In societies in which most adults with intellectual disabilities need adequate engagement in substantial amount of physical labour as per their abilities for achievement of independent living. In our Indian situation we never try for sustainability of the abilities for independent living.
Few people are sensitive or patient enough to understand a disabled person's problems. Daily life throws up numerous challenges and people are often at the receiving end of some misplaced sympathy or charity.
In the 1950s and 1960s, a shift in the trend of services from institutions to community for the disabled persons took place in the developed countries such as the United States. Since then, community participation in the rehabilitation of the disabled is gaining momentum. This change of outlook has promoted growth of concepts like normalization, education in a least restrictive environment, home based skill training and additional support services for parents, family and community.
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The enthusiasm generated by the community based service movements stimulated the World Health Organization (WHO) to bring out two technical reports in 1958 and 1969, which suggested that rehabilitation should be a natural and essential component of health care. The Alma Ata Declaration of 1978 further endorsed the view that rehabilitation services should be part of 'Health for All' by 2000 AD. The Community Based Rehabilitation (CBR) approach received global recognition with the 1982 United Nation's declaration of the Decade of Disabled Persons and the adoption of the World Programme of Action Concerning Disabled Persons. The philosophy of CBR was to integrate disabled people into the societal mainstream rather than create special environments for them. WHO recommended that CBR should be set in the context of community services, especially in relation to primary health care. Though the term CBR received unqualified support internationally, there is a great disparity in its interpretation and it has generated controversies over its application in practice.
The term rehabilitation refers to any process, procedure or program that enables an individual with disability to function as a more dependent and personally satisfying level. This functioning should include all aspects- physical, mental, emotional and vocational of the individual's life (Levison, 1994).
APPROACH TO REHABILITATION
ILO Definition: "Rehabilitation involves the combined and coordinated use of medical, Social, educational and vocational measures for retraining the individual to the highest possible level of functional ability."
Sight Savers Definition: "Rehabilitation is a need-based, goal oriented, time limited process of providing a disabled person with the knowledge and skills required, together with the requisite special equipment and training in the use of that equipment, with in an individually appropriate time frame, thus empowering him to change his life and to participate actively in his family and community to the fullest extent possible.
COMMUNITY BASED REHABILITATION (CBR)
The community based rehabilitation is an extension of the term rehabilitation with the major difference in the mode of delivery of services and the venue for imparting training and other inputs leading to comprehensive rehabilitation. When the term CBR is expatiated, it means imparting training and providing services to the individual in the community itself with the active participation of the family and the community leading to comprehensive rehabilitation.
According to Narayan and Shiv Kumar (2002) the ultimate objective of any training is towards achieving personal adequacy, social competency and economic independence in the trainee. Through CBR if we achieve these objectives for the person with intellectual disabilities, there should be careful planning for the simple reason that the person with mental retardation have difficulty in 'critical thinking' and 'independent action' due to their cognitive deficits. This demands active family and community participation in decision making and problem solving on behalf of persons affected, as, many a time, her/his contribution in these aspects are limited. Nevertheless, given an opportunity s/he can be certainly a contributing member in her/his family.
WHO Definition of CBR: "CBR involves measures taken at the community level to use and build on the resources of the community, including the impaired, disabled and the handicapped persons themselves, their families and their community as a whole."
The programme to be successful should focus on preventive and restorative aspects through empowering the community to participate fully in taking along their members who need help. There are many ways to explain CBR, some of the ideas are given below:
Always on Time
Marked to Standard
CBR is a strategy within the community for the rehabilitation, equalization of opportunities and social; integration of all the people with disabilities.
CBR is implemented through the combined efforts of people with disability themselves, their family and communities, appropriate health, educational, vocational and social services.
CBR is a need based rehabilitation done in the community at the community level by utilizing the contribution of the community. People with disability and their families are intensively involved in the decision making process as are the members of the community.
NEED AND SIGNIFICANCE OF THE STUDY
Community-based rehabilitation (CBR) has been advocated internationally for more than 20 years as the core strategy for improvement of the quality of life of persons with disabilities. Despite emphasizing that disabled persons should be active partners in the planning and implementation of all measures affecting their civil, political, economic, social and cultural rights, persons with disabilities have not yet become sufficiently involved in evaluations and impact assessments. Based on these observations of gaps in previous evaluations, the Swedish Organizations of Disabled Persons International Aid Association (SHIA) and the World Health Organization (WHO) have concluded that it is timely to study the impact of the CBR strategy, after its 20 years of existence, from the perspective of persons with disabilities, including both children and adults.
The aim of the study is to examine the impact of CBR programmes on the quality of life of disabled persons and to identify the CBR initiatives perceived as being the most useful. The study is not attempting to evaluate the different programmes in relation to their particular objectives and strategies. Instead, it attempts to give voice to the experiences of persons with disabilities in some programmes with different aims, structures and strategies.
The way of reaching out to the unreached intellectually challenged persons particularly in rural areas is to initiate and implement Community Based Rehabilitation Programme (CBR). It is not a matter of choice but a compulsion for our country.
Hence, in this background the present study was planned to be undertaken.
OBJECTIVES OF THE STUDY
To compare the impact of home based educational programme for the persons with Intellectual Disability under CBR Project Unit schools.
To compare the impact of home based educational programme for the persons with Intellectual Disability under Special Schools Setup.
There exists a significant difference in the mean scores before and after implementation of home based educational programme for intellectually disabled persons in CBR Project Unit schools.
There exists a significant difference in the mean scores before and after implementation of home based educational programme for intellectually disabled persons in Special school setup.
There exists a significant difference in the mean scores after implementation of home based educational programme on the quality of life of intellectually disabled persons under CBR Project Unit and special school setup.
By seeing the nature of the present study exploratory method of educational research was used.
DESIGN OF THE STUDY
Pre-Test - Post Test Research Design was used in order to test the hypotheses.
POPULATION AND SAMPLE
All the persons with intellectual disability of Odisha state comprised of the population of the present study.
In the present study three Schools having CBR Project Units and three Special schools for Persons with Intellectual disability were selected purposively. Out of these selected schools sample of 46 subjects with intellectual disability in CBR Project Unit and 40 Persons with intellectual disability from Special Schools were included in sample selected on the basis of purposive sampling method.
In the present study the following tools were used.
I. Case Record Proforma
This Proforma is developed by National Institute for the Mentally Handicapped (NIMH), Secunderabad, India, in the year 1985. It is used for collection of detailed case history of the individual under study. The case information was recorded under the 18 Heads.
II. Madras Developmental Programming System (MDPS)
Prof. Jaychandran and P. Vimla developed MDPS in the year 1985, to assess the Behavioural manifestation in the child. It contains checklist of functional statements covering 18 domains (each domain listing 20 items arranged hierarchically from early years competency to adult stages of functioning) cover functional adaptive behaviours suitable in Indian culture and conditions. This tool is applicable for all age groups ranging from Early Intervention, Special School, Home Based and Community Based settings.
III. Intervention Programme
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After identification of subjects on the basis of the scores obtained on MDPS, the treatment in the form of Educational and Rehabilitation Programme was give to the CBR workers and Volunteer by the investigator. Investigator has implemented CBR based strategies to the sample subjects under the study.
RESULTS OF HYPOTHESES
Hypothesis No-1 There exists a significant difference in the mean scores before and after implementation of home based educational programme for intellectually disabled persons in CBR Project Unit schools.
Significance Difference between Mean Scores of before and after implementation of home based educational programme for intellectually disabled persons in CBR Project Unit schools
Level of Significance
*N.S- Not significant at 0.01 level of significance
It can be observed from table 1 that the mean attitude scores of male and female teachers towards inclusion of disabled children are 62.76 and 63.87 with corresponding S.Ds 4.57 and 2.93 respectively. The calculated't' value (1.82) of male and female teachers' attitude towards inclusion of disabled children in the regular classroom is not significant at 0.01 level of significance with df / 158. Hence, hypothesis No. 1 which is stated earlier is not retained. It means that the attitude of male and female secondary school teachers' towards inclusion of disabled children in the regular classroom do not differs significantly.
Hypothesis No-2 There exists a significant difference in the mean scores before and after implementation of home based educational programme for intellectually disabled persons in Special school setup
Significance Difference between Mean Scores of before and after implementation of home based educational programme for intellectually disabled persons in Special schools setup
Level of Significance
*Sig - Significant at 0.01 level of Significance
It is indicated from table 2 that the mean attitude scores of urban and rural teachers towards inclusion of disabled children are 66.89 and 63.43 with corresponding S.Ds 3.10 and 3.88 respectively. The obtained't' value (6.07) of urban and rural teachers' attitude towards inclusion of disabled children in the regular classroom is significant at 0.01 level of significance with df / 158. Hence, hypothesis No. 2 which is stated earlier is retained. It means that the attitude of urban and rural secondary school teachers' towards inclusion of disabled children in the regular classroom differs significantly. Further, it reveals that urban teachers were tend to have more aware towards inclusion of disabled children in regular classroom as compare to rural background teachers
Hypothesis No-3 There exists a significant difference in the mean scores after implementation of home based educational programme on the quality of life of intellectually disabled persons under CBR Project Unit and special school setup
Significance Difference in Mean Scores after implementation of home based educational programme on the quality of life of intellectually disabled persons under CBR Project Unit and special school setup
P > 0.01
* Significant at 0.01 Level of significance
It reveals from the table 3 that the mean attitude scores of More experienced and less experienced teachers towards inclusion of disabled children are 62.39 and 64.26 with corresponding S.Ds 3.41 and 3.86 respectively. The obtained t-ratio (2.92) of more experienced and less experienced teachers' attitude towards the inclusion of disabled children in regular classroom is significant at 0.01 level of significance with df/158. Hence, hypothesis No.3 is retained. It means that there is significant difference between the attitude of more experienced and less experienced teachers towards the inclusion of disabled children in regular classroom. Further, it shows more experienced teachers were tend to have more aware towards inclusion of disabled children in regular class as compare to less experienced teachers towards the inclusion of disabled children in regular classroom.
(1) It was found that most of teachers were aware about inclusion of disabled children in the regular classroom but still there is a need to spread of awareness among the teachers of secondary schools towards the inclusion of disabled children in regular classroom.
(2) There is no significant difference in the attitude of male and female teachers towards the inclusion of disabled children in regular classroom. As the mean of male teachers are 62.76 and the mean of female teachers are 63.87 respectively. Further, it shows that both male and female teachers were having similar kind of awareness about the inclusion of disabled children in the regular classroom.
(3) There is significant difference in the attitude of urban and rural secondary school teachers towards the inclusion of disabled children in regular classroom, the means of regular teachers are 66.89 and the mean of rural teachers are 63.43 respectively, it revealed that urban teachers were tends to have more awareness towards the inclusions of disabled children in regular classroom as compare to rural background teachers.
(4) There is significant difference in the attitude of more experienced and less experienced teachers towards the inclusion of disabled children in regular classroom the mean of more experienced teachers are 62.39 and the mean of less experienced teachers are 64.26 respectively. Further it revealed that more experienced teachers were tends to have more awareness towards the inclusions of disabled children in regular classroom as less experienced teachers.
The most outstanding characteristics of any research are that it must contribute something new to the development of the area concerned. So, the investigator has drawn some educational implications that have emerged out from the study. The present has its implications based on findings. The present study has implications for teachers, parents, administrator, policy maker, govt. and private sector, NGOs etc. Since, the present study is conducted on the attitudes of the teachers towards the inclusive education; the study has some practical implications for teachers.
It has been found from the drawn findings on the basis of percentages of the present study that almost all the teachers were aware about inclusions of disabled children in the regular classrooms, but still there is need to spread the awareness regarding inclusions of special education need children in regular classroom.
It is necessary because the teachers belong to rural background and keeping more than 8 years teaching experience exhibit less positive attitude towards inclusion of disabled children in regular classroom.
Therefore, need is felt to organize some awareness programmes to inculcate the positive attitude and bring about more awareness among these teachers toward the equal opportunity of educational provisions of the disabled which is constitutional right.
The present study bears implication for the parents as well as community members. Children with special needs are no more considered disabled; rather they are termed & recognized as differently able persons. The parents of the special educational needs (SEN) children should exhibit positive attitude for the education of their children in the regular classroom along with normal children, rather than sending them in segregated setting exclusively meant for a particular disability. The parents should also discuss the problem of their children openly instead of trying to hide their disability so that the teacher can take effective measures to bring the children to the mainstream.
Society plays a crucial role as far as the inclusion of the disability is concerned. It is the society that aggregates the conditions of the disabled children labeling which developed poor self concept, self confidence and problem in adjustment among these children. The disabled children are also the equally important members of the society. Many role modelers were played an important role in bringing about awareness in the society about the capacity of the disabled persons and the significant of their education.
Again, the present study essentially has some implications for the govt., administrator and policy makers. The policy makers and administrators simply can from the policies only, but it is the govt., which executes and implements those in actual sense. Govt. should allocate more funds to implement the policies that are framed on behalf of the disabled. Supervisory committees should be appointed to inspect whether the policies are executed in the schools or not.
To conclude, it can be said that inclusive education is a mandate today. In fact, inclusive education is need of the time. It becomes the crucial issue in the field of education attracts all concerned. It is the immense pleasure that inclusive education is a programme way all over the world, but still there is a room for improvement. To remove the gap between inclusive and exclusive teachers, parents, society, administrators, govt. and privates agencies and NGOs should collectively work to implement the policies of inclusive education.
The stories told by the interviewees in this study give evidence of many positive effects of the CBR programmes, but they also express concerns about the efficiency and sustainability of the programmes. CBR programmes seem to have initiated change processes in social norms and values, which are essential for the further development of quality of life of persons with disabilities.
This study indicates that CBR has impacted positively on the following aspects of quality of life:
ïƒ˜ Empowerment and influence
ïƒ˜ Social inclusion
However, impact is limited concerning:
ïƒ˜ Physical well-being
ïƒ˜ Confidence and trust in society to fulfil its human rights obligations
The number of communities reached remains very small and the expectation that the community (or district government), once awareness was raised, would provide the necessary resources, basic services and simple assistive devices, etc., has not been fulfilled.
Looking at the different CBR programmes it can be concluded that the initiatives perceived as the most useful by persons with disabilities were (in order of prior ity):
ïƒ˜ social counseling
ïƒ˜ training in mobility and daily living skills
ïƒ˜ providing or facilitating access to loans
ïƒ˜ community awareness-raising
ïƒ˜ providing or facilitating vocational training/apprenticeships
ïƒ˜ facilitating formation of local self-help groups, parents' groups and DPOs
ïƒ˜ facilitating contacts with different authorities
ïƒ˜ facilitating school enrolment (school fees and contacts with teachers)
It was noted that CBR programmes largely continue to regard persons with disabilities as beneficiaries and not as participants with a voice and a choice. Any influence by disabled persons and their organizations in the CBR programmes is limited. The number of persons with disabilities engaged at different levels in CBR programmes is still negligible even after 20 years of these programmes being realized.
CONCLUSIONS AND RECOMMENDATIONS
The study outlines a number of recommendations by persons with disabilities suggesting how CBR programmes could be improved in the areas of awareness-raising, medical care, rehabilitation, education and income generation. It especially indicates that, in all these areas, participation of disabled persons as role models, self-advocates and employed experts would increase quality and efficiency of the programmes.
CBR programmes must recognize that social change and fulfillment of human rights will not occur by targeting the community level alone. Neither will they occur by targeting only central policy- makers and legislators. Improved conditions for persons with disabilities depend on the combined efforts of a number of stakeholders. Persons with disabilities and their families need to be empowered, disabled people's organizations (DPOs) and parents' organizations need to be strengthened and duty bearers (such as government officials and professionals) need to build their capacity. This means that future CBR programmes should ensure support to these three spheres and facilitate input and collaboration between many stakeholders and sectors.
Donors and CBR implementing agencies should consider reviewing programmes and develop capacity in the light of the findings in this report. Complementary CBR training material and handbooks should be developed to meet the new needs and challenges.
Finally, it should be noted that CBR as a title no longer reflects the nature of the programmes implemented because they target many levels of society - not only the community level they address all issues affecting the quality of life of persons with disabilities - not only rehabilitation.