1. Fitness to Practice Seminar http://www.tcd.ie/disability/projects/fitness/index.php Declan Treanor Tuesday 16 th January 2007

2. Agenda Welcome 2.15The Disability Act and Equality Legislation – implications for teaching and learning / reasonable accommodation 2.30Clarification of what reasonable accommodations can be provided and what is unreasonable in: Lecture / seminar, Lab work, Practice Education and Examinations, including assessment of practical or clinical skills. Discussion format –Break 3.30Decision-making route – admissions, reasonable accommodations, practice education. What routes should be used? How are decisions documented? What steps are needed to produce a pro-forma that will enable College to act in such a way as to protected from possible discrimination and ensure standards? Discussion format 4.00The next steps…

3. Aims of Seminar To discuss College’s responsibilities under relevant legislation (Disability Act 2005 and Equality legislation), including reasonable accommodations for practice education settings. To clarify what constitutes reasonable (and unreasonable) accommodations for students with disabilities undertaking professional courses. To start the process to produce a pro-forma in relation to decision-making around admissions, reasonable accommodations and practice education.

4. Context University Strategic Plan College Admission policy - non-traditional students Universities Act 1997 Equal Status Act 2000 Employment Equality Act 1998 Disability Act 2005 HEA National Policies on access/disability College Policy on disability 2000 onwards TCD Student Disability Services Code of Practice 2004

5. Disability Act 2005 The Act brings a corporate whole institutional duty to promote disability equality Promote equality of opportunity Eliminate unlawful discrimination Eliminate disability-related harassment Promote positive attitudes towards people with disabilities Encourage participation by people with disabilities in public life May also involve treating people with disabilities more favourably

6. Discrimination There are two forms of discrimination that will be made unlawful: failure to make a reasonable adjustment, where any arrangements, including physical feature of premises, or services place a disabled person at a substantial disadvantage in comparison to persons who are not disabled: and unjustified less favourable treatment for a reason which relates to a disabled person’s disability.

7. Reasonable Accommodation (RA) The most important area for the purposes of students with disabilities may be the provisions in respect of reasonable accommodation. The Act deals with the reasonable accommodation provisions, and states: … discrimination includes a refusal or failure … to do all that is reasonable to accommodate the needs of a person with a disability … if without such special treatment or facilities it would be impossible or unduly difficult for the person to avail himself or herself of the service

8. College definition of RA a reasonable accommodation might be any action that helps alleviate a substantial disadvantage. Making a reasonable accommodation might involve changing procedures, modifying the delivery of the course taken, providing additional services (e.g. examination arrangements, materials in large print), or altering the physical environment (College Code of Practice Students with disabilities 2004).

9. The situation If the student meets set competence standards, with the provision of reasonable accommodations, they pass and are fit to practice. If the student does not meet the competence standards, with reasonable accommodations, then they fail. Disabled student applies to College College cannot discriminate, but must provide reasonable accommodations Reasonable accommodation s established and put in place.

10. Requirement of College 1.To assess what accommodations a student will require to complete the course. 2.To assess whether these are reasonable and deliverable. 3.To provide accommodations. The student then undertakes the course, with accommodations in place. If the student meets the demands, they are “fit to practice”.

11. Assessing What Is A Reasonable Adjustment In assessing what is a ‘reasonable’ adjustment – education providers will have to consider: Whether the adjustment would effect the maintenance of academic and other standards. The cost of the adjustment and the financial resources available. Whether making the adjustment or additional provision is practical. The effectiveness of the adjustment or additional provision. The disruption caused to others. Whether the student, or others, should provide the additional provision or services. The importance of the service to which access is being sought.

12. Fitness to Practice Fitness to practice has been defined as a person’s ability to practice their profession in a way which meets appropriate standards, meaning that a person has the skills, knowledge, attitudes, character and health to perform necessary functions safely and effectively (adapted from HPC, 2005).

13. Definition of Fitness to Practice Framework for ensuring quality and safety Demonstrates fitness to learn, graduate and practice: Knowledge, skills Competence Capability Attitudes, character, conduct Health

14. Not fit to practice - indicators Deficient performance Deficient competence Misconduct Ill-health, physical or medical Criminal conviction/caution

15. What is a competence standard? An academic, medical or other standard applied by or on behalf of an education provider for the purpose of determining whether or not a person has a level of competence or ability Need to differentiate between the standard and the process of attaining the standard Standard must be objectively justifiable – a proportionate means of achieving a legitimate aim

16. What isn’t a competence standard? Being able to cope with the demands of a course Having good health or fitness (if unnecessary) Attendance requirements (if unnecessary) Completing a course in a certain timeframe Speaking clearly Handwriting an examination

17. RA and competence standards Competence standards cannot be adjusted But assessment processes must be Anticipatory duty applies

18. Failing students If a student does not meet the course requirements, assuming that appropriate accommodations are in place, then they fail, as with any other student. The key is to ensure that all appropriate reasonable accommodations are in place.

19. Types of accommodations Lectures / Seminars Lab-work Practice Education Exams, including assessment of practical work.

20. Accommodations - Lectures These are typically as for any course and may not be specific to Health Sciences. Examples include: Provision of lecture notes Appropriate venues Use of AT or human assistance (e.g. ISL interpreter, note-taker)

21. Accommodations – lab work This includes a variety of practical work, including clinical skill areas. Examples of accommodations may include: Lab assistant Interpreter Adaptation of course requirements and assessment method

22. Accommodations – lab work It may be necessary for a student to develop their own methods of performing clinical tasks, provided that these are safe. More time may be needed to learn specific skills.

23. Accommodations - Exams Standard written examinations may require accommodations as for any College course, e.g. extra time. Viva and practical examinations may need alternative accommodations, such as an interpreter or adjustment of practical requirements. The key is that the student has the opportunity to demonstrate knowledge, skill and attitude as per the course requirements. A different form of assessment may be required.

24. Accommodations – Practice Education It is the responsibility of College to provide reasonable accommodations to students in practice education. It may not be necessary for a student to do all forms of placement, provided that the accreditation body’s requirements are filled. Practice education should provide the student with the opportunity to demonstrate the core skills that are essential for competence in the area of work. Typically these are set down by the accreditation / registration bodies.

25. Accommodations – Practice Education The types of accommodations will depend on the practice setting and on the student, but should be agreed in collaboration with the student and the practice educators. It is reasonable for a student to use a human assistant to perform tasks, provided that the student’s knowledge and skill are used, rather than that of the assistant.

26. Case Study 1 Deaf / hard of hearing student Lecture accommodations – use of an ISL interpreter and note-taker, as well as provision of notes. Lab accommodations – use of ISL interpreter. Extra time to learn skills may be needed. Examination accommodation – interpreter for viva and practical examinations. In practice education, interpreter is used.

27. Case Study 2 Student with dyslexia Lecture accommodations – provision of lecture notes, as writing / reading speed are slower. Lab accommodations were not necessary Examination accommodations include use of a computer and extra time. In practice education, a subject-specific word- book is used. Ideally the student would like to record notes using a computer.

28. Case Study 3 Student with physical disability Lecture accommodations – provision of lecture notes and lectures in accessible venues Lab accommodations – use of lab assistant. Student directs assistant. Examination accommodations - extra time and use of computer In practice education – assistant where necessary, choice of accessible locations / areas so that student can demonstrate core skills.

29. Case Study 4 Blind or vision impaired student Lecture accommodations – provision of lecture notes and alternate formats for information. Lab accommodations – use of lab assistant. Audio description of tasks, longer time to develop skills Examination accommodations - extra time alternate format papers and use of computer In practice education – reader if required, choice of venue / setting

30. Case Study 5 Student with mental health condition Lecture accommodations – provision of supports for study skills etc. (e.g. through Unilink) Lab accommodations – none required Examination accommodations - alternate venue, if required. In practice education – use of support, such as Unilink to manage stress, time management and other issues.

31. Deciding what is reasonable As well as issues under legislation (previously discussed), the accommodation must ensure that the student has the opportunity to demonstrate knowledge and skill in the area. It is not reasonable to use an assistant where the assistant’s skill is required - it is reasonable to have an assistant to enable the student to access information (e.g. ISL interpreter, reader) or if the student can direct the assistant safely.

32. Decision-making routes UK guidelines suggest that clear, consistent decision-making routes (with clear documentation) are essential to reduce the likelihood of discrimination. Decisions through all stages (admission, assessment of need, provision of supports, etc) need to be consistent and well documented. They should be individual-based (I.e. not prejudicial), but anticipatory duty is required.

33. Prejudicial views UK documentation warns against deciding that students with a given disability will be unable to perform tasks – each applicant must be considered in terms of whether accommodations are possible, and then whether it is possible for a student to reach core competences with these accommodations in place. (The reality may be that it is not possible to accommodate certain disabilities, but the decision should not be a blanket “ban” on certain impairments.)

34. Employability It is NOT College’s responsibility to decide whether a student will be employable. College is responsible for making accommodations for students as long as they are undergoing training. The student either passes or fails (as with any student) based on whether they have met the competences, with accommodations. Once a student graduates, they are fit to practice- it them becomes the role of the employer to provide reasonable accommodations.

35. The next steps… College needs to establish: Clear, consistent decision making route, from admissions to graduation. Standards / practices relating to reasonable accommodations for students undertaking professional courses (similar to document that is already in existence) Professional bodies need to establish interpretations of core competences

36. Next Steps Continued… Decision-making route – admissions, reasonable accommodations, practice education. What routes should be used? How are decisions documented? What steps are needed to produce a pro-forma that will enable College to act in such a way as to protected from possible discrimination and ensure standards?

37. How can College move forward?