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, AdvCertEdDirector of the Disability Service, TCD

Presentation Aims

• Background & Need for research • Results & Findings from research • Recommendations for the future

Background

‘Student Journey’ from pre-entry to employment or further education

Project1. 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 symposiumhttp://www.tcd.ie/disability/projects/Phase2/Placement-support/symp.php

Student Cohort

Course breakdown

Research background

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 self-confidence (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 ask-Issues 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.

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)

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%

151315143

Professional Course Category*(n=61)

Business/Education/Social Studies/SLT/DeafHuman Nutrition/Dentistry/MedicineNursing and OT/PT/RT

29.5%24.6%45.9%

181528

Choice of placement setting(n=50)

Yes, choiceNo, no choice

2872

1436

Breakdown of disability type of student respondents (n=61)

Why I disclosed? The Benefits?

Benefits of Disclosure

Helps get appropriate support“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.”

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”

Benefits of Disclosure

Why I did not disclose?

Fear & JudgementBeing 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

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 AttitudesChanging 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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Useful ResourcesUseful Resources:

Association of Higher Education, Access, and Disability (2012). National Guidelines for Working with Nursing and Midwifery Students with a Disability or Specific Learning Difficulty in Clinical Practice.Disability Service Trinity College Dublin (2013). Supporting Trinity College students with Disabilities into Employment.Doyle, A. (2010). Clinical Placement Handbook for Students with Dyslexia. Trinity College Dublin.Howlin, F. & Halligan, P. (2011) Supporting Nursing and Midwifery Students in ClinicalPractice: A Resource Guide for Clinical and Academic Staff. University College Dublin

Guide to Disclosure, AHEAD Press, 2011

Demystifying Disability in the Workplace, AHEAD Press 2009