Patricia Saleeby is a Bradley University associate professor and Social Work program director. She's worked for nearly 25 years to promote a different framework for talking about disability.
She was the keynote speaker this week for Social Work Day at the United Nations. Saleeby recently spoke with WCBU's Tim Shelley about the message she took to the UN.
This interview is edited for clarity and length.
You spoke this week at the United Nations and the topic on the table was social work. Tell me a little bit about why you were at the UN.
Sure. So this year marked the 39th annual Social Work Day at the United Nations. And the theme this year was creating a more inclusive world overcoming barriers to enable environments. For many years, I've worked as a disability advocate. And for 25 years now, I have been a consultant working on projects related to promoting international classifications with the WHO, the World Health Organization. So this year, I was very excited when they announced that they will be focusing on a disability topic here at the UN. So I was honored to be invited as a keynote speaker to talk a little bit about what I have done over the last 25 years with promoting those international classifications.
When we're talking about international classifications for categorizing disabilities, and talking about disabilities, why is it important that we have that kind of common language internationally?
That's a great question. So many of us have heard of electronic health records. Well, part of the value of it is that it is portable. And you can take that record with you from one health setting to another. So for example, if you go from a hospital, and you're discharged, but you need to go into post acute care, or you may enter a nursing home, the portability of having electronic health record in one place with all that information is quite valuable.
To enable that to happen, you have to have a uniform process, you now have to have a consistent terminology. These international classifications provided we currently use in our global health system classification known as the ICD, which is the International Classification of Diseases. Almost every health system through the world uses this. So if you have a diagnosis of a health or mental health condition, you have a unique code that corresponds to that condition, the condition and communicates to insurance companies to pay out for treatment and an intervention related to that code. But it really doesn't tell us that much information. It's very limited. So we, years ago, in the late 1990s created another classification called the ICF, which is the International Classification of Functioning Disability and Health. And this enables us to code and classify in a consistent manner, code related to functioning. So it tells us a lot more that about a person and their lived experience beyond what we get from diagnosis only.
This is really more of a, would it be accurate, as a diagnosis of what exactly particular issues a patient might be dealing with?
Well, I would say that we're trying to lean away from diagnosis to make the assessment, which is a comparable term. But yes, you are correct. We're trying to find a consistent manner how we can report functioning data. And so assessments that are based on a number of different things that are reflected in the ICF, how we can communicate that from one practitioner to another across disciplines, from one clinical setting to another, and, of course, country to country, which is wonderful for population based disability statistics.
So are most countries using the ICF then?
There's a number of countries that use the ICF. One of the drawbacks, if you will, is the size, quite frankly, of the United States. We are a massive global health system. And so it's very difficult to just make a change, let's say overnight, but we're getting there and there are many entities in the United States. Now looking at the ICF. The Veterans Administration, the VA, for example, which is one of the largest health care providers in the United States has adopted the ICF terminology officially, we're already doing these assessments. Social workers, physical therapists, occupational therapists, speech language pathologists, we do use the ICF, in terms of how we look at functioning in the lives of the of our patients and our clients. It's just that we're at a point now where they may officially mandate if you will, or require that we have it all coded to the ICF system.
So it's important really to get everyone on the same page and up to speed. So, like, we kind of referenced the beginning, everybody speaking the same language, so to speak.
Absolutely. The other very valuable component of the ICF is the framework. And about 20 or so years ago, it was a game changer, if you will, in terms of how we situate and understand disability. That it isn't something that's very linear, it is not something very static, it's something that is very interactive, as we know, between that individual and his or her environment. And what we now know as social determinants of health really, is represented in the ICF, there is an entire section on the environment, it's very comprehensive, very robust, and enables us to better understand what in the environment contributes to someone's health condition and status. And what impedes them in their daily lives in terms of their functioning.
Social determinants of health. I'm glad you mentioned that. You're hearing a lot more about that, in recent years, how someone's health isn't just, perhaps, their physical function, it's also got to do with where they live, you know, think factors like poverty, other factors. Why is it important to consider all of these various aspects when we're talking about the total of someone's well being, so to speak?
Well, you have to think about in our daily lives, how much the environment really does affect us. And it can affect us positively, right? And we often call this a facilitator. And that is, in fact, the terminology used in the ICF system, something that can help us like the support of a family member or friend.
And then there also are the barriers. And that's what we hear about more often, the things that hinder us impede us from actually doing what we want to do, what we can do and so forth. So for example, if you're a person with a disability, the disabling factor, quite frankly, might not be the condition that you have. You might have Spina bifida perhaps, or maybe Parkinson's disease, or schizophrenia, but you can still do a job. But what hinders you and impedes you from actually working may be, let's say, negative attitudes of somebody or discriminatory bias in the workplace.
So it's really important and essential that we capture this information to determine what are the factors that are causing people not to do what they should be doing? And then the next step, which is intervention and treatment, where should we intervene, because it wouldn't make sense, for example, to work with someone in terms of vocational rehabilitation if they can actually do the job. And that's not the problem, if you will. But it makes more sense to look at how we can change societal attitudes, and how we can eliminate discriminatory policies in the workplace. Because that in this particular situation, or scenario, is the actual barrier.
And that gets into something else I was reading in the description of (your background), kind of a capability approach to disability. So this is a different way of viewing it, perhaps. And you touched upon that a little bit already.
I have. So years ago, there was an there is an individual named Amartya Sen, who created the capability approach. And so what he looked at specifically related to poverty as a better understanding a non traditional kind of economic approach, if you will, that there was something that was happening in terms of what he called the conversion process, that an individual's circumstances, pretty much their environment can create issues along the way, and then cause them not to actually be able to function, do the things that they should be doing and then achieve capabilities or create a capability set.
And if you don't have that capability set, then you're not going to be able to pick and choose. So there's limitations in your choice. And so I found the theoretical framework, the capability approach, by recommendation of my advisor when I was a student at Washington University, and I thought it was really a good theory to be able to apply to understanding disability. So I was one of the first people credited in the world, to uniquely apply the capability approach to better situating and understanding disability. And it just makes sense when you think about all the things that are in the environment, some of the, which I've already mentioned, that really do create barriers to people with disabilities. And those are the things that we need to focus on, quite frankly, to be able to any of all our environments for persons, not only with disabilities, but also people without disabilities.
So what do you think people should understand about this? As you said, there's things like workplace discrimination, maybe people who just don't understand the impact a particular disability has, particularly when we're talking about things like mental health, for instance. For the common general public people who aren't well versed in medical terminology and everything else, how can they understand this and apply this mindset to how they're viewing things?
Well, when I spoke recently at the United Nations, I think the conceptual framework was a really good resource. For many people, I saw a lot of cameras coming out taking photos of it. It's nice to have a visual, right? And I think that the understanding around the framework, the kind of the underlying value, is the fact that we recognize or we should be recognizing more, that the environment plays a key role in our lives.
You know, sometimes, you know, as a professor here at Bradley University, I have students that will contact me and say, I can't come to class today. And there's always a reason, right? And maybe it is because of a health condition. Maybe it's because they're overwhelmed with other work that they have for other classes, sometimes it's a transportation issue, and their car broke down, and they're not able to get to campus. It is not that they cannot necessarily perhaps sit in the actual classroom.
So you know, how we might intervene is going to be different to make sure that we can kind of remove these barriers or eliminate them, so that they can actually get to class and get the work and actually be able to engage in the learning process. So I think the theoretical framework, just the understanding behind it, and what it's trying to do, is really a game changer, if you will.
And it can be widely applied. Like you said, even as a teacher or a professor, you can use this framework to really kind of view what your students are going through and see what potential solutions might be, like a transportation challenge or something of that nature?
Absolutely. I mean, the ICF has been integrated, not only in what we would assume makes sense in terms of let's say, disability eligibility and countries, or disability population statistics as a common framework to understand and define "disability," but it has been used also in school settings. It's been used in a number of clinical settings, especially in rehabilitation, for example. It is something that is increasingly recognized, I think, in part because of the framework is something that is very helpful and better understanding disability, and then helping us develop more effective and more sustainable interventions. So I think that it will, and I hope it will increase in terms of being able to be integrated into practice across different sectors.
