It is meant for Post Graduation students of Special Needs Education, Rehabilitation Psychology and Social Work

1. AMBO UNIVERSITY
INSTITUTE OF EDUCATION AND BEHAVIORAL SCIENCES
DEPARTMENT OF SPECIAL NEEDS AND INCLUSIVE EDUCATION
P.B.NO-19, AMBO, OROMIYA , ETHIOPIA, EAST AFRICA
Course Code: SNIE6014 Credits Hr.: 02 ECTS : 05
Module Name: Early Intervention and Rehabilitation Counseling
Course Title: Community Based Rehabilitation
Target Group: Post Graduation (M.A) Regular
Name of the Instructor: Dr. Pavan Kumar Yadavalli (Ph.D)
Designation : Associate Professor
Part-1

2. UNIT-I What is community Based Rehabilitation?
1.1 Introduction: In this unit, the focus is on the CBR.
Special attention is given to explanations of its
historical development, major elements to be
included, underlying guiding principles in the practice
etc. Following activity questions are presented to
check how you master the issues treated in the unit.
Objectives:-
After learning this unit students are expected to:
Trace the historical development of CBR
 Define what CBR is
List down major principles of CBR
Identify elements of CBR
Realize objectives of CBR

3. 1.2 Historical Background of CBR
 CBR was introduced 30 years ago as an innovative
program in the disability prevention and rehabilitation
of people with disabilities.
 This program was primarily designed to deal with the
situation in developing countries.
 The strategy of CBR program is to develop the local
community through community development strategy so
that the community will be able to participate and be
involved in the implementation of the program. It has been
advocated internationally as the core strategy for the
improvement of quality of life of the peoples with
disabilities.

4. 1.2 Historical Background of CBR Cont’d…….
The historical concept of peoples with disabilities is related to
the practice and impact of the different stages on the peoples
themselves. Helander, E (1999) briefly explained the different
historical stages in the life of peoples with disabilities as
follows.
i. The elimination period: during this time peoples with certain
physical disabilities were subjected to getting rid of.
ii. Poor house: it was relatively better than the first period in
which individuals with disabilities were removed from the
view of the non-disabled peoples.
iii. Institutional care: this was the time when peoples with
disabilities were provided services on a segregated base.
Moreover this model was taken as a base for the emergency of
the concept of CBR.

5. 1.2 Historical Background of CBR Cont’d…….
iv. Integration: it is the time yet not achieved which
encourage a process that would lead to the integration of
peoples with disabilities their families and the
community.
v. Self-actualization and empowerment: This is the
highest level in the life of peoples with disabilities
focusing and creating the conditions that enable these
peoples to develop their full potential.
One important reason for the very slow development of
CBR is that historically it has been seen as a low priority
around the world because of a number of factors. Among
the common one include the following:

6. 1.2 Historical Background of CBR Cont’d…….
• Cost-benefit ratio of providing services to those with
disabilities
• Under-estimation of disabled peoples’ potential to
achieve
• Negative societal attitudes towards disability
• Discriminatory practices
• Absence of urgency – rehabilitation tends to focus on
the chronic, non-communicable diseases or illnesses
that do not pose a risk to others
• Interest of biomedical practitioners focuses on
improvement and cure, which is not always feasible or
realistic for rehabilitation or the 'Cure or Care' model
• Public policy is not influenced by those with disabilities
as they represent a relatively small marginalized
minority.

7. 1.3. Meaning and definition of Community Based Rehabilitation
1.3.1 What is CBR?
According to the view of World Health Organization(WHO)
and United Nations Education Scientific Commissions
Organization (UNESCO) CBR is a strategy that can address
the need of peoples with disabilities with in their
community which can be implemented through the
combined efforts of peoples with disabilities themselves,
their families, organizations and communities,
governmental and non-governmental organizations, health,
education, vocational, social and other services.
Community based rehabilitation is a combination of two
important words; community and rehabilitation. Thus in
order to get clear concept about the definition of CBR, let
us first define the two terms separately.

8. 1.3.1 What is CBR? Cont’d……….
‘Community’ consists of people living together in some
form of social organization sharing political, economic,
social and cultural characteristics in varying degrees.
‘Rehabilitation’ includes all measures aimed at reducing
the impact of disability for an individual enabling him or
her to achieve independence, social integration, a better
quality of life and self actualization.
Based on the above definition of key words
different authorities and scholars define
community based rehabilitation in different ways.
For the purpose of our discussion two important
definitions will be given.

9. 1.3.1 What is CBR? Cont’d……….
1. Community based rehabilitation is a strategy that can
address the needs of peoples with disabilities with in
their communities (WHO, ILO, UNESCO, 2004).
2. Community based rehabilitation is a common sense
strategy for enhancing the quality of life of peoples with
disabilities by improving services delivery in order to
reach all in need by providing more equitable
opportunities and by promoting and protecting their
rights (Helander , 1999).
3. The joint position paper by WHO, ILO, UNICEF
and UNESCO of the 2002 defines CBR in a rather
flexible and broad manner in the following way.

10. 1.3.1 What is CBR? Cont’d……….
Community based rehabilitation is a
strategy within general community
development for rehabilitation, equalization
of opportunities and social inclusion of all
children and adults with disabilities. It is
implemented through the combined efforts
of people with disabilities themselves, their
families and communities, and the
appropriate health, education, vocational
and social services.

11. 1.4 Objective of Community Based Rehabilitation
1.4.1 Major objective
The major objective of community based rehabilitation is
to ensure that people with disabilities are empowered to
maximize their physical and mental abilities, have access
to regular services and opportunities and become active,
contributing members of their communities and their
societies. Thus, community based rehabilitation
promotes the human rights of people with disabilities
through attitude changes within the community.
community based rehabilitation aims to include people
who have disabilities from all types of impairments,
including difficulty hearing, speaking, moving, learning or
behaving. Community based rehabilitation also includes
all age groups: children, youth, adults and older people.

12. 1.4.2 Specific objectives
CBR as a strategy developed in line with the following specific
goals to improve the life of peoples with disabilities and to assure
defined inclusion in the society.
• Assisting in training persons with disabilities through home
visiting, towards achieving independency, productivity and
inclusion.
• Raising awareness of the community about the need for, and
benefit of CBR and ensuring that resources will be committed
for the benefit of persons with disabilities.
• Empowering communities to take their responsibility for
planning, implementation and being involved in monitoring and
evaluation of the CBR programs.
• Identifying mechanisms for decentralising government CBR
programs and for transferring decision making power from
central level to communities and people with disabilities.

13. 1.4.2 Specific objectives Cont’d………
• Ensuring participation of all ministries especially of health,
education, social welfare, labor, development and finance in
responding to the need of the people with disabilities.
• Ensuring that governmental and nongovernmental
organizations and private service providers respond to the
needs of people with disabilities in an integrated manner.
• Identifying a strategy for the coordination among all the
stakeholders mainly government, NGOs, Disabled People
Organizations (DPOs) and communities.
• Facilitating the participation of people with disabilities
especially people who have restricted mobility and access.
• Promoting the representation of all types of disability among
DPOs participating in the CBR, to ensure that the program is
accessible to all disabled persons.

14. 1.4.2 Specific objectives Cont’d………
• Assisting people with disabilities to form their own community
level organizations that should also include parents of persons
with disabilities.
• Ensuring that governmental and nongovernmental organizations
and private service providers respond to the needs of people with
disabilities in an integrated manner.
• Identifying a strategy for the coordination among all the
stakeholders mainly government, NGOs, Disabled People
Organizations (DPOs) and communities.
• Facilitating the participation of people with disabilities
especially people who have restricted mobility and access.
• Promoting the representation of all types of disability among DPOs
participating in the CBR, to ensure that the program is accessible to all
disabled persons.
• Promoting people with disabilities to be represented in
decision making and political systems at different levels.

15. 1.4.3 Vision and Mission of CBR
This program is a people centered approach that aims at
meeting the needs of persons with disabilities to allow
them to become as self-sufficient and independent as
possible within their own social context, promoting their
rights and facilitating their successful inclusion into society,
mobilizing community resources.
The program aims at changing misperceptions, educating
the general public about disabilities and providing disabled
people with the necessary skills to become more self-
sufficient and integrated into the wider community.
The CBR workers are considered to be key animators
among the local community; they train and encourage the
family and the community to take and fully participate in
the rehabilitation process, promoting positive attitudes
towards disability and emphasizing the principles of equal
opportunities and social justice.

16. 1.5 Principles of Community Based Rehabilitation
What are the major Principles of CBR?
For the effective planning, implementation and evaluation of CBR as
a strategy it should be guided on a set of principles. According to
Helander (1999) the following five points can be forwarded as basic
principles.
1.5.1. Equality: It is based on the assumption that all human beings are
of inherently equal worth, are entitled to equal rights and share the
same responsibilities. Being human beings having
different abilities, unique personality do not make them unequal in
worth. However it is a fact that peoples with disabilities in most
societies are denied equality in rights.
It emphasized that there is no ‘higher’ or ‘lower’ position in this
relation. Each party has its own roles and works according to its
potency to reach the same vision that has been decided before. No
party should ever feel superior because it gives the assistance. Nor
should a party feel inferior because it receives the assistance. It must
be kept in mind that upon the completion of the program both parties
must feel satisfied.

17. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.2. Social Justice :
It holds the assumption that services and opportunities provided
for peoples with disabilities should be at the disposal of all and not
be reserved for a numerically small group among them. Moreover it
Justifies that the ultimate goal is to make individualized care,
training, schooling, and access to employment and income
generation available to all peoples with disabilities. The program
must benefit both parties. The implementation of the program
must not cause one party to suffer, while the other party reaps the
benefits.
1.5.3. Solidarity
The responsibility for fostering human life is shared by all. Solidarity
should be shown toward those children, the elderly, and those who
have a disability among us who are dependent and need help. The
purpose and efforts of solidarity should be seen as a privilege of all
and not as a charity for some.

18. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.4. Integration
All members of the society should join in the
mainstream of community life. Segregation of
services, housing, jobs, education
transportation and so on is mainly caused by
social factors and cultural prejudice. Integration
of peoples with disabilities in all aspects of life
will, in the larger perspective help term to
achieve friendship with and esteem by others
and attain the degree of human dignity.

19. 1.5 Principles of Community Based Rehabilitation Cont’d……
Authorities in the field of special need forward some basic rules in
how to integrate peoples with disabilities in the larger community.
Here are the basic rules.
A. Family life: Peoples with disabilities should have freedom to find
a partner, hove children, and set up their own family and live in
their community.
B. Shelter: peoples with disabilities should have shelter and be
able to move about freely at home and in their surrounding.
C. Food: they should be breast-fed and should have a faire share
of their family food.
D. Schooling: As a child with disability, they should go to school
with in the non disabled.
E. Education and training: Children with disability should get the
opportunities for education and training that they need in
order to proper themselves to work and live independently.

20. 1.5 Principles of Community Based Rehabilitation Cont’d……
F. Leisure time: Peoples with disabilities should be free to
join others on social, cultural and religious occasions.
G. Public services: different public services should be accessible to
all peoples. For example road and public transport should be
designed in such a way to let access of peoples with disabilities.
H. Economic opportunities: Peoples with disabilities should have
the same opportunities to work as other people and any loss of
income cause by their disability should be compensate.
I. Political participation: Peoples with disabilities should be
allowed to vote and to participate in government as other citizens
do. Their voice should be heard in matters of concern.

21. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.5 Dignity
It holds the assumption that all peoples with disabilities should
live a life in dignity (quality that earns or deserves respect).
In addition to the above explained principles, the world program
of Action for Peoples with Disabilities forwarded the following
issues as important principles of community based rehabilitation
1. Empowerment: Refers to an attainment of set of essential
rights such as the right to live normal patterns of life with in the
community, be treated as individuals and receive additional
support and professional services from the community. It is an
on-going process that comes through working with peoples with
disabilities and their families as well as other community
members. It begins with a transfer of knowledge through
awareness creation.

22. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.5 Dignity
2. Participation: As a principle of community development
program, CBR emphasizes the participation of peoples with
disabilities, local government and others in the planning,
implementation and evaluation of CBR activities. Under this
principle, it underscores that true change and development
can only emerge through active participation of the affected
community; not through the good will of others working for
them.
The involvement of peoples with disabilities and their families
in the planning and decision making in matters affecting their
lives facilitates the incorporation of the felt needs and
priorities and concerns of peoples with disabilities during
program design.

23. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.5 Dignity
3. Use of ordinary structure: Peoples with disabilities
should receive the assistance they deserve for their
needs within the ordinary structures of education,
health, social services etc. available at the community
level. Thus, they share an ordinary life within and a long
with other members of the community, which is the
basis for developing sense of identify.
It is generally believed that rehabilitating peoples with
disabilities using ordinary structures available at the
community level reduces over head costs, make CBR
cost- effective unlike the major problems common to the
institution based rehabilitation.

24. 1.5 Principles of Community Based Rehabilitation Cont’d……
1.5.5 Dignity
4. Contribution: With the right type of assistance by the
community, most peoples with disabilities are believed
to become economic self-reliant and make meaningful
contribution to their families and to community at large.
All peoples, whether they have disabilities or not, need
enabling measures through education, training,
employment and many other social services to achieve
self-reliance and to contribute their part. CBR requires
motivating local communities, peoples with disabilities,
their families and friends to mobilize their own resources
(human, material and finance) and take part in
rehabilitation training.

25. 1.6. Essentials of CBR
CBR is empty without community involvement.
Developing awareness at community level and
motivating community members to become
active in rehabilitation activities are thus
crucial to its effectiveness. Since rehabilitation
encounter many factors related to government,
community and peoples with disabilities
themselves, a commitment to cooperation of
activities should be made at all levels.
In this regard world Program of Action for
Peoples with Disabilities listed the following
essential elements of CBR:

26. 1.6. Essentials of CBR Cont’d………
1.6.1. Sense of community ownership
CBR should be seen first and foremost as a program that belongs
to the community. It views community members as vital in the
rehabilitation process as well. The community eventually decides
on the activities that it will undertake. This is an important factor
particularly for ensuring the sustainability of the programme.
1.6.2. Acceptance by the community
Problems arising from stereotyping are believed to have been
negatively affecting the integration of peoples with disabilities in
to the main stream community life than caused by the impact of
the impairment itself. Disability is a social problem; rehabilitation
must aim at bringing about a desirable change in community
attitudes toward disability. For the rehabilitation to be successful,
communities must recognize and accept that peoples with
disabilities have the same rights as other people to participate fully
in the society.

27. 1.6. Essentials of CBR Cont’d………
1.6.3. Transfer of knowledge to the community
CBR promotes decentralization of responsibilities through a wider
dissemination of disabilities know how and rehabilitation skills to
peoples with disabilities, their families and members of the
community. As opposed to the institutional approach comments
based rehabilitation emphasizes use of decentralized community
services in which families of peoples with disabilities are
considered to be primary agents for handling the daily training and
care for their disabled family member.
1.6.4 Utilization of resources in community
Under CBR, it is believed that resources necessary for the
rehabilitation of peoples with disabilities are available in the
community and need to mobilize. Success in CBR, among others,
means success in winning the people which in turn requires
involvement and working with them, their resources, culture,
religion, values, traditions, etc.

28. 1.6. Essentials of CBR Cont’d………
1.6.5. Trust in community
CBR should trust communities and be based upon values and
indigenous knowledge of community members and to make full
use of local professional and vocational skills. The experience of
peoples with disabilities and their families should be respected as
a valuable contribution to the program and, where possible,
empower them to develop and mange their own program.
1.6.6. Integration of services available in the community
CBR seeks multi-sector collaboration and the integration of all
relevant sectors such as educational, health, legislative, social,
vocational and other community services. Moreover it encourages
the participation of peoples with disabilities and their families.
Contribution of CBR and health workers, community leaders,
government, NGOS etc. is essential in the prevention of disability
and rehabilitation activities.

29. 1.7. Components of CBR
CBR as a strategy to improve the
quality of life of peoples with
disabilities has the following main
functional components:
1.7.1. Creating a positive attitude towards peoples with disabilities:-
It helps to ensure equalization of opportunities for
people with disabilities with in their own communities.
Positive attitude among community members can be
created by involving them in the process of program
design and implementation, and by transferring
knowledge about disability issues to community
members.

30. 1.7. Components of CBR Cont’d………
1.7.2. Provision of functional rehabilitation services
Often peoples with disabilities need assistance to
overcome or minimize the effects of their
functional limitations. In communities where
professional services are not accessible, field
rehabilitation workers should be recruited from
the community and trained to provide primary
rehabilitation therapy in areas of rehabilitation,
medical, eye care service, hearing services,
physiotherapy, occupational therapy, orientation
and mobility training, speech therapy,
psychological counseling, orthotics and
prosthetics, other devices.

31. 1.7. Components of CBR Cont’d………
1.7.3. Provision of education and training opportunities
Peoples with disabilities must have equal access to
educational opportunities and training that of will enable
them make the best use of the opportunities that occur in
their lives. The education and training services can be
provided in the following areas:
• Early childhood intervention and referral, especially to
medical rehabilitation services
• Education in regular services
• Non formal education where regular schooling is not
available
• Special education in regular schools
• Sign language and brail training
• Training in daily living skills

32. 1.7. Components of CBR Cont’d………
1.7.4. Creation of micro and macro income generation opportunities
Peoples with disabilities need access to micro and macro income-
generation activities, including obtaining financial credit through
existing systems, where possible,. In some and rural areas, income
generation activities should focus on locally appropriate vocational
skills.
1.7.5. Provision of care facilities
For peoples with disabilities with no family or if their
families are incapable of caring for them, in order for
them to survive, long-term core facilities must be
provided in the community where they can get the
assistance that they need. Moreover, day-care facilities
may be needed to provide respite for families who either
work or need time off for other activities.

33. 1.8 Characteristics of CBR
Community-based rehabilitation is implemented
through the combined efforts of disabled people
themselves, their families and communities, and
the appropriate health, education, vocational and
social services. ‘Community-based rehabilitation’
was designed as a model by which cost-effective
community / home-based rehabilitation could be
provided in developing countries (Helander,1989).
CBR, as internationally defined, is very much client-
centric as opposed to profession-centric.

34. Conclusion
From the points discussed in this unit, the following key ideas can be concluded.
1. Because of the advancement in technology and the rise of
democracy, the traditional local community has been
changing into the local community with new characteristics.
Community development strategy is not appropriate anymore
with the situation of the changing local community.
2. In the future, affinity-based community could be a new
resource for community-based rehabilitation. Although its
vision and mission are not directly related to the issues of
disabilities, in practice the affinity-based community can
participate in promoting the quality of life of people with
disabilities.

35. Conclusion Cont’d…….
3. Responding to the various changes in heterogeneous community
besides a scientific Definition, community-based rehabilitation
needs to formulate a simple, practical definition (working
definition) so that it will be easy for people in general to
understand it. In this way people in general will be able to get
involved in community-based rehabilitation programs more easily.
4. Adapting to the new realities and opportunities,
community-based rehabilitation has to transform itself.
The meaning of transformation here is: the vision and
mission of community-based rehabilitation are still the
same but the concept, strategy, and techniques are
different, thus it is more dynamic and inclusive.
The End