Chapter 3: Identification & Differentiated

Services

3.1 Impact of Disability and Vulnerability on

daily life
1. The Nature of the Disability: Disability can be
acquired (a result of an accident, or acquired disease) or
congenital (present at birth).

 If the disability is acquired, it is more likely to cause a

negative reaction than a congenital disability.
 Congenital disabilities are disabilities that have always
been present, thus requiring less of an adjustment than an
acquired disability.
2. The Individual’s Personality - the individual personality
can be typically positive or negative, dependent or
independent, goal-oriented or laissez-faire
3. The Meaning of the Disability to the Individual-
4. The Individual’s Current Life Circumstances -
◦ The individual’s independence or dependence on others
(parents).
◦ The economic status of the individual or the individual's
caregivers, the individual's education level.
5. The Individual's Support System - The individual’s
support from family, a significant other, friends, or
social groups.
3.2 Economic Factors and Disability
 People with few economic assets are more likely to
acquire pathologies that may be disabling
 Economic resources can limit the options and abilities of
someone who requires personal assistance services or
certain physical accommodations
 Economic factors also can affect disability by creating
incentives to define oneself as a PwDs.
3.3 Political Factors and Disability
 If the political system is well enforced it will profoundly improve
the prospects of people with disabling conditions for achieving a
much fuller participation in society

3.4 Psychological Factors of Disability

 One's psychological environment, including personal resources,
personality traits/behavior, and cognition.
 These constructs affect both the expression of disability and an
individual's ability to adapt to and react to it.
3.5 The Family and Disability
 The family can be either an enabling or a disabling
factor for a person with a disabling condition.
3.2 Needs of Persons with Disabilities and
Vulnerabilities.
 People with disabilities do not all share a single
experience.
 The special needs of PWDs are emanated from different
factors
• These are:
- Personal experience of individuals with
impairments;
- Type of the impairment;
- Severity /degree of the impairment; and
- Onset of the impairment.
• Hence, professionals as per their discipline should give
response differently to the needs of PWDs considering
these realities.
• Analyzing human beings, Maslow has identified five
categories of needs, with different priority levels.
.
 Persons with disabilities and vulnerabilities have socio-
emotional, psychological, physical and social environmental
and economic needs in general.
 The basic needs of persons with disabilities and
vulnerabilities to ensure equality:
 Full access to the Environment (towns, countryside & buildings)
 An accessible Transport system
 Technical aids and equipment
 Accessible/adapted housing
 Personal Assistance and support
 Inclusive Education and Training
 An adequate income
 Equal opportunities for employment
 Appropriate and accessible Information
 Advocacy (towards self-advocacy)
 Counseling
 Appropriate and Accessible Health Care
3.3. Disability Inclusive Intervention &
Rehabilitation Services
• A ‘One-size-fits-all’ approach to provide services for

PWDs and vulnerable groups is no longer enough.

• Including PWDs in everyday activities and

encouraging them to have roles similar to peoples who

do not have a disability is disability inclusion.
• This involves making sure that adequate policies and

practices are in effect in a community or organization.

• Inclusion should lead to increased participation of

PWDs in socially expected life roles and activities such

as being a student, worker, friend, community member,
patient, spouse, partner, or parent.
• Disability inclusion means provision of differentiated

services for PWDs and other vulnerable groups.

 Differentiated service means a multiple service delivery model
that can satisfy the most needs of PWDs and other vulnerable
groups.
 This includes the availability of accommodative public services
in infrastructure, health care, education, social protection etc.
 PWDs and other vulnerable groups are often excluded (either
directly or indirectly) from development processes and
humanitarian action because of physical, attitudinal and
institutional barriers.
 The effects of this exclusion are increased inequality,
discrimination and marginalization.
3.3.Definition and components of Rehabilitation
Intervention
• Rehabilitation is a process designed to optimize function

and improve the quality of life of those with disabilities.

• There are general underlying concepts and theories of

rehabilitation interventions.
• Examples of these theories and concepts include movement

and motor control, human occupation models, education

and learning, health promotion and prevention of additional
and secondary health conditions, neural control and central
nervous system plasticity, pain modulation, development
and maturation, coping and adjustment, biomechanics,
linguistics and pragmatics, resiliency and self-reliance,
auditory processing, and behavior modification.
• The conduct of rehabilitation intervention is not a simple process.
It involves multiple participants, and it can take on many forms.
• The following is a description of the individual components that,
when combined, comprise the process and activity of
rehabilitation:
 Multiple Disciplines;
 Physicians;
 Occupational Therapists;
 Physical Therapists;
 Speech and Language Therapist;
 Audiologists;
 Rehabilitation Nurses;
 Social Workers;
 Case Managers;
 Rehabilitation Psychologists;
 Neuropsychologists;
 Therapeutic Recreation Specialists;
 Rehabilitation Counselors;
 Orthotists and Prosthetists;
 Additional Rehabilitation Professionals;
 Persons with the Disability and His or Her Family;
 Community Based Rehabilitation Workers.
3.4. Creating Welcoming (Inclusive) Environment

 3.4.1. Environmental modifications can

take many forms:
 Assistive devices,
 Alterations of a physical structure,
 Object modification, and
 Task modification.
Examples of Environmental Modification

1. Mobility Aids
◦ Hand Orthosis
◦ Prosthetic limb
◦ Wheelchair (manual and/or motorized)
◦ Canes
◦ Crutches
◦ Braces

2. Communication Aids
◦ Voice-activated computer
◦ Closed or real-time captioning
◦ Computer-assisted note taker
◦ Print enlarger
◦ Books on tape
◦ Sign language or oral interpreters
◦ Braille writer
◦ Cochlear implant
 3. Accessible Structural Elements
◦ Ramps, Elevators
◦ Wide doors
◦ Safety bars
◦ Enhanced lighting

4. Accessible Features
◦ Built up handles
◦ Voice-activated computer
◦ Automobile hand controls

5. Job Accommodations
◦ Simplification of task
◦ Flexible work hours
◦ Rest breaks
◦ Splitting job into parts

6. Differential Use of Personnel

◦ Personal care assistants
◦ Note takers
◦ Secretaries Editors
◦ Sign language interpreters
Inclusive Learning Environment
• The learning environment in inclusive school supposed to
be suitable for all learners with or without disabilities.
• The environment for learning includes issues such as

• Classroom Situations,

• Flexible Curriculum,

• Teaching Methods,

• Adapted Teaching,

• The relationship between teachers and students and

• Appropriate class size and other issues.

3.4. Strategies to Disability Inclusive Intervention and
Rehabilitation
1. Implementing the Twin-track Approach

Track 1: Mainstreaming disability as a cross-cutting issue

within all key programs and services (education, health, relief
and social services, etc) to ensure these programs and services
are inclusive.
 This is done by: gathering information on the diverse needs of
persons with disabilities during the assessment stage.
 Track 2: Supporting the specific needs of vulnerable
groups with disabilities to ensure they have equal
opportunities to participate in society.
 This is done by strengthening referral to both internal
and external pathways and ensuring that sector
programs to provide rehabilitation.
2) Implementing Prevention Strategies
1. Primary Prevention – actions intended to avoid or remove the cause of
an impairment in an individual or a population before it arises.
 It includes health promotion and specific protection (e.g., HIV
Education).
2. Secondary Prevention (Early Intervention) – actions to detect a health
and disabling conditions at an early stage in an individual or a population,
facilitating cure, or reducing or preventing spread, or reducing or
preventing its long-term effects. (e.g., Supporting women with
intellectual disability to access breast cancer screening).

3. Tertiary Prevention (Rehabilitation) – actions to reduce the impact of

an already established disease by restoring function and reducing disease

related complications. (e.g., Rehabilitation for children with

musculoskeletal impairment).
Rehabilitation
 Rehabilitation is to “returning or restoring of PwDs to their previous
state or condition”.
 Rehabilitation signifies restoring any individual to social,
functional, economic status he/he enjoyed before the onslaught of
impairment.
 It refers to all the measures, which need to be taken to bring the
individual to her/his functional capabilities which he possessed
before his impairment.
 Rehabilitation is a process designed to optimize function and
improve the quality of life of those with disabilities.
 Rehabilitation involves multiple participants, and it can take on
many forms:
1. Multiple Discipline Professionals:
 Physicians
 Occupational Therapists
 Physical Therapists
 Speech and Language Therapist
 Audiologists
 Rehabilitation Nurses
 Social Workers
 Rehabilitation Counselors
 Experts in Orthotics and Prosthetics, etc.

2. Persons with the Disability

3. Families/Care givers
Models of Rehabilitation

1. Institutional Based Rehabilitation

2. Out-reach Based Rehabilitation

3. Community Based Rehabilitation

1. Institutional Based Rehabilitation

 Institutional rehabilitation programs are those in which the

patient is housed during treatment.
 These are voluntary but participation is also often court-
mandated.
 Patients are supposed to remain in the facility full-time.
 Some are locked-door programs, with patients being restrained
from leaving.
 Others do not interfere with a client intent on leaving, though
they may forbid return.
.
 General and specialized services are offered in an institution or
home for PwDs.
 General institutions include centers that provide services for
people for all types of disability.
 Specialized ones include homes which provide services for
specific types of disabilities.
2. Out-reach Based Rehabilitation

 Out-reach rehabilitation services are typically provided

by health care personnel based in institutions.
 Such a program provides for visits by rehabilitation
personnel to the homes of people with disabilities.
 The focus is on the PwDs, and perhaps the person's
family.
.

 Out-patient treatment is a type of rehab program in

which the patient lives in their own home and attends
to the daily routines of life, such as work, school and
family obligations, while going to the rehab facility at
regular intervals for treatment.
 The intervals vary according to need, and can be
daily, weekly or on whatever schedule the mental
health or substance abuse professional deems
necessary.
 3. Community Based Rehabilitation
 CBR was originally designed for developing countries where
disability estimates were very high and the countries were under
severe economic constraints.
 Community Based Rehabilitation (CBR) is a strategy within
general community development for rehabilitation, equalization of
opportunities and social inclusion of all people with disabilities
(WHO, ILO, UNICEF & UNESCO, 2004).

 Community-based programs are those that are set within

the community, rather than at a more formal facility.
CBR

 All the activities that PwDs, their family members and

community members do in their community for PwDs,
such as general care, adaptation of family members to
disabled, education, health etc.
 CBR is a strategy that seeks to ensure that PwDs are
involved in the development of their community by
having equal access to rehabilitation and other services
and opportunities- health, education and income.
CBR

 This definition advocates a broad approach for developing

programs that involves the following elements:
A. The participation of people with disabilities and their
representatives at all stages of the development of the program.
B. The formulation and implementation of national policies to
support the equal participation of people with disabilities.
C. The establishment of a system for program
management.
D.The multi-sectoral collaboration of governmental
and nongovernmental sectors to support communities
as they assume responsibility for the inclusion of their
members who experience disabilities.
E. CBR focuses on strengthening the capacity of peoples
with disabilities, and their families.
F. CBR focuses on challenging negative views and
barriers in society to enable equal rights and
opportunities.
Major Objectives of Community Based
Rehabilitation:

 To ensure that people with disabilities are able 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.

 To activate communities to promote and protect the human rights

of people with disabilities through changes within the

community, for example, by removing barriers to participation.