1. Professional Practice and Placement Support – working with education providers, placement providers and professional courses
Judith Waterfield
Head of Disability ASSIST Services
University of Plymouth
Jane Wray, Research Fellow, Faculty of Health and Social Care
The University of Hull

2. Today’s presentation
Outline the experiences of students, practice and academic staff in health and social care disciplines using research including:
The CEPPL and Disability ASSIST joint project on the experience of health and social disciplines of placements and the development of a placement provider access tool
The Professional Education Disability Support Project (PEdDS)
Summarise the key benefits of organising and delivering inclusive placement experiences
Identify the implications for organising reasonable adjustments in the workplace

3. Legal and HE imperatives
UK Equality Legislation (SENDA 2001, DDA 2005)
Quality Assurance Agency (QAA) – Code of Practice: Students with Disabilities
Widening Participation Agenda
‘Pressure Groups’ e.g.. SKILL National Bureau for Students with Disabilities
Recommendations from the DRC FI into Fitness standards – specific recommendations on placements

4. University of Plymouth
Pilot study for a placement tool to help practice educators plan accessible placements ; individual student interviews (20) and placement assessments to capture the views and perspectives of disabled students in placement settings

5. The Professional Education Disability Support Project (PEdDS)
Funded by HEFCE Disability Fund (2003 – 2005)
Semi-structured interviews with a voluntary sample from 10 institutions in the North of the England
50 disabled social work students
50 staff (25 Placement staff, 12 academic staff and 12 Disability support staff

6. The University of Hull
Using PDP to organise adjustments on placement. Evaluation data collected from 5 students and 7 clinical mentors, and 5 personal supervisors
Making decisions about disabled students and their fitness to practise in Nursing, Teaching and Social Work funded by the DRC. Survey of 39 education providers across the UK

7. What is the experience of disabled students at present?
Common challenges across the two institutions
Attitudes
Communication
Disclosure
Emotional Factors
Fitness to Practice
Learning Outcomes
Reasonable Adjustments
Venue Accessibility

8. Attitudes Of the mentor, supportive or not ?
‘Really nice people, really laid back, maybe luck of the draw; pacing myself wasn’t an issue’. CEPPL
‘My supervisor was hard to get on with; he admits he’s really arrogant, but says he doesn’t care’. CEPPL
“What did shock me was, considering the whole area of study that I’m in, how many people are so intolerant and so unaware of, you know, sort of disability, they’re not tuned in at all” (PEdDS Student with a medical condition) 8

9. Communication Early, clear and frequent communication essential
Reviews, schedule extra meetings
‘there was no wake up call at the half way stage’ (he was failed)
“you’d be knocking your head against a brick wall half the time because they wouldn’t communicate back with you…lecturers weren’t always as supportive as they could be” (PEdDS Placement mentor) 9

10. Disclosure
No duty on student to disclose except for health and safety requirements or ‘good health’
Confidentiality is a right – unless safety of self and others is compromised (Data Protection Act and DDA)
Assumptions that disclosure had taken place
Partial disclosure
No clear policy on managing disclosure – Who needs to know?
When we analysed the key themes we identified several common threads:
Disclosure
Barriers
Choice of placements
Good practice examples in terms of what works.
FIRST DISCLOSE

11. Disclosure
PEdDS SW Placement Co-ordinator - “They are worried that if they disclose that will have an impact on their placement. It is mainly the attitudes of the actual placement provider that I think is the main barrier rather than the actual needs.”
PEdDS SW Student with a SLD - “I mean I am sort of slightly concerned about what people’s reaction would be in terms of - you don’t quite know who’s going to be looking at the form and what kind of preconceptions and prejudices they’re gonna have.”
When we analysed the key themes we identified several common threads:
Disclosure
Barriers
Choice of placements
Good practice examples in terms of what works.
FIRST DISCLOSE

12. Emotional factors Anger re ‘unfair criticism’ CEPPL
‘I fear imposing my clumsiness on patients’ CEPPL
‘Do people get exasperated with me?’ CEPPL
‘I felt bullied, was told not to complain’ CEPPL
Feeling a burden/nuisance “If I complained about there not being anywhere to sit properly in the first one I did feel like I was just being a pain sort of thing.” (PEdDS student with mobility difficulty) 12

13. Emotional Factors - Stress
“Well, it’s going to stress the student - stress levels are going to be high, and stress levels on placement are high anyway. The nature of the practice placement is stressful. So they’re going to have like at least a double dose of stress simply dealing with the pragmatics of managing their disability” (PEdDS Placement Mentor)

14. Treated differently?

15. Concerns about future employment (students)

16. Technology Supportive (e.g. mild dyslexia) Crucial (severe VI)
Maintenance “they wouldn’t make sorting it out a priority
Assisting technologies don’t always work alongside providers systems
Confidentiality?
Good for the student – good for patients and clients 16

17. Fitness to practise
Can someone with dyslexia or dyspraxia be a health professional?
PEdDS SW Placement Co-ordinator - “There was a student who was struggling to produce written work to the appropriate standard and people were struggling to know whether it was an issue of disability or whether it was the fact that she just didn’t understand what was going on, or whether it was the two together.” 17

18. Fitness to practice
Maths & Drug Calculations: anxiety and concern of clinical mentors but see ‘Strategies’
DRC Nursing Academic staff - “initial concerns related to capability for moving and handling of patients, reacting quickly to emergency situations including running after a patient who absconds from the ward, level of stamina for shift work, including 12 hour shifts.”
PDP Placement Mentor – “there were very few issues. The literacy problems this student ostensibly displayed were no different to a significant proportion of students already encountered.”

19. …must not be compromised.
Learning outcomes
…must not be compromised.
All students must meet criteria of competence.
Is there another way the criteria can be met? i.e. can we change the mode of assessment to achieve demonstration of knowledge
‘Its about reducing the particular barriers that the individual student faces’
‘This may mean finding a different path to the same goal’ 19

20. ‘Reasonable Adjustments’
A keynote of the Disability legislation
Potential conflicts with ‘practice realities’?
A reasonable adjustment - advance notice to allow preparation
“We had to do preparation work and make sure that supervision was reinforced with notes…We also got a tape recorder so she could tape the notes straight away without waiting to come back. We tried to set up a lot of systems” (PEDDS Practice Assessor/Teacher)
Attitudes again! 20

21. Strategies
Very powerful for student to be aware of and describe them clearly, especially building towards employment and interview.
‘Not a week goes by without an issue arising – I have to come up with coping strategies for each new activity’.
Important for academic and placement staff to be aware of the strategies the student uses 21

22. Venue Accessibility
Communication – last minute changes can cause stress
Small changes make a big difference
Everyone benefits
“They’ve made sure that shelf space for me is at the right height so I am not bending you know, any of the other workers will pick up files or anything else that I can’t lift.” (PEdDS SW student with a mobility disability) 22

23. The benefits of inclusive practice
Facilitates disclosure “It is very helpful to me as a practice teacher if students do disclose information and being able to do that thinking and planning and discussing in advance rather than confronting the situations as they arise” (PEdDS SW Practice Assessor/Teacher)
“It gives me a lot more empathy towards the client groups and a lot more patience. (PEdDS SW student with a medical condition)
Helps us to attract and retain high quality disabled people onto professional programmes and in the workplace

24. The benefits of inclusive practice
Creates a more positive and productive learning experience for students
Enhances relationships between placement staff and student
“----checking out how was I feeling, are you alright? He (practice teacher) ran the computer, you know making a laptop available to me and stuff like that, giving me the space and not giving me grief when----I was feeling a bit rough.” (PEdDS SW student with a medical condition)

25. The benefits of inclusive practice
Recognises diversity and not difficulty
Eliminates discriminatory practice. Authorities have positive duties too (DDA 2005)
A more positive and productive mentoring relationship for placement and programme staff

26. The key challenges for disability equality and professional placement learning
Communication – How do we ensure that there is effective communication between academic and practice settings and the student?
Attitude – How can we ensure that the mentor has sufficient support and information to facilitate the learning experience of the students? How can we stop equating ‘disability’ with ‘difficulty’ 26

27. The key challenges for disability equality and professional placement learning
Strategies – How can we support the student to ‘translate’ the strategies learnt in an academic environment into a placement environment and take responsibility for their learning?
Time factors – How can we address organisational constraints?

28. How do we ensure there is effective communication?
Establishing clear lines of communication within a policy that has shared responsibility
How should a Department manage the disclosure of a students’ disability to the placement? Who needs to know? And when? Who should inform the placement?
Has the Department discussed and agreed mutual responsibilities with placement provider partners?
What constitutes a reasonable adjustment? ‘How reasonable is reasonable’? Who will meet the costs? 28

29. How do we ensure there is effective communication?
Formalise communication procedures
Written procedures /flowchart disseminated to all staff
Written agreement on what adjustments will be implemented, how they will be monitored and reviewed
Build this into existing documents and monitoring/evaluation approaches

30. What needs to happen to facilitate the student learning experience?
Pre placement planning
Identifying any skills or knowledge deficit and addressing this i.e. awareness of potential and actual barriers facing disabled students
Regular communication 30

31. Supporting the student to ‘translate’ strategies from academic to placement environment
Taking responsibility for their learning
Involving the student in pre placement planning
Understanding of professional accountability
Developing skills for employability
Enabling the student to use their technologies in the placement setting 31

32. Time factors Placements are often allocated at short notice
Students are always ‘extra-numerary’, but does the mentor have time to give extra support and training? “I’m happy to check with someone when I can’t read handwriting but others are often far too busy’” CEPPL 32

33. Time factors
“There is certainly time; extra time to discuss. Space; extra space to reflect on what they are doing and making sure that others members of the team have access to information that the student wants them to have… to ensure that the placement runs smoothly really” (PEDDS SW Practice Assessor/Teacher)

34. How can we address organisational constraints?
Work placements are covered by DDA part 4 and staff organising such events should anticipate the requirements of disabled students (DRC 2007)
Policy that acknowledges shared responsibility and obligations “The duty to make reasonable adjustments applies to a placement provider in the same way as it applies to an employer” (DRC Codes of Practice on Employment and Occupation (2004: 9.46) 34

35. How can we address organisational constraints?
Facilitating access to additional funding where this is available
Academic staff ‘understanding’ the realities of practice – “worried I would not be able to provide the student with the support she required, due to the work pressures on the ward. I explained this to the SSL and felt happier that she was involved and aware of this.” (PDP Placement Mentor)
Flexible deadlines, part-time placements

36. Key considerations prior to organising reasonable adjustments in the workplace
Early, pre-placement planning involving programme staff, placement staff, students and disability expertise
Importance of having a clear and transparent approach for managing disclosure and ensuring confidentiality
Negotiation and delivery of adjustments with shared responsibility and formal agreement
Adequate preparation of both student and mentor
Monitoring student progress (including impact assessment of placements)
Post placement evaluation

37. Key considerations for staff organising reasonable adjustments in the workplace
Pro-active positive approach to duties under legislation
Embedding of approach into policy and procedures rather than as an ‘add on’

38. DRC Code of Practice on Trade Unions and Qualifications Bodies (2004)
It would be reasonable to expect the sending organisation and the placement provider to co-operate in order to ensure that appropriate adjustments are identified and made. It is good practice for a placement provider to ask a disabled person about reasonable adjustments before the placement begins, and to allow him to visit the workplace in advance to see how his needs can be addressed. 38

39. DRC Code of Practice on Trade Unions and Qualifications Bodies (2004)
Once a particular adjustment has been identified, it would be reasonable for the sending organisation and the placement provider to discuss its implementation, bearing in mind their respective obligations under the Act.” (9.49)

40. Positive advantages of disability equality in professional placement learning and employment
Personal insight
Stimulates ideas
Empathy between patient and practitioner
Potential improvements for student/employee improves the experience of clients and patients
Inspire confidence and a positive outlook
Determination compensates for challenges

41. For more information about individual projects...
CEPPL/DAS
Deidre Ford (CEPPL)
Terry Dowling (DAS)
PEdDS project – research report and best practice guide free to download at
PDP project – report available from Jane Wray on request
DRC project on ‘Making decisions about disabled students and their fitness to practise in Nursing, Teaching and Social Work’ available at