The Disability Maze Books is a series of books poses a number of significant questions and explores several specific answers as well as ways of thinking, which encourage innovative responses to the challenges of the positive assessment of the individual needs of people with disabilities.
When I started work on these books, colleagues and friends asked me if I wanted to replace the assessment systems with which we are all familiar, with one of my own. Many of them also wanted to know where my focus would be set. Would I concentrate on the fields of education, social-care, or the health system?
My hope is to encourage a holistic, positive, approach to the assessment of individual needs. There is much evidence to suggest that assessments carried out by professionals in the fields of education, social-care and health, often have a negative focus. In simple terms, the aim of many forms of assessment seems to be to highlight limitations and to focus on the things that someone finds difficult, or impossible. This approach is often referred to as ‘the deficit model’.
My argument is not that the assessment process itself is negative. I believe that the problem lies in the limited way in which the information given by assessments is used. There is widespread reluctance to look beyond any deficits, which quite accurately, may be identified.
One reason for the popularity of deficit modelling is that it gives easily predictable and replicable results. There are obvious advantages for assessors with this approach. The assessor knows, in advance, that someone with a given condition is likely to respond in a particular way during the test.
The major difficulty with deficit modelling arises from this same predictability. It is far too easy to allow our familiarity with given conditions, and the test procedures, to guide us towards familiar responses. The danger is that conclusions and recommendations are not drawn from test results. Instead, recommendations are made from a predetermined stock. In short, deficit modelling can become a short cut. Instead of working to find the most appropriate course of action for the individual, this approach encourages us to decide which of our stock responses an individual can be made to fit. In basic form: if you have condition A, B, or C, then you need solution 1, 2 or 3. This approach quickly fails when the individual’s needs cannot be standardised. If someone has conditions A, C and F, for example, the predetermined model suggests that they would need three separate solutions simultaneously, solution 1, 3 and 6.
The problem occurs when multiple solutions are in conflict. There has been a tendency, for many years, particularly within special education, to concentrate on the dominant condition and to make some effort to accommodate the others. In turn, this has meant that the dominance of one condition, often leads to other needs not being addressed in the best possible way.
Replacing the deficit-focused approach requires us to add new ways of thinking to our established methods of working. Clearly, we still need to identify the things that individuals find difficult or impossible, and to identify limitations. It is my contention, however, that having done so, we should continue the assessment process to find any skills and abilities, which might indicate possible solutions.
The new element of a positively focused assessment will consider the impact of the individual’s needs as well as that of our recommendations. An impact model takes full account of the consequences of our recommendations on all aspects of a person’s life and includes consideration of the impact upon family members, friends and colleagues, whose lives may be changed when a person with a disability gains a new skill or level of autonomy.
The word ‘assessment’ conjures up an adverse emotional reaction in many people. We have all undertaken some form of an assessment, for instance when sitting an examination, and many of us have found it a distinctly unpleasant experience. Why should we assess people? Even more to the point, why launch a series of books on the subject?
Disability can limit the range of an individual’s communication, and his or her degree of independence in day-to-day life. This often means less is possible, less expected, less attempted and less achieved. Limitation breeds the assumption of further limitation. HRH Prince Charles, Prince of Wales once said,
Man’s greatest enemy is not disease but despair.
[My] approach to Consultation, Assessment, Research and Evaluation (CARE) is grounded in the firm knowledge that this cycle must be broken. There are no magic wands. Nothing can remove a disability and no solution is ever achieved without flexibility, effort and determination. [We must] provide an effective bridge between a person’s current level of ability and what he or she wants to achieve. It is a bridge whose central peers are potential, motivation and realism.
Mike Tawse, 1991 and 1994
Since many assessments are considered essential, and may even be required by law, improving their accuracy is a worthwhile goal. As well as the inaccurate use of tests, a breakdown in communication between professionals can lead to the wrong decisions being made, and inappropriate therapy or treatment plans being offered. Any one client may be treated, assessed or discussed by a number of professionals with different training, areas of expertise, vocabulary and approaches to assessment. The term “client” itself suggests one particular approach to care.
In the context of this series of books, it is crucial to keep in mind that assessment should be a positive experience, rather than, as so often seems the case, a self-validating one. One assesses in order to determine a course of action rather than for the simple pleasure of assessment for its own sake.