Environmental Contexts and Disability: Volume 8

This study frames the international disability movement – NGOs, foreign donors, and transnational networks focused on promoting the 2006 UN Convention on the Rights of Persons with Disabilities – as an organizational environment. As the movement expands into the Global South, it actively pressures local grassroots associations to adopt a new organizational model in order to become membership-based advocacy organizations. Many groups, however, are embedded in local civic environments that expect them to act as self-help and social support organizations. As such, grassroots associations are caught between two organizational environments, each promoting different models and practices.

This analysis draws upon 18 months of participant observation and 69 interviews gathered from a local coalition of seven grassroots disability associations in Nicaragua. This ethnographic approach is combined with sociological institutionalism, an analysis that emphasizes the way organizations conform to organizational models that spread across a field.

The local associations responded in a variety of ways to the advocacy model promoted by the international movement. Organizations either conformed, resisted, or developed hybrid organizational models on the basis of internal characteristics that determined how they straddled the two organizational environments.

This paper highlights the way international models may be ineffective in local environments that have civic traditions and lower levels of governmental capacity than found in the West. Some disability associations, however, will creatively combine local and international models to create new initiatives that make a positive impact in the lives of persons with disabilities at the grassroots.

In recent years, recognition of environmental influences in public health has expanded to include more components of the environment such as the built environment, attitudes, and public policies. This environmental attention has addressed the need for healthier housing, schools, roads, and work sites, as some examples. Paralleling the development of awareness of the impact of environment on health and health behaviors, the influence of the environment and its contribution to the experience of disability has become more apparent. This national descriptive analysis of environmental barriers contributes to our understanding of the extent of environmental considerations for the entire U.S. adult population, not just older individuals, and will document those problems for those with self-reported functional limitations (i.e., disability).

This analysis uses the 2002 National Health Interview data to examine physical, social, and policy barriers experienced by the U.S. national population of adults age 18 or over. Focusing specifically on those who report a physical, activity, participation, or mental health limitation, the experience of barriers in the home, workplace, school, and the community is examined using descriptive analyses.

Results indicate that approximately 11% of the population with disabilities and 2% of the nondisabled adult population experience barriers in their daily lives. Severity of limitations and poor health status among those with disabilities increase the experience of barriers. The only sociodemographic factor related to reporting barriers was income. Depending on the kind of limitation, up to 28.6% of the population with disabilities experience barriers. The two most frequently reported types of barriers were building design and attitudes of other people.

This analysis provides an indication of how the environment is experienced by adults with disabilities and identifies perceived barriers found in the home, the work/school environment and the community. It starts to provide a baseline for understanding of the environment as experienced by persons with disabilities and suggests the most pressing areas for attention.

To our knowledge, this is among the first nationally representative analysis of barriers that interfere with daily activities experienced by adults in the United States. It highlights the experience of adults with disabilities and describes numerous types of potential barriers.

The Americans with Disabilities Act was established to promote universal access to community environments. Accessibility is not included in established community assessment systems, however, and there are few data comparing accessibility across cities. This lack of data hampers public policy, restricts consumer choice, and limits the development of a science of the environment and participation.

We developed a protocol for directly observing accessibility of public places and rated 226 randomly selected businesses in 19 towns in Montana.

Combining accessibility ratings across nine categories of accessibility, Montana’s small cities and towns achieved an overall accessibility rating of 2.66 on a four-point scale; equivalent to a D +  using a civil engineering grading framework. Exploratory analyses showed significant relationships between accessibility ratings and community economic variables. Surprisingly, our analyses showed a negative correlation with percent of city residents with disability.

It is feasible to assess accessibility of communities in a standard format. Systematic and longitudinal assessments of the accessibility of community infrastructure can contribute to community planning and development. There is a need to create a program to routinely monitor community environments as they change, integrate the findings into public policy and practice, and use the data as a basis for advancing a science of the environment.

Since the mid-1990s, the social model of disability has come under scrutiny. Several researchers have examined the role of ontology (philosophical ideas about the nature of what it means to be human) in relation to disability. In this paper, we situate this burgeoning understanding of disability within the set of post-cartesian ontologies, which disrupt the separation of the mind from the body and its attendant dichotomies. Furthermore, we seek to show how such a change can carry through to the research paradigm and therefore affect tangible outcomes of disability research.

A commitment to an embodied ontology requires first and foremost that researchers rethink what is being studied by focusing on the diverse characteristics of being and its actualization within the world. This will involve an emphasis on the lived experience of the body, including issues of affect, identity and movement, as well as broader issues of embodied being.

Using a research program currently underway at the Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) as a detailed example, we draw on the ontological framework to help articulate the way research can be re-organized. We show how projects at different scales can be brought to work together, and highlight how a focus on embodiment issues facilitates such multi-disciplinary, inter-project collaboration. We note that adopting such an ontology-based framework will accomplish three major outcomes: (1) increase the relevance and effectiveness of new projects with regard to the overall vision; (2) enhance cross-project synergies and ensure stronger ties between research and practice; and (3) contribute to shifting the underlying ontology from a more cartesian approach to a post-cartesian embodied perspective.

The new ontologies embrace, integrate and extend the earlier social and biomedical perspectives, and offer a critical perspective on technology. The embodied approach recognizes not only the embodiment of research subjects, but also the embodied experience of the researchers themselves. In addition, the approach leads to a more holistic organization of research within a global, interconnected structure of projects rather than simply a collection of separate projects organized into thematic areas, as was done in previous decades. This reorganization of research enhances the ability to engage academic researchers with practitioners not just in the hospital and clinical settings, but also within the wider community.

In Schelling’s “checkerboard” model of segregation, individuals’ moderately held preferences about the proportion of their neighbors who are similar versus dissimilar to them can, through an automatic and mathematical process, yield dramatic population-level segregative behaviors. The notion of such an automatic segregative process would seem to have implications for spatial dynamics when a group home for persons with disabilities is introduced into a community. This study sought to examine those implications alongside data in the research literature regarding community acceptance of group homes.

Using an agent-based modeling approach, computer simulations were constructed to apply Schelling’s model, as well as an alternative model, to community reaction to the introduction of group homes for persons with disabilities. Simulation conditions were set to roughly correspond to the proportion of group homes or other congregate living situations, as well as vacant dwellings, in a typical community in the United States.

The simulations predict that group homes will, to varying degrees, become spatially isolated within their communities. These predictions conflict with previous research findings that suggest minimal relocation of neighbors and rapid adjustment of communities to the presence of group homes.

Simulations of an automatic segregative process might offer a baseline or a “null hypothesis” of sorts, allowing us to more fully understand the extent of the social and socioeconomic forces that serve to moderate or override such an automatic process, allowing communities to adjust to group homes’ presence.

Recent developments in image recognition and “Big Data” offer a method for monitoring the physical accessibility of community environments over time. The stimulus characteristics of images showing access features in context are extremely complex, however, and defining access features that are recognizable by humans or machines is a challenging task. Carefully defining access features provides a basis for teaching both humans and machines to recognize those features and to rate the degree of accessibility.

We employed a stage-process to identify access features detectable in images presented by GSV. We created definitions of features, developed a protocol for conducting community observations, and used it to conduct assessments of access images of 14 towns and cities in 9 states and the District of Columbia.

Interobserver agreement averaged 84% on features and 93% on people observed. A combined access score across communities averaged 60%; ranging from 32% to 100%. A scaled “minimum access” score averaged .92; ranging from .59 to 1.0. We observed 158 people, 3 of whom used a mobility device and 13 of whom used other wheeled devices.

Equating these ratings to academic grades suggests that several communities fail to achieve standards of accessibility but do achieve minimal levels of access in their civic cores. Google Street View offers a data source for human observers to assess the accessibility of communities. Researchers should explore the feasibility of using supervised and unsupervised learning to establish machine recognition of access features.

This report provides information on the cultural environment of professionals concerned with disability, and the implications of that environment for the inclusion and participation of disabled persons in society. We place that environment within an historical context sensitive to the role of power and the constructed nature of the social world to illustrate the importance of cultural environments for understanding factors shaping inclusion of disabled persons.

We use data from coding terms used in the Review of Educational Research for nearly 80 years to examine the cultural environment of professionals concerned with disabilities and suggest such an environment may characterize many professions and the social sciences generally. We examine 23 terms used in academic discourse to refer to disabled populations, tracking change in use of the terms over 80 years.

There has been increased attention to disability from the 1930s to the early 2000s. The increase has been accompanied by a decline in use of terms undermining the dignity and capability of disabled persons, and an increase in terms providing a context for dignity and capability. Such changes suggest a cultural environment propitious for inclusion and participation of disabled and disadvantaged persons.

Implications are considered through a model noting the role of a positive cultural environment in shaping inclusion and participation of disabled populations. The model suggests the power and limitations of cultural environments, while at the same time noting the role of countervailing processes hindering greater inclusion and participation.

The “New Paradigm” of disability and the International Classification of Function Disability and Health both describe an ecological model of disability that has significantly influenced policy and law, and this model is frequently cited as a background in published research. Given the central role of “the environment” in this ecological model, we asked, what is the status of research on the environment and disability? Specifically, is a scoping review warranted in this area of research?

We conducted a “rapid scan” of the National Rehabilitation Information Center (NARIC) database for articles reporting studies of the environment – defined as the arranged or built environment. We also scanned Google Scholar to ascertain the frequency of articles that might report research into the environment.

NARIC archived 12,486 items published from January 2007 to June 2012; 530 (4.2%) of which contained the search term “environment.” Of the 530 items, 78 (14.7%) also included the terms architecture space, accessibility, and ICF. Over the same time period, Google Scholar returned 109,000 entries to search terms “disability and environment,” 349 (0.3%) of which also included the terms architecture space, accessibility, and ICF.

This application of a method for rapidly assessing the status of the literature suggests that research into some aspects of the environment and disability may be under-represented. A more complete review, requiring more resources, is warranted.

The objective of this paper was to identify and analyze barriers to hiring persons with disabilities from the perspective of employers and persons with disabilities.

A scoping review was used to evaluate both evidence and grey literature. An integrative analysis was employed to explicate the most salient macro and meso level barriers that limit the hiring of persons with disabilities.

A total of 38 articles from 6,480 evidence literature and 19 documents from grey literature were included in data extraction. Barriers included: negative attitudes in society, by employers and coworkers (macro and meso); workplace barriers (meso) were about lack of employer knowledge of performance skill and capacity of persons with disabilities, and the lack of awareness of disability and the management of disability-related issues in hiring and retention; and service delivery system barriers (macro) were focused on the lack of integration of services and policies to promote hiring and retention.

Knowledge gained furthers the understanding of the breadth of social, workplace and service delivery system obstacles that restrict the entry into the labor marker for persons with disabilities.

Barriers to employment for persons with disabilities at the macro and meso level are evident in the literature and they remain persistent over time despite best efforts to promote inclusion. Findings in this review point to the need for more specific critical research on the persistence of social, workplace and service delivery system barriers as well as the need for pragmatic approaches to change through partnering and development of targeted information to support employers in hiring and employing persons with disabilities.

The benefits of green space and nature are increasingly recognized and translated into public health policy and practice. Alongside this trend, inclusion of all people into parks and nature has been an important area of parks and recreation practice. Nature inclusion for those with disabilities, youth, seniors and immigrants has become a focus of Alberta Parks in collaboration with the Ministry of Tourism Parks and Recreation in Western Canada. This study was designed to examine the experiences of participants in two such government-supported inclusive nature activities, including day trips and more extensive week-end or week-long nature experiences for adults with disabilities and caregivers.

Two phases of qualitative data collection occurred as part of a pilot project. The first phase was comprised of eight semi-structured interviews (four adults with cognitive, developmental, emotional/mental health or physical disabilities and four caregivers). In a second phase 27 participants (also adults with a range of disabilities and paid, voluntary or family caregivers) engaged in a semi-structured reflective writing process during the existing nature activities (day trip, week-end or week-long inclusive nature experiences).

This is one of the first studies in the field to embrace the benefits of adopting both a human capabilities approach, emphasizing that human diversity is fundamental to equality and development, and an ecopsychological view, with a concern for individual perspectives and well-being as fundamentally interconnected to the environment.

Three dominant qualitative themes of inclusive nature experiences emerged: ‘Sensory Activation’, ‘Reimagined Social Relations’ and ‘Reinvented Self’. Inclusion in nature for both caregivers and adults with disabilities holds promise as an activity that can support mental well-being through a reimagining and equalizing of relationships and one’s experience of self in the physical environment.

Such evidence is important for decision-making and programme development among collaborative partners, including not-for profit disability-related recreation organizations and both public health and parks departments of government. In particular, the findings highlight areas for further activity development targeting those with sensory impairment and relationship disharmony.

We explore the effects and interplay of physical and social environments on the inaccessibility of gynecological health care for women with spinal cord injury. We also explore women’s responses to the inaccessibility of this care, in hopes of trying to understand better how women navigate their gynecological health and health care when faced with physical and social environmental constraints.

The data for this phenomenological study were gathered using in-depth, qualitative interviews with 20 women living with spinal cord injuries in or around Detroit, Michigan. Each interviewee was questioned about overall health and physical functioning, accessibility of doctor offices, interactions with health care providers, gynecological health-seeking behaviors, and complementary and alternative medicine use. In this paper we report on data on women’s difficulties in securing gynecological health care experiences and related attitudes and practices.

Findings echo past literature about the inaccessibility of doctor’s offices, including the lack of suitable exam tables and medical equipment. Office staff varied in their willingness to help transfer women from wheelchairs to exam tables as well, often creating what we term an inaccessible social environment. Individual women in our sample found different strategies for navigating the environmental contexts of a doctor’s office and the encounters that they had with providers within medical settings. These strategies had varying impacts on individuals’ abilities to secure gynecological health care.

Our findings point to the possibility of an interplay between and intersection of physical and social environments within medical settings that needs to be explored further and, potentially, the primary importance of the social environment over the physical environment in determining whether an individual’s disability makes health care inaccessible.

The objective of this paper is to report results from a Canadian-based study addressing systems-level barriers that restrict the employment of persons with vision loss, specifically in the experience of searching for and maintaining competitive employment. This paper aims to generate knowledge which may inform strategies and advocacy efforts to enhance opportunities for, and experiences of, paid employment for persons with vision loss.

This constructivist, grounded theory study used in-depth, semi-structured interviews with seven participants with restricted vision (those who are legally blind) to frame data collection and analyses.

Three interconnected themes emerged: facing and negotiating barriers, the cyclical process of seeking and keeping employment and settling for second best. Participants described barriers to employment that have been described in previous literature that not only continue to exist, but that act to potentiate one another, resulting in settling for competitive employment experiences that are second best. This represents a type of social injustice that has been previously described as ‘occupational injustice’. We explain this concept and link it to participants’ experiences.

This was a small, geographically bounded study. Nonetheless, the findings resonate with previous research and further our understanding regarding how barriers are experienced.

Knowledge gained furthers the understanding of how systemic obstacles restrict and bound the participation of persons with vision loss in the labour market.

While the barriers to employment for persons with low vision have been previously well described, this paper demonstrates how these barriers interact and act synergistically with one another, thereby reinforcing the need to focus on shortcomings at the service, system and policy level, in addition to individual rehabilitation.