Arbaminch University

School of pedagogical and of Behavioral Sciences

Department of Special Needs and Inclusive Education

Course title: Inclusiveness/Inclusive Education

Handout for all undergraduate students

Course code SNIE 1012

Credit hours: 2 (4 ECTS)

June, 2021
Arbaminch University, Ethiopia

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 INCLUSIVENESS
Preamble
People with special needs /disabilities are excluded or discriminated groups in society from
social, economic and political participations due to negative attitude, negligence,
inaccessibility and exclusion from all development endeavors. It is obvious that people with
disabilities are the large stand most disadvantaged minority in the world disability (World
Health Organization and World Bank 2011). Recognizing the high prevalence of hearing
loss, According to WHO (2012), more than 275 million people are reported to have moderate
to profound hearing loss across the world. In Ethiopia, according to the 2007 Population and
Housing Census, there were 64,930, from total 27,288 deaf and 37,632 were hard of hearing.
So prevalence in Ethiopia is high. Most of these people are children and young (Central
Statistical Agency, 2010; Sintayehu, 2015).

An exclusion practice of this large number of persons with hearing impairments in Ethiopia
is an indicator of violating fundamental human rights that undermines their potential/ability
to contribute to poverty reduction and economic growth within their household, their
community and the country. Nevertheless, a remarkable step toward recognizing people with
disabilities as equal and active members of society has been made through the UN
Convention on the Rights of Persons with Disabilities (CRPD), which came into force in
May 2008. The CRPD calls for enjoyment of all human rights and fundamental freedoms by
children and adults with disabilities, and points to the importance of early intervention as
well as inclusion in the education system. Exclusion practices of persons with disabilities
have a long history, affecting the life of people with disabilities and the society at large.
Inclusiveness promotes effective developments through full participation of all
members of people with disabilities and vulnerabilities, where all are equally contributors of
the country development and equitable beneficiaries. Through inclusive practices, it is
possible to identify and remove educational, economic, social and physical barriers so that
people with disabilities and vulnerabilities can participate and benefit from all developments.
Genuine inclusion of people with disabilities and vulnerabilities allow them actively to
participate in development processes and eliminate dependence syndrome, leads to broader
benefits for families and communities, reduces the impacts of poverty, and positively
contributes to a country‘s economic growth, development and ultimately create inclusive

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society. All stages of development processes of any organization should be inclusive through
creating equal access to education, health care services, work and employment, social
protection and all development center of human being.

Chapter one: Understanding Disabilities and Vulnerabilities

Disability is often taken as an effect of (impairment) the loss of an anatomical, physiological,
or psychological structure of function, which may result from a disease, accident or other
genetic or environmental agents; and as a restriction or lack of ability to perform tasks in the
manner or within the range considered normal for an individual of a specified age and culture
group.
1.1. Definitions of Basic Terms (Impairment, Disability and Handicap)

Impairment: means a lack/abnormality of an anatomic, physiological or psychological

structure or function or deviation on a person. It refers to any loss or abnormality of
physiological, psychological or anatomical structure or function. It is the absence of
particular body part or organ. It could also a condition in which the body exists but doesn‘t
function. Some children, for instance, have impairments such as eyes that do not see
well, arms and legs that are deformed, or a brain not developing in a typical way
etc.
Disability: Is any restriction or functional limitation of ability resulting from impairment to
perform an activity in the manner or within the range considered normal for a person of the
same age, culture, and education.

Handicap: a disadvantage for a given individual, resulting from an impairment or disability

that limits and prevents the fulfillment of a role that is normal, depending on age, sex, social
and cultural factors, for that individual. The word handicap, in fact, is thought to come from a
time when disabled people had to beg in the streets, with cap in hand.
1.2. Models of disabilities

1.2.1. Medical model (approach)

Disability is pathology (physiological, biological and intellectual). Disability means

functional limitations due to physical, intellectual or psychic impairment, health or psychic
disorders on a person (WHO, 1996). The medical definition has given rise to the idea that

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people are individual objects to be treated, changed" or improved" and made more normal.
The medical definition views the disabled person as needing to fit in rather than thinking
about how society itself should change. This medical definition does not adequately explain
the interaction between societal conditions or expectations and unique circumstances of an
individual.

1.2.2. The social definition of disability

Disability is a highly varied and complex condition with a range of implications for social
identity and behavior. Thus, disability largely depends on the context and is a consequence of
discrimination, prejudice and exclusion. It also emphasizes the shortcomings in the
environment and in many organized activities in society, for example on information,
communication and education, which prevent persons with disabilities from participating on
equal terms.

Medical model: Social model:

Child is faulty Child is valued

Diagnosis and labeling Strengths and needs identified

Impairment is focus of attention Barriers identified and solutions developed

Medical model: Social model:

Segregation and alternative services Resources made available

Re-entry if normal enough or permanent Diversity welcomed; child is welcomed

exclusion

Society remains unchanged Society evolves

1.3. Causes of Disability

Disability can be caused by the following factors.

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Genetic Causes
Abnormalities in genes and genetic inheritance can cause intellectual disability in children. In
some countries, Down syndrome is the most common genetic condition. Sometimes,
diseases, illnesses, and over-exposure to x-rays can cause a genetic disorder. .

Environmental
Poverty and malnutrition in pregnant mothers can cause a deficiency in vital minerals and
result in deformation issues in the unborn child. After birth, poverty and malnutrition can also
cause poor development of vital organs in the child, which can eventually lead to disability.
The use of drugs, alcohol, tobacco, the exposure to certain toxic chemicals and illnesses,
toxoplasmosis, cytomegalovirus, rubella and syphilis by a pregnant mother can cause
intellectual disability to the child. Childhood diseases such as a whooping cough, measles,
and chicken pox may lead to meningitis and encephalitis. This can cause damage to the brain
of the child. Toxic material such as lead and mercury can damage the brain too. Unfortunate
life events such as drowning, automobile accidents, falls and so on can result in people losing
their sight, hearing, limbs and other vital parts of their body and cause disability.
Unknown Causes
The human body is a phenomenal thing. Scientists have still not figured out what and how
some things in the body, cells, brain, and genes come about. Humans have still not found all
the answers to all the defects in the human body. .
Inaccessible environments
Sometimes society makes it difficult for people with some impairment to function freely.
When society develops infrastructure such as houses, roads, parks and other public places
without consideration to people with impairment, the basically make it impossible for them to
take care of themselves. For example, if a school is built with a ramp in addition to stairs, it
makes it easy for people with wheelchairs to move about freely. This way, their impairment
is not made worse. Lack of education, support services, health and opportunities for people
with impairment can cause additional disability to people with disabilities and even people
with no disability.
1.4. Some type of Disabilities

Some nine major disabilities are listed and briefly discussed in the coming pages below.

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Visual impairment
Visual impairment in general designates two sub- classifications. These are blindness and low
vision.
Blindness: total or partial inability to see because of disease or disorder of the eye, optic
nerve, or brain. The term blindness typically refers to vision loss that is not correctable with
eyeglasses or contact lenses. Blindness may not mean a total absence of sight, however.
Some people who are considered blind may be able to perceive slowly moving lights or
colors.
Low vision: the term low vision is used for moderately impaired vision. People with low
vision may have a visual impairment that affects only central vision the area directly in front
of the eyes or peripheral vision the area to either side of and slightly behind the eyes.

Hearing Impairment
Different people define the term hearing impairment differently. The definitions given to
hearing impairment convey different meaning to different people. Different definitions and
terminologies may be used in different countries for different purpose. Pasonella and Carat
from legal point of view, define hearing impairment as a generic term indicating a continuum
of hearing loss from mild to profound, which includes the sub-classifications of the hard of
hearing and deaf.
a) Hard of Hearing: "a hearing impairment, whether permanent of fluctuating, which
adversely affects a child's educational performance but which is not included under the
definition of deaf"' (Whelan, 1988). This term can also be used to describe persons with
enough (usually with hearing aids) as a primary modality of acquisition of language and in
communication with others.
b) Deaf: Those who have difficulty understanding speech, even with hearing aids but can
successfully communicate in sign language. Cultural definitions of deafness, on the other
hand, emphasize an individual‘s various abilities, use of sign language, and connections with
the culturally deaf community.

Specific learning disability

Specific Learning Disability means a disorder in one or more of the basic psychological
processes involved in understanding or in using language, spoken or written, that may

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manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do
mathematical calculations.

The term includes such conditions as perceptual disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia. The term does not include learning
problems that are primarily the result of visual, hearing, or motor disabilities; of intellectual
disability; of emotional disturbance; or of environmental, cultural, or economic disadvantage.
Learning disabilities should not be confused with learning problems which are primarily the
result of visual, hearing, or motor handicaps; of intellectual disability; of emotional
disturbance; or of environmental, cultural or economic disadvantages.

Generally speaking, people with learning disabilities are of average or above average
intelligence. There often appears to be a gap between the individual‘s potential and actual
achievement. This is why learning disabilities are referred to as hidden disabilities‖: the
person looks perfectly normal and seems to be a very bright and intelligent person, yet may
be unable to demonstrate the skill level expected from someone of a similar age. A learning
disability cannot be cured or fixed; it is a lifelong challenge. However, with appropriate
support and intervention, people with learning disabilities can achieve success in school, at
work, in relationships, and in the community.

Types of Specific Learning Disabilities Auditory Processing Disorder (APD)

Also known as Central Auditory Processing Disorder, this is a condition that adversely
affects how sound that travels unimpeded through the ear is processed or interpreted by the
brain. Individuals with APD do not recognize subtle differences between sounds in words,
even when the sounds are loud and clear enough to be heard. They can also find it difficult to
tell where sounds are coming from, to make sense of the order of sounds, or to block out
competing background noises.

Dyscalculia: Dyscalculia is a specific learning disability that affects a person‘s ability to

understand numbers and learn math. Individuals with this type of LD may also have poor
comprehension of math symbols, may struggle with memorizing and organizing numbers,
have difficulty telling time, or have trouble with counting.
Dysgraphia: Dyscalculia is a specific learning disability that affects a person‘s handwriting
ability and fine motor skills. Problems may include illegible handwriting, inconsistent

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spacing, poor spatial planning on paper, poor spelling, and difficulty composing writing as
well as thinking and writing at the same time.
Dyslexia: Dyslexia is a specific learning disability that affects reading and related language-
based processing skills. The severity can differ in each individual but can affect reading
fluency; decoding, reading comprehension, recall, writing, spelling, and sometimes speech
and can exist along with other related disorders. Dyslexia is sometimes referred to as a
Language Based Learning Disability (LBPD).
Language Processing Disorder: Language Processing Disorder is a specific type of
Auditory Processing Disorder (APD) in which there is difficulty attaching meaning to sound
groups that form words, sentences and stories. While an APD affects the interpretation of all
sounds coming into the brain, a Language Processing Disorder (LPD) relates only to the
processing of language. LPD can affect expressive language and/or receptive language.
Non-Verbal Learning Disabilities: Non-Verbal Learning Disabilities is a disorder which is
usually characterized by a significant discrepancy between higher verbal skills and weaker
motor, visual-spatial and social skills. Typically, an individual with NLD (or NVLD) has
trouble interpreting nonverbal cues like facial expressions or body language, and may have
poor coordination.
Visual Perceptual/Visual Motor Deficit: Visual Perceptual/Visual Motor Deficit is a
disorder that affects the understanding of information that a person sees, or the ability to draw
or copy. A characteristic seen in people with learning disabilities such as Dysgraphia or Non-
verbal LD, it can result in missing subtle differences in shapes or printed letters, losing place
frequently, struggles with cutting, holding pencil too tightly, or poor eye/hand coordination.

Communication Disorder
Speech and language impairment means a communication disorder such as stuttering,
impaired articulation, language impairment, or a voice impairment that adversely affects a
child‘s educational performance. It is disorder that adversely affects the child's ability to talk,
understand, read, and write. This disability category can be divided into two groups: speech
impairments and language impairments.

Speech Impairments
There are three basic types of speech impairments: articulation disorders, fluency disorders,
and voice disorders.

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Articulation disorders are errors in the production of speech sounds that may be related to
anatomical or physiological limitations in the skeletal, muscular, or neuromuscular support
for speech production. These disorders include:
• Omissions: (bo for boat)

• Substitutions: (wabbit for rabbit)

• Distortions: (shlip for sip)

Fluency disorders are difficulties with the rhythm and timing of speech characterized by
hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases. Common
fluency disorders include:
Stuttering: rapid-fire repetitions of consonant or vowel sounds especially at the beginning of
words, prolongations, hesitations, interjections, and complete verbal blocks
Cluttering: excessively fast and jerky speech
Voice disorders: are problems with the quality or use of one's voice resulting from disorders
in the larynx. Voice disorders are characterized by abnormal production and/or absences of
vocal quality, pitch, loudness, resonance, and/or duration.

Language Impairments
There are five basic areas of language impairments: phonological disorders, morphological
disorders, semantic disorders, syntactical deficits, and pragmatic difficulties. Phonological
disorders are defined as the abnormal organization of the phonological system, or a
significant deficit in speech production or perception. A child with a phonological disorder
may be described as hard to understand or as not saying the sounds correctly. Apraxia of
speech is a specific phonological disorder where the student may want to speak but has
difficulty planning what to say and the motor movements to use.
Morphological disorders are defined as difficulties with morphological inflections
(inflections on nouns, verbs, and adjectives that signal different kinds of meanings).
Semantic disorders are characterized by poor vocabulary development, inappropriate use of
word meanings, and/or inability to comprehend word meanings. These students will
demonstrate restrictions in word meanings, difficulty with multiple word meanings,
excessive use of nonspecific terms (e.g., thing and stuff), and indefinite references (e.g., that
and there).

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Syntactic deficits are characterized by difficulty in acquiring the rules that govern word order
and others aspects of grammar such as subject-verb agreement. Typically, these students
produce shorter and less elaborate sentences with fewer cohesive conjunctions than their
peers. Pragmatic difficulties are characterized as problems in understanding and using
language in different social contexts. These students may lack an understanding of the rules
for making eye contact, respecting personal space, requesting information, and introducing
topics.

Autism
Autism means a developmental disability significantly affecting verbal and nonverbal
communication and social interaction, generally evident before age three that adversely
affects a child‘s educational performance. Other characteristics often associated with autism
are engaging in repetitive activities and stereotyped movements, resistance to environmental
change or change in daily routines, and unusual responses to sensory experiences. The term
autism does not apply if the child‘s educational performance is adversely affected primarily
because the child has an emotional disturbance. A child who shows the characteristics of
autism after age 3 could be diagnosed as having autism if the criteria above are satisfied.

Autism is a neurodevelopment disorder defined by impairments in social and communication

development, accompanied by stereotyped patterns of behavior and interest (Landa, 2007).
Autism is pervasive developmental disorder characterized by lack of normal sociability,
impaired communication and repetitive obsessive behavior such as politeness, turn-taking
(Young & Nettlebeck , 2005). Linked to Profound Learning Disability (PLDs) are further
impairments in the production of speech. Among these are (i) personal pronouns reversal for
instance the use of I instead of you and vice-versa, (ii) the misuse of such prepositions as in,
on, under, next to (...), and (iii) the prevalence, in speech, of echolalia formal repetition of
other‘s utterances (Arron and Gittens, 1999).
Children with autism vary literally in their use of words, (Rutter, 1966). Communication
deficiencies may leave a lasting mark of social retardation on the child. The link, between
social skills and language is made evident by the often spontaneous appearance of
affectionate and dependent behavior in these children after they have been trained to speak
(Churchill, 1966 & Hewett, 1965).
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Emotional and Behavioral Disorders
According to Individuals with Disabilities Education Act (IDEA), the term Emotional and
Behavioral Disorders means a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree that adversely affects
educational performance
1) An inability to learn that cannot be explained by intellectual, sensory, or health factors;

2) An inability to build or maintain satisfactory interpersonal relationships with peers and

teachers;
3) Inappropriate types of behavior or feelings under normal circumstances;

4) A general pervasive mood of unhappiness or depression; or

5) A tendency to develop physical symptoms or fears associated with personal or school
problems.

Classification of Behavioral and Emotional Disorders

An individual having behavioral or emotional disorders can exhibit widely varied types of
behavior. Therefore, different classification systems of behavioral and emotional disorders
can be used for special education. Different professionals have developed a classification
system, which shows some promise for educational practice. These include:
Conduct disorder: individuals may seek attention, are disruptive and act out. The disorder is
classified by type: overt (with violence or tantrums) versus covert (with lying, stealing,
and/or drug use).
Socialized aggression: it is marked by truancy, gang membership, and feeling of pride in
belonging to delinquent subculture. Early symptoms include stealing, running away from
home, habitual lying, cruelty to animals, and fire setting.
Attention problems: These individuals may have attention deficit, are easily destructible and
have poor concentration. They are frequently impulsive and may not think the consequence
of their actions.
Anxiety/Withdrawn: These individuals are self-conscious, reserved, and unsure of
themselves. They typically have low self-esteem and withdraw from immediate activities.
They are also anxious and frequently depressed.

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Psychotic behavior: These individuals show more bizarre behavior. They may hallucinate,
deal in a fantasy world and may even talk in gibberish
Motor excess: These students are hyperactive. They cannot sit nor listen to others nor keep
their attention focused
Kauffman (1993) conclude that emotion or behavioral disorders fall into two broad
classifications:
Externalizing Behavior: also called under controlled disorder, include such problems
disobedience, disruptiveness, fighting, tempers tantrums, irresponsibility, jealous, anger,
attention seeking etc…
Internalizing Behavior: also known as over controlled disorders, include such problems
anxiety, immaturity, shyness, social withdrawal, feeling of inadequacy (inferiority), guilt,
depression and worries a great deal

Causes of behavioral and emotional disorders

Behavioral and emotion disorders result from many causes, these includes the following.

1. Biological: includes genetic disorders, brain damage, and malnutrition, allergies,

temperament and damage to the central nervous system.
2. Family factors: include family interactions, family influence, child abuse, neglect, and
poor disciplinary practices at home.
3. Cultural factors: include some traditional and cultural negative practices, for example
watching violence and sexually oriented movies and TV programs.
4. Environmental factors- include peer pressure, living in impoverished areas, and schooling
practices that are unresponsive to individual needs.

Intellectual Disability
Intellectual disability is a disability characterized by significant limitations in both
intellectual functioning and in adaptive behavior, which covers many everyday social and
practical skills. This disability originates before the age of 18. An individual is considered to
have an intellectual disability based on the following three criteria:
1. Sub average intellectual functioning: It refers to general mental capacity, such as learning,
reasoning, problem solving, and so on. One way to measure intellectual functioning is an

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 IQ test. Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in
intellectual functioning.
2. Significant limitations exist in two or more adaptive skill areas: It is the collection of
conceptual, social, and practical skills that are learned and performed by people in their
everyday lives.
• Conceptual skills-language and literacy; money, time, and number concepts; and self-
direction.
• Social skills-interpersonal skills, social responsibility, self-esteem, gullibility,
innocence (i.e., suspicion), social problem solving, and the ability to follow
rules/obey laws and to avoid being victimized.
• Practical skills activities of daily living (personal care), occupational skills,
healthcare, travel/transportation, schedules/routines, safety, use of money, use of the
telephone.

3. The third component, developmental period of mind requires that the disability occur
before age 18.
People with intellectual disabilities academic learning can be affected, as well as their ability
to adapt to home, school, and community environments are presented under the following
sub-headings:
General Cognition: People with intellectual disabilities vary physically and emotionally, as
well as by personality, disposition, and beliefs. Their apparent slowness in learning may be
related to the delayed rate of intellectual development (Wehman, 1997).
Learning and Memory: The learning and memory capabilities of people with intellectual
disabilities are significantly below average in comparison to peers without disabilities.
Children with intellectual disabilities may not spontaneously use appropriate learning or
memory retention strategies and may have difficulty in realizing the conditions or actions that
aid learning and memory. However, these strategies can be taught (Fletcher, Huffman, &
Bray, 2003; Hunt & Marshall, 2002; Werts, Wolery, Holocombe, & Gast, 1995; Wolery &
Schuster, 1997).
Attention: To acquire information, children must attend to the learning task for the required
length of time and control distractions. Children with intellectual disabilities may have
difficulty distinguishing and attending to relevant questions in both learning and social
situations (Saunders, 2001). The problem is not that the student will not pay attention, but

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rather that the student does not understand or does not filter the information to get to the
salient features (Hunt & Marshall, 2002; Meyen & Skrtic, 1988).
Adaptive Skills: The adaptive skills of people with intellectual disabilities are often not
comparable to those of their peers without disabilities. A child with intellectual disabilities
may have difficulty in both learning and applying skills for a number of reasons, including a
higher level of distractibility, inattentiveness, failure to read social cues, and impulsive
behavior (Hardman et al., 2008). The lack or underdevelopment of these skills notably affects
memory, rehearsal skills, organizational ability, and being in control of the process of
learning (Erez & Peled, 2001; Hunt & Marshall, 2002).
Speech and Language: People with intellectual disabilities may have delayed speech,
language comprehension and formulation difficulties. Language problems are generally
associated with delays in language development rather than with a bizarre use of language
(Beirne-Smith et al., 2006; Moore-Brown & Montgomery, 2006). People with intellectual
disabilities may show delayed functioning on pragmatic aspects of language, such as turn
taking, selecting acceptable topics for conversation, knowing when to speak knowing when
to be silent, and similar contextual skills (Haring, McCormick, & Haring, 1994; Yoder,
Retish, & Wade, 1996).
Motivation: People with intellectual disabilities are often described as lacking motivation, or
outer-directed behavior. Past experiences of failure and the anxiety generated by those
failures may make them appear to be fewer goals directed and lacking in motivation. The
result of failure is often learned helplessness. The history of failure is likely to lead to
dependence on external sources of reinforcement or reward rather than on internal sources of
reward. They are less likely to self-starters motivated by self-approval (Beirne-Smith et al.,
2002; Taylor et al., 2005).
Academic Achievement: The cognitive difficulties of children with mild to moderate
intellectual disabilities lead to persistent problems in academic achievement (Hughes et al.,
2002; Macmillan, Siperstein, & Gresham, 1996; Quenemoen, Thompson, & Thurlow, 2003;
Turnbull et al., 2004), unless intensive and extensive supports are provided.
Physical characteristics: Children with intellectual disabilities with differing biological
etiologies, may exhibit coexisting problems, such as physical, motor, orthopedic, visual and
auditory impairments, and health problems (Hallahan & Kauffman, 2006). A relationship
exists between the severity of the intellectual disabilities and the extent of physical
differences for the individual (Drew & Hardman, 2007; Horvat, 2000). The majority of

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children with severe and profound intellectual disabilities have multiple disabilities that
affect nearly every aspect of intellectual and physical development (Westling & Fox, 2004).

Levels of support for individuals with intellectual disabilities

Levels of supports range from intermittent (just occasional or as needed for specific
activities) to pervasive (continuous in all realms of living).

Levels and areas of support for intellectual disabilities

Level of Duration of Frequency of Setting of support Amount of professional
support support support assistance
Intermittent Only as needed Occasional or Usually only one or Occasional consultation or
infrequent two (e.g. 1–2 monitoring by professional
classes or activities)
Limited As needed, but Regular, but Several settings, but Occasional or regular contact
sometimes frequency varies not usually all with professionals
continuing
Extensive Usually Regular, but Several settings, but Regular contact with
continuing frequency varies not usually all professionals at least once a
week
Pervasive May be lifelong Frequent or Nearly all settings Continuous contact and
continuous monitoring by professionals
Source: American Association on Mental Retardation, 2002: Schalock & Luckassen, 2004.

Physical disability/Orthopedic Impairment and Health impairment

Physical disability is a condition that interferes with the individual‘s ability to use his or her
body. Many but not all, physical disabilities are orthopedic impairments. (The term
orthopedic impairment generally refers to conditions of muscular or skeletal system and
sometimes to physical disabling conditions of the nervous system).
Health impairment is a condition that requires ongoing medical attention. It includes asthma,
heart defects, cancer, diabetes, hemophilia, HIV/AIDS, etc.

Classification and Characteristics

Physical disabilities: based on the impact of physical disability on mobility and motor skills,
it is divided into three. These are:

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Mild physical disability: these individuals are able to walk without aids and may make
normal developmental progress.
Moderate physical disability: individuals can walk with braces and crutches and may have
difficulty with fine-motor skills and speech production.
Severe physical disability: these are individuals who are wheel-chair dependent and may
need special help to achieve regular development.

The physical disability could be broadly classified in to two main groups:

I. The neurological system (the brain, spinal cord & nerve) related problems.
I. Musculo skeletal system (the muscles, bones and joints) are deficient due to various
causes.
A. Neurological system: with a neurological condition like cerebral palsy or a traumatic
brain injury, the brain either sends the wrong instructions or interprets feedback
incorrectly. In both cases, the result is poorly coordinated movement. With the spinal cord
injury or deformity, the path ways between the brain and the muscles are interrupted, so
messages are transmitted but never received. The result is muscle paralysis and loss of
sensation beyond the point where the spinal cord or the nerve is damaged. These
individuals may have motor skill deficits that can range from mild in coordination to
paralysis of the entire body. The most severely affected children are totally dependent on
other people or sophisticated equipment to carry out academic and self-care task
Additional problems that can be associated with cerebral palsy include learning
disabilities, mental retardation. Seizures, speech impairments, eating problems, sensory
impairments, and joint and bone deformities such as spinal curvatures and contractures
(permanently fixed, tight muscles and joints). Approximately 40 percent of those with
cerebral palsy have normal intelligence; the remainders have from mild to severe
retardation. This is an extremely heterogeneous group having unique abilities and needs.
Epilepsy: is disorder that occurs when the brain cells are not working properly and is often
called a seizure disorder. Some children and youth will epilepsy have only a momentary loss
of attention (petit mal seizures); others fall to the floor and then move uncontrollably.
Fortunately, once epilepsy is diagnosed, it can usually be controlled with medication and
does not interfere with performance in school. Most individuals with epilepsy have normal
intelligence. Epilepsy is a condition that affects 1 to 2 percent of the population. It is

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characterized by recurring seizures, which are spontaneous abnormal discharge of electrical
impulses of the brain.
Spinal bifida and spinal cord injury: damage to the spinal cord leads to paralysis and loss
of sensation in the affected areas of the body. The spinal bifida is a birth defect of the
backbone (spinal column). The cause is unknown but it usually occurs in the first twenty-six
days of pregnancy.
B. Musculoskeletal system: it includes the muscles and their supporting framework and the
skeleton.
1) Progressive muscle weakness (muscular dystrophy);
2) Inflammation of the joints (arthritis), or
3) Loss of various parts of the body (amputation)
The list of the impairment and associated with musculoskeletal malformation are the
following:
a) Muscular dystrophy: is an inherited condition accruing mainly in males, in which the
muscles weaken and deteriorate. The weakness usually appears around 3 to 4 years of age
and worsens progressively. By age 11 most victims can to longer walk. Death usually comes
between the ages of 25 and 35 from respiratory failure or cardiac arrest.
b) Arthritis: is an inflammation of the joints. Symptoms include swollen and stiff joints,
fever, and pain in the joints during acute periods. Prolonged inflammation can lead joint
deformities that can eventually affect mobility.
c) Amputation: a small number of children have missing limbs because of congenital
abnormalities or injury or disease (malignant bone tumors in the limbs). These children can
use customized prosthetic devices (artificial hands, arms, or legs) to replace limp functions
and increase independence in daily activities.
Other muscle-skeletal disorders are:

Marfan syndrome is a genetic disorder in which the muscles are poorly developed and the
spine is curved. Individuals with Marfan syndrome may have either long, thin limbs,
prominent shoulder blades, spinal curvature, flat feet, or long fingers & thumbs. The heart
and blood vessels are usually affected. The greatest danger is damage to aorta, which can
lead to heart failure. Individuals with marfan syndrome need to avoid heavy exercise and
lifting heavy objects.

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Achondroplasis: is a genetic disorder that affects 1 in 10,000 births. Children with this
disorder usually develop a normal torso but have a straight upper back and a curved lower
back (sway back). These children are at risk of sudden death during sleep from compression
of the spinal cord interfering with their breathing. The disability may be lessened through the
use of the back braces or by surgery.
Polio: is a viral disease that invades the brain and cause severe paralysis of the total body
system. Its mild form results in partial paralysis. Post-polio muscles that were previously
damaged weaken, and in some persons, other muscles that were not previously affected
weaken as well.
Club foot: is a major orthopedic problem affecting about 9,000 infants each year. This term
is used to describe various ankle or foot deformities, i.e.
 Twisting inward (equino varus), the most severe form Sharply angled at the heel
(calcanel vaigus), most common
 The front part of the foot turned inward.
These conditions can be treated with physical therapy, and a cast on the foot can solve the
problem in most instances. In more severe cases, surgery is necessary. With early treatment,
most children can wear regular shoes and take part in all school activities.
Cleft lip and cleft palate: are opening of the lip or roof of the mouth, respectively, that fail
to close before birth, the cause is unknown. Most cleft problems can be repaired through
surgery.

Health Impairments
What are the common health problems of students?

Any disease that interferes with learning can make students eligible for special services.
These disease caused problems are as follow.
Heart disease: this is common among young people. It is caused by improper circulation of
blood by the heart some of the disorders are congenital) present at birth); others are the
product of inflammatory heart disease. Some students have heart value disorders; others have
disorders of the blood vessels. His time heart implantation helps children to get cured.
Cystic fibrosis: is a hereditary disease that affects the lungs and pancreas. It leads to
recurrent respiratory and digestive problems including abnormal amounts of thick mucus,

18
sweet and saliva. The disease is so progressive and few who have it survive beyond age 20.
Children with such disease often spend significant timeout of school.
Acquired immune deficiency syndrome (AIDS): is a very severe disease caused by human
immunodeficiency virus (HIV) infection and transmitted primarily through exchange of
bodily fluids in transfusions or unprotected sex, and by contaminated needles in addictive
drug use.
Hemophilia: is a hereditary disease in which the blood clots very slowly or not all. The
disorder is transmitted by sex-linked recessive gene and nearly always occurs in males.
Asthma: is a chronic respiratory condition characterized by repeated exposed of breathing
difficulties especially while exhaling.
Diabetes: Developmental or hereditary disorder characterized by inadequate secretion or use
of insulin
Nephrosis & Nephritis Kidney disorders or diseases caused by infections, poisoning,
burns, accidents or other diseases
Sickle-cell anemia: Hereditary and chronic blood disease (occurring primarily in African
Americans) characterized by red blood cells that are distorted and that do not circulate
properly
Leukemia: Disease characterized by excessive production of white blood Cells

Lead poisoning Disorder: caused by ingesting lead-based paint chips or other substances
containing lead
Rheumatic fever disease: characterized by painful swelling and inflammation of the
joints that can spread to the heat and central nervous system.
Tuberculosis: Infectious disease that commonly affects the lungs and may affect other
tissues of the body.
Cancer: Abnormal growth of cells that can affect any organ system

1.5. Vulnerability

Vulnerable means being at risk of being harmed. Everyone can be harmed, so being
vulnerable is part of being human. In principle, everyone is vulnerable to some adverse event
or circumstance, but some people are more vulnerable than others. For instance, people with
disabilities are more likely as a group to experience greater vulnerability. They are also often
more severely affected by the vulnerability they experience. Based on the existing literature,

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vulnerability can be generally defined as a complex phenomenon that refers to the following
dimensions:
1. Economic difficulties/lack of financial resources: poverty, low living standards,
housing problems (e.g. too damp, too expensive, too cold or difficult to heat) etc.;
2. Social exclusion: limited access to facilities such as transportation, schools, libraries
or medical services;
3. Lack of social support from social networks: no assistance from family members,
friends, neighbors or colleagues (referring to practical help as well as emotional
support) like highly gifted individuals;
4. Stigmatization: being a victim of stereotypes, being devalued, confronted with
disgraceful behavior because of belonging to a particular social or ethnic group;
5. Health difficulties: disadvantages resulting from poor mental health, physical health
or disabilities;
6. Being a victim of crime: in family context especially of violence.

1.5.1. Causes of Vulnerability

Vulnerability may be causes by rapid population growth, poverty and hunger, poor health,
low levels of education, gender inequality, fragile and hazardous location, and lack of access
to resources and services, including knowledge and technological means, disintegration of
social patterns (social vulnerability). Other causes includes; lack of access to information and
knowledge, lack of public awareness, limited access to political power and representation
(political vulnerability), (Aysan,1993). When people are socially disadvantaged or lack
political voice, their vulnerability is exacerbated further. The economic vulnerability is
related to a number of interacting elements, including its importance in the overall national
economy, trade and foreign-exchange earnings, aid and investments, international prices of
commodities and inputs, and production and consumption patterns. Environmental
vulnerability concerns land degradation, earthquake, flood, hurricane, drought, storms
(Monsoon rain, El Niño), water scarcity, deforestation, and the other threats to biodiversity.

1.5.2. Characteristics of Vulnerable People

The following are thought to be characteristics of vulnerable people (with examples of

groups of potentially vulnerable people):
1. Less physically or mentally capable (infants, older adults, people with disabilities)

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 2. Fewer material and/or financial resources (low-income households, homeless)

3. Less knowledge or experience (children, illiterate, foreigners, tourists)

4. Restricted by society to grow and develop according to their needs and potentials
People who are helped by others (who are then restricted by commitments) are still
vulnerable people, which includes the following extracted from various researches.
Women: particularly women in developing nations and those who are living in rural areas are
vulnerable for many backward traditional practices. These women are oppressed by the
culture and do not get access to education and employment (Comfort et al., 1999; Morrow,
1999; McEntire et al. (2002; Thomalla et al. (2006; Laukkonen et al. (2009; Rubin, 2010;
GNCSODR, 2013; GP DRR, 2013).
Children: Significant number of children are vulnerable and at risk for development
(Morrow, 1999; McEntire et al., 2002; Thomalla et al., 2006; Laukkonen et al., 2009 Dinh et
al., 2012; Rubin, 2010; GP DRR, 2013; GNCSODR, 2013; Dinh et al. (2012). Children are
vulnerable for psychological and physical abuse This include illegally working children,
children who are pregnant or become mothers, children born out of marriage, children from
a single-parent, delinquent children, homeless children, HIV infected children, uneducated
children, institutionalized children, married children, mentally ill children, migrant children,
orphans, sexually exploited children, street children, war-affected children…etc.
Minorities: some people are vulnerable due to their minority background. Particularly, ethnic
(cultural and linguistic minority), religious minority. These people are political and socially
discriminated (Comfort et al., 1999; Cardona, 2003; Brooks, 2003; National Research
Council, 2006; Cutter et al., 2010; ).
Poverty: People are vulnerable for many undesirable phenomena due to poverty. This may
be resulted in, poor households and large households, inequality, absences of access to health
services, important resources for life, lack of access to education, information, financial and
natural resources and lack of social networks (Morrow, 1999; McEntire et al., 2002; Brooks,
2003; Dwyer et al., 2004; Vincent, 2004; Leichenko et al., 2004; National Research Council,
2006; Naudé et al., 2007; Kahn and Salman, 2012; MacDonald, 2013).
Disabilities: People with disabilities very much vulnerable for many kind of risks. This
includes abuses, poverty, illiteracy, health problems, psychological and social problems
(Comfort et al., 1999; McEntire et al., 2002; Naudé et al., 2007; Cutter et al., 2010; Dinh et
al., 2012; . Balica et al., 2012; GNCSODR, 2013).

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Age: Old people or very young children are vulnerable for all kinds evils (Comfort et al.,
1999; Morrow, 1999; McEntire et al. 2002; Cardona (2003; Vincent, 2004; Naudé et al.,
2007; Dinh et al., 2012; Adikari et al., 2013; GNCSODR,2013).
Illiteracy and less education: People with high rates of illiteracy and lack quality
educational opportunities are vulnerable for absence all kinds of developments (Cardona,
2003; Adger et al., 2004; Leichenko et al., 2004; Naudé et al., 2007; Kahn and Salman, 2012;
Adikari et al., 2013).
Sickness: Uncured health problems for example people living with HIV/AIDS are much
vulnerable for psychosocial problems, poverty and health (Vincent, 2004; Adger et al., 2004;
Naudé et al., 2007).
Gifted and Talentedness: Gifted and talented children are vulnerable for socio emotional
developments. Due to lack of psychological support they may feel isolation as they are pulled
from their regular classrooms and given instruction in separate settings and due to myths and
expectations of themselves and the public (Shechtman & Silektor, 2012, p. 63; Schuler,
2000).

Chapter Two: Inclusion

2.1. Concept of Inclusion

Inclusion is based on the principle that all students are entitled to equitable access to learning,
achievement and the pursuit or search of excellence in all aspects of their educational, social
and economic wellbeing.
2.2. Definition of Inclusion

Inclusion in education/service refers to an ongoing process aimed at offering quality

education/services for all while respecting diversity and the different needs and abilities,
characteristics and learning expectations of the students and communities and eliminating all
forms of discrimination (UNESCO, 2008, P.3, as cited in EADSNE, 2010, p.11). Inclusive
services at any level are quality provisions without discrimination or partiality and meeting
the diverse needs of people.

Inclusion is seen as a process of addressing and responding to the diversity of needs of all
persons through increasing participation in learning, employment, services, cultures and
communities, and reducing exclusion at all social contexts. It involves changes and

22
modifications in content, approaches, structures and strategies, with a common vision which
covers all people, a conviction that it is the responsibility of the social system to educate all
children (UNESCO 2005), employ and provide social services. Besides, inclusion is defined
as having a wide range of strategies, activities and processes that seek to make a reality of the
universal right to quality, relevant and appropriate education and services. It acknowledges
that learning begins at birth and continues throughout life, and includes learning in the home,
the community, and in formal, informal and non-formal situations. It seeks to enable
communities, systems and structures in all cultures and contexts to combat discrimination,
celebrate diversity, promote participation and overcome barriers to learning and participation
for all people. It is part of a wider strategy promoting inclusive development, with the goal of
creating a world where there is peace, tolerance, and sustainable use of resources, social
justice, and where the basic needs and rights of all are met.
2.3. Principles of Inclusion

The fundamental principle of inclusion is that all persons should learn, work and live together
wherever possible, regardless of any difficulties or differences they may have. Inclusive
education extends beyond special needs arising from disabilities, and includes consideration
of other sources of disadvantage and marginalization, such as gender, poverty, language,
ethnicity, and geographic isolation. The complex inter-relationships that exist among these
factors and their interactions with disability must also be a focus of attention. Besides,
inclusion begins with the premise that all persons have unique characteristics, interests,
abilities and particular learning needs and, further, that all persons have equal access
education, employment and services. Inclusion implies transition from separate, segregated
learning and working environments for persons with disabilities to community based
systems. Moreover, effective transitions from segregated services to inclusive system
requires careful planning and structural changes to ensure that persons with disabilities are
provided with appropriate accommodation and supports that ensure an inclusive learning and
working environment. Furthermore, UNESCO (2005) has provided four major inclusion
principles that support inclusive practice. These include:
1) Inclusion is a process. It has to be seen as a never-ending search to find better ways of
responding to diversity. It is about learning how to live with difference and learning how to
learn from difference. Differences come to be seen more positively as a stimulus for fostering
learning amongst children and adults.

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2) Inclusion is concerned with the identification and removal of barriers that hinders the
development of persons with disabilities. It involves collecting, collating and evaluating
information from a wide variety of sources in order to plan for improvements in policy and
practice. It is about using evidence of various kinds to stimulate creativity and problem -
solving.
3) Inclusion is about the presence, participation and achievement of all persons. Presence ‘is
concerned with where persons are provided and how reliably and punctually they attend;
participation ‘relates’ to the quality of their experiences and must incorporate the views of
learners/and or workers and achievement is about the outcomes of learning across the
curriculum, not just test and exam results.
4) Inclusion invokes a particular emphasis on those who may be at risk of marginalization,
exclusion or underachievement. This indicates the moral responsibility to ensure that those at
risk are carefully monitored, and that steps are taken to ensure their presence, participation
and achievement.
2.4. Rationale for Inclusion

Implementation of inclusion has number of rationales. These are: educational, social, legal,
economic and inclusive society building foundations
Rationales for Inclusion and Their Respective Descriptions
Educational Foundations
• Children do better academically, psychologically and socially in inclusive
settings.
• A more efficient use of education resources.
• Decreases dropouts and repetitions
• Teachers competency( knowledge, skills, collaboration, satisfaction
Social Foundation
• Segregation teaches individuals to be fearful, ignorant and breeds prejudice.
• All individuals need an education that will help them develop relationships
and prepare them for life in the wider community.
• Only inclusion has the potential to reduce fear and to build friendship, respect
and understanding.
Legal Foundations
• All individuals have the right to learn and live together.

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 • Human being shouldn‘t be devalued or discriminated against by being
excluded or sent away because of their disability.
• There are no legitimate reasons to separate children for their education
Economic Foundation
• Inclusive education has economic benefit, both for individual and for society.
• Inclusive education is more cost-effective than the creation of special schools
across the country.
• Children with disabilities go to local schools
• Reduce wastage of repetition and dropout
• Children with disabilities live with their family use community infrastructure
• Better employment and job creation opportunities for people with disabilities
Foundations for Building Inclusive Society
• Formation of mutual understanding and appreciation of diversity
• Building up empathy, tolerance and cooperation
 Promotion of sustainable development
2.5. Factors that Influencing Development of Inclusion

Inclusion originated from three major ideas. Inclusive education is a basic human right;
quality education results from inclusion of students with diverse needs and ability
differences, and there is no clear demarcation between the characteristics of students with and
without disabilities and vulnerabilities. Therefore, separate provisions for such students
cannot be justified. Moreover, inclusion has got the world‘s attention because it is supposed
to solve the world‘s major problems occurring in social, economic, religious, educational and
other areas of the world. For instance, it is supposed to: counteract-social, political, economic
and educational challenges that happen due to globalization impact; enhance psychosocial,
academic and other benefits to students with and without special needs education; help all
citizens exercise educational and human rights; enhance quality education for all in regular
class rooms through inclusion; create sustainable environmental development that is suitable
for all human beings; create democratic and productive society that promote sustainable
development; build an attitude of respecting and valuing of differences in human beings; and
ultimately build an inclusive society.

25
Inclusive education is facilitated by many influencing actors. Some of the major drivers
include:
1. Communities: pre-colonial and indigenous approaches to education and
community-based programs movement that favor inclusion of their community
members.
2. Activists and advocates: the combined voices of primary stakeholders
representatives of groups of learners often excluded and marginalized from education
(e.g. disabled activists; parents advocating for their children; child rights advocates;
and those advocating for women/girls and minority ethnic groups).
3. The quality education and school improvement movement: in both North and
South, the issues of quality, access and inclusion are strongly linked, and contribute
to the understanding and practice of inclusive education as being the responsibility of
education systems and schools.
4. Special educational needs movement: the new thinking ‘of the special needs
education movement as demonstrated in the Salamanca Statement has been a positive
influence on inclusive education, enabling schools and systems to really respond to a
wide range of diversity.
5. Involvement of International agencies: the UN is a major influence on the
development of inclusive education policy and practice. Major donors have formed a
partnership the Fast Track Initiative to speed progress towards the EFA goals. E.g.
UNESCO, etc.
6. Involvement of NGOs movements, networks and campaigns: a wide range of civil
society initiatives, such as the Global Campaign for Education, seek to bring policy
and practice together and involve all stakeholders based on different situations
7. Other factors: the current world situation and practical experiences in education.
The current world situation presents challenges such as the spread of HIV/AIDS,
political instability, trends in resource distribution, diversity of population, and social
inclusion. This necessitates implementation of inclusion to solve the problems. On the
other hand, practical experiences in education offers lessons learned from failure and
success in mainstream, special and inclusive education. Moreover, practical
demonstrations of successful inclusive education in different cultures and contexts are
a strong influence on its development

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2.6. Benefits of Inclusion

It is now understood that inclusion benefits communities, families, teachers, and students by
ensuring that children with disabilities attend school with their peers and providing them with
adequate support to succeed both academically and socially.
Benefits for students with special needs education developing:
• Appropriate models of behavior. They can observe and imitate socially acceptable
behaviors of the students without special needs
• Improved friendships with the social environment
• Increased social initiations, interactions, relationships and networks

• Gain peer role models for academic, social and behavior skills

• Increased achievement of individualized educational program (IEP) goals

• Greater access to general curriculum

• Enhanced skill acquisition and generalization in their learning

• improved academic achievement which leads to quality education service s

• Attending inclusive schools increases the probability that students with SEN will
continue to participate in a variety of integrated settings throughout their lives (increased
inclusion in future environments that contribute building of inclusive society).
• Improved school staff collaboration to meet these students‘ needs and ability differences
• Increased parental participation to meet these students‘ needs and ability differences
• Enhanced families integration into the community

Benefits for persons without Special Needs Education

Students without special educational needs (SEN) will:
• Have a variety of opportunities for interacting with their age peers who experience SEN
in inclusive school settings.
• serve as peer tutors during instructional activities

• Gain knowledge of a good deal about tolerance, individual difference, and human
exceptionality.
• Learn that students with SEN have many positive characteristics and abilities.

27
 • Have chance to learn about many of the human service profession such as special
education, speech therapy, physical therapy, recreation therapy, and vocational
rehabilitation. For some, exposure to these areas may lead to career choices.
• Have increased appreciation, acceptance and respect of individual differences among
human beings that leads to increased understanding and acceptance of diversity
• Get greater opportunities to master activities by practicing and teaching others

• Have increased academic outcomes

• have opportunity to learn to communicate, and deal effectively with a wide range of
individuals; this prepares them to fully participate in society when they are adults that
make them build an inclusive society

Benefits for Teachers and Parents/Family

Inclusive education has benefit to teachers. The benefit includes: developing their knowledge
and skills that meet diverse students ‘needs and ability differences to enhancing their skills to
work with their stakeholders; and gaining satisfaction in their profession and other aspects.
Similarly, parents/family benefit from inclusive education. For example, parents benefit
from implementation of inclusive education in developing their positive attitude towards
their children‘s education, positive feeling toward their participation, and appreciation to
differences among humankinds and so on. For detailed information, see the table below.
when they participate in inclusive education of their children
Benefits of inclusion for Teachers and Parents/Family

Benefits for Teachers Benefits for Parents/Family

• They have more opportunities to learn new • They have greater opportunities to
ways to teach different kinds of students. explore new ideas by
• They gain new knowledge, such as the communicating more often with
different ways children learn and can be others from within and outside their
taught. school, such as in school clusters or
• They develop more positive attitudes and teacher networks, or with parents
approaches towards different people with and community members.
diverse needs.

28
• They can encourage their students to be more Strategies, thus expanding the
interested, more creative and more attentive skills of both general and special
• They can experience greater job satisfaction educators
and a higher sense of accomplishment when • They benefit from develop
ALL children are succeeding in school to the Developing teamwork and
best of their abilities. collaborative problem-solving
skills to creatively address
• They get opportunities to exchange challenges regarding student
information about instructional activities and learning
teaching They:

• Learn more about how their children are • Develop positive attitude that help
being educated in schools with their peers in them promoting the recognition and
an inclusive environment appreciation that all students have
• Become personally involved and feel a strengths and are contributing
greater sense of accomplishment in helping members of the school community
their children to learn. as well as the society
• Feel valued and consider themselves as equal
partners in providing quality learning
opportunities for children.
• Learn how to deal better with their children
at home by using techniques that the teachers
use in school.
• Find out ways to interact with others in the
community, as well as to understand and help
solve each other‘s problems.
• Know that their children and all children are
receiving a quality education.

Benefits for Society

Inclusion goes beyond education and should involve consideration of employment,
recreation, health and living conditions. It should therefore involve transformations across all
government and other agencies at all levels of society. When students with special needs and
without special needs are educated through quality inclusive education, it not only benefits
29
students, teachers and parents it also benefits the society. Some of the major benefits may
include:

Introduction of students with disabilities and vulnerabilities into mainstream schools bring in
the students into local communities and neighborhoods and helps break down barriers and
prejudice that prevail in the society towards persons with disability. Communities become
more accepting of difference, and everyone benefits from a friendlier, open environment that
values and appreciates differences in human beings. Meaningful participation in the
economic, social, political and cultural life of communities own cost effective non-
segregated schooling system that services both students with and without special needs
education.

Ultimate goal of inclusion

The goal of inclusive education is to create schools where everyone belongs. By creating
inclusive schools, we ensure that there‘s a welcoming place in the community for everyone
after their school year‘s end. Students educated together have a greater understanding of
difference and diversity. Students educated together have fewer fears about difference and
disability. An inclusive school culture creates better long-term outcomes for all students.
Typical students who are educated alongside peers with developmental disabilities
understand more about the ways that they‘re all alike. These are the students who will be our
children‘s peer group and friends. These students hold the promise of creating inclusive
communities in the future for all our children. These students will be the teachers, principals,
doctors, lawyers, and parents who build communities where everyone belongs.
Inclusive society is a necessary precondition for inclusive growth is a society which does not
exclude or discriminate against its citizens on the basis of disability, caste, race, gender,
family or community, a society which levels the playing field for investment‘ and leaves no
one behind. Thus, Inclusive growth which is equitable that offers equality of opportunity to
all as well as protection in market and employment transitions results from inclusive society.

Features of Inclusive Environment

An inclusive environment is one in which members feel respected by and connected to one
another. An inclusive environment is an environment that welcomes all people, regardless of
their disability and other vulnerabilities. It recognizes and uses their skills and strengthens

30
their abilities. An inclusive service environment is respectful, supportive, and equalizing. An
inclusive environment reaches out to and includes individuals with disabilities and
vulnerabilities at all levels from first time participants to board members.
It has the following major characteristics:
• it ensures the respect and dignity of individuals with disabilities
• it meets current accessibility standards to the greatest extent possible to all people with
special needs
• provides accommodations willingly and proactively
Persons with disabilities are welcomed and are valued for their contributions as individuals.

Inclusive Environments
An inclusive environment is a place that is adjusted to individuals ‘needs and not vice versa
that individuals are adjusted to the environmental needs. It acknowledges that individual
differences among individuals are a source of richness and diversity, and not a problem, and
that various needs and the individual pace of learning and development can be met
successfully with a wide range of flexible approaches. Besides, the environment should
involve continuous process of changes directed towards strengthening and encouraging
different ways of participation of all members of the community.
An inclusive environment is also directed towards developing culture, policy and practice
which meet pupils’ diversities, towards identifying and removing obstacles in learning and
participating, towards developing a suitable provisions and supporting individuals.
Therefore, successful environment has the following characteristics:
• It develops whole-school/environment processes that promote inclusiveness and
quality provisions and practice that are responsive to the individual needs and
diversities

• It recognizes and responds to the diverse needs of their individuals and ensuring
quality provisions for all through appropriate accommodations, organizational
arrangements, resource use and partnerships with their community.

• It is committed to serve all individuals together regardless of differences. It is

also deeply committed to the belief that all persons can learn, work and be
productive.

• It involves restructuring environment, culture, policy, and practice.

31
 • It promoting pro-social activities

• It makes provides services and facilities equally accessible to all people

• It involves mobilizing resources within the community

• It is alert to and uses a range of multi-skilled personnel to assist people in their

learning and working environment.

• It strives to create strong links with, clinicians, caregivers, and staff in local
schools, work place, disability services providers and relevant support agencies
within the wider community.
• It develops social relationships as an equal member of the class. It is also the
classroom responsive to the diversity of individuals’ academic, social and personal
learning needs.

Barriers to Inclusion
Though many countries seem committed to inclusion their rhetoric, and even in their
legislation and policies, practices often fall short. Reasons for the policy-practice gap in
inclusion are diverse. The major barriers include:
• Problems related with societal values and beliefs- particularly the community and
policy makers’ negative attitude towards students with disability and vulnerabilities.
Inclusion cannot flourish in a society that has prejudice and negative attitude towards
persons with disability.
• Economic factors- this is mainly related with poverty of family, community and
society at large
• Lack of taking measures to ensure conformity of implementation of inclusion
practice with policies
• Lack of stakeholders taking responsibility in their cooperation as well as collaboration
for inclusion
• Conservative traditions among the community members about inclusion

• Lack of knowledge and skills among teachers regarding inclusive education

• Rigid curricula, teaching method and examination systems that do not consider
students with dives needs and ability differences.
• Fragile democratic institutions that could not promote inclusion

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 • Inadequate resources and inaccessibility of social and physical environments
• Large class sizes that make teachers and stakeholders meet students‘ diverse needs
• Globalization and free market policy that make students engage in fierce completion,
individualism and individuals’ excellence rather than teaching through cooperation,
collaboration and group excellence.
• Using inclusive models that may be imported from other countries

2.7. Promoting Inclusive Culture

Culture: is the ideas, customs, and social behavior of a particular people or society. An
organization‘s culture is the culmination of the priorities, values and behaviors, which
support their employees in how they work singularly, in teams and with clients. Culture plays
a huge role in shifting the diversity needle and forming truly inclusive environments. Hence,
inclusive culture: involves the full and successful integration of diverse people into a
workplace or industry. Additionally, inclusive culture extends beyond basic or token
presence of workers who have disabilities. They encompass both formal and informal
policies and practices, and involve several core values:
Representation: The presence of people with disabilities across a range of employee roles
and leadership positions
Receptivity: Respect for differences in working styles and flexibility in tailoring positions to
the strengths and abilities of employees and
Fairness: Equitable access to all resources, opportunities, networks and decision making
processes.
Dimensions of Inclusive culture
There are three dimensions/elements of an inclusive culture:

1. Universal design

2. Recruitment, training and advancement opportunities

3. Workplace accommodations and accessibility (Policy & Practice)

1. Universal Design
One of the most heralded concepts in disability advocacy and cultures in the last decade is the
concept of “universal design”. Universal design refers to the construction of structures,
spaces, services, communications and resources that are organically accessible to a range of
people with and without disabilities, without further need for modification or

33
accommodation. While accommodations procedures remain a needed function of most
contemporary institutions and industries, forward-thinking approaches to disability inclusion
will frequently involve developing sites and resources that require no accommodation to be
fully usable and receptive to people with disabilities.
A few examples for the universal design practices may apply in the workplace include:
Routinely providing manuals, materials and forms to all employees in a variety of digital
formats that are as readily accessible to people who use adaptive computer technologies as to
other employees, building workspaces accessible to people who use wheelchairs or other
assistive devices, as well as to all other employees and providing employees with a variety of
flexible schedule and work options. This allows employees who have energy or functionality
limitations to organize their time and strengths, and all employees are better able to manage
time and life/work balance.

2. Recruitment, Training, & Advancement Opportunities

Effective recruitment of people with disabilities involves two components:

1. Accessible outreach and hiring practices and

2. Targeted recruitment of workers with disabilities.

Accessible outreach and hiring practices essentially entail making sure that outreach
materials, networking and recruitment sites, communications, and application processes all
include a range of accessible options, or are free of barriers that might inhibit people with
disabilities from participating. Wherever possible, outreach and hiring resources generally
should be equally accessible to workers with and without disabilities.
For example, making recruitment literature and job applications readily available in digital
and large-print formats, or holding outreach events in spaces without stairs or other barriers
and with accessible communications technology, helps to ensure that people with disabilities
will be included in recruitment practices.
Targeted recruitment: involves specific outreach to people with disabilities. Although
making general recruitment practices more accessible goes a long way towards building an
inclusive hiring structure, individual employers are not always able to overcome existing
barriers for instance, when recruiting via externally sponsored job fairs that are not
accessible. Therefore, targeted recruitment enables employers to reach and interview
qualified people with disabilities. In turn, having accessible recruitment practices relative to

34
hiring, materials and communications helps to ensure that targeted recruitment will be
successful not just in identifying qualified candidates, but by making sure there are no
barriers to effective outreach and eventual employment.
Training: Training plays a dual role in the creation of inclusive workplace culture. The first
consideration involves the degree to which people with disabilities have equitable access to
training sites, events, and materials. The second concern relates to the training of managers,
particularly middle management, and human resources staff, to work effectively with all
people, including those with disabilities. The consequences of inadequate training are
substantial, in reducing job satisfaction, with corresponding negative consequences for
productivity and retention. In turn, companies favored by employees with disabilities make a
concerted effort to create equitable and accessible training resources.
Advancement: Research demonstrates that in order to have equitable opportunities for
promotion and professional development, like most employees, workers with disabilities
typically require access to mentoring. As with recruitment, mentoring and coaching involves
a dual dynamic in which: Existing mentoring programs are advertised, implemented and
maintained with attention to inclusion of workers with disabilities, and targeted mentoring
and coaching programs specifically assist employees with disabilities. These may include the
creation of explicit disability affirmative action policies related to promotion, targeted
professional networking opportunities, and the establishment of disability affinity networks
and related supports to encourage full integration into the workplace culture.

3. Workplace Accommodations and Accessibility: Policy & Practice

Policy plays a critical role in generating meaningful inclusion of people with disabilities
workplace accommodations and accessibility. In addition to recruitment, training and
advancement, workplace policies need to carefully plan for the provision of reasonable
accommodations. When assessing the effectiveness of existing accommodations policies,
employee experiences can be described based on two measures of equity. The first indicator
of an inclusive workplace culture involves the perception of procedural justice‖, meaning that
employees with disabilities perceive the accommodations policy as fair, accessible and
functional. The practice of negotiating and providing accommodations constitutes an
additional opportunity for generating an experience of interactional justice.
Interactional justice refers to the experience of feeling that the managers or colleagues with
whom one is interacting are behaving fairly, reasonably and respectfully. Experiential and
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Bottom Line Outcomes: The Benefits of Inclusive cultures are specifically beneficial for
employees with disabilities, but also have positive results for all employees, as they include a
number of elements of a healthy work environment. Specific positive outcomes include:
 Reduced expenses corresponding to reduced employee turn-over
 Increases worker commitment to and identification with organizational
success
 Improves employee health and well-being
 Improves productivity
 Increases employee investment in work performance
 Reduces perception of discrimination and inequity
 Improves cooperation and collaboration among co-workers, employees
and management
Improves cooperation and collaboration between
Creating an inclusive organizational culture is challenging but extremely advantageous.
Here's why and how, however, the business benefits and the outcomes of an inclusive
organization fairness and respect, value and belonging, safe and open, and empowerment and
growth should be compelling enough to push forward. These are some of the benefits of an
Inclusive organization that needs to be considered:
 Higher Job Satisfaction
 Lower Turnover.
 Higher Productivity
 Higher Employee Morale
 Improved Creativity and Innovation
 Improved Problem-Solving
 Increased Organizational Flexibility.
Inclusive education, when practiced well, is very important because all children are able to be
part of their community and develop a sense of belonging and become better prepared for life
in the community as children and adults. It provides all children with opportunities to
develop friendships with one another.
In general inclusive values are appreciating diversity, equality and equity, cooperativeness,
participation, community, and sustainability are examples of inclusive values that are
fundamental for successful inclusive education. Appreciating diversity, equality and equity,

36
cooperativeness, participation, community, and sustainability are examples of inclusive
values that are fundamental for successful inclusive education.

Chapter three
Identification and Differentiation Services
Identification and differential services respond to persons with disabilities in different ways.
Some react negatively and thus their quality of life is negatively affected. Others choose to
focus on their abilities as opposed to their disabilities and continue to live a productive life.
There are several factors that affect the impact a disability has on an individual. The
following are often considered the most significant factors in determining a disability's
impact on an individual.
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

37
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.
The Individual’s Personality: the individual personality can be typically positive or negative,
dependent or independent, goal-oriented or laissez-faire. Someone with a positive outlook is more
likely to embrace a disability then someone with a negative outlook. Someone who is independent
will continue to be independent and someone who is goal oriented will continue to set and pursue
goals.
The Meaning of the Disability to the Individual: Does the individual define himself/herself by
his/her looks or physical characteristics? If so, he/she is more likely to feel defined by his/her
disability and thus it will have a negative impact.

The individual's support system: The individual‘s support from family, a significant other, friends,
or social groups. If so, he/she will have an easier time coping with a disability and thus will not be
affected negatively by their disability.

Common effects of a disability may include but not limited to health conditions of the person;
mental health issues including anxiety and depression; loss of freedom and independence;
frustration and anger at having to rely on other people; practical problems including
transport, choice of activities, accessing buildings; unemployment; problems with learning
and academic study; loss of self-esteem and confidence, especially in social situations. But all
these negative effects are due to restricted environments, not due to impairments.
The disability experience resulting from the interaction of health conditions, personal factors,
and environmental factors varies greatly. Persons with disabilities are diverse and
heterogeneous, while stereotypical views of disability emphasize wheelchair users and a few
other classic‖ groups such as blind people and deaf people. Disability encompasses the child
born with a congenital condition such as cerebral palsy or the young soldier who loses his leg
to a land-mine, or the middle-aged woman with severe arthritis, or the older person with
dementia, among many others. Health conditions can be visible or invisible; temporary or
long term; static, episodic, or degenerating; painful or inconsequential. Note that many
people with disabilities do not consider themselves to be unhealthy. Generalizations about
disability or people with disabilities‖ can mislead. Persons with disabilities have diverse
personal factors with differences in gender, age, language, socioeconomic status, sexuality,
ethnicity, or cultural heritage. Each has his or her personal preferences and responses to
disability. Also while disability correlates with disadvantage, not all people with disabilities
are equally disadvantaged. Women with disabilities experience the combined disadvantages
38
associated with gender as well as disability, and may be less likely to marry than nondisabled
women. People who experience mental health conditions or intellectual impairments appear
to be more disadvantaged in many settings than those who experience physical or sensory
impairments. People with more severe impairments often experience greater disadvantage.
Conversely, wealth and status can help overcome activity limitations and participation
restrictions.

People with disabilities and vulnerabilities live with challenges that impact their abilities to
conduct Activities of Daily Living (ADL). Disability and vulnerabilities can limit or restrict
one or more ADLs, including moving from one place to another (e.g., navigation,
locomotion, transfer), maintaining a position (e.g., standing, sitting, sleeping), interacting
with the environment (e.g., controlling systems, gripping objects), communicating (e.g.,
speaking, writing, hand gestures), feeding (chewing, swallowing, etc.), and perceiving the
external world (by movement of the eyes, the head, etc.), due to inaccessible environment.
Many older persons face one or more impairments. Their situation is often similar to that of
people with disabilities. Their needs are similar to those people with multiple disabilities with
a decrease in the muscular, vision, hearing and cognitive capacities.
3.1.1. Disability and economic factors

There is clear evidence that people with few economic assets are more likely to acquire
pathologies that may be disabling. This is true even in advanced economies and in economies
with greater levels of income equality. The impact of absolute or relative economic
deprivation on the onset of pathology crosscuts conditions with radically different etiologies,
encompassing infectious diseases and most common chronic conditions. Similarly, economic
status affects whether pathology will proceed to impairment. Examples include such
phenomena as a complete lack of access to or a delay in presentation for medical care for
treatable conditions (e.g., untreated breast cancer is more likely to require radical
mastectomy) or inadequate access to state-of-the-art care (e.g., persons with rheumatoid
arthritis may experience a worsened range of motion and joint function because disease
modifying drugs are not used by most primary care physicians). In turn, a lack of resources
can adversely affect the ability of an individual to function with a disabling condition. For
example, someone with an amputated leg who has little money or poor health insurance may

39
not be able to obtain a proper prosthesis, in which case the absence of the limb may then
force the individual to withdraw from jobs that require these capacities.
Similarly, economic resources can limit the options and abilities of someone who requires
personal assistance services or certain physical accommodations. The individual also may not
be able to access the appropriate rehabilitation services to reduce the degree of potential
disability either because they cannot afford the services themselves or cannot afford the cost
of specialized transportation services.

The economic status of the community may have a more profound impact than the status of
the individual on the probability that disability will result from impairment or other disabling
conditions. Research on employment among persons with disabilities indicates, for example,
that such persons in communities undergoing rapid economic expansion will be much more
likely to secure jobs than those in communities with depressed or contracting labor markets.
Similarly, wealthy communities are more able to provide environmental supports such as
accessible public transportation and public buildings or support payments for personal
assistance benefits.

3.1.2. Disability, vulnerability and the environment

The prevailing understanding about the cause of disability has undergone profound change
worldwide. Previous models of absolute determinism that viewed pathology and disability
interchangeably and that excluded consideration of the environment have been replaced by
models in which disability is seen to result from the interaction between the characteristics of
individuals with disabilities and the characteristics of their environment. Cultural norms
affect the way that the physical and social environments of the individual are constituted and
then focus on a few-but not all-of the elements of the environment to provide examples of
how the environment affects the degree of disability. The amount of disability is not
determined by levels of pathologies, impairments, or functional limitations, but instead is a
function of the kind of services provided to people with disabling conditions and the extent to
which the physical, built environment is accommodating or not accommodating to the
particular disabling condition. Because societies differ in their willingness to provide the
available technology and, indeed, their willingness to provide the resources to improve that
technology, disability ultimately must been seen as a function of society, not of a physical or
medical process.

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Disability is not inherent in an individual but is, rather, a relational concept a function of the
interaction of the person with the social and physical environments. The amount of disability
that a person experiences, depends on both the existence of a potentially disabling condition
(or limitation) and the environment in which the person lives. For any given limitation (i.e.,
potential disability), the amount of actual disability experienced by a person will depend on
the nature of the environment, that is, whether the environment is positive and enabling (and
serves to compensate for the condition, ameliorate the limitation, or facilitate one's functional
activities) or negative and disabling (and serves to worsen the condition, enhance the
limitation, or restrict one's functional activities). Human competencies interact with the
environment in a dynamic reciprocal relationship that shapes performance. When functional
limitations exist, social participation is possible only when environmental support is present.
If there is no environmental support, the distance between what the people can do and what
the environment affords creates a barrier that limits social participation.

The physical and social environments comprise factors external to the individual, including
family, institutions, community, geography, and the political climate. Added to this
conceptualization of environment is one's intrapersonal or psychological environment, which
includes internal states, beliefs, cognition, expectancies and other mental states. Thus,
environmental factors must be seen to include the natural environment, the human made
environment, culture, the economic system, the political system, and psychological factors.

41
 Some Enabling and Disabling Factors in the Physical Environment

Type of environment
Type of

Factor Natural Environment Built Environment

Enabling

Dry climate Ramps

Flat terrain Adequate lighting

Clear paths Braille signage

Disabling

Snow Steps

Rocky terrain Low-wattage lighting

High humidity Absence of flashing light alerting systems

The environmental mat may be conceived of as having two major parts: the physical
environment and the social and psychological environments. The physical environment may
be further subdivided conceptually into the natural environment and the built environment.
Both affect the extent to which a disabling condition will be experienced by the person as a
disability.

Three types of attributes of the physical environment need to be in place to support human
performance. The first attribute is object availability. Objects must be in a location that is
useful, at a level where they can be retrieved, and must be organized to support the
performance of the activity. Neither a sink that is too high for a wheelchair user nor a
telecommunications device for the deaf (TDD) that is kept at a hotel reception desk is
available. The second attribute is accessibility. Accessibility is related to the ability of
people to get to a place or to use a device. Accessibility permits a wheelchair user to ride a
bus or a Braille user to read a document. The third attribute is the availability of sensory
stimulation regarding the environment. Sensory stimulation, which can include visual,
tactile, or auditory cues, serves as a signal to promote responses. Examples of such cues

42
could include beeping microwaves, which elicit responses from people without hearing
impairments, or bumpy surfaces on subway platforms, which tell users with visual
impairments to change their location.
The Natural Environment
The natural environment may have a major impact on whether a limitation is disabling. For
example, a person who has severe allergies to ragweed or mold, which can trigger disabling
asthma, can be free of that condition in climates where those substances do not grow. The
physical conditions still exist, but in one environment they may become disabling and in
another environment they might not. Another example might be that a person who has limited
walking ability will be less disabled in a flat geographical location than he disabled in both
places during the winter than during the summer. Thus, the natural environment, including
topography and climate, affect whether or to what degree a functional limitation will be
disabling.
The human made Environment
The physical environment is a complex interaction of built-in objects. Built objects are
created and constructed by humans and vary widely in terms of their complexity, size, and
purpose. Built objects are created for utilitarian reasons and also for an outlet for creativity.
For instance, built objects such as dishwashers and computers have the potential to enhance
human performance or to create barriers.
Rural environment, Disability and Vulnerability
Vulnerable and marginalized groups, how rural landscapes, infrastructure and communities
shaped social understandings of disability, and how these understandings might uniquely
shape opportunities a better life of this group of people. People with disabilities,
vulnerabilities and marginalized groups have no voices about their lives and what rural living
means to them. Physical landscapes are infused with social meaning and that the feelings we
have for particular places are built up through an accumulation of experiences that invoke
strong emotional responses. Rurality must be considered as more than an issue of context or
setting. Instead, rurality professionals in rural should prioritize the voices and experiences of
those who live rurally, and that the specific characteristics or aspects of the particular rural
communities to which they belong.

Since larger population of Ethiopia (more than 85%) are agricultural community, life and
aspirations of disabilities and vulnerable groups highlight both the pull and the push of rural

43
living without appropriate services and supports. Persons with disabilities, vulnerable and
marginalized groups living in rural areas have double disadvantaged due to their impairments
and vulnerabilities and unfavorable physical and social environment. Professional who is
working in rural areas should work in collaboration accordingly. More specifically, these
group of people have been excluded from agricultural works (productivity) due its nature
high demand to labour and lack of technologies and well organized support from
professional.
3.1.3. Creating Welcoming (Inclusive) Environment

External environmental modifications can take many forms. These can include assistive
devices, alterations of a physical structure, object modification, and task modification. The
role of environmental modification as a prevention strategy has not been systematically
evaluated, and its role in preventing secondary conditions and disability that accompany a
poor fit between human abilities and the environment should be studied. Environmental
strategies may ease the burden of care experienced by a family member who has the
responsibility of providing the day-to-day support for an individual who does not have the
capacity for social participation and independent living in the community. These
environmental modifications may well be an effort at primary prevention because the
equipment may provide a safety net and prevent disabling conditions that can occur through
lifting and transfer of individuals who may not be able to do it by themselves.

Rehabilitation must place emphasis on addressing the environmental needs of people with
disabling conditions. Environmental strategies can be effective in helping people function
independently and not be limited in their social participation, in work, leisure or social
interactions as a spouse, parent, friend, or coworker.

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Examples of Environmental Modification
1. Mobility aids
• Hand Orthosis
• Mouth stick
• Prosthetic limb
• Wheelchair (manual and/or motorized)
• Canes
• Crutches
• Braces
2. Communication aids
• Telephone amplifier or TDD
• Voice-activated computer
• Closed or real-time captioning
• Computer-assisted note taker
• Print enlarger
• Reading machines
• Books on tape
• Sign language or oral interpreters
• Braille writer
• Cochlear implant
• Communication boards FM, audio-induction loop, or infrared systems
3. Accessible structural elements
• Ramps Elevators

• Wide doors

• Safety bars

• Nonskid floors

• Sound-reflective building materials

• Enhanced lighting

• Electrical sockets that meet appropriate reach ranges

• Hardwired flashing alerting systems Increased textural contrast
Accessible features

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 • Built up handles

• Voice-activated computer
• Automobile hand controls
Job accommodations
• Simplification of task
• Flexible work hours
• Rest breaks
• Splitting job into parts
• Relegate nonessential functions to others
Differential use of personnel
• Personal care assistants

• Note takers

• Secretaries Editors

• Sign language interpreters

3.1.4. Impact of the Social, Cultural and Psychological Environments on the Enabling-
Disabling Process

The social environment is conceptualized to include cultural, political, and economic factors.
The psychological environment is the intrapersonal environment. This section examines how
both affect the disabling process.
3.1.5. Culture and the Disabling Process

Culture affects the enabling-disabling process at each stage; it also affects the transition from
one stage to another. This section defines culture and then considers the ways in which it
affects each stage of the process.

Definition of culture: it includes both material culture (things and the rules for producing
them) and nonmaterial culture (norms or rules, values, symbols, language, ideational systems
such as science or religion, and arts such as dance, crafts, and humor). Nonmaterial culture is
so comprehensive that it includes everything from conceptions of how many days a week has
or how one should react to pain to when one should seek medical care or whether a
hermaphroditic person is an abomination, a saint, or a mistake. Cultures also specify

46
 punishments for rule-breaking, exceptions to rules, and occasions when exceptions are
permitted. The role of nonmaterial culture for humans has been compared to the role of
instincts for animals or to the role of a road map for a traveler. It provides the knowledge that
permits people to be able to function in both old and new situations. Both the material and
nonmaterial aspects of cultures and subcultures are relevant to the enabling-disabling
process. However, for our purpose we will focus primarily on the role of nonmaterial culture
in that process. Cultures have an impact on the types of pathologies that will occur as well as
on their recognition as pathologies. However, if a pathology is not recognized by the culture
(in medical terms, diagnosed), the person does not begin to progress toward disability (or
cure).
Enabling and Disabling Factors
Element of Social and Psychological Environment
Type of
Factor

Culture Psychological Political Economic

Expecting people Having an active Mandating relay Tax credits to hire people
Enabling

with disabling coping strategy systems in all states with disabling conditions
conditions to be
productive
Expecting everyone Cognitive Banning discrimination Targeted earned income
to know sign restructuring against people who can tax credits
language perform the essential
functions of the job
Stigmatizing people Catastrophizing Segregating children Economic disincentives to
Disabling

with disabling with mobility get off Social Security

conditions impairments in schools Disability Income benefits
Valuing physical Denial Voting against No subsidies or tax credits
beauty paratransit system for purchasing assistive
technology
Pathway from Pathology to Impairment to Functional Limitation

Culture can affect the likelihood of the transition from pathology to impairment. A
subculture, such as that of well-educated society, in which health advice is valued, in which
breast cancer screening timetables are followed, and in which early detection is likely, is one
in which breast tumors are less likely to move from pathology to impairments. In a subculture

47
in which this is not true, one would likely see more impairments arising from the pathologies.
Cultures can also speed up or slow down the movement from pathology to impairment, either
for the whole culture or for subgroups for whom the pathway is more or less likely to be
used. For example, some religions, women are less likely to seek health care because it
means a man must be available to escort them in public, which is unlikely if the males are
breadwinners and must give up income to escort them, and women are also less likely to seek
health care if the provider is male. Thus, their culture lessens the likelihood that their
pathology will be cured and therefore increases the likelihood that the pathology will become
impairment.

Culture clearly has an impact on whether a particular impairment will become a functional
limitation. Impairments do not become limiting automatically. Rather, cultures affect the
perception that the impairment is in fact the cause of the limitation, and they affect the
perception that the impairment is in fact limiting. If a society believes that witchcraft is the
reason that a woman cannot have children, medical facts about her body become irrelevant.
She may in fact have fibroids, but if that culture sees limitation as coming from the actions of
a person, there is no recognition of a linkage between the impairment and the functional
limitation. Rather, any enabling-disabling process must go through culturally prescribed
processes relating to witches; medically or technologically based enabling-disabling
processes will not be acceptable.

3.1.6. Disability Inclusive Intervention and Rehabilitation Services

A “One-size-fits-all” approach to provide services for persons with disabilities and

vulnerability groups is no longer enough. Including people with disabilities in everyday
activities and encouraging them to have roles similar to peoples who do not have a disability
is disability inclusion. This involves more than simply encouraging people; it requires
making sure that adequate policies and practices are in effect in a community or organization.
Inclusion should lead to increased participation 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 persons with
disabilities and vulnerabilities. Differentiated service means a multiple service delivery
model that can satisfy the most needs of persons with disabilities and vulnerabilities. Socially
expected activities may also include engaging in social activities, using public resources such

48
as transportation and libraries, moving about within communities, receiving adequate health
care, having relationships, and enjoying other day-to-day activities. To reach ambitious
targets for the general population, as well as targeted care for persons with disabilities and
vulnerable groups, we need differentiated service delivery.

Persons with disabilities and vulnerabilities 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. To change this, a disability inclusion approach must be implemented.
The twin-track approach involves: (1) ensuring all mainstream programs and services are
inclusive and accessible to persons with disabilities, while at the same time (2) providing
targeted disability-specific support to persons with disabilities.
The two tracks reinforce each other. When mainstream programs and services, such as health
and education services, are disability-inclusive and aware, this can help facilitate both
prevention of impairments, as well as early identification of children and persons with
disabilities who can then be referred to disability-specific services. And the provision of
disability-specific supports, such as assistive devices, can help facilitate more effective
inclusion of persons with disabilities in mainstream services.
[Link]. Strategies to prevention, intervention and rehabilitation

Prevention
Prevention of conditions associated with disability and vulnerability is a development issue.
Attention to environmental factors – including nutrition, preventable diseases, safe water and
sanitation, safety on roads and in workplaces – can greatly reduce the incidence of health
conditions leading to disability. A public health approach distinguishes:
i) Primary prevention – actions to avoid or remove the cause of a health problem in an
individual or a population before it arises. It includes health promotion and specific
protection (for example, HIV education).
ii) 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 (for
example, supporting women with intellectual disability to access breast cancer
screening).

49
 iii) Tertiary prevention (rehabilitation): actions to reduce the impact of an already
established disease by restoring function and reducing disease related complications
(for example, rehabilitation for children with musculoskeletal impairment).
Primary prevention issues are considered as crucial to improved overall health of countries’
populations. Viewing disability as a human rights issue is not incompatible with prevention
of health conditions as long as prevention respects the rights and dignity of people with
disabilities, for example, in the use of language and imagery. Preventing disability and
vulnerability should be regarded as a multidimensional strategy that includes prevention of
disabling barriers as well as prevention and treatment of underlying health conditions.
Implementing the Twin-track Approach
Implementing the twin-track approach involves:
Track 1: Mainstreaming disability as a cross-cutting issue within all key programs and
services (education, health, relief and social services, microfinance, infrastructure and camp
improvement, protection, and emergency response) to ensure these programs and services are
inclusive, equitable, non-discriminatory, and do not create or reinforce barriers.

This is done by gathering information on the diverse needs of persons with disabilities during
the assessment stage; considering disability inclusion during the planning stage; making
adaptations in the implementation stage; and gathering the perspectives of persons with
disabilities in the reporting and evaluation 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, assistive devices and other disability-specific services are accessible to persons
with disabilities and vulnerable groups and adhere to protection standards and inclusion
principles. A Sector‘s organizational structures and human resources on disability inclusion
should aim to reflect this twin-track approach. In particular, each sector should have
disability program officers in all fields working to implement disability-specific support
activities.
3.1.7. Implement Disability Inclusive Project/ Program

As a direct service provider, consultant and materials and equipment producers concerned
with realizing equity, quality services and protecting human rights, all sectorial strategies,

50
program, projects and services must be disability-inclusive. The sectors operations should be
largely framed within broad programs, making it very important to ensure that disability
inclusion is reflected in program strategies and design documents. This in turn will help to
subsequently ensure disability is also incorporated into the projects that are designed to
contribute to the overall program objectives. However, persons with disabilities are often not
considered in crucial stages of most sectorial and developmental program and projects
because of lack of awareness about the characteristics of people with disabilities,
vulnerability groups and disability inclusion in practice. The following tips will help to
overcome the challenges as key considerations for including persons with disabilities in all
program and project cycle management stages of Assessment, Planning, Implementation and
Monitoring, and Reporting/Evaluation.
A) Education and vocational training –Inclusive Education realize the universal right to
education for all, meaning all mainstream education services need to be supporting
children and persons with disabilities.
B) Health – vulnerable groups and persons with disabilities have the same health-care
needs as all other peoples and health sector services can also play an important
prevention and early identification role to ensure children and persons with impairments
have timely access to health services and referral rehabilitation support.
C) Relief and social services – the two-way link between poverty and disability means that
vulnerable group and peoples with disabilities and their families need to be able to
access relief support.
Infrastructure and camp improvement, shelter, water and sanitation and environmental
health: universal design concepts must be considered in all infrastructure and construction
programs and projects.
Livelihoods, employment and microfinance: vulnerable groups and people with disabilities
face numerous barriers to achieving an independent livelihood, it is crucial that specific
sectors responsible for livelihood programs and projects to make accessible to all vulnerable
and people with disabilities.
Protection: marginalized groups and people with disabilities may face risks and
vulnerabilities to experiencing violence, exploitation, abuse, neglect and violation of rights
and therefore need to be specifically considered and included in protection programs and
projects.

51
Humanitarian and emergency response: the disproportionate effect of emergency and
humanitarian situations on vulnerable groups and people with disabilities should be reflected
in the design and implementation of the humanitarian projects.
Implement effective Intervention and Rehabilitation
Rehabilitation interventions promote a comprehensive process to facilitate attainment of the
optimal physical, psychological, cognitive, behavioral, social, vocational, a vocational and
educational status within the capacity allowed by the anatomic or physiologic impairment,
personal desires and life plans, and environmental disadvantages for a person with a
disability.

Consumers/patients, families, and professionals work together as a team to identify realistic

goals and develop strategies to achieve the highest possible functional outcome, in some
cases in the face of a permanent disability, impairment, or pathologic process. Although
rehabilitation interventions are developed within medical and health care models, treatments
are not typically curative. Professionals have the knowledge and background to anticipate
outcomes from the interventions, with a certain degree of both optimism and cynicism, drawn
from past experiences.

Rehabilitation requires goal-based activities and, more recently, measurement of outcomes.

The professionals, usually with the patient/ consumer and/or family, develop goals of the
interventions to help mark progress or identify the need to reassess the treatment plan. Broad
goals and anticipated outcomes should include increased independence, prevention of further
functional losses or additional medical conditions when possible, improved quality of life,
and effective and efficient use of health care systems. Consideration of accessibility of
environments and social participation can, and increasingly should, be included within the
scope of outcomes and goals for independence. A broad range of measurement tools have
been developed for use within rehabilitation, and these standardized tools, along with
objective measures of performance (e.g., distance walked, ability to perform a task
independently), are typically documented throughout the course of the intervention. 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,

52
development and maturation, coping and adjustment, biomechanics, linguistics and
pragmatics, resiliency and self-reliance, auditory processing, and behavior modification.
These concepts, alone or in combination, form the basis for interventions and treatment plans.

Advances in medical research now support or explain some of the theories or concepts. It has
been demonstrated, for example, that retraining reorganizes neural networks and circuits, that
skill retraining must be task specific and maintaining a skill is use dependent, that central
nervous system cells and chemical messengers may be replaced, that neural circuits and
connections can be regrown, and that all muscles can be strengthened. Medical rehabilitation
is often considered separately, and is focused on recognition, diagnosis, and treatment of
health conditions (e.g., medication for treatment of fatigue in multiple sclerosis, botulinum
injections for spasticity management in brain injury); on reducing further impairment (e.g.,
treatment of ongoing shoulder adhesive capsulitis in stroke, management of osteoarthritis of
the remaining knee in above-knee amputation); and on preventing or treating associated,
secondary, or complicating conditions (e.g., neurogenic bladder management with
intermittent catheterization in spinal cord injury, diagnosis of cervical spinal stenosis in an
adult with cerebral palsy). Although medical rehabilitation does use rehabilitation
interventions and espouses the principles of rehabilitation, medical aspects are additive to
rehabilitation interventions and principles, with common goals of improved function and
outcomes.

There is convincing evidence that the rehabilitation process and interventions improve the
functional outcomes of people with a variety of injuries, medical conditions, and disabilities.
Assistive technology is often used in conjunction with rehabilitation interventions; this topic
is covered in the Assistive Technology and Science volume in this series. Rehabilitation
interventions are associated with social participation (e.g., access to education using
rehabilitation interventions) and career planning and employment (e.g., long term goal of
rehabilitation interventions). These topics are covered in the Education and Employment and
Work volumes. There are additional efforts not covered in this volume that may also be a part
of rehabilitation interventions and processes, which include the discrete areas of mental
health and addiction rehabilitation. These are important areas that have crossover with
rehabilitation interventions, have defined sets of standards and regulation, and have robust
histories of development.

53
Rehabilitation was conceived within the more traditional model of medical care, but it is
increasingly obvious that disability issues are more than medically driven. The social justice
and civil rights model of disability is important to understand, and elements must be
incorporated into rehabilitation interventions, especially as they relate to accessibility of
environments and services. Of all the medical specialties and programs, rehabilitation is the
one most based on quality of life and functioning within the community. Inequalities and
differences must be addressed within the structures of funding and spheres of influence.
Increasingly, insurance plans determine the availability of rehabilitation services, equipment
and assistive devices, and community-based resources; government funding is more limited
for education, especially for those with special needs; and businesses and workers’
compensation programs are more restrictive with flexibility and coverage policies.
Components of Rehabilitation Interventions
Rehabilitation is a process designed to optimize function and improve the quality of life of
those with disabilities. Consequently, it 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
Rehabilitation interventions usually involve multiple disciplines. Although some focused
interventions may be identified by a single service such as cognitive retraining by a
psychologist or speech pathologist, and Audiologic rehabilitation through hearing-aid
evaluation and dispensing-sole service does not engender the rehabilitation concept of a team
approach, and it is often differentiated as therapy or medical service rather than rehabilitation.
There are a variety of professionals who participate in and contribute to the rehabilitation
process within a team approach. The list is long, and it includes (although is not limited to)
such professionals as the following:
Physicians
The physician‘s role is to manage the medical and health conditions of the patient/consumer
within the rehabilitation process, providing diagnosis, treatment, or management of
disability-specific issues. Often, the physician leads the rehabilitation team, although other
team members can assume the leadership role depending on the targeted goal or predominant
intervention. Because of the depth and breadth of their knowledge and training, certified
rehabilitation physicians or physiatrists usually are the best qualified to anticipate outcomes

54
from rehabilitation interventions and the process of rehabilitation. They also can provide the
diagnosis and treatment of additional medical conditions related to the specific disability or
underlying pathology, which will have an influence on performance and outcome.

Occupational therapists
Occupational therapists (OTs) typically work with patients/consumers through functional
activities in order to increase their ability to participate in activities of daily living (ADLs)
and instrumental activities of daily living (IADLs), in school and work environments, using a
variety of techniques. Typical techniques include functional training, exercise, splinting,
cognitive strategies, vision activities, computer programs and activities, recommendation of
specially designed or commercially available adaptive equipment, and home/education/work
site assessments and recommendations.

Physical therapists
Physical therapists (PTs) assess movement dysfunction and use treatment interventions such
as exercise, functional training, manual therapy techniques, gait and balance training,
assistive and adaptive devices and equipment, and physical agents, including electrotherapy,
massage, and manual traction. The outcome focus of interventions is improved mobility,
decreased pain, and reduced physical disability.
Speech and Language Therapist
Speech and language therapist assess, treat, and help to prevent disorders related to speech,
language, cognition, voice, communication, swallowing, and fluency. Rehabilitation
interventions involve more than the spoken word, including the cognitive aspects of
communication and oral-motor function with swallowing. Assistive technology using
augmentative or alternative communication (AAC) devices (e.g., BIG Mack switch-
activation devices, DynaVox dynamic display and digitized voice devices) is another focus
area of speech pathologists.
Audiologists
Audiologists identify, assess, manage, and interpret test results related to disorders of hearing,
balance, and other systems related to hearing. Hearing screens and more technologically
advanced testing systems fall under the areas of practice. Audiologic rehabilitation
interventions include developing auditory and central processing skills, evaluating and fitting
for a variety of hearing aids and supports, training for use of hearing prosthetics, including

55
cochlear implants, and counseling for adjustment to hearing loss or newly acquired hearing.
Although sign language is a technique used to assist with communication for those with
hearing impairments, competency is not required for audiologists.

Rehabilitation nurses
The rehabilitation nurse usually takes the role of educator and taskmaster throughout
rehabilitation, but these professionals have most prominence within inpatient rehabilitation
programs. They are expert at bladder management, bowel management, and skin care, and
they provide education to patients and families about these important areas and also
medications to be used at home after discharge. Activities developed within the active
therapeutic rehabilitation programs are routinely used and practiced, such as dressing,
bathing, feeding, toileting, transfers to and from wheelchairs, and mobility.
Social Workers
Social workers in health settings may provide case management or coordination for persons
with complex medical conditions and needs; help patients navigate the paths between
different levels of care; refer patients to legal, financial, housing, or employment services;
assist patients with access to entitlement benefits, transportation assistance, or community
based services; identify, assess, refer, or offer treatment for such problems as depression,
anxiety, or substance abuse; or provide education or support programming for health or
related social problems. Social workers work not only with the individual receiving
rehabilitation services, but with family members, to assist both the individual and family in
reaching decisions and making emotional or other adjustments.

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Case Managers
Case management is a relatively new concept that has come about with the survival of
patients/consumers with complex medical problems and disabilities, and with the
development of a more complex health care system. Case managers possess skills and
credentials within other health professions, such as nursing, counseling, or therapies,
although they usually have a nursing background. These professionals collaborate with all
service providers and link the needs and values of the patient/consumer with appropriate
services and providers within the continuum of health care. This process requires
communication with the patient/consumer and his or her family, the service providers, and
the insurance companies. Within the rehabilitation environment, case managers ensure that
ongoing care is at an optimal level and covered by insurance or other payer programs, during
and following inpatient rehabilitation or throughout an outpatient rehabilitation process.
Coordination of services following the inpatient admission can be the most difficult task. A
hospital, rehabilitation program, or insurance company may employ case managers.
Rehabilitation Psychologists
Rehabilitation psychology is a specialized area of psychology that assists the individual (and
family) with any injury, illness, or disability that may be chronic, traumatic, and/or
congenital in achieving optimal physical, psychological, and interpersonal functioning
(Scherer et al.,2004). This profession is an integral part of rehabilitation, and it involves
assessment and intervention that is tailored to the person‘s level of impairment and is set
within an interdisciplinary framework.
Neuropsychologists
Neuropsychology is another specialized area within psychology, and it is of particular
importance in the care of individuals who have sustained brain injuries. These professionals
possess specialized skills in testing procedures and methods that assess various aspects of
cognition (e.g., memory, attention, and language), emotions, behaviors, personality, effort,
motivation, and symptom validity. With this testing, the neuropsychologist can determine
whether the level and pattern of performance is consistent with the clinical history,
behavioral observations, and known or suspected neuropathology, and the degree to which
the test performance deviates from expected norms. Additional contexts encountered in brain
injury survivors can complicate the clinical presentation and impact neuropsychological test
performance. The neuropsychologist can identify emotional states arising from changing life
circumstances (e.g., depression, anxiety), medical co-morbidities (e.g., substance abuse, heart

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disease), and social-contextual factors (e.g., litigation, financial distress), and can then
explain their potential influence to the injured person, family members, and other health care
providers.
Therapeutic recreation specialists
Recreational therapists, also referred to as therapeutic recreation specialists, provide
treatment services and recreation activities for individuals with disabilities or illnesses. They
use a variety of techniques to improve and maintain the physical, mental, and emotional
wellbeing of their clients, with the typical broad goals of greater independence and
integration into the community. Therapists promote community-based leisure activities as a
complement to other therapeutic interventions, and as a means to practice those clinic- or
hospital-based activities within a real-world context.
Rehabilitation counselors
Rehabilitation counselors (previously known as vocational counselors) assist persons with
both physical and mental disabilities, and cover the vocational, psychological, social, and
medical aspects of disability, through a partnership with the individuals served.
Rehabilitation counselors can evaluate and coordinate the services needed, provide
counseling to assist people in coping with limitations caused by the disability, assist with
exploration of future life activities and return-to-work plans, and provide advocacy for needs.
Orthotists and Prosthetists
These professionals practice within a unique area of rehabilitation, combining technical and
some clinical skills. The orthotist fabricates and designs custom braces or orthotics to
improve the function of those with neuromuscular or musculoskeletal impairments, or to
stabilize an injury or impairment through the healing process. The prosthetist works with
individuals with partial or total limb absence or amputation to enhance their function by use
of a prosthesis (i.e., artificial limb, prosthetic device). The orthotist/prosthetist usually works
with a physician, therapist, or other member of the rehabilitation team to ensure an effective
design to meet the needs of the individual, especially regarding the ability to maneuver
within the built environment and be socially active.
Additional rehabilitation professionals
Other rehabilitation professionals who might be considered members of the team include
nutritionist, spiritual care, rehabilitation engineer, music therapist, dance therapist, child-life
specialist, hospital-based school teacher, massage therapist, kinesiologist, and trainer, among
others.

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3.1.8. Person with the Disability and His or Her Family

The person with the disability and his or her family members are partners in this team
process. In fact, they are key members of the team. Personal and family/support system goals,
family/friend support, and community resources are driving forces regarding goals and
discharge planning within the rehabilitation process. The process involves the best strategies
of interventions based on standards of care, the evidence base regarding outcomes related to
interventions, the experience of the practitioners, and the personal and family needs and
contexts of the person with the disability. Professionals should be skillful in their
communication to consumers about anticipated outcomes and effectiveness of interventions.

Community-Based Rehabilitation

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 then 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.

CBR was originally designed for developing countries where disability estimates were very
high and the countries were under severe economic constraints. It promotes collaboration
among community leaders, peoples with disabilities and their families and other concerned
citizens to provide equal opportunities for all peoples with disabilities in the community and
to strengthen the role of their organization. According to the view of World Health
Organization (WHO) and United Nations Education, Scientific and Cultural Organization
(UNESCO), CBR is a strategy that can address the need of peoples with disabilities within
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

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rehabilitation. Thus in order to get clear concept about the definition of CBR, let us first
define the two terms separately.

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 or refers to measures which aim to enable persons with disabilities
to attain and maintain maximum independence, full physical, mental, social and vocational
ability, and full inclusion and participation in all aspects of life. If you give a person a fish,
he/she will eat for a day; if you teach him/her to fish, he/she eat for a lifetime
Based on the above definition of key words, CBR is therefore, a systematized approach
within general community development whereby Persons with Disabilities are enabled to live
a fulfilling life within their own community, making maximum use of local resources and
helping the community become aware of its responsibility in ensuring the inclusion and equal
participation of Persons with Disabilities (PWDs). In the process, PWDs are also made aware
of their own role and responsibility, as they are part of the community.

The idea of CBR is that people with disabilities should have the right to a good life. The help
they need should be available to them, at a low cost. It should be offered to them and their
family in a way that suits their usual way of living, whether in a village, a town or a city.
They should have education like everybody else. They should be able to take up jobs and
earn their living. They should be able to take a full part in all the activities of their village, or
town or city.
The idea of CBR is that, even if people learn very slowly, or has problems seeing or hearing,
or finds it hard to move about, they should still be respected for being men and women, girls
and boys. Nobody should be looked down on or treated badly just because they have a
disability. Houses, shops and schools should be built in such a way that everyone can easily
go in and out and make use of them. Information should be given to people in a way they
understand, not only in writing, which is hard for people who cannot read or see it.
Information should be given in spoken forms as well, so that everyone has a fair chance to
use it. To do all this would mean a lot of changes. But they would be good changes, because

60
everyone could live a better life, helping each other and respecting one another. In addition,
for the purpose of our discussion two important definitions will be given:

1. Community based rehabilitation is a strategy that can address the needs of peoples with
disabilities with in their communities (WHO, UNESCO, 2004).

[Link] 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 .

3. The joint position paper by WHO, ILO, UNICEF and UNESCO of the 2004 define CBR in
a rather flexible and broad manner in the following way: 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. This definition particularly 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-sectorial 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.
g) Currently, three main meanings are attached to the notion of CBR: People taking care of
themselves, a concept and an ideology and community based rehabilitation which will be
described below.

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3.1.9. Implement Technologies for Disability Inclusion Inclusiveness and Information
Technology (ICT)

Inclusiveness and Information Technology examines the extent to which regulatory

frameworks for information and communication technologies (ICTs) safeguard the rights of
persons with disabilities and vulnerabilities as citizenship rights. Effective access to
information is crucial in facilitating the participation of citizens in civil society. Accessibility
concerns in the information and communications technologies (ICTs) sector have become
particularly important, given the increased role played by ICTs in everyday life. For persons
with disabilities and vulnerabilities, technological developments such as the proliferation of
the Internet and the provision of services for accessing digital television such as audio
description (video description), closed signing, and the availability of subtitles (captions) in
live broadcasts enabled by speech-to text technologies can make an important contribution to
facilitating independent living. Unfortunately, persons with disabilities and vulnerabilities
still face significant barriers in accessing ICTs. These barriers include, inter alia, poorly
designed Web sites (e.g., with graphics not readable by computerized screen readers, with
information that can be accessed only by the use of the mouse rather than the keyboard),
limited availability of subtitles on webcasts, the use of multiple remote controls for digital
television, and difficult to navigate on-screen displays.

These access barriers have the potential to affect persons with disabilities, including persons
with sensory disabilities (visual and/ or hearing), mobility disabilities, or cognitive
disabilities. The objective to ensure equal access to information should play a central role in
any regulatory framework for the ICT sector. Nevertheless, despite the potential of
technology to empower the public as citizens, the regulatory framework for the ICT sector
has been criticized for its overall perception of the public as economic actors and for the
insufficient level of protection conferred to citizenship values such as equality and dignity.
[Link]. Inclusiveness and assistive technology

Worldwide the number of persons with disabilities, vulnerabilities and marginalized groups is
increasing alarmingly because of population aging, accident, global warming and climate
change, medical advancement, humanitarian crises, natural disaster, conflict and increases in
chronic health conditions, among other causes. Over a billion people, about 15% of the
world's population, have some form of disability. Between 110 million and 190 million adults

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have significant difficulties in functioning. Technologies promote independence for people
with disabilities and vulnerability. The use of devices, computers, robots, and other
established assistive technology (AT) can potentially increase the autonomy of people with
disabilities and vulnerability, by compensating for physical limitations and circumventing
difficulties with normal activities of daily living (ADL).

Vulnerability and disability have adverse impact on quality life of these groups. Vulnerable
people and those living with disabilities are losing their independence and overall wellbeing.
The growing number of persons with disabilities and vulnerabilities is too large to be cared
for through traditional government programs. The cost associated with such programs and the
lack of a skilled caregiver workforce makes it very difficult to meet the needs of this segment
of the population. It is therefore inevitable that we resort to technology in our search for
solutions to the costly and challenging problems facing persons with disabilities and
vulnerabilities.
Wellbeing or quality of life is an important concern for persons with disabilities,
vulnerabilities and marginalized groups, who, like every person, is seeking to be well, happy,
healthy, and prosperous. Persons with disabilities, vulnerabilities and marginalized groups
have several important components of wellbeing. A key activity is independent living with
convenient access to goods and services, as well as being socially active and enjoying self-
esteem and dignity. In modern societies, persons with disabilities, vulnerabilities and
marginalized groups can attain some components of wellbeing such as access to services
using assistive technology (AT). Other components, such as freedom of navigation and
travel, are much more difficult because of environmental obstacles encountered by the
disabled.
[Link]. Importance of the Assistive Technologies (AT)

Surgery, generic therapy, rehabilitation, human assistance, and the use of assistive
technology (AT) help disabled people cope with their disabilities. Surgery (medical
intervention) helps decrease deficiency and, in some cases, restores capability. Genetic
therapy attempts to remediate genes responsible for a given disease or disorder. Although
promising in concept, genetic therapy is in its infancy and, as yet, has no broad application.
Rehabilitation develops and adapts residual capabilities, while human assistance aids Persons
with disabilities and vulnerabilities in their daily living activities. Unfortunately, such
assistance is not always available and not necessarily cost-effective. AT can increase the
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autonomy, independence, and quality of life for Persons with disabilities and vulnerabilities
and can also enable the integration of social, professional, and environmental aspects of life
for Persons with disabilities and vulnerabilities populations.

AT Definitions
Assistive technology encompasses all systems that are designed for Persons with disabilities
and Vulnerabilities, and that attempt to compensate the handicapped. This includes robotic
tele manipulators, wheelchairs, or navigation systems for the blind. AT also includes systems
that restore personal functionality, such as external prostheses and or theses. There are
various organizational definitions for assistive technology: The international standard ISO
9999 defines AT (refering to AT as technical aid‖) as any product, instrument, equipment or
technical system used by a disabled person, especially produced or generally available,
preventing, compensating, monitoring, relieving or neutralizing the impairment, disability or
handicap‖ . In the United States, the Technology Act and Assistive Technology Act define an
AT device as any item, piece of equipment or product system, whether acquired
commercially, modified, or customized, that is used to increase, maintain, or improve
functional capabilities of individuals with disabilities .These Acts also define an assistive
technology service as any service that directly assists an individual with a disability in the
selection, acquisition, or use, of an assistive technology device.
The Older Americans Act defines AT as technology, engineering methodologies, or scientific
principles appropriate to meet the needs of, and address the barriers confronted by, older
individuals with functional limitations.

In Europe, the European Commission (EC) defines AT as products, devices or equipment

that is used to maintain, increase or improve the functional capabilities of people with
disabilities‖. The World Health Organization (WHO) defines an Assistive Device as-
Equipment that enables an individual who requires assistance to perform the daily activities
essential to maintain health and autonomy and to live as full a life as possible. Such
equipment may include, for example, motorized scooters, walkers, walking sticks, grab rails
and tilt-and-lift chairs‖ WHO also defines assistive technology as-An umbrella term for any
device or system that allows individuals to perform tasks they would otherwise be unable to
do or increases the ease and safety with which tasks can be performed.

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[Link]. AT and Daily Living of Persons with Disabilities and Vulnerabilities

Assistive technology affords Persons with disabilities and vulnerabilities greater equality of
opportunity, by enhancing and expanding their communication, learning, participation, and
achievement with higher levels of independence, wellbeing, and quality of life. Such assistive
technologies are essential for helping persons with disabilities and vulnerabilities with severe
physical, sensorial, or mental limitations to become more independent, and to improve their
quality of life. Persons with disabilities and vulnerabilities utilize AT to enhance the
performance of their daily living tasks, including communication, vision, hearing, recreation,
movement, seating and mobility, reading, learning, writing, and studying, as well as
controlling and accessing their environment.

Assistive Technology varies from low-tech devices such as a cane or adapted loop, to high-
tech systems such as assistive robotics or smart spaces. Currently, most popular technologies
for Persons with disabilities and Vulnerabilities are simple; or examples of mobility-
enhancing equipment include wheelchairs, communication via mobile telephones and
computers, and voice-activated smart devices to enhance environmental control. Advances in
communication and information technologies further support the development of new, more
complex technologies such as utilization of smart wheelchairs, assistive robots, and smart
spaces.
Needs & Barriers: Safety Technologies, Self-care and medication management, social needs
socialization, access to information technology, communication and interaction with environment,
access to public administration and facilities (authorities, banks, public services), shopping recreation
and leisure problems with speech, writing, esteem independence and employment.
Assistive technologies: Mobile systems [phones, wearable electronics, computers,
augmentative and alliterative communication (including I/O interfaces)
(adaptable/configurable interfaces, tactile interfaces), vibrotactile displays reading screen,
speech technologies, augmentative–alliterative communication. Socialization and
entertainment tools (special games, virtual companion‘s videoconferences). Medication
organizers (medication reminder/management), speech technology (audio technology) for I/O
interfaces and control, writing translators, text speech translators, transportation (public
transportation facilities, smart environments home control, pervasive computing, context
awareness, middleware) shopping tools (Internet access) and education tools

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Needs & Barriers are survival, hygiene (toileting, bathing, laundry); feeding (food
preparation, eating, drinking), remembering, housekeeping home cleaning, safety, safety
technologies, safety of environment, self-care and medication management, social needs,
socialization, navigation, access to information technology, education, communication and
interaction with environment, shopping, esteem, independence, employment, recreation and
leisure
Assistive technologies may include: Mobile systems (phones, wearable electronics, and
computers), socialization and entertainment tools (special games, virtual companions,
videoconferences), augmentative and alliterative communication (including I/O interfaces),
adaptable/configurable interfaces, organizer and reminder assistants for timekeeping),
medications, (appointments, hygiene, etc., electronic organizers, medication
reminder/management, procedure assistants, transportation public transportation facilities)
Communication aids (communicators, multimedia procedure, assistants, large-screen
programmable phones, electronic information organizers, electronic mail)

People with Motor Disabilities impairment include Upper-limbs difficulties/ dexterity,

lower limb deficiencies. Needs & Barriers are the need for mobility, working in the
inaccessible environment. Assistive technologies may include orthotics (cognitive orthotics),
smart environments, home control, shopping tools (internet access) and education tools
AT and the Marketplace
Markets for assistive technologies follow the general marketing rule that products introduced
into a market influence the demand and growth of markets for such products. In practice, AT
products can either represent a barrier to demand or become an engine of demand. This
relationship between Persons with disabilities and Vulnerabilities and AT in the marketplace
follows one of two strategies: (1) trivialization or (2) specialization, which are discussed as
follows:
Specialization: is based on the development of products or services that are adapted for
Persons with disabilities. In practice, the AT industry considers Persons with disability
populations as solvent autonomous markets. Developed products are adapted for Persons
with disabilities needs, so the satisfaction of each target population or subpopulation is good,
thereby supporting further product development or adaptation. Nonetheless, the market for
such AT is not growing quickly, owing to (1) development costs, (2) high price of the final
product, and (3) generally low income of people with disabilities. The exception to this rule is

66
products for elderly retired people, which have significantly higher incomes and a much
larger market.
Trivialization: considers Persons with disabilities as an augmentation of the market for
devices used by people without disabilities. In this strategy, industry does not target Persons
with disabilities and Vulnerabilities populations directly. Instead, the products for Persons
with disabilities and Vulnerabilities are of standardized type, that is, generic with
multipurpose capabilities. Given requirements for safety and comfort, these products and
services are designed to be modified or adapted to meet Persons with disabilities and
Vulnerabilities needs. This strategy targets a much larger market but does not consider user
satisfaction among Persons with disabilities and Vulnerabilities.
AT and Design Methods
Given the requirements of functionality, safety, and comfort, the design of AT for Persons
with disabilities and Vulnerabilities requires both excellent engineering capacities and
relevant knowledge about Persons with disabilities and Vulnerabilities characteristics.
Product developers must be fully aware of needs, wants, and capabilities of Persons with
disabilities and Vulnerabilities populations, as well as limitations associated with each
handicap. Numerous design methods have been suggested to assist in the process of AT
development. Most widely known are user centered design and universal design, which are
discussed as follows:
User-centered design is a set of techniques and processes that enable developers to focus on
users, within the design process. In practice, users are involved in the development process,
depending on their skills and experience, and their interaction is facilitated by a domain
expert. The intensity of this involvement varies with the stage of research and product
development. Often, the developed AT meets persons with disabilities satisfaction. However,
this design method is expensive in terms of resources and time expended by engineers and
domain experts. It is also difficult to recruit potential end users and to interact with them,
especially when these end users are older people, or people with disabilities (see also Chapter
34).
Universal design (also called design for all) is the design of products and environments to be
usable by all people, to the greatest extent possible, without the need for adaptation or
specialized design. Here, the design process is guided and constrained by a number of
objectives: accessibility, adaptability, trans generational applicability, and/or universal
applicability or appeal. Universal design does not emphasize differences among persons with

67
disabilities, or between persons with disabilities and the general population. Instead, the ideas
of adapting products, services, or the environment are extended to users at large. In practice,
products are developed to meet the needs of average users. If a user is different, significantly,
from the average population, (e.g., a person with a significant handicap), then, the product
will provide poor user satisfaction.
Universal Design
It is frequently the case that the built environment can be modified permanently so that
functional limitations become less disabling and personal or temporary assistive technologies
are not needed. For example, the presence of ramps increases the ability of wheelchair users
to get around and thus decreases the degree to which the condition that led to their use of a
wheelchair is disabling. The presence of ramps will increase frequency of trips out of the
house and into the community for wheelchair users when ramps are installed in their houses.
Wider doors, lower bathroom sinks, and grab bars are other examples of modifications to
build environments that decrease the degree to which a building itself may be disabling.
Lighting patterns and the materials used for walls and ceilings affect the visual ability of all
people, even though the largest impact may be on improving the ability of the person who is
hard of hearing to hear in a particular room or the ability of a person who is deaf to see an
interpreter or other signers.
Universal design is based on the principle that the built environments and instruments used
for everyday living can be ergonomically designed so that everyone can use them.
Traditionally, architecture and everyday products have been designed for market appeal, with
a greater focus on fashion rather than function. However, as the population of older adults
and people with disabling conditions increases, there has been a greater trend toward
universal design.

Today, with the influence of consumer demand and through thoughtful disability policy,
greater emphasis is placed on the development of built materials that are ergonomically
friendly to users, regardless of their abilities. Universal design is an enabling factor in the
environment that allows the user with a functional limitation to become more independent,
yet without an additional cost or stigma attached to the particular product. For example,
people who were deaf previously had to purchase an expensive closed-captioning unit to
attach to their television sets to view closed-captioned programs. Today, as a result of new
federal legislation, all new television sets are manufactured with a closed-captioning

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microchip that allows any user access to broadcast closed captioning. Thus, it is useful not
only for deaf users but also for other vulnerable groups, such as older individuals who are
starting to lose their audio acuity, or a person watching a late-night talk show in the bedroom
who does not want to wake his or her partner. In all of these ways, the environment affects
the degree to which a functional limitation is disabling for a person. However, decisions
about the use of technology or built environments are social decisions. The next major
section considers the effects of the social and psychological environments on the extent to
which a particular functional limitation will be disabling or not.

Implementing Inclusive Job Opportunities

The right to work is fundamental to being a full and equal member of society, and it applies
to all persons, regardless of whether or not they have a disability. A decent job in the open
labor market is a key bulwark against poverty. It also enables people to build self-esteem,
form social relationships, and to gain skills and knowledge. Moreover, a productive
workforce is essential for overall economic growth. Barriers to employment thus not only
affect individuals’ lives, but the entire economy. Despite the fact that the majority of jobs can
be performed by individuals with disabilities, the pathways to their employment are often
strewn with barriers. An OECD study of its members showed that persons without disabilities
were nearly three times more likely than persons with disabilities to participate in the labor
market.2 Evidence suggests the same is true for countries in the Asia and Pacific region,
although data to illustrate the full extent of this trend is scarce. The employment gaps
suggested above are likely to understate the divergent work experiences of persons with and
without disabilities, since they do not factor in differences in type of employment. Persons
with disabilities and vulnerabilities are more likely to be own-account workers and occupy
jobs in the informal sector, often without the security offered by work contracts, salaries,
pension schemes, health insurance and other benefits. Even when persons with disabilities are
formally employed, they are more likely to be in low-paid, low-level positions with poor
prospects for career development. Simple comparisons of the employment rates for persons
with and without disabilities can therefore be misleading.

The recently adopted 2030 Agenda for Sustainable Development calls on governments
around the world to promote full employment and decent work for all, including persons with
disabilities and vulnerabilities. Besides directly targeting employment, the 2030 Agenda and

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the accompanying SDGs also emphasize the need to guarantee the rights of persons with
disabilities and vulnerabilities to equal and accessible education; social, economic and
political inclusion, and access to cities, transport systems and public space.
Barriers of employment
Barriers to the employment of persons with disabilities take many forms and operate at many
levels, both within and beyond the workplace itself. Persons with disabilities may be
prevented from working due to inaccessible transportation services; the lack of accessible
information and communications services; the preference of employers for candidates
without disabilities; legal stipulations that prevent individuals with particular impairments
from working in certain fields; or the discouragement of family and community members.
Whilst these obstacles are often interconnected, and act collectively to limit employment
opportunities for persons with disabilities, it is essential to distinguish between different
barriers in order to develop effective policy responses. The major types of barriers are
described below.
Attitudes and Discrimination: Employers may be reluctant to hire persons with disabilities
based on the perception that they are less productive or less capable of carrying out their jobs
than others. Colleagues of persons with disabilities may also hold prejudicial attitudes. At a
wider level, social attitudes that cast persons with disabilities as objects of pity and need
perpetuate the assumption that they should not work. In some cultures, people view
disabilities as being indicative of wrongdoing in a past life, or are simply uncomfortable
around people who seem different. Persons with disabilities may also be discouraged from
working by their families, often out of a sense of shame or a well-intentioned but stifling
desire not to impose additional burden on their family members.

Though there are laws and regulations in some sectors, majority of social and economic
sectors in Ethiopian do not yet have anti-discrimination legislation that specifically targets
the employment of persons with disabilities. Discrimination is a major barrier faced by
persons with disabilities in their efforts to find employment in the labour market. Clearly,
there needs to be greater awareness about the need to break down barriers faced by persons
with disabilities be it lack of accessibility features in public services or of laws that protect
persons with disabilities from discrimination by employers.
Accessibility: The accessibility of the following areas is crucial to the employment of
persons with disabilities: the physical environment; transportation; information and

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communications; and other facilities open to the public. In the workplace itself, a lack of
physical features such as ramps and elevators can prevent persons with mobility disabilities
from being able to work. Similarly, the lack of accessible information and communication
infrastructure in workplaces such as clear signage, computers equipped with software such as
screen-readers, and devices such as Braille displays can prevent persons with print and
intellectual disabilities from being able to gain employment. Lack of access to sign language
interpretation or captioning services can inhibit the employment of deaf people. In addition to
the informational and physical design of the workplace itself, the broader inaccessibility of
public environments and crucially, transport, can prevent persons with disabilities from being
able to travel to work, receive information about job opportunities, and communicate with
employers.
Education and Training: Persons with disabilities have disproportionately restricted access to
education and training. This severely limits their job opportunities due to a lack of skills and
knowledge that are relevant to find or retain a job. Children with disabilities are less likely to
attend school, and when they do they are less likely to stay in school.18 In Indonesia,
children with disabilities are one third less likely to complete their primary education as those
without a disability. In India in 2007, close to 40 per cent of children with disabilities were
not enrolled in school, compared to only between 8 and 10 per cent of children in scheduled
tribes or castes groups that also face high levels of discrimination and poorer socio-economic
outcomes. Notwithstanding the numerous other barriers they face, persons with disabilities
are thus often prevented from being able to acquire the human capital necessary to effectively
compete for jobs. In addition, young persons with disabilities who have attended school may
not get the support they need when transitioning from school to work.
Social Networks: Another barrier to employment for persons with disabilities can be their
more limited social networks. Social networks greatly aid the process of searching for work,
the lack of which is likely to limit options for persons with disabilities. As part of their
broader exclusion from many important social activities, persons with disabilities often
therefore lack the opportunity to build social relationships with those who may be in a
position to offer suggestions for potential work opportunities. These limited networks are part
of the broader cultural and attitudinal barriers that inhibit participation in social, leisure,
civic, and religious activities. A key benefit brought by employment itself is the building of
social relationships with colleagues, clients and business partners. As a result of the barriers

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they face in entering and retaining work, many persons with disabilities are also denied the
possibility of expanding their networks at the workplace itself.
Women and disabilities: In many developing countries including Ethiopia, as a result of
continued prejudices both towards women and surrounding disability, women with
disabilities are doubly discriminated against in the labor market. Study found that in many
developing countries, women with disabilities are only half as likely as men with disabilities
to have a job. Moreover, when they are employed, women with disabilities encounter worse
working conditions and lower pay as compared with other women, as well as men with
disabilities. Women with disabilities are also less likely to receive education and vocational
training, and those women who do access education and attain a degree of financial stability
are more likely to have done so before acquiring their disability. However, it remains difficult
to quantify these trends as a result of the limited availability of reliable data that is
disaggregated by both sex and disability. Not only the particular difficulties faced by women
with disabilities as they search for work, but also the significance of social networks in
sharing potential employment opportunities. The governments and NGOs must ultimately
step up to improve the precarious economic situation many women with disabilities find
themselves in.
Legal Barriers: As a result of discriminatory attitudes about the perceived capabilities of
persons with disabilities, some countries impose legal restrictions on their participation in
certain types of employment or processes. In some countries, people must be considered
physically and mentally healthy‘ or sound‘ to represent oneself in a court of law, to occupy
official positions, or to use certain public services.25 Such laws effectively rule out large
numbers of persons with disabilities from accessing employment, based on the blanket
assumption that they are incapable of doing particular jobs effectively. Japan is one country
that previously had such laws, but has taken action to rectify them.
Inflexible work arrangements: Another common obstacle to the employment of persons
with disabilities is the inflexibility of work arrangements. In some cases, persons with
disabilities might prove to be competent and productive employees, but are nonetheless
unable to perform certain tasks. The same is true for scheduling the work day. Persons with
disabilities may have particular transportation issues or other needs that require a slightly
different work day. An employer‘s willingness to rearrange the responsibilities and schedules
associated with a particular job can mean the difference between employment and
unemployment for many persons with disabilities. Indeed, a greater degree of flexibility of

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working arrangements can boost the morale and productivity of any employee, regardless of
whether or not they have a disability.
Dismissal on the basis of disability: Workers who are injured and acquire a disability on the
job may face unaccommodating policies and a lack of rehabilitative services, which limit
their ability to return to work. The absence of anti-discrimination legislation in the majority
of countries in the region thus allows employers to dismiss staff on the basis of disability
with impunity. Several countries, such as Iran, offer rehabilitation programs and services to
help dismissed workers to find new employment. Ultimately though, legislation which
protects the rights of workers from dismissal on the basis of disability is also needed to more
comprehensively tackle the problem

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The Benefit of Trap
Another obstacle to the employment of persons with disabilities can ironically be imposed by
social protection schemes ultimately designed to support them. These schemes can encourage
individuals to stay out of the labor force if they are structured in such a way as to make the
receipt of benefits contingent on the inability to work. Therefore, even if persons with
disabilities believe that they can work, they may choose not to in order to continue receiving
disability benefits. Even if working could offer them a higher level of income, persons with
disabilities may still choose to receive benefits because of the risk of attempting to hold down
a job that does not provide adequate support, or is not flexible towards their needs. It is
important to stress that this benefit trap’ is mainly relevant to more developed countries with
more generous benefit schemes. The situation in most of the region‘s middle-to-low income
countries is entirely different. However, it is vital for governments to avoid creating strong
work disincentives.
3.1.10. Strategies to Improve Employment for Persons with Disabilities and
Vulnerabilities

There a number of strategies that is available to governments in respective sector as they

work to improve the employment prospects of persons with disabilities, vulnerable and
marginalized groups. In addition, private sector initiatives that have been demonstrated to
improve the employment experiences of persons with in these groups are also discussed
below.
Anti-Discrimination Legislation: These laws make it illegal to discriminate against an
individual on the basis of disability in a range of areas including: employment; education;
access to public buildings; the provision of goods and services, and political processes. With
regard to employment, anti-discrimination laws protect persons with disabilities from
discriminatory actions in hiring and termination of contracts and affirm the right of persons
with disabilities to access employment on an equal basis with others. Anti-discrimination
laws challenge collectively held discriminatory attitudes against persons with disabilities by
influencing the nexus between law, norms and social mores. Anti-discrimination laws can be
made stronger when they include mandates for reasonable accommodations that remove
additional barriers to employment for persons with disabilities. Crucially, however, these
laws must outline clear enforcement mechanisms.
When penalties are neither stipulated nor enforced, employers are left free to discriminate
with impunity.
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Vocational Education and Training: Technical vocational education and training (TVET)
programs can help to ensure that the workforce has the skills and knowledge necessary to
obtain and retain a job, while also driving productivity and economic growth. Persons with
disabilities often have limited opportunities to build skills and knowledge that are relevant to
the labor market. A vital first step in improving access to employment for persons with
disabilities is therefore to ensure that employment support and vocational programs are as
inclusive as possible. Such programs should also be held in accessible locations, and
reasonable accommodations should be made to improve the access of persons with
disabilities. Some persons with disabilities may not be able to attend mainstream training
programs. In such situations, to allow them to participate, programs targeted at persons with
disabilities may be required. It is crucial; however, that the content of such training programs
is geared to labor market demands, and not determined by prior beliefs about what persons
with disabilities should do or are capable of doing.
Wage Subsidies: Wage subsidies cover a portion of employees’ wages, usually for a limited
period of time, as a way to lessen the risk perceived by employers of hiring persons with
disabilities. Since wage subsidies directly target the recruitment process of private firms, they
enable employers to overcome their reservations about hiring employees with disabilities. It
is vital that care is taken in determining the eligibility, amount and duration of subsidies, to
avoid the subsidies exceeding the actual gap in productivity between persons with and
without disabilities. Studies on the impact of subsides show mixed results on employment
rates. Most studies suggest, however, that both workers and employers are satisfied with
wage subsidy schemes.
Supported Employment
These programs integrate persons with disabilities into the open labor market by providing
direct, on-the-job support to employees with disabilities. Supports are usually offered for a
limited period of time. One common type of support is a job coach. Job coaches provide
onsite, individually tailored assistance to help persons with disabilities perform their jobs.
Coaches also help persons with disabilities adjust to their working environment, and assist in
determining which accessibility accommodations are necessary. Supported employment has
been shown to be particularly cost-effective for people with intellectual and psychosocial
disabilities, in terms of productivity and health related costs. Supported employment requires
employers to be open to having such services on site, and to be willing to work cooperatively

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with job coaches and other service providers. Employment support services and job coaches
require special training.
Workplace accommodation schemes: These schemes reduce the costs to employers of
making workplaces more accessible to persons with disabilities. In so doing, workplace
accommodation schemes seek to minimize employer reluctance to hire persons with
disabilities. There are two ways Government programs can decrease or even eliminate those
costs. The first is by offering tax breaks or tax credits for expenditures undertaken to make
such adjustments. This strategy may, however, be less effective for small businesses with
cash flow issues or limited tax liability. Another strategy is to provide full or partial funds for
reasonable accommodations for employees with disabilities. Such funding can be provided in
various ways, either through employment agencies, using fines from quota systems, or by
offering grants to employers from separate Government agencies. Investment in assistive
equipment for employees returned costs by about eight times through increased productivity
and reduced absenteeism.
F) Workers’ Compensation

These programs are designed to address the issue of occupational injuries and illnesses. They
provide cash and medical benefits to employees whose disability is acquired in the
workplace. Generally, workers compensation operates through insurance programs either
through public insurance programs, or private or even self-insurance at large firms. Because
employer premiums are experience rated, they are higher for firms with more accidents.
Thus, the approach incentivizes workplace safety and encourages employers to support
employees who acquire disabilities at work to be able to return to their jobs. In many
countries, employers are legally mandated to establish workers compensation programs.
Quota Systems: Quota systems mandate that firms hire at minimum a certain percentage of
persons with disabilities. Typically, quotas apply only to large employers. Empirical data
points to only small net employment gains of persons with disabilities. In addition, quotas
can prove difficult to both monitor and enforce. Moreover, by obliging employers to hire a
specific number of persons with disabilities, quota systems perpetuate the prejudice that
persons with disabilities are not really equivalent to others in their capacity to be productive.
Sheltered Workshops: These programs only hire persons with disabilities, and structure jobs
around the perceived abilities of each employee. Sometimes the stated goal of sheltered
workshops is to serve as a training ground for the eventual transition of employees to the
open labor market. In reality, however, employees with disabilities are rarely supported to
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make this transition. Employees are generally paid poorly, and the workshops in which they
work are seen as charitable enterprises and are funded as such, with revenues being a function
not of sales but of the number of employees. Rather than promoting sheltered workshops,
governments can serve their citizens with disabilities better by removing barriers towards
their employment in the open labor market. Persons with severe disabilities may find it
difficult to enter the open labor market, even if other barriers to their employment are
removed. In certain cases therefore, programs that create non-competitive job opportunities
may be necessary. Government and public agencies should be mandated by law to
preferentially procure certain products from such workshops in order to guarantee a stable
income for their employees with severe disabilities.
Private Sector initiatives: In addition to government-driven strategies, a number of private-
sector initiatives also serve to illustrate the need for action to be taken not only by
governments, but by employers themselves.
Employer Networks: A number of networks of private companies around the world have
initiated their own programs to promote the employment of persons with disabilities.
Sometimes these organizations are established in response to the creation of a quota policy,
sometimes out of a sense of corporate social responsibility, and sometimes because of a
compelling business case for being more inclusive.
The main activities of employer organizations include:

• Raising awareness and building capacity on disability inclusion;

• Providing information and tools on disability and employment;

• Influencing policy on the employment and training of persons with disabilities;

• Providing career development opportunities and organizing vocational training;

• Linking jobseekers with disabilities and employers;

Support disability-inclusive business: Private employers can play an important role in

developing policies and programs to boost employment for persons with disabilities, as well
as their own bottom line. It is recommended that governments:
a) Introduce programs to raise awareness among private employers of the business
case for hiring persons with disabilities.
b) Support employer’ organizations and networks to share inclusion practices and
build their capacities to harness the potential of employees with disabilities.

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 Disability-Inclusive Business a number of large employers should be proactive in
promoting disability inclusion within their businesses. Many of these businesses draw on their
positive experiences of hiring persons with disabilities to demonstrate the business case for
inclusive employment, citing that persons with disabilities:
• Have higher retention and lower accident rates than employees without
disabilities, and comparable productivity;
• Represent an untapped source of skills and talent and transferable problem
solving skills developed in daily life;
• Often have valuable skills and experiences learned on the job prior to having a
disability;
• Can provide unique insights to help firms to develop their products or services
to customers and clients with disabilities;
• Can improve the company‘s image, increasing morale, creating links to the
community, and appealing to potential customers who have a disability or
whose family members have a disability.
Social enterprises: Social enterprises are businesses that seek to advance a social cause
whilst being financially self-sustainable. Rather than being driven solely by the desire to
make profits, these businesses also aim to maximize social impact. Social enterprises that
consciously seek to hire persons with disabilities, or address issues and barriers affecting the
lives of persons with disabilities can therefore help to boost the employment of persons with
disabilities, and also influence wider social change. Box 10 shows an example of a disability-
inclusive social enterprise.
Support persons with disabilities in the workplace: Governments can enhance the working
experiences of persons with disabilities firstly by leading by example in terms of public
sector employment practices, and secondly by establishing programs and services that
support persons with disabilities to do their jobs effectively. It is therefore recommended that
governments:
a) Promote flexible working arrangements to ensure that qualified, productive individuals are
not unnecessarily prevented from doing certain jobs.
b) Provide funding support and tax incentives to start ups and social enterprise
initiatives that aim to hire persons with disabilities or address specific needs of persons
with disabilities.

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 c) Provide subsidies or tax incentives that support the inclusion of persons with
disabilities in the workplace.
d) Develop job coach accreditation and training standards and provide job coaching
services to enable persons with disabilities to do their jobs effectively and
productively.
Building a more inclusive society: in order to create more accessible physical environments,
public transport and knowledge, information and communication services, and government
should facilitate opportunities for persons with disabilities to work as well as society at large.
It is recommended that governments:
a) Develop and implement accessibility standards for the physical environment in line with
universal design, including public buildings and transport services, to ensure that individuals
with mobility disabilities are not denied employment opportunities.
b) Promote and provide knowledge, information and communication services in accessible
formats, in line with universal design, to meet the needs of persons with sensory, intellectual
and psychosocial disabilities to apply for and retain a job.
Foster greater social inclusion by establishing links with disabled persons’ organizations,
including groups of women with disabilities, and working to promote employment
opportunities.
Boost education and training opportunities: Education and training is vital for all
individuals to develop their human capital, and to acquire skills and knowledge relevant to
the labor market. Governments must therefore ensure that persons with disabilities are able to
access education and training on an equal basis with others. It is recommended that
governments:
a) Make education systems more inclusive, both to make schools more accessible to children
with disabilities, and to modify instruction to meet the needs of all children.
Mainstream disability inclusion into technical vocational education and training (TVET)
programs, to support persons with disabilities to acquire knowledge and skills necessary to
find and retain decent work.
Break down attitudinal barriers and challenge discrimination: Discriminatory attitudes
towards persons with disabilities inform and produce other barriers to the full and equal
participation of persons with disabilities in society, including in employment. For
governments to better understand and challenge attitudinal barriers, it is essential to:

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 a) Undertake research to examine the causes and manifestations of discriminatory
attitudes towards persons with disabilities across society.
a) Launch public awareness campaigns and programs to promote the rights of persons
with disabilities and to challenge discriminatory attitudes surrounding disability.
Conduct disability awareness training such as Disability Equality Training for public
employees at the national and local levels.
Improve data collection on disability and employment: Designing, monitoring and
evaluating policies to promote decent work for persons with disabilities requires timely and
high quality information. It is recommended that governments:
a) Include the six core Washington Group questions on disability in labor force
surveys so that reliable, internationally comparable indicators on employment and
disability can be generated on a regular basis.
b) Conduct disability-dedicated surveys to improve the quality of data and
understanding on barriers to employment and in turn develop more responsive
policies.
c) Take a consistent approach to disability identification so that multiple data sources
can be used in conjunction to get a more complete picture of the experiences of
persons with disabilities.

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