October 2020

moocowinthecity 2020-10-20 No Comments

Inclusion and Equity through Universal Design vs. Ableism and Inequality Through Accommodations

I am a certified ESL teacher. I set up the IDF Ground Forces Command’s first-ever English as a Second Language instruction and evaluation program (which I ran until I left the Foreign Relations Branch for my final position in the Foreign Training Division). Within that position, I finished as a commander, and as the Instruction NCO for the Foreign Training Division’s Battalion Commanders Course. I have also taught Hebrew as a Second Language (here in the United States), and I have had the honor of being a Visiting Scholar at New York University where I put my MBA and my brain together with other thinkers and creatives to support a common mission.

I am also the sum of my experiences (as are we all). Growing up with learning disabilities, neurological disabilities, mental health conditions, and eventually physical disabilities as I entered adulthood, I am no stranger to the Special Education system. I remember school before the passing of the Americans with Disabilities Act of 1990 and I remember school right after it passed. I also remember school many years after it passed (for what little changes there were). I spent the majority of my academic career in Special Education 6:1:1 classes (six students, one teaching assistant, one teacher). Therefore, it should come as no surprise, that this experience has had an impact on my thoughts, feelings, and beliefs when it comes to what constitutes ethical and appropriate course design (though I very much feel that I can support these thoughts, feelings, and beliefs with evidence).

My pedagogy is, largely, based on Universal Design, which is a belief that I hold dear, and a belief that I bring with me into my Social Work practice (and other areas of my life). While Universal Design comes to us (initially) from the field of Architecture (I grew up in a construction family), its tenets are applicable in education and elsewhere [zotpressInText item=”8BT8KDNS” format=("%a%, %d%)"]. Indeed, Universal Design has been enshrined in Federal Law for Special Education over the past two decades [zotpressInText item=”8BT8KDNS” format=("%a%, %d%)"].

I believe that I can make a very strong case that we cannot teach Social Work, ethically, without following Universal Design principles. The very system of seeking (and someone in power providing) “accommodations” is not only ableist, but it runs counter to equity, and trauma-informed principles.

[zotpressInText item=”8BT8KDNS” format=”%a% (%d%)”] writes that “Typically, accommodations are provided upon request. While this represents a significant improvement over situations found in the earlier phase, accommodations tend to maintain inequality” (p. 35). This is, as [zotpressInText item=”8BT8KDNS” format=”%a% (%d%)”] notes, due to a plethora of reasons: delay in receiving accommodations, requiring the creation of special materials, having to go to separate locations to receive accommodations (which is othering), and more.

Simply put, ‘accommodations’ or ‘reasonable accommodations’ may have worked in the late 90s (as we were beginning to transition to Universal Design), but they are hardly the standard-bearer that we want today.

Accommodations violate Trauma-Informed Principles for a variety of reasons. First, because they require the assent of those in power to those who require accommodation for their academic needs. This is not power-sharing (collaboration). Accommodations also do not build emotional safety (leaving the room, having to request alternative assignments, having to identify needs or advocate for accommodations in front of peers, or having it become apparent that one is not participating in the same activities, does not engender feelings of safety).

Accommodations also do not generate trustworthiness within Social Work programs, because there is an expectation that Social Workers uphold the highest level of Social Work Principles and Values as espoused in the Code of Ethics, and a feeling of moral injury can occur when this does not happen, or when conflicts arise.

Infographic by the Institute on Trauma and Trauma-Informed Care (2015)

There are any number of NASW principles or ethical points within the code that could be called upon to illustrate my point, for time and space, we will take the gestalt of striving for equity, justice, equal rights, championing the marginalized, and being inclusive as running themes of the CoE.

So if not accommodations (the model that has been an almost immovable wall at universities) then what?

Universal Design

Universal Design is, by its nature, proactive, whereas, accommodations are reactive [zotpressInText item="JJ8LBV55" format="(%a%, %d%)"]. While accommodations seek to make the smallest amount of changes possible for the smallest amount of students, Universal Design seeks to make all courses as widely accessible as possible for all students, following accepted Universal Design Principles [zotpressInText item="JJ8LBV55" format="(%a%, %d%)"].

UDL for Learning Table. Full options available at http://udloncampus.cast.org/page/udl_about — *CAST (2018). Universal design for learning guidelines version 2.2 [graphic organizer]. Wakefield, MA. Author.*

[zotpressInText item="FPR3AN4P" etal="yes" format="%a% (%d%)"] note that Universal Design can not only help overcome barriers and create wider access for all faculty, staff, and students, but they also recognize that it can assist countries in meeting their obligations underneath a variety of United Nations treaties.

In their recommendations, [zotpressInText item=”FPR3AN4P” etal=”yes” format=”%a% (%d%)”] share that technology should be leveraged to “support inclusion, rather than letting it become a barrier” (p. 6). Additionally, [zotpressInText item=”FPR3AN4P” etal=”yes” format=”%a% (%d%)”] recommend that Universal Design become a campus-wide discussion and that the framework for Universal Design work to take into account all needs, thereby eliminating the necessity for accommodations.

Universal Design requires not only multi-modal learning options but the anticipation of needs that are unforeseen, as well as ways in which student learning can be assessed across a variety of learning means and systems [zotpressInText item=”9M92Y393″ etal=”yes” format=”(%a%, %d%)”].

Universal Design can be hard (to be sure). [zotpressInText item=”8BT8KDNS” format=”%a% (%d%)”] provides many suggestions for incorporating Universal Design into education (in what was then entering, and now leaving the second decade of Universal Design in education).

I recommend building upon this work through coalition building and interdisciplinary teamwork. While one may be an expert in course design, it does not make one an expert in universal design, and while one may be an expert in Social Work (or a part of social work), it likewise does not make them an expert in pedagogy. Here, course design through collaborative activities such as Business Model Canvasing can bring the necessary experts, artists, thinkers, as well as shareholders and stakeholders together, in order to come up with curriculum and course designs that are truly Universal and Trauma-Informed by nature, and universal/multi-modal by design. By including members of the Disability community (rather than experts on disability), additional barriers and needs can be identified and handled.

Am I seeking the tearing down, restructuring, and rebuilding of entire courses, schools, and universities in order to actually be inclusive and meet our higher values? Yes.

Do I think it’s reasonable? Yes.

Do I think it will be a lot of work? Yes (though likely, not nearly as much as some may fear).

Do I think it will enhance learning, create more opportunities for discourse, and exploration, open avenues for scholarship and research, and innovation? Yes.

Do I think it’s going to require moving beyond a ‘straightforward’ syllabus, or technology or apps or ways of teaching and ‘testing’ that we’ve become used to, or enamored, or comfortable with? Absolutely. Equity takes work.

Closing Thoughts

The Disability community has never made anyone comfortable. We don’t exist to make anyone comfortable. Well behaved crips rarely make history. We, however, have always been on the side of progress, even when we’ve had to chain our wheelchairs, walkers, and scooters to one another to make it happen.

Universal Design is a necessary next step forward for ensuring equity and ethics in education. It starts with multiple learning options and modes of assessment, and expands to transforming programs to meet UDL principles. When combined with a Trauma-Informed Human-Rights perspective, we have an opportunity to make a substantive difference in the lives of everyone who seeks an education. We must move toward a world where accommodations will become superfluous by design.

References

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Journey

A Solution Focused Brief Therapy Note (Update to the Update)

moocowinthecity 2020-10-14 No Comments

This is an updated entry from my previous discussions on the topic, which can be found here, and here.

The genesis of this is that I was discussing at with a friend and colleague, former professor, mentor, and one of the people who got me started on my path to be a Solution Focused Counselor/Therapist (that’s a lot of titles) what my notes look like as a Solution Focused Brief Therapist in public practice in the United States where, especially when billing insurance, we must justify our work through documentation, to say nothing of our ethical requirements to document appropriately…so I figured I’d share the template and format I use.

I have come up with the following format for therapeutic interactions which, with the exception of the MSE, I write collaboratively with my patients. This takes no more than five minutes at the end of our session, and ensures I don’t ever get behind on paperwork/case noting.

I do not take any notes during a session in order to foster open and direct communication. There is nothing between myself and the patient (no pad, no pen). This requires a great amount of practice in active listening. I recommend a lot of role play to become comfortable with the technique.

Below is an example of a contrived session I made up about John Doe, it should bear no resemblance to anyone living or dead since I just came up with it on the fly, sans-coffee, while waiting for my flight:

MSE:

Patient presented on time, dressed appropriately, appeared alert and well-oriented. There was no evidence of disruption in speech flow or content, memory, or perception. Current mood observed as euthymic with affect congruent to mood. Thoughts were organized and goal-directed. Judgment appeared good, and insight appeared moderate.

Patient presented with:
– Desire to reduce symptoms is depression;
– Desire to reduce symptoms is anxiety;
– Desire to improve capability for regulating moods/emotions;
– Desire to reduce stressors regarding family;
– Desire to reduce stressors related to work.

Clinical Note:
Mood: John doe reports that, overall he is doing okay, but that he is also still contending with depression. John reports that he is using coping skills, and feels okay in this moment. This writer validated John’s moods/emotions, as well as John’s use of coping skills.

WHSLS (What’s Happened Since the Last Session): John Doe shared that this week he was able to get out of bed and go to classes twice. John shared that he was also able to wash half of the dishes in his sink. John shared that he had a fight with his friend, that he regrets, and is unsure of what he wants to do about it, and that his indecision is bothering him.

BHFTS (Best Hopes For Today’s Session): John shared that if he could work on finding a way to attend his classes, and finish doing his dishes, then today’s session would be helpful, useful, and productive.

Scaling (1-10/Zombies-to-Unicorns): 4.5; Goal (1-10): 5/John shared that he will be at a 5 when he is able to do all of the dishes and is able to go to all of his classes.

Discernment: John and this writer discussed barriers to doing his dishes and to attending classes, and how these barriers are negatively impacting his mental health symptoms**.

Exceptions: John shared that the problem of doing dishes and cleaning in general is not a problem when he comes right home after work. John shared that attending classes weren’t an issue when he got more sleep.

Experiment: John was able to brainstorm ways in which he can address his barriers to move to a 5 on the scale. John will try to do dishes twice this week right after work. John decided he will set a reminder on his phone to go off part way through his commute to remind him. John will set his bedtime back by an hour to get an extra hour of sleep.

Clinical/Psychoeducation: This writer provided psychoeducation on the importance of sleep hygiene and behavioral activation for reducing the sxs of depression.

Risk Assessment: John denied thoughts, plans, or intents or harming himself or others.

Follow Up: Follow up in two weeks. John to complete experiment as outlined above. John will call/come in if he requires additional support between now and his next appointment.

**While problem talk is discouraged, linking the patients concerns, and treatment to their mental health symptoms in discussion is necessary for ethical treatment under insurance. This is possible even in SFBT when we look at the “preferred future” (i.e. “I won’t be so anxious,” or “I won’t be as depressed,” etc.). We have to show how they are negatively impacting mental health symptoms because that is the structure of the medical/insurance setup in the United States.

In any event, I hope this is helpful to the wider SFBT community who is forced to balance SFBT work and insurance (without which, only the wealthy could afford our services), and I look forward to turning this into some kind of presentation at some point (SFBT & Insurance: An Uneasy Truce?).

SFBTCast

moocowinthecity 2020-10-10 No Comments

Episode 8: Welcome back to the show the re-re-reboot & a Lesson on Validation & Changing Language!

https://www.buzzsprout.com/1339411/5834743-episode-8-welcome-back-to-the-show-the-re-re-reboot-a-lesson-on-validation-changing-language.js?container_id=buzzsprout-player-5834743&player=small

Transcript:

So it turns out that two things happened: FIRST, someone else was using my initials…two someone else’s…a television show (we can’t get mad at them for having that as a call sign)…but, sadly, also a hate group (BOO!). So the name got he show has been changed to The Solution Focused Podcast! I have upgraded my gear and equipment (also yay!) and I look forward to getting back to our regular production schedule!

What is also interesting is that I learned a very important lesson on validation that I think will be important to remember and process for this involved in clinical settings.

When I was at a Solution Center we utilized the Outcome Rating Scale created by Scott D. Miller and his team at the International Center for Clinical Excellence (ICCE). This always lead to us being able to ask our patients about their emotions, and validating them – naturally, and without thinking about it!

However, moving into a clinical setting, we don’t (yet) have time to do that we each patient (scheduled back to back, and eschewing paper) so in dropping that practice, I realized I was missing a key component of my Solution Focused Work: the emotional check in and validation. This was pointed out to me by a colleague when I was covering for her, and some of her patients commented on it (she is almost entirely a DBT practitioner, so very opposite in approach, and very noticeable by her patients).

The MOMENT I made a conscientious effort to bring validation as an immediate first step, before what was “What’s better this week?”, as part of my regular practice, there was a noticeable change with my patients: sessions became more fluid, patients felt better (their self-report), and items on treatment plans seemed to have gotten resolved quicker, or at least had more progress noted in them. Engagement seemed to be up. This shows us, I think (admittedly without quantitative detail) qualitatively the importance of validation.

Secondly is word choice: I found that “what’s better this week” no longer fit with my view on trauma informed practice I changed my question to now be “what’s happened since last session” and then, from there, I can guide to “have things gotten better, stayed the same, or gotten worse” through a variety of different ways.

In Solution Focused Work, we believe that words make all of the difference, and in fact, the therapy happens with the words that are used in session…which is why we have to choose them so precisely.

I’ll put out an updated conceptual template for case noting later in the week. For now, welcome back, it’s good to be back on the air!

Thank you for listening. Please tune in again next Sunday (and every time in-between), as we continue forward together down our solutions focused path. Comments, constructive criticism, feedback, and questions can be sent to [email protected]. Yes I’m on Social Media at @TheMattSchwartz on all of the platforms you’d think to look at. I’m Matt Schwartz, and it’s a pleasure to be your host.

The music you’re listening to in the background today is Boston Landing on “Blue Dot Sessions” generously shared through a creative commons license. Please find more of their music at www.sessions.blue, that’s w-w-w- dot s-e-s-s-i-o-n-s- dot b-l-u-e. I’ll see you next Sunday with more; unti