Intersectionality
• gender and identity
• Age and being rural and urban environment
• economic and Religious, social changes have also
impact on the life of persons with disabilities.
The Health Care Needs of Persons with Disabilities and Vulnerabilities
People with disabilities report seeking more health
care than people without disabilities and have
greater unmet needs.
• no treatment-(mental illness)
receive less screening for breast and cervical
cancer(women with disabilities)
• less likely to have their weight
checked(intellectual limitation).
Conditions of disability
Persons with disabilities may experience greater
vulnerability to:
secondary conditions
co-morbid conditions
age-related conditions
Engaging in health risk behaviors and higher rates
of premature death.
Barriers to Health Care for Persons with Disabilities and Vulnerable Groups
a) Prohibitive costs
b) Limited availability of services
c) Physical barriers
d) Inadequate skills and knowledge of health
workers
Addressing for Inclusive Barriers to Health Care
a) Policy and legislation
b) Financing
c) Service delivery
d) Human resources
Disability, vulnerability and the
Environment
disability is seen to result from the interaction between
the characteristics of individuals with disabilities and
the characteristics of their environment.
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
and
the extent to which the physical, built environment is
accommodating or not accommodating to the
particular disabling condition
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.
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.
in addition 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
The environmental mat may be conceived of as having two major parts:
the physical environment and the social and psychological
environments.
Environment
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.
Con’d
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.
con’d
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
.
A) 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.
B) 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
Con’d
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.
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
Examples of Environmental Modification
Mobility aids
Hand Orthosis
Mouth stick
Prosthetic limb
Wheelchair (manual and/or motorized
Canes
Crutches
Braces
Con’d
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
Con’d
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
Con’d
Accessible features
Built up handles
Voice-activated
computer
Automobile hand controls
Con’d
Job accommodations
Simplification of task
Flexible work hours
Rest breaks
Splitting job into parts
Relegate nonessential functions to others
Con’d
Differential use of personnel
Personal care assistants
Note takers
Secretaries Editors
Sign language interpreters
Con’d
Culture and the
Disabling Process
Con’d
Culture affects the enabling-disabling process at
each stage; it also affects the transition from
one stage to another.
Element of Social and Psychological Environment
Culture Psychological Political Economic
Expecting Having an Mandating Tax credits
people with active relay to hire
disabling coping systems in people with
Enabling conditions strategy all states disabling
to be conditions
productive
Stigmatizing Denial Segregating No subsidies
people with children or tax
disabling with credits for
Disabling conditions mobility purchasing
impairments assistive
in schools technology
Pathway from Functional Limitation to Disability
• the transition from functional limitation to
disability is affected by culture.
• the functional limitation would not become a
disability
• The culture defines the roles to be played and the
actions and capacities necessary to satisfy that
role
• A disability can exist without functional limitation
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
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.
Disability Inclusive Intervention and Rehabilitation
Services
To implement disability inclusion The twin-track
approaches
(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
Strategies to Disability inclusive 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.
Con’d
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)
Con’d
• 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).
Con’d
• 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).
Implementing the Twin-track Approach
• Track 1: Mainstreaming disability as a
cross-cutting issue
• Track 2: Supporting the specific needs of
vulnerable groups with disabilities
Con’d
Implement Disability Inclusive Project/ Program
Education and vocational training
Health
Relief and social services
Infrastructure and camp improvement, shelter, water and sanitation and
environmental health
Livelihoods, employment and microfinance
Protection
Humanitarian and emergency response
Implement effective Intervention and Rehabilitation
Rehabilitation interventions promote a
comprehensive process to facilitate attainment of
the optimal physical, psychological, cognitive,
behavioral, social, vocational, avocational, and
educational status
Community-Based Rehabilitation
• 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
Components of Rehabilitation Interventions
•Multiple Disciplines
•Physicians
•Occupational Therapists
•Physical Therapists
•Speech and Language Therapist
•Audiologists
•Rehabilitation Nurses
•Social Workers
•Case Managers
•Rehabilitation Psychologists
•Neuropsychologists
•Therapeutic Recreation Specialists
•Rehabilitation Counselors
•Orthotists and Prosthetists
•Additional Rehabilitation Professionals
•Person with the Disability and His or Her Family
•Community-Based Rehabilitation
•
Con’d
• 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.
•
Con’d
1. Community based rehabilitation is a strategy that can address the needs of
peoples with disabilities with in their communities (WHO, UNESCO, 2004).
2. Community based rehabilitation is a common sense strategy for enhancing the
quality of life of peoples with disabilities by improving services delivery in
order to reach all in need by providing more equitable opportunities and by
promoting and protecting their rights
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.
Con’d
Currently, three main meanings are attached to
the notion of CBR:
People Taking Care of Themselves
A Concept and an Ideology
Community Based Rehabilitation
Assistive technology
AT and User Needs: A Classification Scheme
A. People with Communication Disabilities refers to
Needs & Barriers
Assistive technologies
B. People with Cognitive Disabilities: The impairments may include
Needs & Barriers are
Assistive technologies may include
C. People with Motor Disabilities impairment include
Needs & Barriers are
Assistive technologies may include
AT and the Marketplace
• 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
• Trivialization
Barriers of employment
Barriers for employment and job opportunities for persons with disabilities and
vulnerable group:
a)Attitudes and Discrimination
b)Accessibility
c) Education and Training
d)Social Networks
e)Women Disabilities
f) Legal Barriers
g) Inflexible Work Arrangements
h)Dismissal on the Basis of Disability
i) The Benefit Trap
Strategies to Improve Employment for Persons with Disabilities and Vulnerabilities
[Link]-Discrimination Legislation
[Link] Education And Training
[Link] Subsidies
[Link] Employment
[Link] Accommodation Schemes
[Link]’ Compensation
[Link] Systems
[Link] Workshops
[Link] Sector Initiatives
[Link] Networks
[Link] Disability-Inclusive Business
[Link] Enterprises
[Link] Persons with Disabilities in the Workplace
[Link] a More Inclusive Society
[Link] Education and Training Opportunities
[Link] Down Attitudinal Barriers and Challenge Discrimination
[Link] Data Collection on Disability and Employment
