Normalisation
As you will remember from our previous lesson, during the 19th century there was move towards segregating people with intellectual and developmental disabilities (IDD) from the rest of society.? Institutionalisation was the result of this and people with IDD were expected to live their lives in hospitals or other residential institutions.
Normalisation is a movement that began during the 1960?s and which sought to create living conditions for individuals with IDD that are as close to those experienced by typically developing individuals as possible with respect to living, working, leisure and housing conditions.? Sometimes, people make the mistake of thinking that normalisation means making people with IDD ?normal?. This is not accurate.? It is about making sure that the we remove barriers that stop people with IDD from living the lives they wish to live.
Normalisation theorists noted that people with IDD are a vulnerable group. They argued that vulnerable groups within society are a high risk of being systematically devalued by society. Groups who are devalued are seen as being different or lesser. As a result, people come to see that treating such people in a different or negative way as natural.
Members of a devalued group are often seen as:
- Dangerous
- Objects of ridicule
- Objects of pity
- Burdens
- Childlike
- Sick or Diseased
The consequences of this perception is that the devalued are:
- Rejected ? expected to live with their own kind
- Segregated ? both physically and socially isolated from other groups
- De-individualised ? treated as the same as all other members of their group
- Controlled ? denied the ability to make choices about their lives
- Deprived ? denied typical educational, health and vocational opportunities
This process can be cyclical. The more a group is treated differently, the more people see members of the group as fundamentally different from ?normal? people. Such treatment is often rationalised as being ?for their own good?.
Normalisation advocates often promote Social Role Valorisation to counteract this de-valuing process. Social Role Valorisation seeks to:
- Prevent people from being placed in negative social roles in the first place
- Reverse or reduce the impact of existing negative roles
- Promote vulnerable people into positive, valued social roles
For ABA professionals, Normalisation theory can help us understand the context of providing services to people with IDD. It can also help us identify if interventions have social validity and raise awareness of potential harms that can be caused to a client. We should seek to ensure that we help our clients achieve ?positive, valued, social roles? that are desirable to them.
Person-centred Service Delivery
Person centred approaches aim to discover how a person wants to live their life and what is required to make that possible. These are approaches are related to the normalisation movement and the moves away from institutional living.
In some jurisdictions, efforts have been made to ensure that regulated service providers (e.g. in health and education) to use person-centre planning or a person-centred approach to service provision.
Person-centred planning is best understood in contrast to other approaches.
When placing people with IDD into segregated institution was the norm, that person was typically view primarily as a patient with a medical problem. The solution their problem was viewed as professional intervention.
The resulting services were often characterised by:
- Large buildings in remote locations ? often far from a person?s home
- Segregation ? with residents only living with other people with disabilities
- Large groups of non-family members living together, sharing rooms and personal space
- Minimal privacy or intimacy
- A lack of liberty
- Strict schedules where management predefined procedures and activities
- A one-size fits all approach based on a person?s diagnosis
- Residents being assigned to an institution based on the care the institution provided
- No choice regarding who provided support.
- No control over personal finances
This entire of model was institution-centred. Residents were ? to one extent or another ? treated as items to be processed. Under this model, staff viewed residents as dependent and did not try to enable them. They viewed their role as being responsible for food preparation, cleaning, driving and medication administration. If a resident tried to do something for themselves, they were often stopped from doing so. As attempts to act independently were punished or placed on extinction, residents became more and more dependent and inactive. They would often feel helpless. They lost skills they previously mastered or just stopped using them. The needs of the institution to run in an orderly fashion took precedence over the autonomy and dignity of the individuals who lived there.
The philosophy of person-centred approaches is to deliberately shift power towards the person who requires support so that they can achieve the freedom that which most of us take for granted. A person-centred approach is not a single technique. Rather, it is an umbrella term that includes a variety of approaches that seek to give disabled people more control over the lives to ensure they are respected and valued.
Delivering ABA in a person-centred way requires planning. Often this means the team around a person coming together to listen ask that person what is meaningful to them, what their dreams and identify what steps can be taken to help bring them closer to that dream. In the case of clients who cannot communicate these desires for themselves, somebody who knows the learner very well can act as an advocate for the learner. This is often a parent, guardian or sibling. In some cases, a professional advocate might be used. ABA assessments such as the EFLS and preference assessments can be useful as part of this process.
When taking an individual through the person-centered planning process, ABA gives us the tools to break down larger goals into a series of smaller attainable objectives that move the learner closer to their goal. We can then use techniques such as reinforcement, shaping, prompting, fading and chaining to help the learner acquire any skills required as part of their plan.