Normalization principle

"The normalization principle means making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life or society." Normalization is a rigorous theory of human services that can be applied to disability services. Normalization theory arose in the early 1970s, towards the end of the institutionalisation period in the US; it is one of the strongest and long lasting integration theories for people with severe disabilities.

"The normalization principle means making available to all people with disabilities patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life or society." Normalization is a rigorous theory of human services that can be applied to disability services. Normalization theory arose in the early 1970s, towards the end of the institutionalisation period in the US; it is one of the strongest and long lasting integration theories for people with severe disabilities. ==Definition== Normalization involves the acceptance of some people with disabilities, with their disabilities, offering them the same conditions as are offered to other citizens. It involves an awareness of the normal rhythm of life – including the normal rhythm of a day, a week, a year, and the life-cycle itself (e.g., celebration of holidays; workday and weekends). It involves the normal conditions of life – housing, schooling, employment, exercise, recreation and freedom of choice previously denied to individuals with severe, profound, or significant disabilities. Wolf Wolfensberger's definition is based on a concept of cultural normativeness: "Utilization of a means which are as culturally normative as possible, in order to establish and/or maintain personal behaviors and characteristics that are as culturally normative as possible." Thus, for example, "medical procedures" such as shock treatment or restraints are not just punitive, but also not "culturally normative" in society. His principle is based upon social and physical integration, which later became popularized, implemented and studied in services as community integration encompassing areas from work to recreation and living arrangement. ===Theoretical foundations=== This theory includes "the dignity of risk", rather than an emphasis on "protection" and is based upon the concept of integration in community life. The theory is one of the first to examine comprehensively both the individual and the service systems, similar to theories of human ecology which were competitive in the same period. The theory undergirds the deinstitutionalization and community integration movements, and forms the legal basis for affirming rights to education, work, community living, medical care and citizenship. In addition, self-determination theory could not develop without this conceptual academic base to build upon and critique. The theory of social role valorization is closely related to the principle of normalization having been developed with normalization as a foundation. This theory retains most aspects of normalization concentrating on socially valued roles and means, in socially valued contexts to achieve integration and other core quality of life values. ===Academe=== The principle was developed and taught at the university level and in field education during the 1970s, especially by Wolf Wolfensberger of the United States, one of the first clinical psychologists in the field of intellectual disability, through the support of Canada and the National Institute on Mental Retardation (NIMR) and Syracuse University in New York. PASS and PASSING marked the quantification of service evaluations based on normalization, and in 1991 a report was issued on the quality of institutional and community programs in the US and Canada based on a sample of 213 programs in the US, Canada and the United Kingdom. ===Significance in structuring service systems=== Normalization has had a significant effect on the way services for people with disabilities have been structured throughout the UK, Europe, Scandinavia, North America, Israel, Australasia (e.g., New Zealand), and, increasingly, other parts of the world. It has led to a new conceptualisation of disability as not simply being a medical issue (the medical model which saw the person as indistinguishable from the disorder, though Wolfensberger continued to use the term into the 2000s), but as a social situation as described in social role valorization. Government reports began from the 1970s to reflect this changing view of disability (Wolfensberger uses the term devalued people), e.g. the NSW Anti-Discrimination Board report of 1981 made recommendations on "the rights of people with intellectual handicaps to receive appropriate services, to assert their rights to independent living so far as this is possible, and to pursue the principle of normalization." The New York State Quality of Care Commission also recommended education based upon principles of normalization and social role valorization addressing "deep-seated negative beliefs of and about people with disabilities". Wolfensberger's work was part of a major systems reform in the US and Europe of how individuals with disabilities would be served, resulting in the growth in community services in support of homes, families and community living. ===Critical ideology of human services=== Normalization is often described in articles and education texts that reflect deinstitutionalization, family care or community living as the ideology of human services. Its roots are European-American, and as discussed in education fields in the 1990s, reflect a traditional gender relationship-position (Racino, 2000), among similar diversity critiques of the period (i.e., multiculturalism). Normalization has undergone extensive reviews and critiques, thus increasing its stature through the decades often equating it with school mainstreaming, life success and normalization, and deinstitutionalization. ==In contemporary society== In the United States, large public institutions housing adults with developmental disabilities began to be phased out as a primary means of delivering services in the early 1970s and the statistics have been documented until the present day (2015) by David Braddock and his colleagues. As early as the late 1960s, the normalization principle was described to change the pattern of residential services, as exposes occurred in the US and reform initiatives began in Europe. These proposed changes were described in the leading text by the President's Committee on Mental Retardation (PCMR) titled: "Changing Patterns in Residential Services for the Mentally Retarded" with leaders Burton Blatt, Wolf Wolfensberger, Bengt Nirje, Bank-Mikkelson, Jack Tizard, Seymour Sarason, Gunnar Dybwad, Karl Gruenwald, Robert Kugel, and lesser known colleagues Earl Butterfield, Robert E. Cooke, David Norris, H. Michael Klaber, and Lloyd Dunn. ===Deinstitutionalization and community development=== The impetus for this mass deinstitutionalization was typically complaints of systematic abuse of the patients by staff and others responsible for the care and treatment of this traditionally vulnerable population with media and political exposes and hearings. These complaints, accompanied by judicial oversight and legislative reform, resulted in major changes in the education of personnel and the development of principles for conversion models from institutions to communities, known later as the community paradigms. In many states the recent process of deinstitutionalization has taken 10–15 years due to a lack of community supports in place to assist individuals in achieving the greatest degree of independence and community integration as possible. Yet, many early recommendations from 1969 still hold, such as financial aid to keep children at home, establishment of foster care services, leisure and recreation, and opportunities for adults to leave home and attain employment (Bank-Mikkelsen, p. 234-236, in Kugel & Wolfensberger, 1969). ===Community supports and community integration=== A significant obstacle in developing community supports has been ignorance and resistance on the part of "typically developed" community members who have been taught by contemporary culture that people with disabilities are somehow fundamentally different and flawed, and that it is in everyone's best interest if they are removed from society (this developing out of 19th century ideas about health, morality, and contagion). Part of the normalization process has been returning people to the community and supporting them in attaining as "normal" as life as possible, but another part has been broadening the category of "normal" (sometimes taught as "regular" in community integration, or below as "typical") to include all human beings. In part, the word "normal" continues to be used in contrast to "abnormal", a term also for differentness or out of the norm or accepted routine (e.g., middle class). ===Contemporary services and workforces=== In 2015, public views and attitudes continue to be critical both because personnel are sought from the broader society for fields such as mental health and contemporary community services continue to include models such as the international "emblem of the group home" for individuals with significant disabilities moving to the community. Today, the US direct support workforce, associated with the University of Minnesota, School of Education, Institute on Community Integration can trace its roots to a normalization base which reflected their own education and training at the next generation levels. People with disabilities are not to be viewed as sick, ill, abnormal, subhuman, or unformed, but as people who require significant supports in certain (but not all) areas of their life from daily routines in the home to participation in local community life. With this comes an understanding that all people require supports at certain times or in certain areas of their life, but that most people acquire these supports informally or through socially acceptable avenues. The key issue of support typically comes down to productivity and self-sufficiency, two values that are central to societal definitions of self-worth. If we as a society were able to broaden this concept of self-worth perhaps fewer people would be labeled as "disabled." ===Personal wounds, quality of life and social role valorization=== However, the perspective of Wolfensberger, who served as associated faculty with the Rehabilitation Research and Training Center on Community Integration (despite concerns of federal funds), is that people he has known in institutions have "suffered deep wounds". This view, reflected in his early overheads of PASS ratings, is similar to other literature that has reflected the need for hope in situations where aspirations and expectations for quality of life had previously been very low (e.g., brain injury, independent living). Normalization advocates were among the first to develop models of residential services, and to support contemporary practices in recognizing families and supporting employment. Wolfensberger himself found the new term social role valorization to better convey his theories (and his German Professorial temperament, family life and beliefs) than the constant "misunderstandings" of the term normalization. ===Related theories and development=== Related theories on integration in the subsequent decades have been termed community integration, self-determination or empowerment theory, support and empowerment paradigms, community building, functional-competency, family support, often not independent living (supportive living), and in 2015, the principle of inclusion which also has roots in service fields in the 1980s. ==References== ==Further reading== "The Principle of Normalization: History and Experiences in Scandinavian Countries," Kent Ericsson. Presentation ILSMH Congress, Hamburg 1985. "Setting the record straight: a critique of some frequent misconceptions of the normalization principle", Perrin, B. & Nirje, B., Australia and New Zealand Journal of Developmental Disabilities, 1985, Vol 11, No. 2, 69–72. A comprehensive review of research conducted with the program evaluation instruments PASS and PASSING. (1999). In: R. Flynn & R. LeMay, "A Quarter Century of Normalization and Social Role Valorization: Evolution and Impact". (pp. 317–349). Ottawa, Canada: University of Ottawa Press. The social origins of normalisation by Simon Whitehead in the reader Normalisation from Europe by Hillary Brown and Helen Smith (1992, Routledge). Foreword by Linda Ward. Reader includes references to Wolfensberger, John O'Brien (Citizen advocacy, Frameworks for accomplishment), Syracuse University Training Institute (European PASS workshops), Australian Training and Evaluation for Change Association, and Great Britain's Community and Mental Handicap Educational and Research Associates, among others. ===Presentations=== New York State Office of Mental Health. (1980). Normalisation Excerpt from 1973 Orientation Manual on Mental Retardation. Goals of Community Residence Workshop. Albany, NY: Author. Nirge, B. (1990, April 23). Lecture: Recent Developments in Community Services in Sweden. Syracuse, NY: Sponsored by Syracuse University, Division of Special Education and Rehabilitation, and the Center on Human Policy. Wolfensberger, W. & Associates. (2001). The "Signs of the Times" and their Implications to Human Services and Devalued People. Syracuse, NY: Training Institute for Human Service Planning and Change Agentry, Syracuse University. [Held at the site of the former Syracuse Developmental Center]. Wolfensberger, W. (2000). Half Day Presentation on Social Role Valorization. Syracuse, NY: Syracuse University, Training Institute on Human Services Planning, Leadership and Change Agentry. Wolfensberger, W. (2000). A Critical Examination of the Current Concept of "Rights" in the Contemporary Human Services & Advocacy Culture. Syracuse, NY: Training Institute on Human Services Planning, Leadership and Change Agentry, Syracuse University. Wolfensberger, W. (2000). The Most Common "Wounds" of Societally Devalued People with an Emphasis on Threats to, Attacks Upon, Their Lives. Syracuse, NY: Training Institute on Human Services Planning, Leadership and Change Agentry, Syracuse University. Wolfesnberger, W. (2000). Deeply-Embedded Concepts About What We Call "Mental Retardation" as Expressed Throughout History in Visual Iconography & Language & Implications for Our Day. Syracuse, NY: Syracuse University, Training Institute on Human Services Planning, Leadership and Change Agentry. ===Syllabi: course readings=== Wolfensberger, W. (1979). "Readings for Universal Issues and Principles in Human Services". (pp. 1–6). Syracuse, NY: Training Institute for Human Service Planning, Leadership and Change Agentry. Wolfensberger, W. (1979). Overheads on PASS, Integration and Normalization. Syracuse, NY: Syracuse University School of Education. ===Assessment reports=== Wolfensberger, W. & Associates. (1985, April). "Passing Assessment Reports Available for Training and Demonstration Purposes". Syracuse, NY: Training Institute for Human Service Planning, Leadership and Change Agentry. Wolfensberger, W. (1989, February). Overview of "PASSING," A New Normalization/Social Role Valorization-Based Human Service Evaluation Tool: Assumptions, Purposes, Structure, & Intended Uses (Revised). Syracuse, NY: Syracuse University, Training Institute on Human Services Planning, Leadership and Change Agentry. ===Historical references=== Nirje, B. (1969). Chapter 7: The normalisation principle and its human management implications. Kugel, R. & Wolfensberger, W. (Eds.), Changing Patterns in Residential Services for the Mentally Retarded. Washington, DC: President's Committee on Mental Retardation. Nirje, B. (1970). The Normalization Principle: Implications and comments. Symposium on "Normalization. Midland Society for the Study of Abnormality, 16(62-70). Wolfensberger, W. (1970). The principle of normalization and its implications to psychiatric services. American Journal of Psychiatry, 127:3, 291–297. Wolfesnberger, W. (1973). The future of residential services for the mentally retarded. Journal of Clinical Child Psychology, 2(1): 19–20. Wolfensberger, W. (1975). The Origin and Nature of Our Institutional Models. Syracuse, NY: Human Policy Press. Wolfensberger, W. (1976). Will there always be an institution? The impact of epidemiological trends. (pp. 399–414). In: M. Rosen, G.R. Clark, & M.S. Hivitz, The History of Mental Retardation: Collected Papers: Volume 2. Baltimore, MD: Paul H. Brookes. Wolfensberger, W. (1983). Social role valorization: A proposed new term for the principle of normalization. Mental Retardation (now Intellectual and Developmental Disabilities), 21(6): 234–239. Wolfensberger, W. (1988). Common assets of mentally retarded people that are commonly not acknowledged. Mental Retardation, 26(2): 63–70.

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