Support for Students with Disabilities in Professional Practice: Perspectives of Stakeholders.

1

• 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

2
Presentation Aims

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

3
Background
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(No Transcript)
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Student Journey from pre-entry to employment or
further education
6
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

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Student Cohort
8
Course breakdown
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Need for the Research
10

• Results and Findings

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Need for the Research

• Over the last decade the number of student with
  disabilities have risen from 450 in 2000, to over
  7,947 in 2012 representing 4 (6.4 TCD) of
  student population (AHEAD 2012)
• In Trinity the numbers on professional courses
  has increased from 67 in 2006 to 245 in 2012-13
• Twenty three per cent are studying in
  professional courses.

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Background Literature

• Increase in the numbers accessing professional
  courses with a disability in line with the
  widening participation agenda (Ryan, 2011
  Rankin, Nayda, Cocks Smith, 2010 Griffiths,
  Worth, Scullard Gilbert, 2010 Cailbourne
  Cornforth, Gibson Smith, 2011 Wood Marshall,
  2010 Stevenson, Clegg, Lefever, 2010)
• Students often acquire a disability when they are
  in college - in particular mental health
  difficulties (Dooley Fitzgerald, 2012 Nolan,
  2011)
• Students can manage the academic environment of
  university because supports are readily available
  however it is during the professional placement
  that issues with their disability emerge- as they
  are performance based (Tee, et al, 2010)

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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)

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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)

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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)

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• 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)

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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)

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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)

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Literature Contd.

• Other reasonable accommodations can include
  counselling, health service and Unilink support
  (Storr, Wray Draper, 2011) and that these
  supports need to be accommodated within the
  placement hours
• Practitioners on the ground moving towards a
  therapist role from an educators role and needing
  support to accommodate the students needs- input
  reasonable accommodations (Hirneth MacKenzie,
  2004)

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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 students 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?

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Questions we need to ask-Issues in the Literature

• How do we encourage disclosure in order to
  receive reasonable accommodation and how do we
  balance this with the fear of disclosure and its
  perceived reprisal.
• How do we support educators to be educators as
  opposed to utilizing their therapist skills when
  challenges arise (Hirneth MacKenzie, 2004)

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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.

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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

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Courses with Professional Practice
Business Studies a language
Clinical speech and language studies
Deaf Studies
Education (B.Ed, (B.Mus.Ed)
Social Work (B.Sc, M.Sc)
School of Dentistry (Dental Hygien (Dip), Dental Science, Dental Nursing, Dental Technologist, Pg Dip Clinical Dental Technology)
Human nutrition and dietetics
Medicine
Nursing (Midwifery, Childrens, General, Psychiatric)
Occupational Therapy
Physiotherapy
Radiation Therapy
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• Section One Results from Staff

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Staff Respondents

• Practice Education Coordinator (n 8) 72.3
• Head of Department (n3) 27.27
• Practice Education Coordinators (n68)

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Demographics Heads of Dept/Practice Education Co-ordinators (N11)
Category of role applies to you? (n11) Practice Education Coordinator (n 8) 72.3 Head of Department (n3) 27.27
Approx. years working as a practice education coordinator? Less than 2 years n0 2-5 years n4 33.33 6-10 years n3 25 11-15 years n1 8.33 16-20 years n1 8.33
Approx. how many students with disabilities are you aware of having placed or supported? 1-3 students n1 12.5 4-10 students n2 25 11-15 students n2 25 16-20 students n1 12.5 20-30 students n0 30-40 students n0 40-50 students n0 More than 50 students n2 25
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Demographics Practice Education Coordinators (n68)
Category of role applies to you? (n61) Practice Educator/Preceptor n 18 32.73 Practice Tutor n20 36.36 Regional Placement Facilitator n5 9.09 Student Supervisor n18 32.73
Approx years working as a practice educator/student supervisor? (n67) Less than 2 years n9 13.43 2-5 years n21 31.34 6-10 years n28 41.79 11-15 years n6 8.96 16-20 years n3 4.48
Approx. how many students with disabilities are you aware of having supervised or supported through practice education? (n66) No students n20 30.30 1 student n10 15.15 2 students n8 12.12 3 students n12 18.18 5-10 students n13 19.70 11-15 students n2 3.03 16-20 students n1 1.52
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Were you aware of the nature of the disabilities of the students you supervised in the workplace? (n40) Aspergers Syndrome n3 Attention Deficit (Hyperactivity) Disorder n4 Blind/Visually Impaired n8 Deaf/Hard of Hearing n13 Dyspraxia n3 Mental Health Difficulties n25 Neurological Condition n7 Speech and Language Disability n2 Physical Disability n7 Significant On-going Illness n17 Specific Learning Difficulty n23 Other n4 (Narcolepsy, Musculoskeletal conditions)
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Training
Training received by PECs and PEs in supporting
students and staff with disabilities.
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(No Transcript)
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Theme 1
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Reach the standard sub themes

• 1. Ability to carry out day-to-day duties
• They wont 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 providers 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
  providers willingness to take students on
  placement in the future)

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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 students 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.

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Appropriate level of support
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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.

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• Section Two Results from Students

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Demographics
of student responses Numbers of students (n)
Year of Students (n60) 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 (n61) 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 (n50) Yes, choice No, no choice 28 72 14 36
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Demographics
of student responses Numbers of students (n)
Number of weeks of professional placement completed by students (n54) No placements completed to date 2-4 weeks 6-10 weeks More than 10 weeks More than 20 weeks More than 30 weeks 16.7 9.3 11.1 14.8 11.1 37.0 9 5 6 8 6 20
Number of professional placements completed by student participants (n41) One placement Two placements Three placements Four placements Five placements Six placements Seven placements Eight placements 26.8 2.4 19.5 17.1 2.4 4.9 0.0 26.8 11 1 8 7 1 2 0 11
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Breakdown of disability type of student
respondents (n61)
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(No Transcript)
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Why I disclosed? The Benefits?
43
Benefits of Disclosure

• Helps get appropriate support
• Everything makes more sense to your supervisor
  if they know whats 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.

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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

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Why I did not disclose?
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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.

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Obstacles
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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.

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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....

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• Legal and Policy background

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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.

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• 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.

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• 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

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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. Employers enquiry can only
  be adequate if employee can fully participate.

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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.

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Fitness to Practice

• Fitness to practice has been defined as an
  individuals 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).

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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.

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• Section 4 of the College Policy refers to the
  need to provide reasonable accommodation to
  students with disabilities.

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• Recommendations and next steps

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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.

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• 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.

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• 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

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• 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.

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• Any Questions?
• Thank you for listening!

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71
Useful Resources

• Useful 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 Clinical
• Practice A Resource Guide for Clinical and
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• Guide to Disclosure, AHEAD Press, 2011
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