Summer 2024 Issue

Disability: Ten Tenets of a Disability-Affirming Practice
By Mbita Mbao, PhD, LICSW, and Elspeth Slayter, MSW, MA, PhD
Social Work Today
Vol. 24 No. 3 P. 22

Moving From a Focus on Disability Access and Inclusion to a Disability-Affirming Practice Framework

Twenty-seven percent of adults in the United States are members of the disability communities,1 with 40% aged 65 and older2—a fact about which social workers are often unaware, despite their involvement in this service sector. Given the high prevalence of disability, the status of these communities remains an area of concern for social workers who want to engage with this stigmatized and oppressed population in a respectful and empowering manner.3

Although concerns about ableism and sanism in the social work realm have been well-documented for decades, social workers most often focus on disability access and inclusion in response to policy mandates. While disability access and inclusion are foundational requirements for social work practice with the disability communities, there’s a call for a move toward what’s known as disability-affirming practice.4,5

Comparing disability access and inclusion to disability-affirming practice is akin to moving from a focus on diversity to a focus on equity, knowing that we need both. When one thinks of disability access and inclusion, the focus is on what the legal requirements are for creating an accessible practice or workplace. Our focus is also on how to carefully and thoughtfully implement laws like the Americans with Disabilities Act of 1990.6 But taking an inclusion and access frame alone, we miss an opportunity to address the widespread ableism and sanism present in both social work and in the world‚ not to mention the ways that these “isms” can become internalized among members of the disability communities.

The disability communities are more likely to experience mental health challenges as a result of societal barriers, cultural stigmas, and internalized ableism or sanism. Therapist Cat Maness7 notes that these communities are likely to have experienced disability-related trauma or stress, including discrimination, access barriers, and either mental or physical pain. It’s essential for social workers to provide accessible disability-affirming therapy for these individuals by incorporating disability-affirming approaches into treatment that ideally can improve outcomes and promote overall wellbeing. Disabled social workers recommend incorporating intersectional, antioppressive, and “critically culturally competent” practices.8

What Is Disability-Affirming Practice?
This framework is focused on creating safe, healing, and validating environments in the context of social work practices that lift up the perspectives, wisdom, creativity, and experiences of various disability communities.

Building on existing commentaries about disability-affirming therapy, we propose the following tenets of an intersectional disability-affirming practice:

1. It’s vital to acknowledge as well as confront experiences of ableism and sanism in the lives of clients from the disability communities by listening to and validating those experiences. This may involve confronting attitudes that may reflect ableism or sanism, such as the idea that disability is a personal failing or that disabled individuals are “less than” people without disabilities.

2. Social workers can foster a positive disability identity.9 Research supports the notion that a positive disability identity fosters better long-term psychological outcomes. While not all clients may wish to identify as disabled (often due to fears of stigma or the idea that their disability is just a medical condition), social workers may be able to connect them with the strong online support available in the disability communities, where a positive and rich disability culture exists.

3. Social workers must learn about disability culture, acknowledging the diverse experiences within those communities. This is akin to the ongoing work of “critical cultural competence,” in which social workers continually seek knowledge about different cultures, knowing that there’s no end point to that work.10 Especially important is the need to lift up the perspectives, contributions, and experiences of the disability communities in discussions with clients.

4. Social workers must recognize that the ways members of the disability community experience the world are not only framed by disability but that other intersecting social identities (such as race, ethnicity, and gender identity) also inform their experiences in life.11 Social workers must know that disability is more prevalent among certain social identity groups, such as women, older adults, some racial and ethnic groups, and adults living below the federal poverty level.12 When social workers understand these complexities of the intersectionality of disability with social identity, they can appropriately advocate for equitable programs and resources to address the needs of specific populations.

5. Social workers can embrace central principles associated with disability practice, such as self-determination, community inclusion, the “dignity of risk,” and the principles of the disability justice movement.13,14

6. Social workers should be attentive to the power of language, acknowledging the endemic nature of ableist and sanist language in Western society. This also relates to being attentive to how members of the disability communities want to self-identify, whether it’s with identity-first or disability-first language or with person-first language, knowing that preferences will vary from person to person and there’s no one right way.3

7. Social workers must continually engage in reflective and reflexive practice15,16 to examine the ways in which they may hold ableist or sanist views or engage in unintentionally ableist or sanist behaviors.17

8. Social workers must have knowledge about chronic illness and the challenges of aging with a disability. Recent data shows that 41.6% of adults with a disability have at least one chronic illness. Training social workers in chronic illness, aging, and disability will help bridge the gap in knowledge and skills and lead to more equitable services and resources for both younger adults and those older than 65.18,19

9. Social workers must embrace working collaboratively to identify person-specific goals and objectives in their work while honoring the fact that members of the disability communities are experts on their own lives.

10. Social workers employed in research and policy must collaborate with and include people with disabilities at all research and program development levels to ensure inclusiveness and appropriate development of interventions that represent the population. Through this collaboration, social workers can produce more inclusive and appropriate evidence, interventions, and programming for this population.20

By drawing on these tenets of disability-affirming practice in addition to a focus on inclusion and access, social workers can build rich, supportive, and empowering relationships with members of the disability communities with which they work.22

— Mbita Mbao, PhD, LICSW, is an assistant professor in the School of Social Work at Salem State University. Her scholarly agenda centers around behavioral health, aging, workforce development, and issues affecting immigrants.

— Elspeth Slayter, MSW, MA, PhD, is a disabled professor in the School of Social Work at Salem State University. Her scholarly agenda centers around disability, race, and ethnicity in the addiction and child protection service sectors.

References
1. Disability impacts all of us. Centers for Disease Control and Prevention website. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html. Updated May 15, 2023.

2. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(32):882-887.

3. Slayter E Johnson L, eds. Social Work Practice and the Disability Community: An Intersectional Anti-Oppressive Approach. Pressbooks; 2023.

4. Misra A. Taking up space: the need for disability-affirming therapy. Feminism in India website. https://feminisminindia.com/2020/10/15/taking-up-space-the-need-for-disability-affirmative-therapy/. Published October 15, 2020.

5. Olkin R. Disability-Affirmative Therapy: A Case Formulation Template for Clients With Disabilities. 1st ed. Oxford University Press; 2017.

6. Americans with Disabilities Act of 1990, 42 US Code § 12101 et seq.

7. Maness C. Disability-affirming therapy. Medium website. https://medium.com/@catmaness/disability-affirming-therapy-e57e917d5472. Published March 27, 2023.

8. Johnson L, Singh R, Slayter E. An anti-oppressive, intersectional practice model for work with the disability communities. In: Slayter E, Johnson L, eds. Social Work Practice and the Disability Community: An Intersectional Anti-Oppressive Approach. Open Social Work Education; 2023.

9. Forber-Pratt AJ, Lyew DA, Mueller C, Samples LB. Disability identity development: a systematic review of the literature. Rehabil Psychol. 2017;62(2):198-207.

10. Nadan Y. Rethinking ‘cultural competence’ in international social work. Int Soc Work. 2017;60(1):74-83.

11. Annamma SA, Connor D, Ferri B. Dis/ability critical race studies (DisCrit): theorizing at the intersections of race and dis/ability. Race Ethnicity and Education. 2013;16(1):1-31.

12. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(32):882-887.

13. Hudson H. Moving from disability rights to disability justice. World Institute on Disability website. https://wid.org/moving-from-disability-rights-to-disability-justice/

14. Disability justice: a working draft by Patty Berne. Sins Invalid website. https://www.sinsinvalid.org/blog/disability-justice-a-working-draft-by-patty-berne. Published June 10, 2015.

15. Slayter E, Johnson L, eds. Social Work Practice and the Disability Community: An Intersectional Anti-Oppressive Approach. Pressbooks; 2023.

16. Schön D. The Reflective Practitioner. Temple Smith; 1983.

17. Schön D. Educating the Reflective Practitioner. Jossey-Bass; 1987.

18. Thompson V. A disability-rights consultant and social worker explains how to check your ableism every day. Popsugar website. https://www.popsugar.com/fitness/interview-disability-rights-vilissa-thompson-ableism-47639340. Updated August 5, 2020.

19. Campbell ML, Putnam M. Reducing the shared burden of chronic conditions among persons aging with disability and older adults in the United States through bridging aging and disability. Healthcare (Basel). 2017;5(3):56.

20. Disability and Health Data System (DHDS). Centers for Disease Control and Prevention website. http://dhds.cdc.gov

21. Isaacson L. Why people with disabilities must be included in research. Int J Market Res. 2021;63(5):537-543.

22. Saur J, Rossetti Z. Affirming Disability: Strengths-Based Portraits of Culturally Diverse Families (Disability, Culture and Equity Series). Teachers College Press; 2019.