Support for Students with Disabilities in Professional Practice:
Perspectives of Stakeholders.
Dr. Clodagh Nolan, Ph.D., M.Sc., M.A., Dip. COT., PG.Dip, Stats.
Director of the Unilink Service & Lecturer Discipline of Occupational Therapy, TCD
Declan Treanor, M.Sc., M.A., B.Sc., PG Dip Ed, AdvCertEd
Director of the Disability Service, TCD
Presentation
Aims
• Background & Need for research
• Results & Findings from research
• Recommendations for the future
Background
Past
• -Little legislation
• -Beginnings of a Disability
Service
• -Unknown numbers of
students with disabilities
attending HEI’s
• -Needs Based Culture
(Handley, 2000)
Now
• Increase in number of students
accessing HEI with a
disability(Claiborne et al, 2011)
• Increase-on professional
courses (Claiborne et al, 2011)
• Disability Act, 2005 &
Employment Equality Act 19982011
• Fitness to Practice Committees
with HEI’s
• University remit is to support
students with disabilities
• Rights Based Culture (Handley,
2000)
Phase 1
Phase 2
Phase 3
• Phase 1: Pathway to College
• Pre-entry, admission and the first year experience
• Phase 2: Pathway through College
• Building and maintaining a college career
• Phase 3: Pathway to employment
• Transition to further study or employment
‘Student Journey’ from pre-entry to employment or
further education
Project
1. An evidence-based research strand to determine
what are the main issues, concerns all have in the
placement process for students with disabilities;
2. Development of placement planning procedures
and supports for students on professional courses
(guide for students);
3. Present findings at this symposium
http://www.tcd.ie/disability/projects/Phase2/Place
ment-support/symp.php
Student Cohort
Course breakdown
Complexity of
the Needs of
Students with
Disabilities
that are
unique to the
Individual
Lack of
knowledge and
Training/
Communication
Pathways in
Supporting
Students on
Practice
Little Research
on Reasonable
Accommodation
for Students on
Practice/
Evidence based
Increase in
Students with
Disabilities on
Professional
Courses - More
students with
Hidden or
Invisible
Disabilities
Registration
demands
standards are
met to protect
the public
Research
background
Legal, Moral
and Ethical
Rationale for
Supporting
Students with
Disabilities on
Practice
Culture of
Inclusivity and
Diversity in
Universities
Literature
• Reasonable accommodations, are widely
understood within the academic environment but
are less defined in professional practice (Morris &
Turnbull, 2007; Murphy, 2008, 2011; Tee, et al,
2010)
• Perception that the quality of the educational
programme is lacking due to the students disability
– which results in staff resentment and difficult
working relationships between the university and
the placements (Andre & Manson, 2004)
Literature Contd.
DISCLOSURE
• No legal obligation for a person to disclose a disability (Murphy,
2008; Morris & Turnbull, 2007; Storr, Wray & Draper, 2011)
• Disclosure for students is a on-going process- burden on the
student (Griffiths, Worth, Scullard & Gilbert, 2010; Stanley,
Ridley, Harris & Manthorpe, 2011)
• The student should have the choice & require time & control
over when to disclose in a supportive environment (Cailbourne
Cornforth, Gibson & Smith, 2011)
• Failure to disclose or delayed disclosure is a potential barrier to
learning (Storr, Wray & Draper, 2011)
Literature Contd.
• Failure to disclose can often result in disadvantaging the
student and result in unsafe and risky behaviours (Andre &
Manson, 2004; Tee, et al, 2010)
• Universities may not always be aware of a students disability
and even if they are, they may have no permission to
disseminate personal information (Hirneth & MacKenzie,
2004; Morris & Turnbull, 2007)
• Responsibility to act if a student discloses to a practice
educator or any member of the University Staff (Disability Act,
2005)
• There is a need to have clear policies in monitoring, evaluating
an communicating reasonable accommodations in practice
(Ashcroft & Lutfiyya, 2013)
ENABLERS IN SUPPORTING DISCLOSURE:
•Enabler to disclosure is the length of time in placements; the
longer the better for disclosure (Tee, et al, 2010)
•More likely to disclose if the environment is positive and
receptive to disclosure with collaborative relationships and the risk
of hurt is minimized (Andre & Manson, 2004; Morris & Turnbull,
2007)
•Framework for honest feedback and discussion of issues enables
and empowers students to disclose (Tee et al. 2010)
•Having ‘Positive Role Models’ who have good experiences
encourages disclosure and confidence to disclose (Griffiths et al,
2010)
•Change focus from disability to the impact of the disability and
learning requirements (Ashcroft & Lutfiyya, 2013)
Literature Contd.
BENEFITS OF DISCLOSURE:
• The balance between personal benefit and emotional cost or
risk to patient safety provides a rationale for disclosure and
non-disclosure (Morris & Turnbull, 2007)
• Being trailblazers for disabled people in their profession
(Stanley, Ridley, Harris & Manthorpe, 2011)
• Disclosure contributes to a better self image and selfconfidence (Stanley, Ridley, Harris & Manthorpe, 2011)
• Provides flexibility in the workplace, such as option to work
at a particular time of day, reduced hours, accessibility &
location of office (Stanley, Ridley, Harris & Manthorpe, 2011)
Literature
Contd.
REASONABLE ACCOMMODATIONS:
• It is essential to make reasonable adjustments in supporting
students with disabilities (Storr, Wray, & Draper, 2011)
• All of the studies identified more time as the overriding
reasonable accommodation that students with disabilities
required while on placement (to allow them to practice skills and
work tasks (Murphy, 2011; Storr, Wray & Draper, 2011; Tee, et al,
2010)
• Learning contracts and more frequent support was also cited as
being particularly important (Tee, et al, 2010)
• Suggested accommodations should always be tailored to each
individual student and their practice context (Tee, et al, 2010)
Questions we need to askIssues in the Literature
• Do professional competencies need to be interpreted for
students with disabilities and do we need to foster positive
change in attitudes to students with disabilities?
• Do all competencies need to be demonstrated in every area of
practice and is there flexibility?
• Do we need to get the right balance between accommodating the
student’s needs and providing a fair assessment?
• How do we (Staff/ Students) negotiate appropriate
accommodations to support students as learners?
• How do we allow extra time for students to reach competencies
given that they are developing coping strategies as learners, given
that in time they will become proficient? (Murphy, 2011)
• Who has responsibility for training both practice educators and
students in disability matters?
Research
Questions
1. What are the perceptions of support (including reasonable
accommodations and contact with the Disability Support
Service) from the perspective of Heads of
Discipline/Department, Practice Education Coordinators,
Practice Educators, and students themselves?
2. What are the concerns of Heads of Discipline/Department,
Practice Education Coordinators, Practice Educators, and
students themselves?
3. What are the perceptions of disclosure in a practice
education environment from the perspective of Heads of
Discipline/Department, Practice Education Coordinators,
Practice Educators, and students themselves?
Methods
• Exploratory descriptive study to:
1) Elicit information and staff perspectives on supporting students with
disabilities on professional placements
• 2) Gain information on how students with disabilities perceive their
difficulties & concerns while on professional placements, and in addition to
explore ways that they would like to be supported.
Surveys
Heads of
Departments/Practice
Education Coordinators
Practice Educators
Students with a
disability & registered
with DS
Methods
• Survey Monkey hosted the 3 surveys
• Pilot: Each survey was developed by experts involved
supporting students with disabilities and they were
piloted with individuals from the target groups
• Target group-all departments within TCD that have a
professional practice component & registered students
with a disability
• Ethics approved by the Faculty of Health Sciences Ethics
Committee
Results and Findings
Section One: Results from
Staff
Staff
Respondents
• Practice Education Coordinator (n= 8) 72.3%
• Head of Department (n=3) 27.27%
• Practice Education Coordinators (n=68)
Concerns identified by
staff in supporting
students with disabilities
Reach the
standard
Appropriate
support
Emergence of
a health issue
Theme 1
Reach the standard
sub themes
1. Ability to carry out day-to-day duties
‘They won’t meet the standards required from them.’
2. Duty of care
‘The safety of the patient/client, e.g. when a student has dyslexia, hand writing can
be difficult to read for the oncoming nurse and other healthcare professional
colleagues.’
3. Time and level of input required
‘If a student requires more than the usual level of support on clinical, they may be
unwilling to take (as many) students the following year.’
‘I often have concerns about the impact on the placement provider’s service
provision to clients… if a student requires more support than is reasonable to
expect them to provide.. This can have a negative impact on the placement
provider’s willingness to take students on placement in the future…)’
Reach the standard
sub themes
4. Future as a professional
‘…At the end of the day we need to meet the needs of the patients
and if the disability prevents you from meeting the standard of care
required by patients I don't think you should be in this job. This
applies to people with serious mental health issues…. the system
needs to capture those who are not capable of delivering safe &
effective care, regardless of disability status.’
5. Fairness and assessment
‘In my area of work competency to a specific procedure is required
therefore it is difficult to change the goal posts for safety reasons.’
6. Student awareness and well-being
‘I think the student’s insight into their own needs & ability to address
these is a significant issue for achieving competence. For some
students this was not an issue, for others it was.’
Appropriate
level of support
•
•
•
•
•
Emergence of a
health
issue
‘Where things really begin to break down is usually when the disability is not
disclosed and is then disclosed mid-placement. This usually means the student
is struggling, there is no official information on disability and there is no
information on reasonable accommodations.’
‘When I am aware informally of condition but student is not comfortable
disclosing to me.’
‘The dyslexic students are easy...it is the ones with undeclared mental health
issues where there is no LENS report that are very difficult.’
‘There were some occasions when I would have suspected that a student I or
another colleague supervised had a disability e.g. mental health condition, but
as we cannot ask and college cannot inform us and the student was not
obliged to tell us, we had to proceed with a difficult placement without any
supports.’
‘Unsure about to what extent I can talk to them about low mood etc. in my
role as supervisor.’
Training
Training received by PECs and PEs in supporting students and staff
with disabilities.
Section Two: Results from
Students
Demographics
% of student
responses
Numbers of
students (n=)
Year of Students
(n=60)
Junior Freshman (1st Year)
Senior Freshman (2nd Year)
Junior Sophister (3rd Year)
Senior Sophister (4th Year)
Postgraduate
25.0%
21.7%
25.0%
23.3%
5%
15
13
15
14
3
Professional
Course
Category*
(n=61)
Business/Education/Social Studies/SLT/Deaf
Human Nutrition/Dentistry/Medicine
Nursing and OT/PT/RT
29.5%
24.6%
45.9%
18
15
28
Choice of
placement
setting
(n=50)
Yes, choice
No, no choice
28
72
14
36
Breakdown of disability type of student respondents
(n=61)
Why I disclosed?
The Benefits?
If you disclosed your disability on
placement, do you feel it was of
benefit to you?
Tell people
about your
disability
Helps get
appropriate
support
Encourages
awareness and
understanding
If something
happens
Helps get appropriate support
Benefits of
Disclosure
“Everything makes more sense to your supervisor if they know what’s going
on. They can't read minds.”
“My practice educator took an interest into my disability and tried to develop
my learning styles .... This was the first time I got to know my disability
really.”
Encourages awareness and understanding
“The staff are more understanding to why I may appear very tired in the
evenings on my long shifts.”
“My supervisor was aware of my needs and though I did not have to take any
time off or adjust my caseload, knowing that the support was there for
me took a lot of stress out of the placement.”
Benefits of
Disclosure
If something happens
“Because if something happens they know how to deal with
it”
“It is always important to let someone know if you have a
disability for health reasons”
“It's a safe decision, if anything was to happen the tutor is
aware of all medical conditions”
Why I did not
disclose?
If you did not disclose your disability on placement,
can you explain why?
Relevance of
Disclosure
Didn't need to
As the need
arises
Didn't occur or
wasn't asked
Fear and Judgement
Being judged
Singled out
Mental Health
Difficulties
Fear & Judgement
Being judged
“I didn't want to be judged on anything other than my ability to do
the work.”
“I felt that I would be judged for it/ that it would be held against me
when it came to grading.”
Singled out
“It makes you singled out for extra attention for CPC and removes
you from clinic setting.”
“It would change the way tutors or other professionals
interacted/taught me.”
Mental Health difficulties
“I would be afraid that they would use my mental health against me
or down the future.”
“As it was a mental health setting I felt slightly awkward if I were to
say I have one as well.”
Obstacles
Did you encounter any obstacles (physical,
attitudinal, social or professional) that you felt
could have been improved while you were on
placement?
Negative Attitudes
Stigma
Changing
expectations
Making a bigger
deal
Negative Attitudes
Stigma
“I would not recommend students with mental health
difficulties disclose because of comments made by practice
educators on my placement with regards to people with
mental health problems (not about me personally).”
“One of my disabilities is mental health in nature which led to a
shift in the behaviour of my supervisor which I felt very
conscious of and uncomfortable with.”
Negative
Attitudes
Changing expectations
“People undermined my ability and gave me a lighter caseload
then what might otherwise have been given.”
Making a bigger deal
“I personally felt people were making a bigger deal out of my
concerns then what they were which was a bit unsettling.”
Powerlessness
“Occasionally I didn't feel I had the power to.... or was brave
enough to confront the problem..... most of the time my
problem was ignored and was hard to explain, especially when
words wouldn't be a strength of mine..... Most of the time I felt
isolated while on placement as no one knew my disability and
sometimes I felt I didn't know it....”
Legal and Policy background
What does the law say
& what is our duty?
• Equal Status Acts 2000-2011, the Employment
Equality Acts 1998-2011 and the Disability Act
(2005).
• The Employment Acts is most relevant to those on
professional courses and gives added protection
to disabled students. Significant legislative
provisions promoting equality & prohibiting
discrimination.
• Section 16(3) (a) for the purposes of the
Employment Equality Acts, a person who has a
disability is fully competent to undertake and fully
capable of undertaking any duties if the person
would be so fully competent and capable on
reasonable accommodation being provided by the
persons employer.
• Section 16(3) (b) the employer shall take
appropriate measures, where needed in a
particular case, to enable a person who has a
disability –
• (i) to have access to employment
• (ii) to participate or advance in employment
• (iii) to undergo training.
• Unless the measures would impose a
disproportionate burden on the employer
What does the law say &
what is our duty?
• Reasonable Accommodation Provision
needs include
• Practical Measures:
• Constructive Dialogue: individual must be
party to the accommodation. Employer’s
enquiry can only be adequate if employee
can fully participate.
Reasonable
Accommodation
• The challenge over time in Colleges is to
develop professionally defined workable
reasonable accommodation that are
appropriate for the workplace and easily
managed by the disabled student on
placements so that these can be taken in to
the world of work by graduates.
Fitness to
Practice
• Fitness to practice has been defined as an
individual’s ability to practice their profession in a
way which meets appropriate standards, meaning
that a person has the skills, knowledge, attitudes,
character and health to perform necessary
functions safely and effectively (adapted from
HPC, 2005).
Fitness to
Practice
• ‘The College Fitness to Practise policy states that
‘if a student has a disability, and there are
concerns over fitness to practise, section 4 of
Schedule 1 shall apply, and the guidelines outlined
therein should be followed prior to any fitness to
practise hearing’’.
• Section 4 of the College Policy refers to the
need to provide reasonable
accommodation to students with
disabilities.
Recommendations and next steps
As a Result of these
findings:
•Encourage Practice Educations Coordinators, Practice
Educators to be more pro-active in supporting and
planning for the needs of students with disabilities…
•To extend the needs assessment process to the workplace
setting which will allow for the development of clearly
defined and individually tailored ‘practice place reasonable
accommodations’.
•Trialling of these ‘practice place reasonable
accommodations’ will require constructive dialogue and
piloting for the development of online resources.
• Promote the benefits of a supportive and inclusive
environment that will encourage students to seek
support (and disclose their disability) and plan for their
needs in placement with both the coordinators and
practice educators.
• Competencies, proficiencies and learning outcomes need
to be clearly defined and ensure that they are accessible
to students with disabilities.
• Strategies need to be developed around
disclosure and non-disclosure at any point during
the placement. Perceived disability also requires
attention and practice educators need to become
confident in discussing issues with students.
• Establish training resources (including
programmes) on understanding reasonable
accommodations, confidentiality, awareness of
and sensitivity to disability issues such as
disclosure and managing disability
• Practice Educators to provide a ‘job description’ for
students to enable them to plan ahead of time for their
needs.
• The research findings and the literature suggest that
students where possible should visit the placement
setting ahead of the placement to learn about the
placement and identify any potential concerns or
issues.
• Establish role models (i.e. professionals with disabilities)
within the professional groups who could act as
mentors for students.
Any Questions?
Thank you for listening!
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