This week we are taking a look at different models that are used to describe disability: the social model (aka Minority-Group Model of Disability), expert/professional model, tragedy and charity model, and the medical model (aka Biological-Inferiority or Functional-Limitation Model.). In addition to these, the social adaptive model, economic model, customer empowerment model, and the religious model. Before this week, I would not have guessed there were this many different models. Beforehand I would have guessed only the medical and social models.
Models of Disability: Keys to Perspective
Models are influenced by two fundamental philosophies. The first sees disabled people as dependent upon society. This can result in paternalism, segregation and discrimination. The second perceives disabled people as customers of what society has to offer.
I’m not really sure I like the framing of people in a society either being a dependent or a customer, but let’s dig into just a few of the models presented in the first reading.
There are too many models to try to synthesize here while I’m reading, so I’m going to note take about three that for now appear to embody themes that arise as I read.
The Tragedy/Charity Model
The biggest problem that we, the disabled have, is that you, the non-disabled, are only comfortable when you see us as icons of pity.
– Nabil Shaban
This quote stood out to me as it echoed what was stated in the TED talk video from last week. This model I would place into a similar theme as the medical and expert models, but could perhaps be more harmful than the other two. The medical model can certainly be critiqued, but the tragedy/charity model, it could be argued, has as much influence into policy making as the medical model, but distinctly lacking expertise. It can permeate society through stories and organizations that don’t continue to examine and update their approaches. That’s not to say the medical model only does this in all cases, but knowing about the updates to the APA diagnoses for example shows some progression overtime. This model dis-enables people and encourages discrimination, in spite of its stated intentions.
The Social Model
the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others, due to physical or social barriers.
– Disabled Peoples International
This model focuses on environmental and societal structures that place barriers, be they physical, attitudinal, or institutional. This model also takes specific contexts into account more so than, say, the tragedy model, the latter involving one-size-fits-all solutions and the former focusing on individual needs. The responsibility of supporting participation shifts in this model from the individual to the society. Common examples you may encounter that apply this model may be ramps near or instead of stairs, or accessible busses. Another might be eyeglasses, and accessibility to these assistive devices. It’s notable that access to such a universal seeming assistive technology like eyeglasses (in Canada at least) may not be available everywhere, even within Canada itself.
The Social Adaptive Model
The write-up in the article for this model is pretty short, but I think worth noting. This model is described as a combination of the social and medical models. It’s foundation appears to be in the social model, many of the barriers faced are put there by society, but there is the inclusion of the position that not all impairments (medically defined) can be addressed with policy changes alone. Unlike the medical model alone, this model flips the focus from discussions of impairments first to capabilities first.
Understanding the Social Model of Disability: The ‘Medical Model’ vs the ‘ Social Model’
Thematically, although there are many models of disability presented this week, these two appear to be the two to focus on, and also the two that may be opposed to one another, despite the creation of the third, social adaptive, model.
Disablement is the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers.
– Disabled People’s International 1981
The way that the articles this week seem to describe the models implies that a model of disability is a way of understanding the sources of disablement (as defined above), the role of actors involved, and approaches to reducing loss or limitation of opportunities to participate in society. Note here that the definitions are over 40 years old at this point, so there has been plenty of work in this area, and even the language being used may be outdated.
If I continue thinking about how a model includes the source, the actors and their roles, and approaches I can try to distinguish these two models in each category. The source for example is within the individual in the medical model. Ultimately the focus is on the impairment itself as the source, and is viewed as something to be corrected. Leading from there, the responsibility for finding ways to reduce loss or limitation of activity is on the medical professional first, the individual second. Finally, approaches focus on “corrective” measures made to the individual experiencing the loss or reduction of activity.
In the social model the source of barriers resides in society through policy, and attitudes. These barriers are imposed by the society onto the individual, and in this model the responsibility to act then is a wider group than in the medical model. Finally, approaches to solutions are capability focused and look at removing the barriers initially created by society, rather than only impairment focused.
How does understanding the models of disability impact our efforts as designers?
First and foremost I think looking at the different models is important for designers to reflect on their own biases towards whether they trend towards the medical related models or the social models, particularly in where their focus is in terms of impairments or capabilities of users. Understanding the user, the environment, the tasks, and what role the designer plays as an agent for removing loss or limitation of participation is also supported by examining these models closely. Depending on the project a designer may come to see that they can make broader policy changes that remove barriers and enable participation in tasks by users. As part of user research, the designer can learn about the capabilities, barriers, and impairments that may be at play with users, and depending on the model subscribed to, design solutions to enable participation. Much of design focuses on user research, but one thing that appears in instructional design models that I often do not see in design thinking related models is context analysis (e.g. Smith & Ragan model). A designer who understands the underpinnings of the social model of disability, for example, can include that as part of their context analysis in addition to environmental context, use context, and socio-political factors.
One key factor in how understanding models impacts the efforts of designers would be to understand that using a single model alone may not be enough for designing the ideal solution(s).
Assistive Technology and Adaptive Strategies
any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability. The term does not include a medical device that is surgically implanted, or the replacement of such device.
– Individuals with Disabilities Education Act (IDEA)
Out of the list provided of assistive technology examples in the article, I would say I have personal experience with three: voice-to-text, text-to-speech, and spelling and grammar tools. For voice-to-text, and audio interfaces in general I first started using voice command on my iPod touch in around 2011. It was actually very useful to say “next”, or “play album, Number of the Beast” and it work. I was on the road a lot back then, and being able to make commands with both hands on the wheel and eyes on the road felt pretty revolutionary. For text-to-speech, I find myself using Microsoft’s immersive reader more and more. It comes integrated in the learning management system I use at work, and allows me to give my eyes a bit of a break from the screen. Finally, I was surprised to see spelling and grammar on this list. I reactivated my grammarly account recently, and use it everyday (although maybe it’s still not obvious).
Adaptive strategies are techniques that everyone can use to improve interaction with websites or applications. Adaptive strategies can be used with standard software, mainstream web browsers, and with assistive technologies.
– Pearson: Accessibility for Assessments
The list provided here I have a lot more experience with, and notably it is a bit more behaviour/interaction focused than discrete physical technologies (or applications). Many of the items listed I had to keep in mind when developing a recent elearning project on the topic of TeleOralHealth. Keyboard navigation was a requirement and thankfully is built into may of H5P’s tools. One surprising part of that experience was the sequence tabbing through the content with a keyboard took, and having to plan it out and try to be consistent with it. Colour and font choices followed WCAG standards, but one thing I’m starting to see more often is mini application on webpages that give the user custom control over those things. The slides in the project had audio narration, and so I ensured that 1) the audio did not play immediately as to not interfere with the screen reader, and 2) that the volume and playback could be controlled. Transcripts were also included for the audio narrations for every slide. Finally, synchronized closed captions were included for each video.
What can we learn by sharing our experiences?
We learn a lot from observing and sharing successes and challenges with our peers. Not only users sharing with designers, but designers with designers, we can see the different ways people interact with the products we make, and how design choices influence that use. If we rely on only our own experience we can inadvertently put barriers in place that limit our users’ ability to get the most out of our products and even extend that to limiting how they can engage in their day-to-day activities.
Different Types of Disabilities
What are the differences in the design needs of someone who is blind and someone who has partial vision?
One of the comments made in an earlier reading was about how in some models of disability groups can be created that are too general. This question touches on that exact idea, in that under the umbrella of vision impairment there are considerable difference in needs of the user. This reminds me of when I took a class students with exceptionalities in my undergrad days. One day we were given goggles that were meant to simulate different kinds of vision impairments. The goggles I wore had the middle sandblasted, making the centre of my vision opaque, but I could still use peripheral vision. This made it possible for me to navigate the halls of the college building without much need for assistance from my classmates, but I couldn’t read documents for example. In the case of a blind user (assuming total blindness not legal blindness) and partial vision I could imaging some solutions would serve both users, such as a screen reader. However, magnification may work for the user with partial vision but not for the blind user. The goal a designer might establish for their user research and task analysis then could be what capabilities do each user have individually. A decision would have to be made then whether a solution that lies on the union of capabilities would be sufficient or if more than one solution/approach would be needed.
Is it possible for a design to achieve perfect accessibility?
Most definitely not. We can design to reduce barriers and make our products more inclusive, but I don’t think there are products/solutions that allow for 100% participation. It’s an admirable goal but I don’t think that’s possible. One thing that does come to mind is also making unintentionally hostile designs under the attempt, or even guise, of accessibility. I forget the name of the square off hand, but there is a park in Toronto that includes stairs with an integrated ramp that is notoriously not accessible. On the surface, adding a ramp “makes the park accessible” for users cannot use stairs, but the way it was executed made it unusable for its intended user base.
What are your greatest concerns thinking now about your current or past designs?
My primary focus coming into this course was thinking about WCAG standards as applied to online courses. In another accessibility short course I took the topic of invisible disabilities such as short term memory impairments did come up which was completely off my radar at the time. The most obvious concerns I have with past projects includes lack of transcriptions for audio and closed captions for video, but have expanded to generally how courses are put together and sequenced and how the choices made could be placing barriers up for students whose needs I hadn’t considered before. Thinking back on the question about sharing experiences, I think that is why it’s so important to hear from students themselves, because I very likely lack the experiences of so many students that my decisions as a designer have direct influence on.