How to get from Equality to Equity

By now most of us have probably seen some version of the “Equality vs Equity” drawing, depicting people of different heights standing on the same size box trying to look over a fence, then the next drawing showing each person on a box that fits their height requirement, so they can all see equally over the fence. That’s Equality (same box) vs. Equity (the box each person needs).

(mentalfloss.com)

But...who is giving out these ‘boxes,’ how are they found, and how do we move from equality to equity in the world of differently-abled individuals? The answer changes depending on the lens you’re looking through.

The Medical Model would look at each person in terms of their deficit, and then assess what was needed for them to see over the fence. The Medical Model would focus on what was wrong and attempt to correct that.

The Social Model would look at the fence, or the ground, to see what needs to be adjusted there...perhaps mounds could be made for people to stand on, or the fence could be made of mesh instead of wood, or...some other thing that changed the environment and not the person.

A Strengths Based approach would focus on the inherent interests and abilities of the individual, then use these to determine what the next steps might be. Perhaps the individual doesn’t want to see over the fence, or perhaps they would like to build their own box for standing on. Strengths based would allow the individual interests and inherent strengths to guide the goals.

Each approach has its own set of strengths and drawbacks.

If a differently abled individual has lived their life in a medical model, they likely see themselves as having deficits in comparison to “normal.” Yet, we live in a medical model system...we need this model provide a diagnosis (based on deficits) so services and accomodations can be offered (for example speech, occupational or speech therapy and school based services on an IEP or 504 plan). However, if we only use a medical model to guide goals and outcomes, always comparing a differently abled individual to a typically abled individual, there will be little chance for the person to truly know themselves, their strengths and their unique ways of being.

If they have been exposed to the social model, they probably realize they can have their environment modified to fit them. Traditionally, the Social Model has been used for people with physical differences (e.g. a wheelchair user) and not one with neurodiverse differences (e.g. autism or ADHD). That said, we can still apply the social model to neurodivergency by educating society to help break down barriers, increase understanding and reduce stigma. In essence, this is a component of advocacy, as in the process of educating we are advocating. However, a social model has its limits as well. One limitation is that it does not address the difference the individual has, only the accommodations for this difference. Therefore, this model does not work when forming goals for improving an individual's abilities.

In a strengths based approach, an individual's inherent strengths and abilities are considered when guiding therapy goals and activities to fulfil the goals. This method has typically been used with very young children (follow their lead, use what they like to engage them, have goals around their interests) but not so much in older children and adults. However, strengths based can be successfully used across the age span. A limitation of the strengths based approach is that it may not not provide the deficit measures needed to approve therapy services and it may not provide a complete picture of an individual (e.g. the areas of growth as well as the areas of strength).

So, once again, how do we support a differently abled individual to move from equality to equity?

I believe the answer is found in combination of these three models. By using a medical model, we can find the differences needed for services, and we can see the areas for growth an individual may benefit from. If we then move to a strengths based approach and use these to guide goals and treatment, we are offering an approach that is more meaningful to the individual, and in doing so, we encourage self advocacy. Within the framework of a social model, we can work with communities to increase visibility and reduce stigma, while also working towards advocacy and self advocacy. In combination of these three, we can identify needs, use inherent strengths and interests to meet the needs, and work with society to reduce stigma and increase visibility.

When an individual understands their unique needs, they can change the world, rather than the world changing them.