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The evolution of the classification of communication disabilities using the World Health Organization schemes
Since 1980, the World Health Organization (WHO) has published a number of classification schemes that have been revised from time to time. The first scheme, namely the International Classification of Impairment Disability and Handicap (ICIDH) (WHO, 1980), used the categories of impairment, disability and handicap. These terms, which reflected “a consequence of disease classification” with negative connotations (WHO, 2001, p.4), were replaced in 1997 by body, structure and function, activity in the revised Beta 1 and Beta 2 drafts (ICIDH-2) (WHO, 1997), aiming to help clinicians shift from a strictly medical impairment-orientated understanding of how to help individuals with chronic impairment, to a social, participation-and support-orientated paradigm (Holland & Hinckley, 2002; Ylvisaker, 2003). The most recent version in the evolving family of WHO classifications, the ICF (WHO, 2001) is the WHO’s current framework for health and disability, to be used internationally as a unified and standard language and framework across disciplines and sectors (WHO, 2001). It is based on a biopsychosocial approach allowing clinicians and researchers to document a wide range of human functioning from biological, individual and societal perspectives (Threats, 2002). Threats, Shadden, Vickers and Lyon (2003) have noted that the ICF (WHO, 2001) is significantly improved in relation to previous versions of the WHO classification. Amongst other things it contains operational definitions for all items, environmental factors; as well as a social model orientation, highlighting the recognition given in this classification scheme to the role of the environment as either facilitating functioning or creating barriers for the people with disabilities. In 2001 the American Speech-Language Hearing Association’s Legislative Council (ASHA, 2001) voted for a new Scope of Practice for the profession, stating that the ICF (WHO, 2001) is the chosen framework for the field, reflecting ASHA’s “present and future need to broaden our view and demonstrate that the profession makes an important impact on the lives of our clients
and the health of the nation” (Threats, 2003, p.4).
The ICF’s (WHO, 2001) classification scheme reflects the multiple interactions of the person with the environment, and provides one with a means of organizing measures of function, activity, participation and environmental context. The latter “make up the physical, social and attitudinal environment in which people live and conduct their lives” (WHO, 2001, p.22) and include aspects external to the person’s control which can have either a positive (facilitative) or a negative (barrier) effect on their functioning. Numerous criticisms have been lodged in the past against the WHO family of classification schemes, and more recently regarding the ICF (WHO, 2001). Hurst (2003), as a disability rights activist and a member of the World Council of Disabled Peoples’ International, has criticized the earlier versions of the WHO classification schemes (WHO, 1980; 1997) as being formulated by “non-disabled experts….who perpetuated the concept of disability being another word for incapacity, impairment or lack of functioning” (p.573). In contrast to these earlier versions, Threats (2004) has noted how the ICF (WHO, 2001) “represents an advocacy approach to disability….designed to empower persons with disabilities and organizations that are trying to ensure the right of persons with disabilities to be fully integrated into society ” (p.5). Threats and Worrall (2004) have emphasized how the details of the ICF (WHO, 2001) continue to be “work in progress” (p.56), attempting to deal with numerous limitations and practical issues including considerable ambiguity and overlap of codes that are complex and require training to use properly (Simmons-Mackie, 2004; Threats & Worrall, 2004).
The corporate legislative environment
In 1994, South Africa emerged from four decades of Apartheid, inheriting a legacy of inequalities across all spectrums of society (Fisher, Katz, Miller & Thatcher, 2003; Grobler, Warnich, Carrell, Elbert & Hatfield, 2002; Swart, 2001). In the South African workplace specifically, various legislative changes have since been made (in line with worldwide trends) aiming to address these inequalities through the removal of some of the existing barriers for previously disadvantaged and minority groups, including those within the reported approximately 2,5 million individuals with disabilities in South Africa (Silver & Koopman, 2000; Swart, 2001). These have included the Employment Equity Act (No 55 of 1998) (outlawing discrimination on the basis of disability during the recruiting process, as well as within the workplace itself), applying to employers with more than 50 employees, or with a turnover annually that exceeds a specific amount (DPSA, 2000). Such companies are termed: designated employers. Other laws include the Skills Development Act (No. 97 of 1998) aimed at improving the skills of the South African workforce and encouraging employers to use the workplace as an active learning environment (Alant, 2001; DPSA, 2000; Grobler et al., 2002; Silver & Koopman, 2000). The Code of Good Practice (Employment Equity Act No 55 of 1998) serves as a guide for the employer and the employee with a disability, promoting equal opportunities and fair treatment for individuals with disabilities. Silver & Koopman (2000) note how in spite of the legislation, very few companies in South Africa have addressed these issues to date, and they challenge South African businesses to join worldwide trends in becoming socially-responsible companies, integrating these laws, and creating inclusive workplaces, which Grobler et al.(2002) likewise emphasize as being “necessary for organizational survival” (p.45). Grobler et al. (2002) have further stressed how companies will need to commit themselves to a diverse workforce, tapping the potential of that workforce, and changing attitudes within the culture of the company from the top management down towards accommodating such a workforce, and removing prejudice and stereotypes.
Swart (2001) undertook research to determine the attitudes of a sample of businesses in the Cape
Province as regards: complying with the Employment Equity Act (No 55 of 1998); employing and accommodating individuals with disability; together with the perceptions of non-disabled employees regarding colleagues with a disability. He noted how (as compared with research carried out by companies in the UK and USA on the costs and benefit of employing individuals with disability), in South Africa “very little, if any research has been done locally on these issues” (p.1-2). His findings included the ignorance and discomfort of non-disabled people around people with disabilities, lack of knowledge concerning the abilities of such individuals, difficulties reported in finding suitably-qualified people with disabilities to employ, and he reported that 25% of his sample of companies (in spite of being designated employers), had no policy in place to integrate employees with disability. Swart (2001) concluded that South African companies need to be more “pro-active” (p.9-1) in implementing policies dealing with such issues. Silver and Koopman (2000) likewise observe that a major change of attitude is needed in the culture of organizations in order to integrate individuals with disability, to match the job with the individuals, and to put the correct supports in place. They encourage South African businesses to become “the employer of choice” (p.9) for people with disabilities, thereby “positioning your organization and managing it in such a way that the most talented people with disabilities and people with the greatest potential are drawn to work for your organization” (p.9).
CHAPTER 1 ORIENTATION
1.1 Introduction
1.2 Background
1.3 Chapter outlines
1.4 Definition of terms
1.5 Abbreviations
1.6 Summary
CHAPTER 2 SOME MAJOR CONTEMPORARY REHABILITATION ISSUES REGARDING THE INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY
2.1 Introduction
2.2 Traumatic Brain Injury (TBI) and cognitive – communication problems
2.3 Cognitive-communication problems following TBI
2.4 Differences between TBI and aphasia
2.5 The evolution of the classification of communication disabilities using the World Health Organization schemes
2.6 Shifting from the medical to the social model
2.7 Approaches to training communication partners of individuals with neurogenic communication disorders
2.8 Summary
CHAPTER 3 CONTEMPORARY CORPORATE PRACTICE AND TRAINING TRENDS IN RELATION TO INDIVIDUALS WITH A COMMUNICATION DISABILITY
3.1 Introduction
3.2 The corporate legislative environment
3.3 Corporate practice and training trends
3.4 Summary
CHAPTER 4 RESEARCH METHODOLOGY
4.1 Introduction
4.2 Methodology
4.3 Research design
4.4 Main study
4.5 Summary
CHAPTER 5 RESULTS
5.1 Introduction
5.2 Measures administered to the experimental group before and after a training session
5.3 Inter-group results
5.4 Intra-group results
5.5 Summary
CHAPTER 6 DISCUSSION OF RESULTS
6.1 Introduction
6.2 Inter-group results: Pre-and-post questionnaires 1 and 2: Confidence and skill constructs
6.3 Summary
CHAPTER 7 CONCLUSIONS AND RECOMMENDATIONS
7.1 Introduction
7.2 Overview of rationale for study and summary of results
7.3 Evaluation of study
7.4 Recommendations for future research
7.5 Summary
