How Patients Included is really about Inclusion

 

I stopped going to health conferences when I was diagnosed with cancer two years ago.  With this pause came perspective.  As a mom attending pediatric conferences, I often had to beg for compensation if I was a speaker.  Even if I was an attendee, I had to go through long, drawn-out negotiations with conference organizers and accounting departments to get my expenses covered.  Every single time I went to a conference there was a cost to me financially and personally.  There was a cost to my family too.

It started to feel like I was an add-on to the conference as a token patient just so they could self-accredit and say they were Patients Included.  With my pause in conference-attending, I now see that I didn’t just FEEL like a token patient, I WAS a token patient.  I now have the clarity to observe that conference organizers treat other patients and families shabbily too.  I would like this practice of shabby treatment to stop.

I was going for one of my regular walks recently and chatting on the phone with Isabel Jordan, who is the co-author of both this great article about compensation and the Patients Included movement.  We have had many conversations about partnering with patients.

My epiphany as I was crunching along a forest path was this:

The principles behind Patients Included at health conferences and the inclusion of disabled people are the same.

Inclusion is inclusion.  Take a look at the now-famous diagram of inclusion that I’ve posted above.  Let’s look at each of those circles under a health conference lens:

1.  Exclusion

For years, patients have been excluded from health conferences.  (This still occurs – even with Patient Engagement conferences.  If you can’t see the irony with that…).  For instance, at cancer conferences in Canada, the idea of inviting patients is still a brand new thing.  Most times we just don’t get invited.  Or one super-celebrity patient gets invited and nobody else. That, too, is exclusion.

2.  Segregation

Sometimes a group of chosen patients are invited to a conference.  There patients are ‘allowed’ to have their own sessions, separate from the rest of the conference.  This is better than exclusion, but it is still segregation.

3.  Integration

This where patients are ‘allowed’ to attend and ‘allowed’ to be in the same room as the other conference attendees.  I’ve been to those conferences – us patients often clump together at sessions and social events and not recognized by the other conference-goers.  Literally nobody saves us a spot at their table, so we sit at our own tables.  Most conferences are like this.  Patients are reluctantly invited and not embraced or accommodated to be full participants.

4.  Inclusion

This circle depicts inclusion.  This is something to aim for and illustrates the intention behind the whole Patients Included movement.  See all the coloured dots that aren’t green?  Those spots are all the patient attendees.  Here we are on conference planning committees, invited (and paid) as speakers and sitting at the big kids’ table with everybody else.  It is important to note that there can be exclusion even within this inclusion model.  That happens if the same patients are invited and attend conferences over and over again.  Within patient groups there can be exclusion too.

Hanging out, patiently waiting, on the other side of inclusion is belonging.

In talking about inclusion of kids with disabilities, Sara Pot – paraphrasing from John Swinton – says it best:

Inclusion = we’ll make room if you show up.
Belonging = you need to be here and you’re missed when you aren’t here.

Now apply this to health conferences.  You have to work your way through these circles and do inclusion right before you even get close to belonging.  Right now, many conferences struggle with even making room and helping patients show up.

Cynical me wonders if health conferences truly want patients at “their” conferences or if they see Patients Included as a tokenistic trend and a flavour of the month.  This would be a real shame and I think a grave misuse of the intention of the original Patients Included charter.

Optimistic me believes that authentic patient inclusion at health conferences can be done.  The key is that patient inclusion (and eventual belonging) will only happen if we do it all together.  If you are unsure if your conference is truly Patients Included – beyond accrediting yourselves and putting Patients Included on your website – you need to ask patients themselves.  Bonus points if you seek a diverse assortment of opinions and don’t just talk to your favourite patients.

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Note:  If you are interested in improving your health conference, I’d recommend you consult with patient partners early on in your planning.  They can help light the way. I do know patient partners who do this kind of work – send me an email and I can connect you up…

good inclusion

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I read the Globe and Mail article today with the rather misleading headline: Are Inclusive Classrooms Failing Students?  (I’d edit this headline to say people are failing students, not inclusive classrooms).

I feel deeply for the families who shared their stories for the piece.  I’ve been one of those families.

We can blame the system but the system is made up of people.  Never forget that.

My son is 15 years old and in Grade 10.  He has Down syndrome.  His story of inclusion is a rocky one, especially in the elementary school years.  His experience from grade 1 – 3 was so bad – and included torment by boys in his classroom that went wholly unaddressed by the principal – I think because the main perpetrator was the son of a prominent lawyer and doctor – that we sold our house and moved across the city to get him into a more welcoming school where we knew he’d be safe.

It was then we realized that each school is different and each year is different, depending on the mix of other kids, families, principals, teachers, Educational Assistants and school districts.  If even one of those factors is misaligned, inclusion is so precarious that the whole house of cards comes tumbling down.

I don’t want to dwell on the bad inclusion.  I want to offer hope to families who have loved ones with disabilities.  It can get better.

Now Aaron is in his third year of high school.  He attends all regular classes – classes that he himself chose – including two academic classes.  He does not balk at going to school now.  As far as I can surmise, he’s happy and importantly, he’s learning and growing.

His first year of high school was a tough transition.  He tested the teachers and it took them some time to get to know him.  But then one unusual thing happened.

In November that year, the special education teachers asked me if I wanted to speak to the school’s Professional Development Day about what inclusion means to our family.  This was my last big talk before I was diagnosed with breast cancer.  Believe me, I took this talk very seriously, as I had a sense about how seminal it was.  I prepared extensively  – interviewing many other families about what they wanted me to share.  I talked to Aaron at length about what was important to him.  (I wrote about what I said here).   It was the most important presentation of my life.

This was because I had a chance to share family stories with the teachers – almost 100 of them – about what mattered to families like mine.  On the day of the talk, I was a sweating nervous wreck.  Thankfully, the audience listened graciously, about what was important to Aaron and to other families who had children with disabilities.  I also spoke about how inclusion benefits the other kids, and how disability is part of diversity just like race and gender orientation.

The teachers’ openness to listening to family stories was everything.

I have been ‘that’ mom for years.  But after the teachers heard my stories, something shifted.  Maybe I was was no longer the difficult ‘special needs’ mom.  Maybe I was someone like them, a person who had something unexpected occur in their life – in my case, I happened to have a child born with a disability.  I was firm in my assertion that my kid had a right to an education just like any other kid.  I was clear that Aaron wasn’t just a problem – he was in fact someone worthy of love and belonging, just like anyone else.

I’ll never know if my talk made a difference.  I don’t think I am the best speaker in the world or that I imparted great wisdom.  But I did tell my story, and shared elements of other family stories, and the teachers did listen.  I do believe this helped Aaron be understood and accepted, even a little bit.  At Aaron’s high school, I have a strong sense that the leadership and teachers believe in Aaron.  That’s so crucial.

I’m writing this post as our little family of three is in the middle of a sleepy vacation.  Today we were in a surfing store.  I noticed the owner watching Aaron intently.  Finally he said, “I have a son with Down syndrome too.  He’s three.”  We talked for a few minutes about how his son was doing and also about how hard life is sometimes.

As I was going out the door, I turned to him and said, “Ah, but it is the most important things in life that are hard.”  He paused and nodded.  We smiled at each other, our secret shared.

The most important things in life are hard.

For the families struggling, I want to say that things are hard because they are important.  I agree that it isn’t fair and it isn’t right.  But also I know you can do hard things.  Keep speaking up.  Keep sharing your stories.

For the educators, please make the space to listen to family stories.  I promise you it can make all the difference in many people’s worlds, including your own.

cut the red tape

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My son is 15 years old and loves to participate in sports.  We’ve learned the hard way that most sports teams don’t want him because he has Down syndrome.

Alas, true inclusion in recreation or sports has rarely happened in real life particularly as Aaron has gotten older.  One exception has been his high school, where he has heartily been welcomed in Physical Education classes and his teacher has embraced the modifications that he requires because of his bum knee, intellectual disability and short stature.  Hurrah for the inclusion champions at his school.

Outside of gym class, Aaron been pushed into segregated sports activities.  I’ve come to peace with this, despite my philosophical insistence on inclusion.  Inclusion to me means belonging in the bigger community.  Being ‘allowed’ to play sports with other kids who are segregated is not inclusion.  But it is what it is and it allows my kid to be active with a diverse group of people and so that’s a positive thing.

In the community, I’m not going to waste my precious advocacy energy fighting to have a team include Aaron if they don’t want him.  So he’s slowly been moved over to segregated sports and recreation programs like those at Challenger Baseball, Down Syndrome Research Foundation and Special Olympics.

Surprisingly, here in the segregated world, accessibility comes into play too.  There is a spectrum of ease of participation.  Challenger Baseball says – your kid wants to play baseball?  Come on in!  We don’t care where you live or what’s going on with you!  Just show up!   Down Syndrome Research Foundation says welcome to our Bollywood and Taekwondo classes!  Sign up if you can afford it (if not, you can ask for a bursary)!  You don’t even have to have Down syndrome!  These are good models and make it easy for kids to be active and have fun.

Now I pause at Special Olympics.  I know Special Olympics is a beloved institution so I’m going to get my hand slapped for this.  But I am going to say it anyway.

Special Olympics has grown into a massive organization. Along with growth comes bureaucracy. Accessibility for people with disabilities here is marred by red tape. Your athlete has Down syndrome?  He must get a controversial neck x-ray before he can register.  You live out of region and your local program is full?  You aren’t welcome on another team, unless you get approval from your home region to transfer over.  And then the transferring region has to approve you too. That requires having many forms filled out and then waiting and waiting, as my son has been doing for the past month.  He can’t attend practice until all the paperwork is done and the season has already begun.

Who loses in the red tape environments?  It is the kids themselves.

I will surmise when an organization gets too big, it drifts away from its grassroots beginnings and loses sight of the people they are supposed to serve.  It becomes about bureaucracy, policy, risk-management, staff/volunteers and rules, not the people themselves.  I’ve seen this happen over and over again with support groups and health/human services organizations too.  This is a darn shame.

This is particularly frustrating because I keep reading articles about how children with disabilities struggle with being physically active.  If we know this is true, why aren’t we making it easier, not harder for kids to participate?

I know that people working and volunteering for these organizations are well-intentioned.  I would ask them to pause and consider:  are your policies and rules causing additional barriers for people to participate?

If they are, I’d respectfully suggest it is time to untangle and take a good hard look at all your red tape. Who is this red tape serving anyhow?   Has red tape become a barrier for people to participate?  And is that okay by you?

Instead, let’s do what we can to let kids be active and have fun and never forget that sports and recreation is not about us adults.  Make it easier, not harder, for our kids to participate.  Help them find ways to be as healthy as they can be – and in the process, to find belonging and friendships too.

 

the day i sobbed at the bakery

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I stopped by Gabi & Jules bakery yesterday to pick up an almond croissant and a maple pecan pie. By the end of my transaction, I was sobbing at the front counter, barely able to eke out any words, my face hot and embarrassed by my unexpected show of emotion.

Before the crying, I was perfectly composed and waiting in line to order my baked goods. There was a young man in front of me. I could tell he wanted to chat, so I turned and faced him and smiled. ‘All the food here is good!’ he said. ‘Have you tried everything?’ I asked. ‘YES!,’ he said, bursting to tell me.  ‘I work here! In the back.’

Now I could feel the tears beginning to well up. I swallowed them back as we chatted a bit more.   This young man had some sort of disability – autism maybe – but that doesn’t really matter. He was obviously very proud that he worked in the bakery.

Being employed is so much more than just a pay-cheque – it can offer a sense of value, worth and belonging.   This particular bakery in Port Moody is well known for its inclusive hiring practices. (Here’s a video and article explaining their philosophy).

After the young man left, I mentioned to the nice woman working behind the counter (Sarah, the manager) that my husband recently heard owner Lisa Beecroft speak at a panel for inclusive employment. I kept it together until this point, until I confessed, ‘Our son is 14 and he has Down syndrome. I hope one day an employer like you will give him a chance.’ Then my voice caught and the tears started to seep out. I managed to finish up before fleeing to my car, but not before Sarah said: ‘Bring your son in one day so he can look around!’ This made me cry even more. I’m sure she thought I was odd (and admittedly I am, especially since the dumb cancer, which seems to have broken me open emotionally).

When Aaron was born, I was clouded in many fears for his life: that he wouldn’t find love or belonging or friends or meaningful work. To be truthful, we are still working on helping him with his search for many of these things. I feel hope in my heart for the future with companies like Gabi & Jules taking a chance on all different kinds of people.

I started going to Gabi & Jules because I heard they hired people with disabilities and I wanted to support them. But now I’m a regular there because the baking is just so damn good. (The hazelnut tarts! The granola! And oh the pies). And now that I’ve met one of the bakers in the back, I have a strong sense, as their logo says, the maple pecan pie we ate last night was made with love.

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*Coming up next week! A special guest blog post from my husband, Mike Waddingham, talking about inclusive employment practices.

his tell-tale heart

tell-taleAt lunch yesterday, Aaron was busy trying to us something he recently learned in English class. He said: the guy had a bird eye! A vulture! His heart was beating out of his chest! He was buried underground!

It took some Googling to figure out what he was talking about. He was referring to Edgar Allen Poe’s short story The Tell-Tale Heart.

This is what happens when you include a kid with a disability in a high school English class. Did he ‘get it’? Yes, he got it more than I did – me with my fancy English university degree, me who doesn’t know much Poe at all.

This isn’t the first time this has happened. A few weeks ago, Aaron arrived home from school with his journal.   In it, he had printed: We learned Romeo and Juliet today. It is a superb story by William Shakespeare. Later, his teacher told me he took a comprehension test about the play. He understood everything: who loved who, who hated who, who died. This is a kid who loves drama in real life. Of course he’d be drawn to it in literature too. He is his mother’s son.

Beth Foraker wrote a lovely piece on her blog about her son (age 14, who also happens to have Down syndrome) and his love of Macbeth.

There is a lot for both educators and parents to think about with these anecdotes. What preconceived notions do we possess about what kids with differences can and cannot learn? I thought about all the myths I carried about Down syndrome when Aaron was first diagnosed: that he would be mindlessly happy all the time (WRONG), that he wouldn’t understand sarcasm (WRONG), that he wouldn’t be a consumer (WHO TOLD ME THAT? SO WRONG). Did I think he would understand Edgar Allen Poe or Shakespeare? I hang my head in shame – no, this version of reality had not crossed my mind.

This holiday season I am thankful for Aaron for having proved me wrong, over and over again. I am grateful for educators like his English teacher. You never know what this kid might learn – we all just have to give him a chance. As Beth points out, this means giving our kids access to curriculum at school and access to rich experiences in life. She so eloquently says: Because we can never guess or know what will touch their hearts and speak to their soul.

good at basketball

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Today my youngest son won the Most Valuable Player Award for his school’s basketball team.  He was chosen by his coach to receive the most prestigious of all awards because he never missed a practice or a game, gave his best effort every time, demonstrated a positive attitude and never ever complained.

When Aaron’s name was announced, the crowd erupted in cheers.  A young girl came rushing up to Aaron to give him a hug.  (I spoke to her Educational Assistant afterwards and she said she and Aaron are great friends).   I was in the audience and I’ll admit that I cried like a little baby.

“I am FAMOUS!” was Aaron’s initial enthusiastic response.  Afterwards, when asked why he won the award, and he shrugged and said, “because I am good at basketball.”

Recently I wrote about the whole Mascot Thing and how Aaron was truly part of this team.  I’m not going to analyze his award and think:  Was this tokenistic?  Did he get it because he has Down syndrome?

No.  He is MVP because his coach decreed so.  Period.  Explaining it away because he has a disability is wrong. Why would I diminish this recognition for him?

I cried because I am proud of him. I cried because he’s my Most Valuable Player too. I cried because he experienced belonging as part of of a team.  I cried because his coach gave him equal playing time at every game. I cried because someone believed in him.  I cried because it hurts his knee when he runs, but he ran his fastest every game.

Yes, I also cried because sometimes my life is hard.  I cried because of all the stares in the mall, the questions about prenatal testing, the lack of mom friends in the school yard, the fights to get funding, the forgotten birthday invitations.  Did I selfishly cry because of all the struggle and society-induced pain?  Maybe.  But screw all that today.

Aaron’s victory is 100% his.  Nobody gifted to him.  He won it because his principal and coach gave him the opportunity to play.   He earned it fair and square.  He won it because he’s good at basketball.  He won it because if you crawl out of bed early on Monday mornings to attend 8 am practices, carefully pick your water bottle and basketball shoes, pack your own gym bag, listen to your coach, show up to every game, work hard in spite of your limitations and fully pour your heart into your passion, one day you might be lucky enough to be recognized with an award.

To me this MVP award is a simple reminder that life is generous and sweet.  Tonight, we celebrate Aaron.  Hamburgers & fries all around!

all that dread for nothing

I still think this is a good idea.

I still think this is a good idea.

The dread started when I received the slip home from Aaron’s school about his first IEP meeting.  It said:

___I will attend my child’s IEP meeting on Thursday October 29 at 3:05 pm
___I will not attend my child’s IEP meeting.

How’s that for choice?  Then started my bad mood, my grumbling and general poor disposition about this impending meeting.

After a few days immersed in dread, I realized that my attitude was everything.  At my work, I often talk to families about communicating with professionals using a positive approach.  I use this quote:

“A prickly personality can advance a magnificent cause, but why make it harder?”

I could walk in all pissed off about the lack of choice in the date, or I could take care of myself, connect with others for support, and walk in with an open mind.  I decided to adjust my standard:  if the educators assembled seemed to care about Aaron and his learning, I would put aside any preconceived notions and biases based on how the meeting was scheduled.

I confided in a few friends about the IEP meeting.  It helped to talk about it with others.  I made sure I went to yoga class at work at lunch time.  Our instructor was kind enough to adjust her session to centre on relaxation and calmness, I left feeling serene.   I carried this feeling into the IEP meeting.

On my way home, I stopped at Starbucks and picked up a (dirty) chai latte, which served as my crutch during the meeting.   (Sounds silly, but clutching that coffee was a comfort to me). I kept my work clothes on to help with credibility.  It seems ridiculous that I feel I have to do this, but I think it helps.

My husband, Mike, (perhaps the most rational man on earth) was there with me.  Showing up as a team helped feel not so outnumbered, and we served as moral support for each other.  Me a ball of emotion; Mike the voice of reason.

Mike said he had never seen me so calm for a school meeting.  I do usually cry (and that’s ok too).  I didn’t cry today.  I felt prepared, but not a bundle of over-prepared anxiety – which generally includes anticipating what could go wrong, what offensive things people might say and how I would respond.  I had prepared myself by doing what I could do to remain open-minded and to dump my biases before I walked into the room.

All the educators there were respectful and engaged.  They solicited our feedback and we felt part of the team.  They had pre-populated the IEP form, but adjusted it when we told them certain goals were and were not important to us (spelling – no.  printing – no.  keyboarding – yes.  reading – yes).

When we walked out, I felt respected and listened to.  Most importantly, I felt as if they cared about my boy and his learning.  And that’s all that really matters in the end.

All that dread for nothing (please remind me of this before the next IEP meeting in May).