goals has yet to be resolved”
(OECD, 2004, p. 3)

13. Disability Benefits
System
1. Measure impairment
2. Translate impairment into
disability
3. Compensate for loss -- $$
4. Fix person so they can work
again

14. Rehabilitation and Return
to Work
1. Directed by physician
2. Rehab – facility-based
3. RTW – ‘Fitness to Work”
statement by physician

16. George Engel
The Need for a New
Medical Model: A
Challenge for
Biomedicine
(Engel, 1977)

17. Biopsychosocial Model
The Medical Model “assumes
disease to be fully accounted for
by deviations from the norm of
measurable biological (somatic)
variance. It leaves no room…for
the social, psychological and
behavioural dimensions of life”.
(Engel, 1977. p.
130)

18. New Definition -- Disease
“pathology of a part that
is identified by objective
criteria”
(Barbour, 1995, p. 10)

19. New Definition --
Impairment
• “a loss of, or loss of the use
of….any body part, system or
function”
• relates to a specific function
(Zabrodski, 1999, pp. 49 & 52)

20. New Definition -- Disability
“a complex phenomenon,
reflecting the interaction beween
features of a person’s body and
features of the society in which
he or she lives”
(http://www.who.int/topics/disabilities/en/)

21. New Definition -- Handicap
a condition that “creates
obstacles to accomplishing life’s
basic activities and if these
obstacles can be overcome only
by compensating in some way for
the effects of the impairment”
(Zabrodske, 1999, p. 52)

22. Nordenfeldt (2003) says…
• Disease and Impairment ►
Medicine and Health
• Disability and Handicap ►
Action Theory and Social
Science

23. Disability and Handicap
Only have meaning when
associated with action and placed
in context
► doing something, somewhere
► must understand the something
and the somewhere
(Nordenfeldt, 2003)

24. Impairment
does not
Predict
Disability

25. Focus ►
Disabling Factors not Disability
1. Person
2. Environment
3. System

26. Disability Policy
Objectives Redefined
Rehabilitation Services
BPS Model “captures factors
that more directly relate to
functional recovery”.
(Loisel, 2009, p. 97)

27. Disability Policy
Objectives Redefined
Financial Compensation
“The vast majority of people…who take up
disability benefits never return to work.”
(OECD, 2009, p. 19)
•Disability does not equate with ‘unable to work’
•Financial compensation should support RTW
efforts

28. Another New Definition –
Work Disability
“preventable absence or
withdrawal from work [which is]
disruptive, potentially harmful and
costly both to the employee and
the employer”
(ACOEM – Ontario Summit to Prevent Work Disability, 2010,
p. 5)

29. Disability
Benefits System
SAW/RT
W

30. Rehabilitation and Return
to Work
Holistic Problem Solving
1. Person
2. Environment
3. System

31. Person
Impairment plus
•Personal circumstances
•Social supports

32. Environment
• Lack of modifications or
accommodations
• Psychological (fears, anxiety,
depression, distress)
• Social (perceived demands, perceptions
of co-workers)
• Discrepancy between demands of the
work and capabilities of the worker
(Loisel, 2009, p. 97)

33. System
“benefits system
itself has a
disabling effect on
people”
(OECD, 2009, p. 17)

34. Iatrogenesis

35. VIDEO CLIP
Viktor Frankl video
http://www.youtube.com/watc
15 to the end

36. Rehabilitation Strategies
in a BPS System
S.P.I.C.E.
IT
UP!

37. Simplicity

38. Proximity

39. Immediacy

40. Centrality

41. Expectanc
y