Article

School settings are a common practice context for rehabilitation
professionals; health advocacy is a common and challenging practice role for
professionals in this context.
This study explored how pediatric practitioners
advocate for children with disabilities at school. Specifically, we examined
everyday advocacy in the context of school-based support for children with
disabilities. METHOD: Our theoretical framework and methodological approach were
informed by institutional ethnography, which maps and makes visible hidden social
coordinators of work processes with a view to improving processes and outcomes.
We included families, educators, and health/rehabilitation practitioners from
Ontario. Of the 37 consented informants, 27 were interviewed and 15 observed.
Documents and texts were collected from the micro-level (e.g. clinician reports)
and the macro-level (e.g. policies). RESULTS: Pediatric practitioners' advocacy
work included two main work processes: spotlighting invisible disabilities and
orienteering the special education terrain. Practitioners advocated indirectly,
by proxy, with common proxies being documents and parents. Unintended
consequences of advocacy by proxy included conflict and inefficiency, which were
often unknown to the practitioner. CONCLUSIONS: The findings of this study
provide practice-based knowledge about advocacy for children with disabilities,
which may be used to inform further development of competency frameworks and
continuing education for pediatric practitioners. The findings also show how
everyday practices are influenced by policies and social discourses and how
rehabilitation professionals may enact change. Implications for Rehabilitation
Rehabilitation professionals frequently perform advocacy work. They may find it
beneficial to perform advocacy work that is informed by overarching professional
and ethical guidelines, and a nuanced understanding of local processes and
structures. Competency frameworks and education for pediatric rehabilitation
professionals may be improved by: encouraging professionals to consider how their
practices, including their written documents, may affect parental burden,
(mis)interpretation by document recipients, and potential unintended
consequences. Policies and texts, e.g. privacy legislation and the Diagnostic and
Statistical Manual (DSM), influence rehabilitation professionals' actions and
interactions when supporting children with disabilities at school. An awareness
of the influence of policies and texts may enable practitioners to work more
effectively within current systems when supporting individuals with disabilities.

Langue : ANGLAIS