Rehabilitation Based in and with the Community
The process of rehabilitation through RBCC depends on the participation of all sectors of the society
Through our program: "Rehabilitation Based in, and with the Community" (referred to by its English acronym, CBR) we employ a community-based methodology, led by an interdisciplinary team of disability professionals, local trained personnel, people with disabilities, relatives of people with disabilities, students and volunteers from around the world.
Our unique methodology has proved successful in allowing us to deliver our holistic rehabilitation services for over 27 years to a growing number of people with disabilities in the region.
The CBR program stimulates the creation of local support systems for rehabilitation in each one of the communities that participate in the program, through the recruitment, training and supervision of local rehabilitation leaders. These leaders can be persons with disabilities or their family members, students, technical or health professionals, catequistas or other voluntary collaborators. Public servants and religious leaders also act as part of these local networks.
Piña Palmera’s work in local rural communities began in 1990. At that time, we applied simple rehabilitation techniques, using the book "Disabled Village Children", by David Werner (published by The Hesperian Foundation) as our guide. Regional personnel trained by Piña Palmera led our rehabilitation work at that time. They visited the houses of persons with disabilities but did not involve any other members of the communities in their work.
In 1994 we decided to adopt a model of Community-Based Rehabilitation in the communities with which we were working, as the number of clients in these communities began to quickly surpass our capacity to attend to them. We utilized a manual with the same name published by the World Health Organization in 1989 as a guide. The goal of our program today is to multiply the possibilities of rehabilitation through training and supervising local leaders, who, once coached, can function as trainers themselves for family members of persons with disabilities.
Not only does this model allow us to serve almost the entire disabled population in the region, but it has also lowered the costs of rehabilitation considerably, because the majority of the trained community therapists are volunteers; and, more importantly, rehabilitation is adopted gradually as a common responsibility.
Thanks to our years of experience, we have developed written criteria and efficient guidelines for the involvement of different community actors in our work.
DEFINITION OF CBR
According to the World Health Organization (WHO), Community-based Rehabilitation means “all methods that can be adopted on the local community level to activate and utilize physical resources and manpower of people with disabilities, their families and the local community in order to achieve rehabilitation and social integration.” (WHO, 1994)
CBR also implies, according to the WHO, “the communal participation in the planning, decision-making and evaluation of the program itself. This strategy might as well be called the democratization of rehabilitation.” (From the manual entitled, "Community Training for Disabled People" by the WHO, 1989)
METHODOLOGY OF THE CBR PROGRAM
Piña Palmera has Adapted the C.B.R. Model Proposed by the WHO to the Context and Conditions Relevant to the Oaxacan Coast
For us, Community-Based Rehabilitation (CBR) is a communal methodology of working with people with disabilities that includes:
- Persons with disabilities and their families who receive training and supervision from Piña Palmera’s therapy team, and function as local rehabilitation promoters;
- The local authorities as well as professionals in other sectors (teachers, doctors, clergy);
- Piña Palmera’s multi-disciplinary therapy team that consists of language therapists, occupational and physical therapists, a social worker, an anthropologist, a psychologist, and persons with visual and physical disabilities.
Our community and social focus is always guided by the interests and needs identified by the local populations that we serve. Each community is in charge of determining the direction and the timing of our work. We work directly with families, teachers, healthcare personnel and local authorities. In the communities where indigenous languages are spoken, we utilize local translators.
Each community has a political, social, and cultural specificity to which we adapt our work. The form and degree of our intervention is derived from a participatory diagnosis (and/or diagnostic done through observation), which we arrive at during our first meeting with community stakeholders. At that meeting, we uncover both community needs and individual interests. Flexible and practical solutions are proposed in order to eventually arrive at long-term goals and plans for thorough monitoring and evaluation of the goals.
THE FOCUS OF THE CBR STRATEGY
Our community-intervention focus, whose ultimate objective is to achieve the social and physical inclusion of persons with disabilities and their families into the active life of the community, covers the following areas:
- Community Diagnostic - Recognition of the conditions in which persons with disabilities in each community are found, existing services (medical, educational, transportation etc), communication channels, local culture, local economy, sources of work, etc. The diagnosis is carried out during an initial meeting with community members interested in the program and with the local authorities.
- Sensitization - Sensitizing Workshops are carried out with the local authorities, medical personnel, and other representatives of the community. In these workshops, lasting about 4 hours, participants experience simulations of different disabilities and are subsequently encouraged to reflect on the experience through group discussion. The ultimate goal of these workshops is to change the attitudes of community stakeholders as they relate to disabilities, discrimination and accessibility.
- Formation of a Community Support Network – This network includes health workers and medical personnel, people with disabilities and their families, teachers and religious representatives. Each sector has specific roles and responsibilities within the network: taking censuses in the different community neighborhoods or in distant ranches, holding meetings with people with disabilities and their families, obtaining spaces for rehabilitation sessions, referring individuals to hospitals, understanding and expressing the needs of people with disabilities and problems regarding their community inclusion, among others.
- Training of Local Promoters: i.e. People with Disability and their Relatives – This is a responsibility of Piña Palmera’s therapy team. Training is carried out in the community according to the disabilities of the citizens and the challenges present in community life.
- Supervision of the Process of Rehabilitation – The Piña Palmera team evaluates, together with families of persons with disablities and/or rehabilitation promoters, the progress of both rehabilitation and inclusion initiatives, as well as the adaptation of selected household items like chairs and tables.
- Inclusion Through the Development of Abilities and Skills – Piña’s team also offers training in different environments as the social, educational and occupational levels on a case-by-case basis.
- Facilitated Self-Help Group Meetings – These facilitated trainings are held around diverse topics that promote the rights of the people with disabilities.
- Socialization of Participants – Socialization of persons with disabilities can be attained in meaningful ways through group activities and games.
- Evaluation - The customized program is evaluated for our community partners every six months.
How do we do it?
To initiate a CBR program in a community, a member of that community must initially propose involvement. The community member can be a family member of someone with a disability, a student, a teacher, or other community member.
We then evaluate the conditions of the community and the interest of the local authorities in helping to support a potential CBR program.
The Piña Palmera team then carries out an initial community visit, and completes a diagnosis together with the authorities and community members. The team also carries out a Sensitizing Workshop.
The CBR program utilizes simple local materials in its therapy, and requires very little space for participants to hold rehabilitation sessions.
The most important elements of the CBR program are that the community is involved in the program and that there is ownership and continuity to the activities.
The program is designed based on the needs of the community, develops in the community and transforms the conditions of the community according to the culture and local proposals.
The Local Promoters:
Who Are They?
They can be a person with a disability, a parent or relative of a person with a disability, a student working on their social service, a teacher, a religious leader, or any other interested community member.
What do they do?
- Assist with the inclusion and development of abilities and skills of community members with disabilities – they may participate in different community spheres such as at school or work, depending on the Local Promoter and the circumstances.
- Train people with disabilities and their relatives in order to carry out the proposed regimens of rehabilitation.
- Coordinate activities aimed at holistic rehabilitation and inclusion with the local authorities and the Piña Palmera therapy team.
- Facilitate meetings Self-help Groups focusing on diverse themes that promote the rights of people with disabilities.
- Participate in group activities and games designed to aid social inclusion efforts.
- Make connections between community actors and people with disabilities and their families.
- Assist in evaluating the program every six months.
In our experience, the parents or other relatives of persons with disabilities have often been the community members selected as Local Promoters.
The Piña Palmera Therapy Team:
Who Are They?
The therapy team from Piña Palmera trains the Local Promoters in basic techniques of rehabilitation and independent life-skills development. The therapy team runs rehabilitation workshops in practical and fun ways in which persons with disabilities can be part of the process. The team uses materials and spaces that already exist in the community. They work mostly through play with children and through normal everyday activities with adults. They devise work plans related to the rehabilitation of each person with a disability, jointly with the Local Promoters, families, and persons with disabilities.
What do they do?
- Assist the Local Promoters and/or families and/or persons with disabilities with particular emphasis in the development of abilities and skills on the physical, social, cultural, and emotional levels of each participant with an eye towards building personal independence.
- Attend directly to participants as needed, and refer them to relevant institutions: hospitals, centers of specialized attention etc., on a case-by-case basis.
- Continue supporting already initiated processes of rehabilitation, inclusion and independent life development.
- Supervise and evaluate their work together with persons with disabilities, their families and the Local Promoters.
- Create spaces for socialization, to promote community interaction according to the abilities of each person, with and without disabilities.
- In addition to the rehabilitation processes, our community partners also take part in self-help groups. These groups are moderated by a member of the Piña Palmera therapy team, or by a member of the group itself. The group is responsible for determining their own discussion topics.
The CBR Coordinator
Who are they?
Besides the therapists, professionals in holistic rehabilitation, people with disabilities and volunteers the CBR program, there is an organizer, who is in charge of supervising and participating in the entire Program.
What do they do?
- Build community interest in holistic rehabilitation, and involve members of the community in the Program however possible.
- Promote physical and social conditions in the community that will permit appropriate implementation of the Program.
- Develop innovative activities and structures to promote the incorporation of people with disabilities into community life.
- Support the initiatives and ideas of the Local Promoters and or relatives of persons with disabilities with regard to their holistic rehabilitation, in the areas of education, labor, health and community.
- Support evaluations of the program in the community
Reading: Rehabilitation Based on the Community:
Experiences of a pilot project, "Piña Palmera" in the district of Pochutla, Oaxaca, Mexico 1994-1996 by Helena Eidlitz / occupational therapist
Systematization of the Experience of Piña Palmera. 2003