"Community-based rehabilitation (CBR) is a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights. It calls for the full and co-ordinated involvement of all levels of society: community, intermediate and national.
It seeks the integration of the interventions of all relevant sectors - educational, health, legislative, social and vocational - and aims at the full representation and empowerment of disabled people. It also aims at promoting such interventions in the general systems of society, as well as adaptations of the physical and psychological environment that will facilitate the social integration and the self-actualization of disabled people.
Its goal is to bring about a change; to develop a system capable of reaching all disabled people in need and to educate and involve governments and the public. CBR should be sustained in each country by using a level of resources that is realistic and maintainable.
CBR focuses on enhancing the quality of life for people with disabilities and their families, meeting basic needs and ensuring inclusion and participation.
CBR is a multi-sectoral approach and has 5 major components: health, education, livelihood, social and empowerment.
CBR was developed in the 1980s, to give people with disabilities access to rehabilitation in their own communities using predominantly local resources.
A 2004 joint ILO, UNESCO and WHO paper repositioned CBR as a strategy for rehabilitation, equalization of opportunity, poverty reduction and social inclusion of people with disabilities.
The goals of CBR are to ensure the benefits of the Convention on Rights of Persons with Disabilities reach the majority by:
• supporting people with disabilities to maximize their physical and mental abilities, to access regular services and opportunities, and to become active contributors to the community and society at large;
• activating communities to promote and protect the human rights of people with disabilities for example by removing barriers to participation;
• Facilitating capacity building, empowerment and community mobilization of people with disabilities and their families.
CBR is implemented in more than 90 countries through the combined efforts of people with disabilities, their families, communities, and relevant governmental and non-governmental organizations working in disability and development. Involvement and participation of people with disabilities and their families is at the heart of CBR.
CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" (WHO, 1994).
It differs from Independent Living in that, according to Lysack (1994), the entire community is the target of CBR programs; the CBR model is one of community development or partnership; ILO ideology places control squarely with disabled consumers.
The CBR principles
The Guidelines are built on some basic and important principles. These are inclusion, participation, sustainability, empowerment, self-advocacy and a barrier free environment.
These principles are overlapping, complimentary and inter-dependent – and cannot be separated one from the other.
1. Inclusion
It is the act or practice which ensures including people with disabilities in community life. It is like what everyone else is, and being welcomed, valued and embraced as an equal member of the community.
Inclusion also means placing disability issues and people with disabilities in the mainstream of activities, rather than as an after-thought or ‘bolt-on’.
Inclusion also means ‘convergence’ – that is, the involvement of people with disabilities in the campaigns, struggles and activities of other oppressed groups which are not centered exclusively on disability issues, such as children living on the streets, farmers, land rights and environment, women’s groups. It means including people with multiple and/or severe disabilities.
2. Participation
Participation means the involvement of disabled people as active contributors to the CBR programme from policy-making to implementation and evaluation, for the simple reason that they know best what they need.
Participation also means people with disability being a critical resource within any CBR programme – providing training, making decisions etc.
Participation requires the imaginative and flexible use of language and communication: for example ways around the barriers of illiteracy; the right to use your own language without discrimination or stigma.
3. Sustainability
Firstly, the benefits of the programme must be lasting. This means an approach to poverty alleviation where the socio-economic gains last beyond the short-term and benefit not just the present but future generations too.
Secondly, the CBR activity must be sustainable beyond the immediate life of the programme itself – able to continue beyond the initial intervention and thrive independently of the initiating agency.
Strong links between government organizations, NGOs, community-based / development organizations and disabled peoples’ organizations will contribute towards sustainability.
This means that disabled people’s organizations and self-help groups – are the hub of any CBR activity.
4. Empowerment
Empowerment means that local people – and specifically people with disabilities and their families – make the programme decisions and control the resources. It means people with disabilities taking leadership roles within programmes.
It means ensuring that CBR workers, service providers and facilitators are people with disabilities and all are adequately trained and supported.
To empower means drawing strength from solidarity and guarding against ways in which institutions and individuals may work to ‘divide and rule’ between groups within the community.
Empowerment necessitates capacity building – that is, the developing and using of the skills necessary to act with authority and responsibility, independent of the initiating agencies and CBR programme managers.
The skills of CBR workers and their managers are crucial too. They need to be empowered by ensuring they have a range and depth of skill appropriate to the complexities of the work.
Their training should include an understanding of the causes and effects of poverty, and the contribution the CBR programme can make to poverty alleviation. CBR workers are themselves often poor and have many other responsibilities. Training and support needs to acknowledge this reality.
5. Self Advocacy
Self-advocacy means the central and consistent involvement of people with disabilities defining for themselves the goals and processes for poverty alleviation. Family members will also play a key role as advocates.
Self-advocacy is a collective notion not an individualistic one. It means self-determination. It means mobilizing, organizing, representing, creating space for interaction and demands. It may mean posing a threat, making a challenge. These are the self-advocacy tools used in any CBR strategy.
6. A Barrier free Environment
Barriers are factors in a person's environment that, through their absence or presence, limit functioning and create disability. These include aspect such as the physical environment that is inaccessible as well as the negative attitudes of society or community towards people with disabilities and even towards their families.
The commonest examples of physical barriers are steps or inaccessible buses for people with mobility impairments.
People’s attitudes influence behaviour and social life at all levels, from interpersonal relationships and community associations to political, economic and legal structures. For example, the stigma and abuse of people with disabilities, leading to their marginalization and stereotyping.
Environmental factors are a major obstacle in inclusion. CBR needs to facilitate and ensure this, where possible.
Monday, May 10, 2010
The Golden Rule - "It's common courtesy"
Interaction with people with disabilities is an unfamiliar and sometimes threatening experience for many people. Avoidance behaviour can occur. Training can help staff deal with these issues.
Interacting with people with disabilities requires commonsense and simple sensitivity. A few key points need to be stressed:
Good service behaviours such as active listening, a service orientation and a results focus work equally well with people with disabilities as with all other people.
Think of the person first and the disability second. Sensitive use of language can help reinforce the "person first" attitude. Reference to "people with disabilities" rather than to "disabled people" helps maintain this stance.
Accept people with disabilities as individuals. People with disabilities may have in common a disability, but the consequences of their disabilities will vary considerably from person to person. Factors such as the degree of impairment, duration, individual coping strategies and styles, support structures available and a host of personality traits will all combine to influence the nature of the individuals needs. Don't generalise about all people with disabilities from your knowledge of a few.
Listen to what people say. Don't assume you know what they want or what is best for them. People with disabilities are no less capable of thinking for themselves than anyone else. There may be challenges in communicating their needs, but assumptions that they cannot decide what they need are also offensive.
Be yourself, be natural, don't force enthusiasm. Do not patronise or be inappropriately solicitous.
A disability is not necessarily an illness. Do not treat people with disabilities as though they are sick. Treat them as healthy individuals. Research indicates that people with disabilities take fewer sick days than other employees. Their impairments cause inconvenience and disability in particular areas of activity, but they are rarely dysfunctional.
Treat people in a manner that is appropriate to their age. It is not appropriate to talk to people with disabilities as if they were children, nor to refer to them as children. Terms such as "girlie" or "sonny" are not appropriate for adults with disabilities.
Speak directly to the person, not to their carer or other third party. People with disabilities often have carers. However, the carers are there to assist in specific ways. Do not assume that they are the mouthpiece or the advocate for the person with a disability. It is insulting to talk in the third person about a person who is present.
If the person with a disability has a communication problem they will usually let you know and indicate a preferred method.
A disability is an inconvenience in certain situations, but it is not necessarily a tragedy which dominates a person's life and makes fulfilment impossible. Individuals find their own ways of adapting. Interacting with people with disabilities.
Interacting with people with disabilities requires commonsense and simple sensitivity. A few key points need to be stressed:
Good service behaviours such as active listening, a service orientation and a results focus work equally well with people with disabilities as with all other people.
Think of the person first and the disability second. Sensitive use of language can help reinforce the "person first" attitude. Reference to "people with disabilities" rather than to "disabled people" helps maintain this stance.
Accept people with disabilities as individuals. People with disabilities may have in common a disability, but the consequences of their disabilities will vary considerably from person to person. Factors such as the degree of impairment, duration, individual coping strategies and styles, support structures available and a host of personality traits will all combine to influence the nature of the individuals needs. Don't generalise about all people with disabilities from your knowledge of a few.
Listen to what people say. Don't assume you know what they want or what is best for them. People with disabilities are no less capable of thinking for themselves than anyone else. There may be challenges in communicating their needs, but assumptions that they cannot decide what they need are also offensive.
Be yourself, be natural, don't force enthusiasm. Do not patronise or be inappropriately solicitous.
A disability is not necessarily an illness. Do not treat people with disabilities as though they are sick. Treat them as healthy individuals. Research indicates that people with disabilities take fewer sick days than other employees. Their impairments cause inconvenience and disability in particular areas of activity, but they are rarely dysfunctional.
Treat people in a manner that is appropriate to their age. It is not appropriate to talk to people with disabilities as if they were children, nor to refer to them as children. Terms such as "girlie" or "sonny" are not appropriate for adults with disabilities.
Speak directly to the person, not to their carer or other third party. People with disabilities often have carers. However, the carers are there to assist in specific ways. Do not assume that they are the mouthpiece or the advocate for the person with a disability. It is insulting to talk in the third person about a person who is present.
If the person with a disability has a communication problem they will usually let you know and indicate a preferred method.
A disability is an inconvenience in certain situations, but it is not necessarily a tragedy which dominates a person's life and makes fulfilment impossible. Individuals find their own ways of adapting. Interacting with people with disabilities.
The Role of the Orientation and Mobility Specialist
Orientation is the process of using sensory information to establish and maintain one’s position in the environment; mobility is the process of moving safely, efficiently, and gracefully within one’s environment.
Mobility is defined as “the capacity, the readiness, and the faculty to move”.
Components of Orientation and Mobility.
O&M services are “provided to blind or visually impaired students by qualified personnel to enable those students to attain systematic orientation to and safe movement within their environments in school, home, and community; and includes teaching students the following, as appropriate:
(a) Spatial and environmental concepts and use of information received by the senses (such as sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel (e.g., using sound at a traffic light to cross the street);
(b) To use the long cane to supplement visual travel skills or as a tool for safely negotiating the environment for students with no available travel vision;
(c) To understand and use remaining vision and distance low vision aids; and
(d) Other concepts, techniques, and tools
The components of an O&M curriculum include sensory, concept and motor development (fine and gross motor skills); environmental and community awareness; formal O&M skills; safety issues; the use of community resources; the use of assistive technology; and purposeful and self-initiated movement.
Other O&M skills include basic skills, indoor travel/cane skills, residential travel, light business travel, use of public transportation, metropolitan/urban travel and special areas/circumstances.
Orientation and Mobility Services
Community instruction where students receive orientation and mobility training off school campuses is also a crucial component of the orientation and mobility curriculum. Community instruction may focus on independent living activities such as shopping for groceries and clothing, banking, mailing packages, eating at a restaurant, or travelling on a subway to a job site. Providing the opportunities to interact with non-disabled and disabled peers; learning how and becoming proficient at integrating orientation and mobility skills into daily living activities, social skills, and employment skills (e.g., transportation, independent travel in the workplace); improving self-esteem and self-efficacy and engaging in community recreational activities are some advantages of community based instruction.
Community instruction assists with the transition of students from school to adulthood. Students with visual impairments and additional disabilities have difficulty generalizing skills in a variety of environments; therefore, community instruction focusing on partial participation and adaptations/modifications encourages community access.
Roles and Responsibilities of an Orientation and Mobility Specialist
Over the years, the role of the O&M specialist has expanded. Today O&M specialists assume many roles.
Instructor and Consultant
The O&M specialist provides direct instruction in concept development, environmental and community awareness, and motor development. Additionally, the O&M specialist is responsible for more advanced O&M skills training, such as cane instruction and street crossings. As a consultant, an O&M specialist may role release some basic instructional duties (e.g., monitor route travel) to a teacher, parent or paraprofessional who interacts with a student on a daily basis.
The O&M specialist has a significant role in the assessment of students. They are responsible for developing and conducting an O&M assessment for all children with visual impairments to determine the nature and extent of services needed. These assessments of students are conducted in partnership with an assessment team.
When assessing students, the O&M specialist uses instruments and checklists, observations of students in natural contexts and various environments, student portfolios, and interviews with the students and their caregivers. When O&M services are needed, an Individualized Rehabilitation Plan (IRP) is developed that includes instructional goals and objectives, the amount of time allocated for instruction, and the location of instruction.
Family and Community Educator
The O&M specialist is responsible for designing and implementing ongoing in-service education activities in the area of O&M for teachers, other professionals, administrators, parents, and consumers. In-service activities should provide information about the role of the O&M specialist and the goals of the O&M program.
O&M in-service activities should also focus on the roles of all appropriate school personnel in the development and reinforcement of concept development; sensory skills training; motor development; and formal O&M skills. To be effective, O&M training should be infused into school curricula and activities, supported and reinforced by all individuals connected with the student.
O&M instruction will have very little impact on children with visual impairments if parents/caregivers and family members are not involved in the process. It is also the responsibility of the O&M specialist to provide training to students with visual impairments and their parents. In addition to working cooperatively with family members in developing realistic goals, the O&M specialist must develop specific activities that parents and family members can implement in the home setting for continuity of instruction to occur. O&M activities should be designed so that parents and other family members can carry them out through daily living activities and recreational activities. The O&M specialist serves as a member of the transdisciplinary team in developing and implementing individualized education programs (IEP) for children with visual impairments. The O&M specialist also provides professional information about alternative systems of independent travel such as adaptive mobility devices.
Many times O&M instruction occurs in the community. Frequently, the O&M specialist has the opportunity to educate the general public regarding the capabilities of persons with visual impairments. Establishing community relationships through O&M instruction may dispel the many misconceptions that the general public often has about blindness and people with visual impairments (Welsh, 1997).
Conclusion
All children with total blindness or low vision, and children with additional disabilities including deaf blindness need an O&M assessment conducted by an O&M specialist to determine their eligibility for orientation and mobility services. Students typically qualify for O&M services when their visual disorder interferes with their ability to learn body, spatial and environmental concepts; to use orientation and mobility tools (e.g., cane, adaptive mobility devices) and low vision devices (telescope, magnifiers); use of their senses for orientation and travel; and how to move safely and/or remain oriented at home, in school or the community. For those students who are eligible O&M services, an O&M specialist should oversee the provision of instruction and/or provide direct instruction.
In summary, the goal of O&M services is for students with visual impairments to become safe and independent travelers. Orientation and mobility is a necessary life skill for everyone. Effective orientation and mobility skills can assist students in the pursuance of their life goals, improvement in their quality of life and successful integration into society.
Mobility is defined as “the capacity, the readiness, and the faculty to move”.
Components of Orientation and Mobility.
O&M services are “provided to blind or visually impaired students by qualified personnel to enable those students to attain systematic orientation to and safe movement within their environments in school, home, and community; and includes teaching students the following, as appropriate:
(a) Spatial and environmental concepts and use of information received by the senses (such as sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel (e.g., using sound at a traffic light to cross the street);
(b) To use the long cane to supplement visual travel skills or as a tool for safely negotiating the environment for students with no available travel vision;
(c) To understand and use remaining vision and distance low vision aids; and
(d) Other concepts, techniques, and tools
The components of an O&M curriculum include sensory, concept and motor development (fine and gross motor skills); environmental and community awareness; formal O&M skills; safety issues; the use of community resources; the use of assistive technology; and purposeful and self-initiated movement.
Other O&M skills include basic skills, indoor travel/cane skills, residential travel, light business travel, use of public transportation, metropolitan/urban travel and special areas/circumstances.
Orientation and Mobility Services
Community instruction where students receive orientation and mobility training off school campuses is also a crucial component of the orientation and mobility curriculum. Community instruction may focus on independent living activities such as shopping for groceries and clothing, banking, mailing packages, eating at a restaurant, or travelling on a subway to a job site. Providing the opportunities to interact with non-disabled and disabled peers; learning how and becoming proficient at integrating orientation and mobility skills into daily living activities, social skills, and employment skills (e.g., transportation, independent travel in the workplace); improving self-esteem and self-efficacy and engaging in community recreational activities are some advantages of community based instruction.
Community instruction assists with the transition of students from school to adulthood. Students with visual impairments and additional disabilities have difficulty generalizing skills in a variety of environments; therefore, community instruction focusing on partial participation and adaptations/modifications encourages community access.
Roles and Responsibilities of an Orientation and Mobility Specialist
Over the years, the role of the O&M specialist has expanded. Today O&M specialists assume many roles.
Instructor and Consultant
The O&M specialist provides direct instruction in concept development, environmental and community awareness, and motor development. Additionally, the O&M specialist is responsible for more advanced O&M skills training, such as cane instruction and street crossings. As a consultant, an O&M specialist may role release some basic instructional duties (e.g., monitor route travel) to a teacher, parent or paraprofessional who interacts with a student on a daily basis.
The O&M specialist has a significant role in the assessment of students. They are responsible for developing and conducting an O&M assessment for all children with visual impairments to determine the nature and extent of services needed. These assessments of students are conducted in partnership with an assessment team.
When assessing students, the O&M specialist uses instruments and checklists, observations of students in natural contexts and various environments, student portfolios, and interviews with the students and their caregivers. When O&M services are needed, an Individualized Rehabilitation Plan (IRP) is developed that includes instructional goals and objectives, the amount of time allocated for instruction, and the location of instruction.
Family and Community Educator
The O&M specialist is responsible for designing and implementing ongoing in-service education activities in the area of O&M for teachers, other professionals, administrators, parents, and consumers. In-service activities should provide information about the role of the O&M specialist and the goals of the O&M program.
O&M in-service activities should also focus on the roles of all appropriate school personnel in the development and reinforcement of concept development; sensory skills training; motor development; and formal O&M skills. To be effective, O&M training should be infused into school curricula and activities, supported and reinforced by all individuals connected with the student.
O&M instruction will have very little impact on children with visual impairments if parents/caregivers and family members are not involved in the process. It is also the responsibility of the O&M specialist to provide training to students with visual impairments and their parents. In addition to working cooperatively with family members in developing realistic goals, the O&M specialist must develop specific activities that parents and family members can implement in the home setting for continuity of instruction to occur. O&M activities should be designed so that parents and other family members can carry them out through daily living activities and recreational activities. The O&M specialist serves as a member of the transdisciplinary team in developing and implementing individualized education programs (IEP) for children with visual impairments. The O&M specialist also provides professional information about alternative systems of independent travel such as adaptive mobility devices.
Many times O&M instruction occurs in the community. Frequently, the O&M specialist has the opportunity to educate the general public regarding the capabilities of persons with visual impairments. Establishing community relationships through O&M instruction may dispel the many misconceptions that the general public often has about blindness and people with visual impairments (Welsh, 1997).
Conclusion
All children with total blindness or low vision, and children with additional disabilities including deaf blindness need an O&M assessment conducted by an O&M specialist to determine their eligibility for orientation and mobility services. Students typically qualify for O&M services when their visual disorder interferes with their ability to learn body, spatial and environmental concepts; to use orientation and mobility tools (e.g., cane, adaptive mobility devices) and low vision devices (telescope, magnifiers); use of their senses for orientation and travel; and how to move safely and/or remain oriented at home, in school or the community. For those students who are eligible O&M services, an O&M specialist should oversee the provision of instruction and/or provide direct instruction.
In summary, the goal of O&M services is for students with visual impairments to become safe and independent travelers. Orientation and mobility is a necessary life skill for everyone. Effective orientation and mobility skills can assist students in the pursuance of their life goals, improvement in their quality of life and successful integration into society.
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