Community Based Rehabilitation Program (CBR).
CBR Program aims to improve social integration of disabled people by providing training, education support, and other experiences. The program also works with volunteers, families and rehabilitation workers on how to make rehabilitation services available to disabled people in their community. CBR Program especially focus's on children with disabilities to; improve access to rehabilitation services; provide aids for daily living; create opportunities to participate in social activities and to develop awareness of their capability.
In the future CBR program hopes that disabled adults and children can fully participate in all activities in their local communities and society.
Program Activities
Introduction
The National Center of Disabled Persons (NCDP) is running a Community Based Rehabilitation (CBR) program in selected districts of Phnom Penh municipality, Kandal and Kompong Speu provinces since 1998. UNICEF supports NCDP CBR program activities in Kompong Speu since February 2001. Baptist World Aid Australia (BWAA) supports NCDP CBR program activities in Kandal and Phnom Penh since January 2004.
According to estimates, there are 550 000 people with severe to moderate disabilities in Cambodia. Nearly 4 000 people with disabilities are identified by field workers and volunteers in the selected areas mentioned above. Aiming at improving disabled people’s quality of life, the program targets in priority children with disabilities and adults with severe disabilities. It increases utilization of services and integration into family and community. Rehabilitation and socio-economic services are either directly provided by the program’s field workers and community volunteers through home visit and village gathering or through referrals to partner organizations. The lack of integration of disabled people is tackled through disability awareness raising activities fostering positive attitudes among the general population. It is also addressed through the promotion and facilitation of peer groups of people with disabilities. Within these groups, people are able to experience solidarity, peer support and to overcome isolation. In addition, group members decide frequently to develop and run income-generating activities together.
1.
Individual service provision
The NCDP/CBR program field worker provides services to people affected by a wide
range of disabilities. At a given time, they each concentrate their efforts on
20 to 25 clients a month (current clients), who include severely disabled
people, children and women with disabilities but disabled people in dire
socio-economic situations as well. These clients, receiving the core of the
services, are visited weekly. Focusing on a limited number of individuals at a
time, the program provides higher quality services to the most vulnerable.
Meanwhile, community volunteers follow-up people with milder disabilities that do not require as much attention (potential clients), with inputs from field workers when necessary needed. Volunteers also act as informants about new cases in their working area and liaise with other service providers and local authorities.
In consultation with the family and client, field workers conduct a thorough individual assessment of the impact disability has on daily life. This gives information on the level of autonomy of the client but also on family and community integration, access to education and income generation. Each of its answer being valued, the evaluation tool provides individual baseline information against which progress is rated.
The field worker providing a mixture of counseling, child stimulation, mobilization, teaching self-help skills e.g. eating, dressing, washing, toileting, and referrals. By making the disabled person more self-reliant, the intervention reduces the family workload and improves its quality of life. A review of the evaluation is conducted every semester, under the supervision of an occupational therapist and or the supervisors. Progress is recorded in an individual evaluation file. A client is discharged when the potential for progress has been achieved and/or moving house. NCDP maintains relationships with a wide range of organizations and services ensuring disabled people are able to access health, physical rehabilitation and other specialized services.
At community level, field workers, volunteers, families make Aids to Daily Living according to the type of disabilities of children. These are standing frames, parallel bars, special seats, toilet seats, round wooden seats, adapted cups / spoons / toothbrush / pen / pencil, jigsaw puzzles, communication boards and various children’s toys, produced at low cost, foster independence in adults and enable children to develop at their own pace.
When the socio-economic situation of a family threatens the success of the program intervention, a grant of a maximum amount of $150 can be released. The supervisors are responsible for assessing the individual situation. The assets, the potential, the needs and the local context of each household are taken into account, and key informants (village leaders, neighbors...) consulted. Once a decision is made regarding the amount of the grant and the nature of the purchase (tools, sewing machine, cow, chicken, grocery stock, raw materials...) the money is released. The NCDP/CBR supervisors provide the household with regular support for several months to ensure decisions are consistent with the original plan. Most grants are used for income generation purposes but some are devoted to building or repairing shelters. Based on experience, 10% of current clients require this input.
2. Peer group promotion
Peer group promotion is
another strategy chosen by the program to overcome the lack of integration of
people with disabilities. Lack of self-esteem, lack of support within the
household and the general low expectations from disabled people contribute to
their exclusion from the community. Joining or forming a group of disabled
people can bring beneficial changes to individual situations. The ability to
share emotional problems and coping mechanisms with peers confronted by similar
challenges helps to overcome loneliness and to raise expectations regarding the
future. The exchange of information on available services and opportunities,
combined with pooled resources put peer group members in a strong position where
self-actualization initiatives and income generating activities become realistic
and feasible. The community can also appreciate disabled people’s ability to
organize them and to creatively overcome their difficulties.
NCDP CBR field workers role is to bring together disabled people who meet criteria that foster the establishment of a peer group. Distance between members, age, sex, activity, socio-economic situation and types of disabilities are considered. People are able to contribute to an analysis of their own problems and the identification of realistic solutions. The group's members will also prepare their action plan and implemented where is technical and or financial assistance provides by the program to mobilize resources needed to achieve the group’s goal and objectives.
3. Disability Awareness Raising
Disability awareness raising is
a strategy designed to tackle disabled people’s poor integration into society.
The program methodically pursues its coverage of the 200 target villages.
Village leaders, health workers, monks, teachers, disabled people and their
families are invited to participate in awareness raising sessions. Participants
are presented with information on basic human rights and principles on disabled
people’s rights, before being involved in several role plays and games that
illustrate obstacles in disabled people’s lives and how critical opportunities
are in terms of health, education, incomes and participation. Posters and
videotapes are used too. While field workers facilitate the debates, they also
touch on mainstream issues such as hygiene, nutrition, vaccination and domestic
violence. Each field worker holds a 2 hours session monthly. The program reaches
more than 2 500 persons per year.
Participants to monthly village sessions are presented with information on basic human rights and principles on disabled people’s rights, before being involved in role plays, games and activities that illustrate obstacles in disabled people’s lives and how critical opportunities are in terms of health, education, incomes and participation. The hypothesis is that taking community members, local authorities, teachers, health and other NGO workers, monks and others through this process fosters positive attitudes, raises expectations from disabled people and ultimately, reduces discrimination within community.
4. Achievement
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>> See CBR-Annual Report 2003 (View by
Acrobat Reader 5.0)