COMMUNITY BASED REHABILITATION AND INSTITUTIONAL BASED REHABILITAION

Difference and relationship between CBR and IBR

1. CBR VS IBR

2. O BJECTIVE SLO12: Differentiate between institutional based rehabilitation and community based rehabilitation

3. D EFI N ITION - CBR Utilization of Existing capacities of the Handicapped person, by the combined & co-ordinated use of Medical ,Social, Educational & Vocational measures to the optimum level of his functional ability

4. Optimum level of fu n ctio n al ability

5. CBR  CBR is a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities.  a strategy for enhancing the quality of life of the disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights

6.  CB R i s imple m ented t h rough t h e co m bined e f forts of o r ganiz a tio n s and com m uni t ie s, and the people wi t h dis a b il i t i es the m selves, their fa m i l ies, releva n t governmental and non-governmental health, education, vocational, social and other services. i.e. it promotes multi-sectoral collaboration.  It promotes rights and participation of people with disabilities and strengthens the role of their organizations in countries around the world. It aims as ‘ a society for all ’.

7. ILO,UNESCO,WHO,  Approaches for CBR development- but sti l l m any people 199 4 - w i th disabilities do not receive rehabilitation services  unable to participate equally in education, training, work, recreation or other activities in their community or wider society 

8. “ Community Based Inclusive Development(CBID) is a rights-based approach within community development for the equalization of opportunities, empowerment and social inclusion of all people with disabilities.” The strategy promotes community leadership and full participation of people with disabilities and their organizations.

9. AIMS OF CBR Individually focused aims Direct service to PWD and their families Family support to caregivers 3.Vocational development 4.Empowerment Community focused aims - (PARAS) Attitude change 2.Sustainability 3.Advocacy 4.Providing education 5.Research

10. Principles of CBR Change community attitude To keep disabled persons functioning Transfer health care knowledge Participation in health care program Increase level of knowledge Develop health care services

11. A DVANTAGES OF CBR Wide coverage service can be achieved Community interaction and the empowerment Affordability Build up of manpower and resources Comprehensive and holistic development Awareness and acceptance Sustainability Wise use of local resources Need based planning

12. D ISADVANTAGES OF CBR Improper care due to lack of specialized trainee Difficulties with evaluation Reducing the importance of professional services Unreliability of community involvement Limitation of local resources Difference in large scale co-ordination and co-operation

13. P ARTICIPANTS IN CBR People with disabilities Families of PWD Communities Government Non governmental organizations

14. I NSTITUTIONAL B ASED R EHABILITATION All the rehabilitation process should start as early as possible and as such it becomes a parallel process to the treatment of severe illness producing the disabilities. The quality of service can be good only at institution based services

15. Most of the severe illnesses in their terminal stages are treated at hospital or institution and where in the institution the rehabilitation has also started. Many of the major disabilities has to be handled by a skilled person and such IBR offers an opportunity not only to start early rehabilitation procedures but also skilled services at the institution.

16. CBR IBR Cost of treatment Cheaper Costly Accessibility of services Accessible to all Only few institutions are accessible to all Extension of services Can be done without of much cost Not possible Social rehabilitation Possible Not possible as patient is away from family Psychological rehabilitation Much Possible as they have support of family Not much possible Skilled personal care Not given Given

17. CBR IBR Application of advanced technique Not possible Possible Quality of service Not good Go o d Active participation Possible Not possible Socio-Economic status Considered Not considered Promotion of awareness Y es Not Community interaction Do n e Not done Ev a lua t i o n Difficult Possible Duration and location of training 3 months-1 year, locally trained 4 year degree, institutionally trained Goal of training Interventions to prepare the re-entry of client to his home. Interventions to discharge patient from hospital.

18. Community Based Rehabilitation Institution Based Rehabilitation Based on Social model and Human rights model Based on Medical Model Concept of capacity building and empowerment Concept of treatment – Prescription Person with disability will be the decision taker Professional is the decision taker Utilization of available resources in their own community Utilization of professional service delivery model Targeted for larger population Target of smaller population Minimal medical service / Basic services High tech medical services Economic status of people with disability is not a barrier Economic status is big barrier for getting the services Team member include person with disability, parents, care givers, family, local community, NDGs, Voluntary organizations, Governments… (Change according to the cultural / context ) Team member include person with disability, physician, physiotherapist, speech therapist orthotics and prosthetic technician, music therapist…(Change according to the medical condition) 

19. What is CBR What is not CBR? flexible rigid or a blue-print active involvement of families and communities an approach which only focuses on the physical or medical needs of a person a partnership approach with disabled people and parents of disabled children long-term residential care capacity building of disabled people and their families, in the context of their community and culture delivering a service to disabled people as passive recipients holistic in its approach to disabled people; addressing social, employment, educational, and other needs not just physical multi-sectoral only outreach from a centre

20. What is CBR What is not CBR? a system which is based in the community, but which uses district level and national level services for referral surveys on disability with no action an approach which aims to enable around 80% of disabled people’s rehabilitation needs to be addressed in the community limited to one sector integrated into existing services and promoting the social inclusion of disabled people an approach which is determined by the needs of an institution or group of professionals an approach with a broad concept of ‘rehabilitation’ an approach which requires that disabled people have to travel to a remote centre or institution to meet their needs a long term strategy segregated and separate from services for other people an approach with a narrow concept of ‘rehabilitation’ a short-term fix

21. R OLE OF P HYSIOTHERAPIST Educating communities who have not been exposed to regular health care, about the benefits of physical therapy within CBR. Consulting disabled people to identify those who can best illustrate change in their lives as a result of rehabilitation. Promoting the inclusion of all disabled people and especially marginalized groups (e.g. People with learning difficulties, women).

22. “ If you gi v e a person a fi s h, he’ll eat for a day ; if yo u te a ch h i m to fi s h h e ’ l l ea t for a li f e t im e .”