Introduction

Full membership in most societies requires individuals to contribute to the economy, both as producers (e.g. labor) and consumers. Employment is not only a means for individuals to obtain tangible benefits such as income, but also a social expectation that confers status, acceptance, inclusion and integration. In the United States especially, work is integral to one's identity, so much so that one of the first questions people are asked by others when first introduced is, "What do you do?" One's paid work is a fundamental marker of identity (Unrah, 2004). Unfortunately for individuals with disabilities, finding employment can be challenging.

Despite increased efforts to enhance the labor force participation of individuals with disabilities, notably progressive legislation such as the Americans with Disabilities Act (ADA, 1990, 2009), unemployment and underemployment persist. The U.S. Bureau of Labor Statistics reported that the employment-population ratio was lower (19.2% vs. 64.5%) and unemployment rate higher (15.0% vs. 9.0%) for persons with a disability compared to persons without a disability. In addition, persons with disabilities are more likely to be employed part-time and in lower paid service sector jobs than their non-disabled counterparts (2011).

Persons with disabilities are disproportionately represented in the poorest segments of society and lack equal opportunity to improve their living standards (Schulz, 2010). It is important to address lack of employment access and opportunity as basic human rights issues because Article 23 of the Universal Declaration of Human Rights guarantees the right to work, to free choice of employment, to just and favorable work conditions, and to protection against unemployment (United Nations, 2012). However, human rights organizations have been slow in paying attention to employment issues in disabled communities (Organization for Economic Co-operation and Development, 2009).

The Americans with Disabilities Act (1990, 2009) is a comprehensive and significant civil rights law that addresses employment issues for people with disabilities (Karger & Rose, 2010). The intent of ADA Title I is to prohibit discrimination against persons with disabilities in areas of employment, accommodations, and services (e.g. transportation). Employers are mandated to provide "reasonable accommodation" to "qualified individuals with a disability" so that they can perform their essential job functions. While the intent of the ADA is laudable, its impact has been disappointing due to barriers to its effective implementation. The cost of accommodation is the most cited concern expressed by employers (Hernandez, Keys & Balcazar, 2000). Moreover, the process for identifying individualized reasonable accommodation is hampered by workers fear of reprisal in requesting for accommodation, and employers fear of ADA-related lawsuits (Karger & Rose, 2010).

In order to prevent discrimination and promote the full inclusion of persons with disabilities in American society, the statutory definition of disability applied to an individual is intentionally broad: "a physical or mental impairment that substantially limits one or more of the major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment" (ADA, 1990). The language of the ADA has been characterized as vague and unclear. Language such as "reasonable accommodation" and "undue hardship" leaves room for interpretation. This lack of clarity has resulted in "an open-ended bill that allowed courts to determine the parameters of the law" (Karger & Rose, 2010, p.80). Hence the legislation itself has become a barrier in a litigious society like the US, as employers fear costly accommodations and/or lawsuits. This fear appears to be unfounded, as most plaintiffs who sue under the ADA are unsuccessful (Lee, 2001). In response to the courts' narrowing of the definition of disability, in 2008 the United States Congress put forth amendments to the ADA, referred to as the ADA Amendments Act (ADAAA), that liberalized the interpretation of the ADA, broadened its scope and instructed courts to cover plaintiffs "to the maximum extent permitted" by the statute. The broadened scope of protection under the ADAAA has led to increased ligation as the threshold to qualify as disabled has fallen (Karger & Rose, 2010).

The National Organization of Disability has surveyed employers regarding the status of employment of persons with disabilities since 1980. Survey results indicate that the employment gap between people with and without disability remains large, with only a small fraction of people with disability participating in the workforce. The survey also found that companies are more likely to have policies and programs around general diversity rather than specific initiatives aimed at persons with disability. For example, few companies offer disability education or programs aimed at hiring persons with disability. The survey conclusion is "the environment for hiring people with disability needs much improvement" (2010, p. 6).

Further evidence of the limited impact of the ADA can be found by comparing two literature reviews by Wilgosh and Skaret (1987) and Hernandez, Keys & Balcazr (2000). The former, conducted prior to the enactment of the ADA, demonstrated that there was a substantial discrepancy between employers' espoused willingness to hire persons with disability and their actual hiring practices. Negative attitudes towards persons with disability prevailed among employers, except for employers with prior positive experiences with persons with disability. Additionally, larger companies had more disability-friendly hiring practices. Persons with higher education and/or with physical or sensory disabilities were viewed more favorably than those with intellectual or psychiatric disabilities.

The more recent review of 37 studies on employer attitudes towards workers with disability and ADA employment rights concluded, "there appears to be a veneer of employer acceptance of workers with disabilities" (Hernandez, Keys & Balcazar, 2000, p. 5). As in the previous review, employers' stated intentions towards hiring persons with disability did not match their hiring practices and behavior towards persons with disability. Employers' negative attitudes towards the disabled community likely stem from their limited interaction with persons with disability, as well as prevailing myths and stereotypes about disability.

The intent of the ADA is muddied and rendered controversial because of contrary conceptualizations of disability. How the "disability problem" is perceived by society impacts assumptions made about individuals with disability, the scope and focus of societal intervention towards persons with disability, and whether social inclusion of the disabled community is solely the concern of members of the community or if it is a shared societal responsibility. For example, the biomedical model views disability as a deviation from the norm; hence the disability is viewed as impairment(s) upon a "normal individual." This view focuses solely on the person with disability as impaired and largely ignores the environment in which they live. Individual-focused interventions prevail — the intervention "fixes" the person to "fit" the environment. The Social Security Disability Insurance program in the United States, for instance, adheres to this philosophy, and has subsequently been criticized for its paternalism and deficit-focused view of the person. Similarly, disablement models proposed by the World Health Organization (WHO) e.g., the International Classification of Impairments, Disabilities and Handicap (ICIDH, 1980), have come under scrutiny for their insufficient focus on the environment. As a result, the WHO replaced the ICIDH with the more inclusive International Classification of Functioning, Disability and Health (ICF) in 2001. The ICF conceptualizes general functioning and full social participation as an outcome of interactions between both personal and environmental factors; it follows that disability ensues from individual and social interactions. The ICF complements the ADA by explicitly calling for interventions that target both workers and their workplaces; its inclusivity and universality stems from conceiving the "disability problem" as both individual and societal.

Occupational science and occupational therapy acknowledges the complexity of human occupation and its performance. Both theory and practice recognize the reciprocal or transactional nature of the relationship between person, environment and occupation (Law, et. al., 1996); they interact in confluent ways to "co-define and co-constitute each other" (Cutchin & Dickie, 2012, p. 27). Occupations are not limited to what is commonly called "work", but rather include peoples' socially mediated quotidian activities that meet their intrinsic needs and societal expectations (Canadian Association of Occupational Therapists, 1997). Occupations structure the habits and routines of daily living, influence one's individual and collective identity, and provide satisfaction and autonomy (Whiteford & Townsend, 2011). Given the transactional intertwining of the person, environment and occupation, it is impossible to study work or work-related experiences outside of the workplace setting (Egan & Townsend, 2005). The Person-Environment-Occupation (PEO) model, comparable with the ICF in its inclusivity and universality, is a robust occupational model that conceptualizes the optimal conditions for occupational performance as the best fit between the person, their occupation and environment (Law et al., 1996). The PEO is the framework used in this study to disentangle the personal, environmental and occupational contributions to work-related issues encountered by persons with disability. This unraveling is necessary to create targeted interventions that optimize the workplace experiences for individuals and inform effective implementation of policy such as the ADA. The ADA's intent to promote full inclusion and equal opportunity for persons with disability necessitates the use of a transactional view of occupational performance as proposed by the PEO model.

However, any study of the ADA that does not acknowledge its roots in justice is incomplete. Occupational justice envisions a society in which all people have the opportunities, resources, and rights to engage in meaningful occupations to meet both intrinsic needs and societal expections (Townsend & Wilcox, 2004; Wilcox & Townsend, 2000). Occupational justice is a "justice of difference" (Whiteford & Pereira, 2012; Whiteford & Townsend, 2011). Occupational science perceives people as occupational and social beings and the doing of occupation influences one's being or identity and belonging (Wilcox, 1998; Rebeiro, 2001). Infringements upon the innate drive to engage in life sustaining occupations lead to occupational injustice resulting in alienation, deprivation, marginalization and imbalance (Townsend & Wilcox, 2004). Infusing the occupational justice perspective into the disability discourse is therefore imperative, as it examines the impact of contextual everyday injustices on occpational performance, a basic human need that is a requisite to the health of individuals and society.

This article melds the PEO model with the conceptual lens of occupational justice to uniquely frame the work experiences of one person and draws attention to the impact of the disconnect between the intent of the ADA and its implementation on the daily lived experiences of a person with disability.

Methodology

This case study, part of a larger study, is designed to illustrate the workplace experiences of one individual with disability. A qualitative case study design provides an in-depth understanding of a phenomenon to explicate context, process, and causes (Flyvbjerg, 2011). A case study approach facilitates gaining insight about the particular and unique experiences of individuals in their "real-life" context. This approach is relevant to occupational therapy and the practice of occupational science; other professions such as nursing, medicine, education and social work have also utilized case studies to inform practice (Simons, 2009). The intent of this case study is not theory construction. My purpose is to describe the everyday workplace experiences of an individual with disability in order to elucidate the complexity of processes that must be considered when developing a richer understanding of the challenges experienced by persons with disabilities and effecting workplace and cultural change.

Briefly, the larger qualitative study used a semi-structured interview with a broad range of open-ended questions that were formulated using the PEO model and included queries regarding work-related experiences, individual history, environment, relationships, etc. The study was conducted in stages focused on cohorts of individuals with specific disabilities: physical disabilities, mental health issues, visual impairments, and acquired work-related disability. Study participants were recruited through advertisement in a newspaper of a local disabilty organization, speaking to members of this community in various venues, and by contacting ADA consultants. The participants were given the interview guide and the consent form prior to the interview that typically lasted on an average 3.5 hours. Audio tapes were transcribed verbatim and the Framework Analysis approach, as described by Ritchie and Spencer (1994) informed the process of data analyses. This approach has been used in health research aimed at informing policy and was appropriate as the study's aim was to understand the impact of ADA in the workplace. It allows use of a prori codes based on a framework, in this case, the PEO model, and also identifies inductive codes that may emerge from data. The process involves five steps: familiarization, identification of a thematic framework (coding sheet), indexing (coding), charting (putting coded data into tables) and mapping and interpretation (Lacy & Luff, 2001).

This particular narrative was selected as the participant was articulate in communicating her experiences during an interview that lasted 4.5 hours. The larger study had many participants who were highly qualified, so this participant was not exceptional in that regard. This may reflect the method and sites used for recruitment. The participant was a successful and established professional with a strong occupational identity and self-worth when she became impaired. The "preferential hierarchy based on disability types" places her in a positive light with employers on account of the physical nature of her disability (Hernandez, Keys, & Balcazar, 2000, p. 12). Also, her impairments do not interfere with her ability to meet the essential job functions and the work accommodation she requires are minimal. Her experiences are context-specific and unique but share many thematic commonalities with the larger study participants, as well as those noted in other studies reported in the literature. She is therefore a good case study to illustrate the challenges encountered by 'high functioning' persons requiring minimal accommodations in procuring employment and gaining acceptance in workplaces.

Results

The Issues Of Occupational (In)Justice: Analysis Of The Case

Occupational justice recognizes the right of people with different needs to be treated commensurate with their difference (Whiteford & Townsend, 2011). This aligns with the intent of "reasonable accommodation" under the ADA (1990, 2009). However, Bonnie's experiences of negotiating for accommodation were complicated, requiring strategic navigation of the organization and overcoming the adversarial attitudes of supervisors and co-workers. Even when persons with disability are hired, studies have shown that many employees are discouraged to request the accommodations to which they are entitled (Harlan & Roberts, 1998). The review by Hernandez, Keys & Balcazar (2000) reveals that little changed in the workplace in the first decade after the ADA was implemented, and that there continues to be a mismatch between employers' eschewed intentions and their actions regarding hiring persons with disability. There is evidence that reasonable accommodation is a source of "workplace tensions" as it is perceived as "special treatment" by supervisors and co-workers who are not disabled (Robert & Harlan, 2006, p. 620). Non-disabled individuals perceive differentiation aimed at enabling the participation of persons with disability as discriminatory or unfair. Scholars have refuted these arguments by claiming that everyone benefits from universal design (Zolna, Sanford, Sabata, & Goldwaithe, 2007); however, unlike specific disability accommodations, universal design may not sufficiently enable individuals with disability to perform essential job functions.

Definitions of disability reflect sociocultural values and dispositions; these are complex, political, and ultimately influence policy. It is important to examine the plurality of societal views and attitudes towards disability if common ground is to be reached. The challenges that Bonnie encountered mostly resided in her environment, not in herself. Given the dynamic and transactional relationship of persons, occupation and environment, it is impossible to analyze her experiences removed from her work and larger social context. "People see themselves, are seen by others, and see how others see them" and by "doing" occupations they express and reconstruct their identities (Asaba & Jackson, 2011, p. 150; Huot & Laliberté-Rudman, 2010). Like occupational identities, disability identities are also dynamic and constantly being negotiated in person and environment interactions (Brown, et.al., 2008). While Bonnie was the single subject of this paper, other studies in the literature report that her experiences regarding formation of her disability identity are far from atypical. For example, participants in Brown et al., (2008) report, "all they [employers] see is the chair" (p. 14). Bonnie's wheelchair came to define her identity and how people behaved in her presence. Rocco (2006) states that although "disability has fluid boundaries intersecting our other identities" (p. 170), it is not discussed as such and infused into discussions on marginalization, which is "the most dangerous form of oppression" experienced by persons with disability (p. 169).

Occupational marginalization is a form of occupational injustice that occurs when people deviate from socially constructed normative behaviors, and is perhaps dangerous, as it is invisible (Townsend & Wilcox, 2004). Bonnie is atypical when she wheels herself to a job interview, and is subsequently excluded from employment opportunities. Exclusion is one interpersonal mechanism by which marginalization occurs (Roberts & Harlan, 2006). Bonnie also experienced marginalization as "avoidance, stilted interaction, and staring" (p. 609) when she was made to feel "invisible" or "untouchable" or stared at by potential employers, co-workers and in the public arena. When individuals denied Bonnie the common courtesy of a handshake or communicated distaste to be seen in public with her she was denied the rights and privileges of mainstream life. A socially inclusive and supportive environment affirms an individual's worth, promotes participation, improves occupational performance and also confers a sense of belonging that is instrumental to identity, health and well being (Rebeiro, 2001). Social inclusion is both a process and an outcome; a means and an end to participation (Whiteford & Pereira, 2011).

Acquiring a disability and grieving for the loss of her old self was a very isolating and lonely experience for Bonnie. Any issue of diversity often spawns false assumptions and stereotyping of people who are different, often due to lack of awareness, understanding, and fear of the unknown. In Bonnie's case, in some sense, her high functioning nature and confidence made her too close to the norm of a professional and competent woman, but for the wheelchair. She reminded others of their own "mortality" and was hence excluded.

Perceived and assumed attributes of persons with disability are not aligned with actual attributes or capabilities and such workplace behaviors are a form of stigmatization and marginalization (Brown et al., 2008; Roberts & Harlan (2006)). Employers also perceive employees with disabilities requiring accommodations as less competent (Hernandez, Keys & Balcazar, 2000). It appears that while Bonnie wanted to 'normalize' her daily life through employment to get past her bodily impairments and disability, her environment created many barriers and did not let her do so readily.

It is therefore intriguing that ultimately Bonnie found work in the disability realm when she was hired by a government agency dealing with disability statutes and their implementation. The irony is that even in such a work environment hostile attitudes for accommodation and discriminatory practices persisted. The "othering" of Bonnie by service providers, now her co-workers, is not surprising as providers are influenced by their social context. Bonnie, hired explicitly to provide the "disabled" perspective, had "an uphill battle". Essentially she was challenging entrenched practices and attitudes of co-workers. Although she was officially one of them in terms of her employment, she remained first and foremost a person with a disability.

Individuals with disability believe that working confers dignity, inclusion, worthiness, and status as a citizen (Brown et al., 2008; Roberts & Harlan, 2006). The importance of work or productivity in Western societies to an individual's value to society, identity, and self-worth is attributed to industrialization and the protestant work ethic (Kantartzis & Mollineux, 2011). Prior to her disability, Bonnie's strong occupational identity and self-worth was largely derived from her work credentials, capability and self-efficacy. Persistent marginalization on account of her disability drained her of energy to "lawyer up and fight this battle". Significant evidence for the discrimination of workers with disabilities exists in the literature and the complexities of workplace interactions make it difficult to understand and prove discrimination in a court of law (Roessler, Neath, McMahon, & Rumrill, 2007). It is difficult to pinpoint, observe, and empirically test motivations that induce discriminatory behaviors; producing objective and evidentiary proof that can withstand scrutiny in a court of law is a challenge. Social stratification based on characteristics that are beyond the individual's control, such as disability, is defined as ascriptive. Robert and Harlan (2006) identified marginalizing interpersonal and organizational mechanisms of ascriptive inequalities in the workplace. This novel approach is important as Bonnie's experiences illustrate that discriminatory interpersonal interactions in workplaces reflect pervasive social attitudes. Ward and Baker (2005) apply capabilities and functioning to workplace integration of individuals with disabilities; functioning is the doings and beings of everyday living and when individuals are marginalized, they are deprived of opportunities to reach their occupational potential (Townsend & Wilcox, 2004). Ultimately, until legislation holds employers accountable to create safe and inclusive workplaces, full participation for persons with disability will be hard to access.

This case study has shown the gap between the intent and the implementation of the ADA. Effective enforcement may need more clear language, a case-by-case analysis of specific accommodation, and overall education around disability issues. Attitudinal barriers based on unfounded and erroneous assumptions play a significant role in marginalization of persons with disability. Short- term goals to change organizational culture with clear, enforceable and consequential discrimination policies and procedures are achievable. The scope of the ADA has been eroded in court battles and its very survival requires stronger legislation and activism (Roberts & Harlan, 2006). The transactional nature of the relationship of people and their environment, exemplified by Bonnie's experiences, illustrates that the intent of legislation cannot be actualized until social attitudes to disability change. Occupational justice requires re-visioning our social values to embrace human rights wholeheartedly and notions of the common good based on the interconnectedness of people, occupation and environment. Given the dominant and pervasive myth of rugged individualism that characterizes the American ethos, the concept of occupational justice may remain a theoretical bridge to practice for the foreseeable future.