CHAPTER ONE

UNDERSTANDING DISABILITIES AND

VULNERABILITIES
1.1 Definitions of Basic Terms (Impairment, and
Disability)
• Discuss the definition of impairment and
Disability.

Impairment means a lack/abnormality/loss of an
anatomic, physiological or psychological structure
or function or deviation on a person. It is the
absence of particular body part or organ.
Synonym with Amharic version “የአካልየአካል ጉዳተኛ”
ጉዳተኛ
 Cont…

Disability: is ambiguous as there is no single
agreement on the concept (Mitra, 2006)

any restriction or lack of ability to perform an
activity in the manner or within the range
considered normal for a person of the same age,
culture, and education.

a person’s functioning is reduced as a result of
impairment, physical, social, policy related
disabling factors

It is not synonymous with AKAL-GUDATENGA

It complex, dynamic, multidimensional, and
contested (WHO and World Bank, 2011).
 Cont….
The full inclusion of people with impairments in society can be
inhibited by:
• Attitudinal barriers (societal barriers, such as stigma)
• Physical barriers (environmental barriers, such as absence of
stairs), and
• Policy barriers (systemic barriers)

• All these problems create a disabling effect and

inhibit disability inclusive development.
• However, if these problems are addressed,
impairment may not lead to disability.
• Societal, environmental, and systemic barriers are
the most popular disabling factors for Persons
with disability.
 What is disability?

• Medical Model/Approach:
• Disability is a pathology (physiological,
biological and intellectual).
• Disability means functional limitations due to
physical, intellectual or psychic impairment,
health or psychic disorders on a person
(WHO,1996).
• Disability is an individual problem. Thus, they
should be ―treated ―changed "or
―improved" and made more ―normal.
 Cont…
• Views the person with disabilities as needing to
―fit in rather than thinking about how society
itself should change.
• The social Model/approach :
Views disability is a societal problem.
Disability is a consequence of discrimination,
prejudice and exclusion.
 emphasize on the shortcoming/limitations of the
environment/activities of the society.
 eg. information communication and education,
which prevent persons with disabilities from
participating on equal terms.
 Cont…
 Medical model:  Social model:

 Child is faulty  Child is valued

 Diagnosis and labeling  Strengths and needs identified

 Impairment is focus of attention  Barriers identified and solutions

developed
 Segregation and alternative  Resources made available
services
 Re-integrate if normal enough  Diversity welcomed; child is
or permanent exclusion welcomed
 1.2 Causes of disability
• What do you think is the causes of disability?
• In the past times, there was misunderstanding
about the causes of disability: i.e.
• Disability is a punishment from God.
• There are some who still believe that disability
is a form of personal punishment for individual
with disability, a kind of karma/chance for their
past mistakes.
• which is totally unacceptable now days.
 Disability can be caused by the following
factors.

1. Congenital Factors/causes that happen

before birth
a) Genetic Causes or Abnormalities in genes
and genetic inheritance can cause disability in
children, for instance intellectual disability.
Down syndrome is the most common genetic
condition that leads to intellectual disability.
 Cont…
b) Non-genetic causes such as
– Maternal malnutrition which means mother’s vital
minerals and nutrients deficiency during pregnancy
result in deformation tissues/organs or dysfunctional
systems in the unborn child ,
– Maternal use of drugs, alcohol, tobacco, the exposure
to certain toxic chemicals and material such as lead
and mercury and over-exposure to radiations for
example, x-rays or chemotherapy can cause a
disability.
– Maternal illnesses and diseases such as
toxoplasmosis, cytomegalovirus, rubella and syphilis
during pregnancy can cause disability.
 2) Acquired/experiential Factors/causes that
happen during/after birth or later in life
Environmental causes such as
• Poverty and malnutrition of children after birth can also cause poor
development of vital organs in the child, which can eventually lead to
disability.
• Childhood diseases such as a whooping cough, measles, meningitis,
encephalitis and chickenpox can cause damage to the brain of the
child and may lead to disability.
• Toxic material such as lead and mercury can damage the brain too.
• Unfortunate life events such as accidents (drowning/sink,
automobile accidents, harsh hitting on head, gunfire wound, falls
etc.) can result in people losing their sight, hearing, limbs and other
vital parts of their body and may cause disability.
2) Unknown Causes Humans have still not found all the answers to all
the defects in the human body. for instance, 85-94. 5% of the causes
of ID are not known.

3) Inaccessible environments: roads, schools, health services, buildings

 1.3 Some type of disabilities:
• Some of major nine disabilities are listed and briefly
discussed in the coming pages below.
1. Visual impairment in general designates two sub-
classifications. These are blindness and low vision.
• Blindness, total or partial inability to see because of
disease or disorder of the eye, optic nerve, or brain. The
term blindness typically refers to vision loss that is not
correctable with eyeglasses or contact lenses. Blindness
may not mean a total absence of sight. However, some
people who are considered blind may have little vision or
be able to perceive lights, colors, or slowly moving objects.
• The term low vision is used for moderately impaired
vision. People with low vision may have a visual
impairment that affects only central vision—the area
directly in front of the eyes—or peripheral vision —the area
to either side of and slightly behind the eyes.
 Cont…
2. Hearing Impairment
• Pasonella and Carat from legal point of view, define hearing
impairment as a generic term indicating a continuum of
hearing loss from mild to profound, which includes the sub-
classifications of the hard of hearing and deaf.
– Hard of Hearing: "A hearing impairment, whether permanent or
fluctuating, which adversely affects a child's educational
performance but which is not included under the definition of
'deaf'." Whelan, R. J. (1988). This term can also be used to describe
persons with enough residual hearing ability (usually with hearing
aids) as a primary modality of acquisition of language and in
communication with others.
– Deaf: Those who have difficulty understanding speech, even with
hearing aids but can successfully communicate in sign language.
Cultural definitions of deafness, on the other hand, emphasize an
individual‘s various abilities, use of sign language, and connections
with the culturally deaf community.
 3. Specific learning disability
• It means a disorder in one or more of the basic
psychological processes involved in understanding
or in using language, spoken or written, that may
manifest itself in the imperfect ability to listen,
think, speak, read, write, spell, or to do
mathematical calculations.
• The term includes such conditions as perceptual
disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia.
• The term does not include learning problems that
are primarily the result of visual, hearing, or
motor disabilities; intellectual disability;
emotional disturbance; or environmental,
cultural, or economic disadvantage.
 Cont…
• people with learning disabilities have average or above
average intelligence. There often appears to be a gap
between the individual‘s potential and actual
achievement. This is why learning disabilities are
referred to as ―hidden disabilities: the person looks
perfectly―normal and seems to behave bright and
intelligent person, yet may be unable to demonstrate
the skill level expected from someone of a similar age
• .A learning disability cannot be cured or fixed; it is a
lifelong challenge.
• However, with appropriate support and intervention,
people with learning disabilities can achieve success in
school, at work, in relationships, and in the community.
 Types of Specific Learning Disabilities
A) Auditory Processing Disorder (APD)
• It also known as Central Auditory Processing
Disorder
• adversely affects how sound that travels unimpeded
through the ear is processed or interpreted by the
brain.
• Individuals with APD do not recognize:

subtle differences between sounds in words, even
when the sounds are loud and clear enough to be
heard.

where sounds are coming from,

make sense of the order of sounds, or

block out competing background noises.
 Cont…
B) Dyscalculia
• Dyscalculia is a specific learning disability that
affects a person‘s ability to understand
numbers and learn math.
• Individuals with this type of LD may also have
poor comprehension of math symbols, may
struggle with memorizing and organizing
numbers, have difficulty telling time, or have
trouble with counting.
 Cont…
C) Dysgraphia
 a specific learning disability that affects a
person‘s handwriting ability and fine motor
skills.
 Problems may include illegible handwriting,
inconsistent spacing, poor spatial planning on
paper, poor spelling, and difficulty composing
writing as well as thinking and writing at the
same time.
 Cont…
D. Dyslexia

affects reading and related language-based
processing skills.

The severity can differ in each individual but
can affect reading fluency; decoding, reading
comprehension, recall, writing, spelling, and
sometimes speech and can exist along with
other related disorders.

Dyslexia is sometimes referred to as a
Language- Based Learning Disability.
 Cont…
E) Language Processing Disorder

a specific type of Auditory Processing Disorder
(APD) in which there is difficulty attaching
meaning to sound groups that form words,
sentences and stories.

While an APD affects the interpretation of all
sounds coming into the brain, a Language
Processing Disorder (LPD) relates only to the
processing of language.

LPD can affect expressive language and/or
receptive language.
 Cont…
F) Non-Verbal Learning Disabilities
• Non-Verbal Learning Disabilities is a disorder
which is usually characterized by a significant
discrepancy between higher verbal skills and
weaker motor, visual-spatial and social skills.
• Typically, an individual with NVLD has trouble
interpreting nonverbal cues like facial
expressions or body language, and may have
poor coordination.
4. Speech and Language Impairments
• Speech and language impairment means a
communication disorder such as stuttering,
impaired articulation, language impairment, or
a voice impairment that adversely affects a
child‘s educational performance.
• It is disorder that adversely affects the child's
ability to talk, understand, read, and write.
• This disability category can be divided into two
groups: speech impairments and language
impairments
 Speech Impairments
• There are three basic types of speech
impairments: articulation disorders, fluency
disorders, and voice disorders. Articulation
disorders are errors in the production of speech
sounds that may be related to anatomical or
physiological limitations in the skeletal, muscular,
or neuromuscular support for speech production.
These disorders include:
– Omissions: (bo for boat)
– Substitutions: (wabbit for rabbit)
– Distortions: (shlip for sip)
– Addition: ( brhown for brown)
 Cont…
• Fluency disorders are difficulties with the
rhythm and timing of speech characterized by
hesitations, repetitions, or prolongations of
sounds, syllables, words, or phrases. Common
fluency disorders include:
– Stuttering: rapid-fire repetitions of consonant or
vowel sounds especially at the beginning of words,
prolongations, hesitations, interjection, and
complete verbal blocks
– Cluttering: excessively fast and jerky speech
 Cont…
• Voice disorders are problems with the quality or
use of one's voice resulting from disorders in
the larynx.
• Voice disorders are characterized by abnormal
production and/or absences of vocal quality,
pitch, loudness, resonance, and/or duration.
 Cont…
B.Language Impairments means a problem of
receiving /understanding or production of
language and/or both.
• In this case, the language impairment might be:
• Receptive language impairment or a problem of
understanding language
• Expressive language impairment or a problem of
expressing language
• Or both a problem of understanding and
expressing language.
 Cont…
• There are five basic areas of language impairments:
• phonological disorders in relation to sound system or
formation,
• morphological disorders in relation to word formation,
• semantic disorders in relation to understanding
meaning, poor vocabulary development, inappropriate
use of word meanings, and/or inability to comprehend
word meanings
• syntactical deficits/syntax disorder in relation to using
the structure/grammar of the language, rules that
govern word order(subject-verb agreement)
• pragmatic difficulties in relation to respecting the
social rule of the language. problems in understanding
and using language in different social contexts. making
eye contact, respecting personal space, requesting
information, and introducing topics
 5 Autism
• A neurodevelopmental disability significantly affecting :

Verbal and nonverbal communication

Social interaction

Evident before age three may above age three

Adversely affects a child‘s educational performance.

characterized by engaging in:
 repetitive/obssesive activities
 stereotyped movements,
 resistance to environmental change or change in daily
routines, and
 unusual responses to sensory experiences.

Linked to Profound Learning Disability (PLDs) are further
impairments in the production of speech
 6. Emotional and Behavioral Disorders
(EBD)
• According to IDEA, the term EBD means a condition
exhibiting one or more of the following characteristics
over a long period of time and to a marked degree that
adversely affects a child’s educational performance
1) An inability to learn that cannot be explained by
intellectual, sensory, or health factors;
2) An inability to build or maintain satisfactory interpersonal
relationships with peers and teachers;
3) Inappropriate types of behavior or feelings under normal
circumstances;
4) A general pervasive mood of unhappiness or depression;
5) A tendency to develop physical symptoms or fears
associated with personal or school problems
 Classification of behavioral and emotional disorders
• EBD can exhibit widely varied types of behavior. Different professionals
have developed a classification system.
• Conduct disorder: individuals may seek attention, are disruptive and act
out. The disorder is classified by type: overt (with violence or tantrums)
versus covert (with lying, stealing, and/or drug use).
• Socialized aggression: individuals join subculture group of peers who
are openly disrespectful to their peers, teachers, and parents. Common
are delinquency and dropping out of school.
• Early symptoms include stealing, running away from home, habitual
lying, cruelty to animals, and fire setting.
• Attention problems- These individuals may have attention deficit, are
easily destructible and have poor concentration. They are frequently
impulsive and may not think the consequence of their actions.
• Anxiety/Withdrawn- These individuals are self-conscious, reserved, and
unsure of themselves. They typically have low self-esteem and
withdraw from immediate activities. They are also anxious and
frequently depressed.
 Cont…
• Kauffman (1993) conclude that emotion or
behavioral disorders fall into two broad
classifications:
• Externalizing Behavior: also called under
controlled disorder, include such problems
disobedience, disruptiveness, fighting, tempers
tantrums, irresponsibility, jealous, anger,
attention seeking etc…
• Internalizing Behavior: also known as over
controlled disorders, include such problems
anxiety, immaturity, shyness, social withdrawal,
feeling of inadequacy (inferiority), guilt,
depression and worries a great deal
 Causes of EBDs
• Biological- includes genetic disorders, brain damage,
and malnutrition, allergies, temperament and damage
to the central nervous system.
• Family factors- include family interactions, family
influence, child abuse, neglect, and poor disciplinary
practices at home.
• Cultural factors- include some traditional and cultural
negative practices, for example watching violence and
sexually oriented movies and TV programs.
• Environmental factors- include peer pressure, living in
impoverished areas, and schooling practices that are
unresponsive to individual needs.
 7. Intellectual Disability (ID)
• ID is a disability characterized by significant limitations in
both intellectual functioning and in adaptive behavior,
• This disability originates before the age of 18.
Criteria to consider ID:
• Significantly sub average intellectual functioning: It
refers to general mental capacity, such as learning,
reasoning, problem solving, and so on. One way to
measure intellectual functioning is an IQ test. Generally,
an IQ test score of around 70 or as high as 75 indicates a
limitation in intellectual functioning.
• Significant limitations exist in two or more adaptive skill
areas: It is the collection of conceptual, social, and
practical skills that are learned and performed by people
in their everyday lives.
 Cont…

Conceptual skills—language and literacy; money, time, and
number concepts; and self-direction.

Social skills—interpersonal skills, social responsibility,
self-esteem, gullibility/acceptance, innocence (i.e.,
suspicion), social problem solving, and the ability to
follow rules/obey Psychotic behavior: These individuals
show Motor excess: These students are hyperactive. They
cannot sit nor listen to others nor keep their attention
focused.
• more bizarre behavior. They may hallucinate, deal in a
fantasy world and may even talk in gibberish/nonsense.
• Practical skills—activities of daily living (personal care),
occupational skills, healthcare, travel/ transportation,
schedules/routines, safety, use of money, use of the
telephone.
 Characteristics of ID
• General Cognition: delayed rate of intellectual development (Wehman, 1997).
• Learning and Memory: The learning and memory capabilities are significantly below average in
comparison to peers without disabilities.
• Attention: Children with intellectual disabilities may have difficulty distinguishing and attending to
relevant questions in both learning and social situations (. The problem is not that the student will not
pay attention, but rather that the student does not understand or does not filter the information to get to
the salient features.
• Adaptive Skills: difficulty in both learning and applying skills for a number of reasons, including a higher
level of distractibility, inattentiveness, failure to read social cues, and impulsive behavior (Hardman et al.,
2008). The lack or underdevelopment of these skills notably affects memory, rehearsal skills,
organizational ability, and being in control of the process of learning (Erez&Peled, 2001; Hunt & Marshall,
2002).
• Speech and Language: delayed speech, language comprehension and formulation difficulties. delayed
functioning on pragmatic aspects of language, such as turn taking, selecting acceptable topics for
conversation, knowing when to speak knowing when to be silent, and similar contextual skills (Haring,
McCormick, & Haring, 1994; Yoder, Retish, & Wade, 1996).
• Motivation: lacking motivation, or outer-directed behavior. Past experiences of failure and the anxiety
may make them appear to be fewer goals directed and lacking in motivation. The result of failure is often
learned helplessness. The history of failure is likely to lead to dependence on external sources of
reinforcement or reward rather than on internal sources of reward. They are less likely to self-starters
motivated by self-approval .
• Academic Achievement: persistent problems in academic achievement unless intensive and extensive
supports are provided.
• Physical characteristics:, may exhibit coexisting problems, such as physical, motor, orthopedic, visual and
auditory impairments, and health problems.
 Levels of support for individuals with intellectual
disabilities
Levels and areas of support for intellectual disabilities
Level of Duration of Frequency of Setting of support Amount of
support support Support professional
assistance
Intermittent Only as needed Occasional or Usually only one or two Occasional consultation
Infrequent (e.g. 1–2 classes or or
activities) monitoring by
professional
Limited As needed, but Regular, but Several settings, but not Occasional or regular
sometimes frequency varies usually all contact
continuing with professionals
Extensive Usually Regular, but Several settings, but Regular contact with
continuing frequency varies not usually all professionals at least
once a week
Pervasive May be lifelong Frequent Nearly all settings Continuous contact and
or continuous monitoring by
professionals
 8. Physical disability/Orthopedic
Impairment and Health impairment
• Physical disability (PD) is a condition that
interferes with the individual‘s ability to use
his or her body.
• Many but not all, physical disabilities are
orthopedic impairments.
• orthopedic impairment generally refers to
conditions of muscular or skeletal system and
sometimes to physical disabling conditions of
the nervous system
 Cont…
• Health impairment is a condition that requires ongoing
medical attention. It includes asthma, heart defects,
cancer, diabetes, hemophilia. HIV/AIDS, etc.
• Classification and Characteristics : based on the
impact of physical disability on mobility and motor
skills, it is divided into three. These are:-
– Mild physical disability:- these individuals are able to walk
without aids and may make normal developmental
progress.
– Moderate physical disability:- individuals can walk with
braces and crutches and may have difficulty with fine-
motor skills and speech production.
– Severe physical disability:-these are individuals who are
wheel-chair dependent and may need special help to
achieve regular development
 Cont…
• The physical disability could be broadly
classified in to two
• The neurological system (the brain ,spinal cord &
nerve) related problems.
• Musculo skeletal system( the muscles, bones and
joints) are deficient due to various causes.
• Neurological system:-with a neurological
condition like cerebral palsy or a traumatic
brain injury.
 Cont….
• The brain either sends the wrong instructions or
interprets feedback incorrectly.
• In both cases, the result is poorly coordinated
movement.
• spinal cord injury or deformity, the path ways between
the brain and the muscles are interrupted, so messages
are transmitted but never received.
• The result is muscle paralysis and loss of sensation
beyond the point where the spinal cord or the nerve is
damaged.
• These individuals may have motor skill deficits that can
range from mild in coordination to paralysis of the
entire body.
 Cont…
• Cerebral palsy associate with learning
disabilities, mental retardation.
• Seizures, speech impairments, eating
problems, sensory impairments, and joint and
bone deformities such as spinal curvatures
and contractures (permanently fixed, tight
muscles and joints).
 Cont…
• Epilepsy:-is disorder that occurs when the brain cells are
not working properly and is often called a seizure disorder.
• Some children and youth will epilepsy have only a
momentary loss of attention (petit mal seizures); others fall
to the floor and then move uncontrollably
• Fortunately, once epilepsy is diagnosed, it can usually be
controlled with medication and does not interfere with
performance in school.
• Most individuals with epilepsy have normal intelligence.
• -Epilepsy is a condition that affects 1 to 2 percent of the
population. It is characterized by recurring seizures, which
are spontaneous abnormal discharge of electrical impulses
of the brain.
Spinal bifida and spinal cord injury
• Damage to the spinal cord leads to paralysis
and loss of sensation in the affected areas of
the body.
• The spinal bifida is a birth defect of the
backbone (spinal column) fail to close.
• The causes are unknown but it usually occurs in
the first twenty-six days of pregnancy.
 Musculoskeletal system
• it includes the muscles and their supporting
framework and the skeleton.
• Examples of such problems are -Progressive
muscle weakness (muscular dystrophy);
-Inflammation of the joints (arthritis),or
-Loss of various parts of the body(amputation)
 Cont…
– Muscular dystrophy:- is an inherited condition accruing mainly
in males, in which the muscles weaken and deteriorate. The
weakness usually appears around 3 to 4 years of age and
worsens progressively. By age 11 most victims can to longer
walk. Death usually comes between the ages of 25 and 35 from
respiratory failure or cardiac arrest.
– Arthritis:-is an inflammation of the joints. Symptoms include
swollen and stiff joints, fever, and pain in the joints during acute
periods. Prolonged inflammation can lead joint deformities that
can eventually affect mobility.
– Amputation:-a small number of children have missing limbs
because of congenital abnormalities or injury or disease
(malignant bone tumors in the limbs). These children can use
customized prosthetic devices (artificial hands, arms, or legs) to
replace limp functions and increase independence in daily
activities.
 Other musculoskeletal
Marfan syndrome
– a genetic disorder in which the muscles are poorly developed
and the spine is curved.
– They may have either long, thin limbs, prominent shoulder
blades, spinal curvature, flat feet, or long fingers & thumbs.
– The heart and blood vessels are usually affected.
– The greatest danger is damage to aorta, which can lead to heart
failure.
– They need to avoid heavy exercise and lifting heavy objects.
Achondroplasis
– is a genetic disorder that affects 1 in 10,000 births.
– Children with this disorder usually develop a normal torso but
have a straight upper back and a curved lower back (sway back).
– These children are at risk of sudden death during sleep from
compression of the spinal cord interfering with their breathing.
– The disability may be lessened through the use of the back braces
or by surgery
 Cont…
• Polio:-is viral disease that invade the brain and cause
severe paralysis of the total body system. In its mild
form results in partial paralysis. Post-polio muscles that
were previously damaged weaken, and in some
persons, other muscles that were not previously
affected weaken as well.
• Club foot:- is a major orthopedic problem affecting
about 9,000 infants each year. This term is used to
describe various ankle or foot deformities, i.e
• Twisting inward (equinovarus), the most severeform
• Sharply angled at the heel (calcanelvaigus), mostcommon
• The front part of the foot turned inward.
 Cleft lip and cleft palate
• Are openings in the lip or roof of the mouth,
respectively, that fail to close before birth, the
cause is unknown.
• Most cleft problems can be repaired through
surgery.
 Health Impairments
• What are the common health problems of
students?
• Any disease that interferes with learning can
make students eligible for special services.
• It requires regular medical follow up
 Common Health Impairments
• Heart disease:- this is common among young people. It
is caused by improper circulation of blood by the heart
some of the disorders are congenital )present at
birth);others are the product of inflammatory heart
disease. Some students have heart value disorders;
others have disorders of the blood vessels. At this time
heart implantation helps children to get cured.
• Cystic fibrosis:- is a hereditary disease that affects the
lungs and pancreas. It leads to recurrent respiratory
and digestive problems including abnormal amounts of
thick mucus, sweet and saliva. The disease is so
progressive and few who have it survive beyond age
20. Children with such disease often spend significant
timeout of school
 Cont…
• Hemophilia:- is a hereditary disease in which the
blood clots very slowly or not all. The disorder is
transmitted by sex-linked recessive gene and
nearly always occurs in males.
• Asthma: is a chronic respiratory condition
characterized by repeated episode of breathing
difficulties especially while exhaling.
• Diabetes: Developmental or hereditary disorder
characterized by inadequate secretion or use of
insulin
• Nephrosis & Nephritis Kidney disorders or
diseases caused by infections, poisoning, burns,
accidents or other diseases
 Cont…
• Sickle-cell anemia Hereditary and chronic
blood disease (occurring primarily in African
Americans) characterized by red blood cells
that are distorted and that do not circulate
properly
• Leukemia: Disease characterized by excessive
production of white blood Cells
• Lead poisoning Disorder caused by ingesting
lead-based paint chips or other substances
containing lead
 Cont…
• Rheumatic fever Disease characterized by
painful swelling and inflammation of joints that
can spread to the heart and central nervous
system.
• Tuberculosis Infectious disease that commonly
affects the lungs and may affect other tissues
of the body.
• Cancer Abnormal growth of cells that can
affect any organ of the body system
 1.3. Vulnerability
• Vulnerable means being at risk of being
harmed.
• Everyone can be harmed, so being vulnerable is
part of being human.
• In principle, everyone is vulnerable to some
adverse event or circumstance, but some
people are more vulnerable than others.
• For instance, people with disabilities are more
likely as a group to experience greater
vulnerability.
 Cont…
• vulnerability can be generally defined as a complex
phenomenon that refers to the following dimensions:
– Economic difficulties/lack of financial resources: poverty,
low living standards, housing problems (e.g. too damp, too
expensive, too cold or difficult to heat)etc.;
– Social exclusion: limited access to facilities such as
transportation, schools, libraries or medical services;
– Lack of social support from social networks: no assistance
from family members, friends, neighbors or colleagues
(referring to practical help as well as emotional support)
like highly gifted individuals;
– Stigmatization: being a victim of stereotypes, being
devalued, confronted with disgraceful behavior because of
belonging to a particular social or ethnic group;
– Health difficulties: disadvantages resulting from poor
mental health, physical health or disabilities;
– in family context especially of violence.
– Being a victim of crime:
 Causes of Vulnerability
• Rapid population growth,
• Poverty and hunger,
• Poor health,
• Low levels of education,
• Gender inequality,
• Fragile and hazardous location,
• Lack of access to resources and services, including knowledge and
technological means, disintegration of social patterns (social
vulnerability).
• Lack of access to information and knowledge,
• Lack of public awareness,
• Limited access to political power and representation (political
vulnerability)
• Environmental vulnerability concerns land degradation, earthquake,
flood, hurricane, drought, storms (Monsoon rain, El Niño), water
scarcity, deforestation, and the other threats to biodiversity.
 Characteristics of Vulnerable People
• Less physically or mentally capable (infants,
older adults, people with disabilities)
• Fewer material and/or financial resources
(low-income households, homeless)
• Less knowledge or experience (children,
illiterate, foreigners, tourists)
• Restricted by society to grow and develop
according to their needs and potentials
 Vulnerable group
• Women living in rural areas are vulnerable for many backward
traditional practices. These women are oppressed by the culture
and do not get access to education and employment
• Children: Children are vulnerable for psychological and physical
abuse children who are pregnant or become mothers, children born
out of marriage, children from a single-parent, delinquent children,
homeless children, HIV- infected children, uneducated children,
institutionalized children, married children, mentally ill children,
migrant children, orphans, sexually exploited children, street
children, war-affected children…etc.
• Minorities: minority background. Particularly, ethnic (cultural and
linguistic minority), religious minority. These people are political
and socially discriminated
• Poverty: poor households and large households, inequality,
absences of access to health services, important resources for life,
lack of access to education, information, financial and natural
resources and lack of social networks
 Cont….
• Disabilities: abuses, poverty, illiteracy, health problems,
psychological and social problems
• Age: Old people or very young children are vulnerable for all kinds
evils
• Illiteracy and less education: People with high rates of illiteracy and
lack quality educational opportunities are vulnerable for absence all
kinds of developments
• Sickness: Uncured health problems for example people living with
HIV/AIDS are much vulnerable for psychosocial problems, poverty
and health (Vincent, 2004; Adger et al., 2004; Naudé et al.,2007).
• Gifted and Talented: Gifted and talented children are vulnerable for
socio- emotional developments. Due to lack of psychological support
they may feel isolation as they are pulled from their regular
classrooms and given instruction in separate settings and due to
myths and expectations of themselves and the public .
 UNIT TWO
CONCEPTS OF INCLUSION
Learning Objectives: By the end of this unit students will able
to:

Define inclusion.

Describe the principles of inclusion.

Explain the rational for inclusion.

Identify factor influenced the development of inclusion.

Elaborate the benefit of inclusion.

Describe the ultimate goal of inclusion.

Mention the features of inclusion.

Identify barriers for inclusion.
 2.1. Definition of Inclusion

Inclusion in education/service refers to
―an ongoing process aimed at offering
quality education/services for all.

It is respecting diversity and the different
needs and abilities, characteristics and
learning expectations of the students and
communities

It is the elimination of all forms of
discrimination.
 Cont…
• Inclusive services at any level are quality provisions
without discrimination or partiality and meeting the
diverse needs of people.
• It is seen as a process of addressing and responding
to the diversity of needs of all persons through
increasing participation in learning, employment,
services, cultures and communities, and reducing
exclusion at all social contexts.
• It involves changes and modifications in content,
approaches, structures and strategies, with a common
vision which covers all people, a conviction that it is the
responsibility of the social system to educate all
children, employ and provide social services.
 Cont…
• Inclusion is defined as having a wide range of
strategies, activities and processes that seek
to make a reality of the universal right to
quality, relevant and appropriate education
and services.
• It seeks to enable communities, systems and
structures in all cultures and contexts to
combat discrimination, celebrate diversity,
promote participation and overcome barriers
to learning and participation for all people.
 Cont…
• It is part of a wider strategy promoting
inclusive development.
• The goal of creating a world where there is
peace, tolerance, and sustainable use of
resources, social justice, and where the basic
needs and rights of all are met.
 Components of the Definition
 Concepts about learners
 Education is a fundamental human right for all
people
 Learning begins at birth and continues
throughout life
 All children have a right to education within
their own community
 Everyone can learn, and any child can
experience difficulties in learning
 All learners need their learning supported child-
focused teaching benefits all children.
 Cont…
• Concepts about the education system and
schools
• It is broader than formal schooling
• it is flexible, responsive educational systems
• It creates enabling and welcoming educational
environments
• It promotes school improvement – makes effective
schools
• It involves whole school approach and collaboration
between partners
 Cont…
• Concepts about diversity and discrimination
• It promotes combating discrimination and exclusionary
pressures at any social sectors
• It enables responding to/embracing diversity as a resource
not as problem
• It prepares learners for an inclusive society that respects and
values difference.
• Concepts about processes to promote inclusion
• It helps to identifying and overcoming barriers to
participation and exclusionary pressures
• It increases real participation of all collaboration, partnership
between all stakeholders
• It promotes participatory methodology, action research,
collaborative enquiry and other related activities
 Cont..
• Concepts about resources
• Promotes unlocking and fully using local resources
redistributing existing resources
• It helps to perceive people (children, parents, teachers,
members of marginalized groups, etc) as key resources
• It helps to use appropriate resources and support within
schools and at local levels for the needs of different
children, e.g. mother tongue tuition, Braille, assistive
devices.
 McLeskey and Waldron (2000) have identified
inclusion and non-inclusive practices
• Students with disabilities and vulnerability
attend their neighborhood schools
• Each student is in an age-appropriate general
education classroom
• Every student is accepted and regarded as a full
and valued member of the class and the school
community.
• Special education supports are provided to each
student with a disability within the context of
the general education classroom.
 Cont….
• All students receive an education that addresses
their individual needs
• No student is excluded based on type or degree
of disability.
• All members of the school (e.g., administration,
staff, students, and parents) promote
cooperative/collaborative teaching arrangements
• There is school-based planning, problem-solving,
and ownership of all students and programs
• Employed according to their capacities without
discriminations
 Inclusion Does Not Mean
• Placing students with disabilities into general
education classrooms without careful
planning and adequate support.
• Reducing services or funding for special
education services.
• Placing all students who have disabilities or
who are at risk in one or a few designated
classrooms.
 Cont…
• Teachers spending a disproportionate amount of time
teaching or adapting the curriculum for students with
disabilities.
• Isolating students with disabilities socially, physically,
or academically within the general education school or
classroom.
• Endangering the achievement of general education
students through slower instruction or a less
challenging curriculum.
• Relegating special education teachers to the role of
assistants in the general education classroom.
• Requiring general and special education teachers to
team together without careful planning and well-
defined responsibilities.
 2.2. Principles of Inclusion
• All persons should learn, work and live together
wherever possible, regardless of any difficulties
or differences.
• Inclusive education extends beyond special needs
arising from disabilities, and includes
consideration of other sources of disadvantage
and marginalization, such as gender, poverty,
language, ethnicity, and geographic isolation.
• Inclusion begins with the premise that all persons
have unique characteristics, interests, abilities
and particular learning needs
 Cont…
• all persons have equal access education,
employment and services.
• Inclusion implies transition from separate,
segregated learning and working environments
for persons with disabilities to community based
systems.
• effective transitions from segregated services to
inclusive system requires careful planning and
structural changes to ensure that persons with
disabilities are provided with appropriate
accommodation and supports that ensure an
inclusive learning and working environment.
 Cont…
• UNESCO (2005) has provided four major inclusion
principles
– Inclusion is a process. It has to be seen as a never
ending searching a better way to respond diversity.
– Inclusion is concerned with the identification and
removal of barriers that hinders the development of
PWDs. It involves collecting, and evaluating information
from a wide variety of sources in order to plan for
improvements in policy and practice. It is about using
evidence of various kinds to stimulate creativity and
problem -solving.
– Inclusion is about the presence, participation and
achievement of all persons.
– Inclusion invokes a particular emphasis at risk of
marginalization, exclusion or underachievement.
 2.3. Rationale for Inclusion
• Educational,
• social,
• legal,
• economic and
• inclusive society building foundations
 Educational Foundations

Children do better academically,
psychologically and socially in inclusive
settings.

A more efficient use of education resources.

Decreases dropouts and repetitions

Teachers competency( knowledge, skills,
collaboration, satisfaction)
 Social Foundation
 Segregation teaches individuals to be
fearful, ignorant and breeds prejudice.
 All individuals need an education that will
help them develop relationships and
prepare them for life in the wider
community.
 Only inclusion has the potential to reduce
fear and to build friendship, respect and
understanding
 Legal Foundations

 All individuals have the right to learn and

live together.
 Human being shouldn‘t be devalued or
discriminated against by being excluded or
sent away because of their disability.
 There are no legitimate reasons to separate
children for their education
 Economic Foundation
 Inclusive education has economic benefit,
both for individual and for society.
 Inclusive education is more cost-effective
than the creation of special schools across
the country.
 Reduce wastage of repetition and dropout
 Children with disabilities live with their family
use community infrastructure
 Better employment and job creation
opportunities for people with disabilities
Foundations for Building Inclusive Society

 Formation of mutual understanding and

appreciation of diversity

 Building up empathy, tolerance and

cooperation

 Promotion of sustainable development

2.4. Factors that Influenced Development
of Inclusion

Communities: pre-colonial and indigenous approaches
to education and community-based programs
movement.

Activists and advocates: the combined voices of
primary stakeholders – representatives of groups of
learners (e.g. disabled activists; parents advocating for
their children; child rights advocates; and those
advocating for women/girls and minority ethnic
groups).

The quality education and school improvement
movement: in both North and South, the issues of
quality, access and inclusion are strongly linked.
 Cont…
• Special educational needs movement: the ‗new
thinking‘ of the special needs education movement
– as demonstrated in the Salamanca Statement
• Involvement of International agencies: the UN,
UNESCO, etc.
• Involvement of NGOs movements, networks and
campaigns:
• Other factors: The current world situation spread of
HIV/AIDS, political instability, trends in resource
distribution, diversity of population, and social
inclusion.
 2.5. Benefits of Inclusion
A) Benefits for Students with Special Needs Education
 Appropriate models of behavior.
 Increased social initiations, interactions, relationships and
networks
 Increased achievement of individualized educational program
(IEP) goals
 Greater access to general curriculum
 Enhanced skill acquisition and generalization in their learning
 Attending inclusive schools increases the probability that
students with SEN will continue to participate in a variety of
integrated settings
 Improved school staff collaboration to meet these students‘
needs and ability differences
 Increased parental participation to meet these students‘ needs
and ability differences.
 Benefits for persons without Special Needs Education
• opportunities for interacting with their age peers
• serve as peer tutors during instructional activities
• Play the role of a special buddy‘ during lunch, in the bus or
playground.
• Gain knowledge of a good deal about tolerance, individual
difference, and human exceptionality.
• Learn that students with SEN have many positive characteristics and
abilities.
• Have chance to learn about many of the human service profession
such as special education, speech therapy, physical therapy,
recreation therapy, and vocational rehabilitation.
• Have increased appreciation, acceptance and respect of individual
differences.
• Get greater opportunities to master activities by practicing and
teaching others
• Have increased academic outcomes
• have opportunity to learn to communicate, and deal effectively
with a wide range of individuals
Benefits of inclusion for Teachers
 learn new ways to teach different kinds of students.
 They develop more positive attitudes and approaches.
 They have greater opportunities to explore new ideas.
 They can encourage their students to be more
interested, more creative and more attentive
 They can experience greater job satisfaction and a
higher sense of accomplishment when all children are
succeeding in school to the best of their abilities.
 They get opportunities to exchange information about
instructional activities and teaching strategies.
 They benefit from Developing teamwork and
collaborative problem-solving skills to creatively
address challenges regarding student learning
 Benefits for Parents/Family
 Learn more about how their children are being
educated in schools with their peers in an inclusive
environment
 Become personally involved and feel a greater sense
of accomplishment in helping their children to learn.
 Feel valued and consider themselves as equal partners
in providing quality learning opportunities for
children.
 Learn how to deal better with their children at home
by using techniques that the teachers use in school.
 Find out ways to interact with others in the
community.
 Know that their children—and ALL children—are
receiving a quality education.
 Experience positive attitude about themselves and
their children by seeing their children.
 Benefits for Society
 Mainstream schools bring in the students into
local communities and neighborhoods.
 Helps break down barriers and prejudice that
prevail in the society towards PwD.
 Communities become more accepting of
difference, and everyone benefits from a
friendlier, open environment.
 Meaningful participation in the economic, social,
political and cultural life of communities own cost
effective non-segregated schooling system that
services both students with and without special
needs education.
 2.6.Ultimate Goal of Inclusion
• The goal of inclusion is to create schools where
everyone belongs.
• By creating inclusive society, we ensure that
there‘s a welcoming place in the community for
everyone after their school year‘s end.
• Students educated together have a greater
understanding of difference and diversity.
• Students educated together have fewer fears
about difference and disability.
• An IS culture creates better long-term outcomes
for all students.
 Cont…
• Inclusive society is a necessary precondition
for inclusive growth is a society which does not
exclude or discriminate against its citizens on
the basis of disability, caste, race, gender,
family or community, a society which ‗levels
the playing field for investment‘ and leaves no
one behind.
• Inclusive growth, which is equitable, that
offers equality of opportunity to all as well as
protection in market and employment
transitions results from inclusive society.
2.7. Features of Inclusive Environment
• members feel respected by and connected to one another.
• welcomes all people, regardless of their disability and other
vulnerabilities.
• It recognizes and uses their skills and strengthens their
abilities.
• respectful, supportive, and equalizing. An inclusive
environment reaches out to and includes individuals with
disabilities and vulnerabilities at all levels
• It has the following major characteristics:

it ensures the respect and dignity of individuals with
disabilities

it meets current accessibility standards to the greatest
extent possible to all people with special needs

provides accommodations willingly and proactively

Persons with disabilities are welcomed and are valued for
their contributions as individuals.
 Inclusive Environments
• It develops whole-school/environment processes
• It recognizes and responds to the diverse needs of their
individuals and ensuring quality provisions for all through
appropriate accommodations, organizational arrangements,
resource use and partnerships with their community.
• It is also deeply committed to the belief that all persons can
learn, work and be productive.
• It involves restructuring environment, culture, policy, and
practice.
• It promoting pro-social activities
• It makes provides services and facilities equally accessible to
all people
• It involves mobilizing resources within the community
• It is alert to and uses a range of multi-skilled personnel
• strong links with, clinicians, caregivers, and staff in local
schools, work place, disability services providers and relevant
 2.8. Barriers to Inclusion
• societal values and beliefs- particularly the community and policy makers
negative attitude towards students with disability and vulnerabilities.
• Economic factors- this is mainly related with poverty of family, community
and society at large
• Lack of taking measures to ensure conformity of implementation of
inclusion practice with policies
• Lack of stakeholders taking responsibility in their cooperation as well as
collaboration for inclusion
• Conservative traditions among the community members about inclusion
• Lack of knowledge and skills among teachers regarding inclusive education
• Rigid curricula, teaching method and examination systems.
• Fragile democratic institutions that could not promote inclusion
• Inadequate resources and inaccessibility of social and physical
environments
• Large class sizes
• Globalization and free market policy that make students engage in fierce
completion, individualism.
• Using inclusive models that may be imported from other countries
 CHAPTER THREE
IDENTIFICATION AND DIFFERENTIATED SERVICES
Learning Objective
• Identify the impact of disability and vulnerability
on daily life.
• Describe the need of persons with disability and
vulnerability
• Elaborate culture and disabling process
• Explain the concepts of Disability Inclusive
Intervention and Rehabilitation Services.
• Explain the concept of Community-Based
Rehabilitation.
• Identify appropriate technologies and assistive
technology for persons with disabilities and
vulnerabilities.
Impact of Disability and Vulnerability
on daily life
Factors related to the person
 People respond to disabilities in different
ways. Some react negatively and thus their
quality of life is negatively affected.
 Others choose to focus on their abilities as
opposed to their disabilities and continue to
live a productive life.
 Cont…
• The Nature of the Disability: Disability can be acquired (a
result of an accident, or acquired disease) or congenital
(present at birth). If the disability is acquired, it is more
likely to cause a negative reaction than a congenital
disability.
• The Individual’s Personality - the individual personality
can be typically positive or negative, dependent or
independent, goal-oriented or laissez-faire. Someone
who is independent will continue to be independent and
someone who is goal- oriented will continue to set and
pursue goals.
• The Meaning of the Disability to the Individual - Does
the individual define himself/herself by his/her looks or
physical characteristics? If so, he/she is more likely to feel
defined by his/her disability and thus it will have a
negative impact.
 Cont….
• The Individual’s Current Life Circumstances - The
individual‘s independence or dependence on others
(parents). The individual's education level. If the
individual is happy with their current life
circumstance, they are more likely to embrace their
disability, whereas if they are not happy with their
circumstances, they often blame their disability.
• The Individual's Support System - The individual‘s
support from family, a significant other, friends, or
social groups. If so, he/she will have an easier time
coping with a disability and thus will not be affected
negatively by their disability.
 Economic Factors and Disability
• Economic assets are more likely to acquire pathologies that may be
disabling.
• Economic status affects whether pathology will proceed to
impairment.
• A lack of resources can adversely affect the ability of an individual
to function with a disabling condition.
• Economic resources can limit the options and abilities of someone
who requires personal assistance services or certain physical
accommodations.
• Poor employment opportunity and contractual labor suffer a lot
than secured employment.
• Inaccessible environment(lack of public transportation, public
building) affected by economic factors
• The community may defined by the environment(micro system
(pwds), meso system (neighborhood, town) and macro
system(region or nation))
• Economic factors also can affect disability by creating incentives to
define oneself as disabled.
 Political Factors and Disability
• The political system, through its role in designing public
policy, can and does have a profound impact on the
extent to which impairments and other potentially
disabling conditions will result in disability.
• If the political system is well enforced it will profoundly
improve the prospects of people with disabling
conditions for achieving a much fuller participation in
society.
• The extent to which the built environment impedes
people with disabling conditions is a function of in
nonpublic buildings. public funds spent to make
buildings and transportation systems accessible and
public laws requiring the private sector to make these
accommodations
 Cont…
• The extent to which people with impairments and
functional limitations will participate in the labor force is a
function of the funds spent in training programs, in the
way that health care is financed, and in the ways that job
accommodations are mandated and paid for.
• Similarly, for those with severe disabling conditions, access
to personal assistance services may be required for
participation in almost all activities, and such access is
dependent on the availability of funding for such services
through either direct payment or tax credits.
• Thus, the potential mechanisms of public policy are
diverse, ranging from the direct effects of funds from the
public purse, to creating tax incentives so that private
parties may finance efforts themselves, to the passage of
civil rights legislation and providing adequate
enforcement.
 Factors Psychological of Disability
• Psychological environment is congruent with
the key assumption in this chapter that the
physical and social environments are
fundamentally important to the expression of
disability.
• Several constructs can be used to describe
one's psychological environment, including
personal resources, personality traits, and
cognition.
• These constructs affect both the expression of
disability and an individual's ability to adapt to
and react to it.
 Social Cognitive Processes
• Cognition consists of thoughts, feelings, beliefs,
and ways of viewing the world, others, and
ourselves.
• Three interrelated cognitive processes have
been selected to illustrate the direct and
interactive effects of cognition on disability.
• These are self-efficacy beliefs, psychological
control, and coping patterns which all these are
socially constructed.
 a) Self-Efficacy Beliefs
• Self-efficacy beliefs that he or she can or can’t accomplish a desired
outcome (Bandura, 1977, 1986).
• Beliefs about one's abilities affect what a person chooses to do, how much
effort is put into a task, and how long an individual will endure when there
are difficulties.
• Self-efficacy beliefs also affect the person's affective and emotional
responses.
• Under conditions of high self-efficacy, a person's outlook and mental
health status will remain positive even under stressful and aversive
situations.
• Under conditions of low self-efficacy, mental health may suffer even when
environmental conditions are favorable.
• The highly self- efficacious individual would work harder at tasks (i.e., in
physical or speech therapy), be less likely to give up when there is a
relapse (i.e., continue therapy sessions even when there is no immediate
improvement), and in general, feel more confident and optimistic about
recovery and rehabilitation.
• The development of self-efficacy of the individual is much affected by the
environmental factors.
 b)Psychological Control
• Psychological control, or control beliefs, is a kin to self-efficacy
beliefs in that they are thoughts, feelings, and beliefs regarding
one's ability to exert control or change a situation.
• Self-generated feelings of control improve outcomes for
diverse groups of individuals with physical disabilities and
chronic illnesses.
• The onset of a disabling condition is often followed by a loss or
a potential loss of control.
• Most critical for adaptive functioning is how a person responds
to this and what efforts the person puts forth to regain control.
• Perceptions of control will influence whether disabling
environmental conditions are seen as stressful and
consequently whether it becomes disabling.
• The individuals control over themselves depends on the
provision of the environments: accessibility or inaccessibility.
 C) Coping Patterns
• Coping patterns refer to behavioral and cognitive efforts to manage
specific internal or external demands that tax or exceed a person's
resources to adjust.
• Several coping strategies may be used when a person confronts a stressful
situation.
• These strategies may include : seeking information, cognitive
restructuring, emotional expression, catastrophizing, wish-fulfilling
fantasizing, threat minimization, relaxation, distraction, and self-blame.
• The effects of certain coping efforts on adaptive and functional outcomes
benefits individuals with disabling conditions. In general, among people
with disabling conditions, there is evidence that passive, avoidant,
emotion- focused cognitive strategies (e.g., catastrophizing and wishful
thinking) are associated with poorer outcomes,
• whereas active, problem-focused attempts to redefine thoughts to
become more positive are associated with favorable outcomes. An
adaptive coping pattern would involve the use of primary and secondary
control strategies. What seems useful is the flexibility to change strategies
and to have several strategies available.
 Cont….
• Active coping is a significant predictor of mental health
and employment-related outcomes. Under conditions in
which individuals with disabling conditions use active
and problem-solving coping strategies to manage their
life circumstances, there will be better functional
outcomes across several dimensions (e.g., activities of
daily living, and employment) than when passive coping
strategies are used.
• Appraisals involve beliefs about one's ability to deal with
a situation.
• Take, for example, two people with identical levels of
impairment. The appraisal that the impairment is
disabling will result in more disability than the
appraisal that the impairment is not disabling,
regardless of the objective type and level of impairment.
 D) Personality Disposition
• Optimism is a personality disposition.
• Optimism (in contrast to pessimism) is used for
illustrative purposes because it relates to many
other personality traits.
• Optimism is the general tendency to view the
world, others, and oneself favorably.
• People with an optimistic orientation rather than a
pessimistic orientation are far better across several
dimensions.
• Optimists tend to have better self-esteem and less
hostility toward others and tend to use more
adaptive coping strategies than pessimists.
 Cont…
• Optimism is a significant predictor of coping efforts
and of recovery from surgery. Individuals with
optimistic orientations have a faster rate of
recovery during hospitalization and a faster rate of
return to normal life activities after discharge.
• Optimism may reduce symptoms and improve
adjustment to illness, because it is associated with
the use of effective coping strategies.
• Psychological interventions directed at altering
cognition lead to improved outcomes (i.e.,
achievement, interpersonal relationships, work
productivity, and health) across diverse populations
and dimensions.
 The Family and Disability
• The family can be either an enabling or a disabling
factor for a person with a disabling condition.
• Although most people have a wide network of
friends, the networks of people with disabilities
are more likely to be dominated by family
members.
• Even among people with disabilities who maintain
a large network of friends, family relationships
often are most central and families often provide
the main sources of support.
• This support may be instrumental (errand-
running), informational (providing advice or
referrals), or emotional (giving love and support).
 Cont…
• Families can be enabling to people with functional
limitations by providing such tangible services:
• housekeeping and transportation and by providing
personal assistance in activities of daily living.
• Families can also provide economic support to help
with the purchase of assistive technologies and to pay
for personal assistance.
• Perhaps most importantly, they can provide emotional
support.
• Emotional support is positively related to well-being
across a number of conditions. In all of these areas,
friends and neighbors can supplement the support
provided by the family.
 Cont….
• It is important to note, however, that families may also be
disabling.
 promote dependency.
 Others fatalistically accept functional limitations and conditions
that are amenable to change with a supportive environment.
 In both of these situations, the person with the potentially
disabling condition is not allowed to develop to his or her
fullest potential.
 Families may also not provide needed environmental services
and resources. For example, families of deaf children frequently
do not learn to sign, in the process impeding their children's
ability to communicate as effectively as possible.
 Similarly, some well- meaning families prematurely take over
the household chores of people with angina, thereby limiting
the opportunity for healthy exercise that can lead to recovery.
 Needs of Persons with Disabilities and Vulnerabilities.
• People with disabilities do not all share a single
experience, even of the same impairment;
• Maslow has identified five categories of needs, with
different priority levels, in the following order:

survival (physiological),

safety,

social needs,

esteem, and

self-actualization (fulfillment). Maslow‘s model is also
valid for persons with disabilities and vulnerabilities,
whose needs are similar to those of ordinary persons.
Nevertheless, many of these needs are not fulfilled, so
disabilities and vulnerabilities seek to fulfill these needs
and reach a state of wellbeing. Initially, disabilities and
vulnerabilities attempt to fulfill the first level of needs
(survival).
Cont…
 Cont…
• survival needs are formed by the physiological needs and
include the biological requirements for feeding, performing
hygiene, sleeping, ADL, and so on. an example of needs in
terms of safety, consider a person with visual impairment
who wishes to cross the street safely. In contrast, for the
elderly, at risk and street children safety might represent
the ability to obtain emergency help after falling and not
being able to stand again.
• Social need is a key element that disabilities and
vulnerabilities would like to develop continuously. For
example, a person with a hearing impairment suffers from
a diminution of social contact, while someone with a motor
disability feels excluded from social activities.
• The third level of the pyramid relates to esteem, both self-
esteem and being favorably recognized by others. Esteem is
often related to the capability of achieving things,
contributing to a work activity and being autonomous.
Needs of persons with disabilities and vulnerabilities
 Full access to the Environment (towns, countryside
&buildings)
 An accessible Transport system
 Technical aids and equipment
 Accessible/adapted housing
 Personal Assistance and support
 Inclusive Education and Training
 An adequate Income
 Equal opportunities for Employment
 Appropriate and accessible Information
 Advocacy (towards self-advocacy)
 Counseling
 Appropriate and Accessible Health Care
 Social Needs of Persons with Disabilities and
Vulnerabilities
• Social protection plays a key role in realizing the rights of persons with disabilities and vulnerabilities of
all ages:

Providing them with an adequate standard of living,

A basic level of income security;

Reducing levels of poverty and vulnerability

It have a major role in promoting their independence and inclusion

By meeting their specific needs and supporting their social participation in a non-discriminatory manner.
• These social protection measures may include poverty reduction schemes;

Cash transfer programs,

Social and health insurance,

Public work programs,

housing programs,

Disability pensions and mobility grants.
• Social protection from a rights-based approach
• Traditional mainly focused on poverty rather than taking into account specific challenges faced by
persons with disabilities and vulnerabilities; particularly active participation in education, access to
health and employment.
• Previous methods of addressing benefits for persons with disabilities have shown limited progress in
overcoming the deeply-rooted social structures.
• Consequently, social protection needs to move beyond traditional welfare approaches to intervention
systems that promote active citizenship, social inclusion and community participation while avoiding
paternalism and dependence.
• The right of persons with disabilities to social protection is recognized by the 1948universal declaration of
human rights (UDHR), the uneconomic and, more specifically, the 2006 unconvention on the rights of
persons with disabilities (crpd). Article 28 of the CRPD in particular recognizes the right of persons with
disabilities to an adequate standard of living and to social protection, ensuring the enjoyment of both
rights without discrimination on the basis of ability.
 Gender and disability
• The importance of work and the daily activities
required of living in the country are paramount in
considering gender. For the male and female with
disabilities and vulnerable groups, work is universally
seen as important, whether paid work or voluntary.
• Many of male and females with disabilities have
creativity and skill in finding ways to do things and
consequently being able to build friendships with other
men in their communities.
• Work, particularly paid work, is also important for
many of the female contributors.
• Sustaining this in the face of community views about
disability is at times difficult, particularly when it is
balanced with expectations of traditional women‘s
roles of home making and childcare.
 Identity and disability
• The relational nature of identity seems to be of central
importance to people with disabilities.
• People with disabilities are not primarily clients or service
users but rather are known members of their communities
with a shared and, at times, intergenerational history.
• Identity marked by disability is complex and multilayered;
relationships, outside of paid, formalized service settings.
• Disability as part of an individual‘s identity is seen by some
as a struggle. This is often dual: internally to individuals and
their sense of self and, too often, in the way they are
perceived and constructed by those around them.
• An acquired disability is experienced as challenging the
nature of one‘s internal pre-established identity and as a
struggle to change the perceptions and attitudes of others
and the physical environment in which a person lives.
 Belongingness and disability
• Belonging is a complex concept involving an attachment to place,
relationships with others, a sense of safety, common values and a
shared and/or developing history. Persons with disabilities and
vulnerable groups have struggled to come to terms with a body and
mind which seem unfamiliar to them, in which they have to make
adjustments or accommodations both for themselves and in terms
of their relationships with others.
• Family relationships as a means of connecting to community and
being known by others, and knowing others outside the family are
important.
• Historically for people with disabilities, rurality was once the site of
exclusion, rather than belonging, where identity and gender were
disregarded in favor of ensuring protection of people with
disabilities and of the society in which they lived..
• People with disabilities and marginalized groups feel isolated. Some
persons with disabilities have actively sought to migrate to urban
environments, to escape from the confines and constraints of small
rural environments and to build broader social networks away from
the farm.
 Intersectionality
• Social structures and norms surrounding age are particularly
significant, shaping the kind of lives people have and their
experience of gender and identity.
• They have particular implications for people‘s attachment to
place and their aspirations and desires for the future.
• Age matters, too, in terms of the support that family and
services can offer in a rural environment and the types of
‗age-appropriate‘ opportunities that can be facilitated in the
person‘s home, family and community.
• Being a particular ‗age‘ in a rural landscape has implications
for the types of social relationship that are openly facilitated
and enabled.
• The wider contextual values and economic and 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.
 Secondary conditions: conditions occur in addition to (and are
related to) a primary health condition.
 Co-morbid conditions: conditions occur in addition to (and
are unrelated to) a primary health condition associated with
disability. diabetes and schizophrenia (15%) compared to a
rate of 2-3% for the general population
 Age-related conditions: The ageing process for some groups
of people with disabilities begins earlier than usual. Premature
aging by 40s and 50s in mosst developmental disabilities
 Engaging in health risk behaviors: Some studies have
indicated that people with disabilities have higher rates of
risky behaviors such as smoking, poor diet and physical
inactivity.
 Barriers to Health Care for Persons with Disabilities and
Vulnerable Groups
 Prohibitive costs: Affordability of health services and transportation are
two main reasons people with disabilities do not receive needed health care
in low-income countries - 32-33% of non-disabled people are unable to
afford health care compared to 51-53% of people with disabilities
 Limited availability of services: The lack of appropriate services for people
with disabilities is a significant barrier to health care.
 Physical barriers: Uneven access to buildings (hospitals, health centers),
inaccessible medical equipment, poor signage, narrow doorways, internal
steps, inadequate bathroom facilities, and inaccessible parking areas create
barriers to health care facility.
 Inadequate skills and knowledge of health workers: People with
disabilities were more than twice as likely to report finding health care
provider skills inadequate to meet their needs.
 Inclusive Barriers to Health Care
• Policy and legislation: Assess existing policies and services, identify
priorities to reduce health inequalities and plan improvements for access
and inclusion.
• Financing: Where private health insurance dominates health care
financing, ensure that people with disabilities are covered and consider
measures to make the premiums affordable. Ensure that people with
disabilities benefit equally from public healthcare programs. Use financial
incentives to encourage health-care providers to make services
accessible and provide comprehensive assessments, treatment, and
follow- ups.
• Service delivery: Provide a broad range of modifications and adjustments
(reasonable accommodation) to facilitate access to health care services.
For example changing the physical layout of clinics to provide access for
people with mobility difficulties or communicating health information in
accessible formats such as Braille. Empower people with disabilities to
maximize their health by providing information, training, and peer
support. Promote community-based rehabilitation (CBR) to facilitate
access for disabled people to existing services.
• Human resources: Integrate disability inclusion education into
undergraduate and continuing education for all health-care professionals.
Train community workers so that they can play a role in preventive health
care services.
 Disability, vulnerability and the Environment
 The prevailing understanding about the cause of disability has undergone profound
change worldwide.
 Previous models of absolute determinism that viewed pathology and disability
interchangeably and that excluded consideration of the environment .
 currently, disability is seen to result from the interaction between the characteristics of
individuals with disabilities and the characteristics of their environment. Cultural
norms affect the way that the physical and social environments of the individual
 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
 Disability is not inherent in an individual but is, rather, a relational concept—a function
of the interaction of the person with the social and physical environments. 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.
 Human competencies interact with the environment in a dynamic reciprocal
relationship that shapes performance.
 The physical and social environments comprise factors external to the individual,
including family, institutions, community, geography, and the political climate. Added
to this conceptualization of 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.
 Cont…
Type of Factor Type of Environment

Natural Environment Built Environment

Dry climate Ramps

Enabling

Flat terrain Adequate lighting

Clear paths Braille signage

Disabling Snow Steps

Rocky terrain Low-wattage lighting

High humidity Absence of flashing light alerting systems

 Cont…
• 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.
• 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.
• 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. Examples of such cues could include beeping microwaves,
which elicit responses from people without hearing impairments, or
bumpy surfaces on subway platforms, which tell users
 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
• 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.
• Thus, the natural environment, including topography
and climate, affect whether or to what degree a
functional limitation will be disabling.
 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
• vulnerabilities and marginalized groups, 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. It include:

Assistive devices,

Alterations of a physical structure,

Object modification, and

Task modification.
• The role of environmental modification;
 primary prevention secondary conditions and disability
 Ease the burden of care experienced by a family
member who has the responsibility of providing the day-
to-day support.
 Environmental strategies will have rehabilitation role
function independently and not be limited in their social
participation, in work, leisure or social interactions as a
spouse, parent, friend, or coworker.
 Cont…..
 Mobility aids – Nonskid floors
 Hand Orthosis – Sound-reflective building materials
 Mouth stick – Enhanced lighting
 Prosthetic limb – Electrical sockets that meet appropriate reach
ranges
 Wheelchair (manual and/or motorized)
– Hardwired flashing alerting systems Increased
 Canes textural contrast
 Crutches Accessible features
 Braces –
Communication aids Built up handles
 – Voice-activated computer
Telephone amplifier orTDD – Automobile hand controls
 Voice-activated computer Job accommodations
 Closed or real-time captioning •
 Computer-assisted note taker Simplification of task
 Print enlarger
 Reading machines
• Flexible work hours
 Books on tape • Rest breaks
 Sign language or oral interpreters • Splitting job into parts
 Braillewriter  Relegate nonessential functions to others
 Cochlear implant Differential use of personnel
 Communication boards FM, audio-induction Personal care assistants
loop, or infrared systems
Accessible structural elements  Note takers
–  Secretaries Editors
Ramps Elevators  Sign language interpreters
– Wide doors
– Safety bars
 Culture and the Disabling Process
• Culture affects the enabling-disabling process at
each stage; it also affects the transition from one
stage to another.
• Culture includes both material culture (things and
the rules for producing them) and nonmaterial
culture (norms or rules, values, symbols,
language, ideational systems such as science or
religion, and arts such as dance, crafts, and
humor).
• Nonmaterial culture is so comprehensive that it
includes everything from conceptions of how
many days a week has or how one should react to
pain to when one should seek medical care or
whether a hermaphroditic person is an
abomination, a saint, or a mistake.
 Cont…
Type of Element of Social and Psychological Environment
Culture Psychological Political Economic
Factor

Expecting people Having an active Mandating relay Tax credits to hire

with disabling coping strategy systems in all states people with
conditions to be disabling conditions
Productive

Expecting everyone Cognitive Banning Targeted earned

to know sign restructuring discrimination income tax credits
language against people who
can perform the
Enabling

essential
functions of the job

Stigmatizing people Catastrophizing Segregating children Economic

with disabling with mobility disincentives to get
conditions impairments in off Social Security
schools Disability Income
benefits
Valuing physical Denial Voting against No subsidies or tax
Beauty paratransit system credits for
Disabling

purchasing assistive
technology
 Cont…
• Cultures can also speed up or slow down the
movement from pathology to impairment,
either for the whole culture or for subgroups
for whom the pathway is more or less likely to
be used.
• Eg. some religions, women are less likely to
seek health care because it means a man must
be available to escort them in public, which is
unlikely if the males are breadwinners and
must give up income to escort them, and
women are also less likely to seek health care
if the provider is male.
 Cont…
• Female circumcision is an impairment that could
lead to functional limitation (inability to
experience orgasm), but if the whole point is to
prevent female sexual arousal and orgasm.
• If the culture does not recognize the
impairment, the rehabilitation process is
irrelevant—there is no need to rehabilitate a
physical impairment if there is no recognized
functional limitation associated with it.
 Pathway from Functional Limitation to
Disability
• The transition from functional limitation to disability is
affected by culture.
• A condition that is limiting must be defined as
problematic—by the person and by the culture—for it to
become a disability.
• Whether a functional limitation is seen as being disabling
will depend on the culture. The culture defines the roles to
be played and the actions and capacities necessary to
satisfy that role.
• For example, a professor who has arthritis in her hands but
who primarily lectures in the classroom, dictates material
for a secretary to type, and manages research assistants
may not be disabled in her work role by the arthritis.
• Although there is a direct path from culture to disability,
there is an also indirect path.
 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.
 This involves more than simply encouraging people; it requires making
sure that adequate policies and practices are in effect in a community
or organization.
 Inclusion should lead to increased participation in socially expected life
roles and activities—such as being a student, worker, friend, community
member, patient, spouse, partner, or parent. Socially expected activities
may also include engaging in social activities, using public resources such
as transportation and libraries, moving about within communities,
receiving adequate health care, having relationships, and enjoying other
day-to-day activities.
 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.
 Cont…
• Persons with disabilities and vulnerabilities are often
excluded (either directly or indirectly) from
development processes and humanitarian action
because of physical, attitudinal and institutional
barriers.
• The effects of this exclusion are increased inequality,
discrimination and marginalization.
• To change this, a disability inclusion approach must
be implemented. The twin-track approach involves:
(1) ensuring all mainstream programs and services are
inclusive and accessible to persons with disabilities
(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
 . A public health approach distinguishes:

• 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).
• 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).
• 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).
 Cont…
• Implementing the Twin-track Approach: Implementing the twin-track
approach involves:
• Track 1: Mainstreaming disability as a cross-cutting issue within all key
programs and services (education, health, relief and social services,
microfinance, infrastructure and camp improvement, protection, and
emergency response) to ensure these programs and services are
inclusive, equitable, non-discriminatory, and do not create or reinforce
barriers.
• This is done by: gathering information on the diverse needs of persons
with disabilities during the assessment stage; considering disability
inclusion during the planning stage; making adaptations in the
implementation stage; and gathering the perspectives of persons with
disabilities in the reporting and evaluation stage.
• Track 2: Supporting the specific needs of vulnerable groups with
disabilities to ensure they have equal opportunities to participate in
society. This is done by strengthening referral to both internal and
external pathways and ensuring that sector programs to provide
rehabilitation, assistive devices and other disability-specific services
are accessible to persons with disabilities and vulnerable groups
 Implement Disability Inclusive Project/ Program
• As a direct service provider, consultant and materials and
equipment producers concerned with realizing equity, quality
services and protecting human rights, all sectorial strategies,
program, projects and services must be disability-inclusive.
• The sectors operations should be largely framed within broad
programs, making it very important to ensure that disability
inclusion is reflected in program strategies and design
documents. This in turn will help to subsequently ensure
disability is also incorporated into the projects that are
designed to contribute to the overall program objectives.
• However, persons with disabilities are often not considered in
crucial stages of most sectorial and developmental program
and projects because of lack of awareness about the
characteristics of people with disabilities, vulnerability groups
and disability inclusion in practice.
• The following tips as a key considerations for including persons
with disabilities in all program and project cycle management
stages of Assessment, Planning, Implementation and
Monitoring, and Reporting/Evaluation.
 Cont…
• Education and vocational training –Inclusive Education realize the universal
right to education for all,
• Health – PWDS same health-care needs as all other peoples and health sector
services play an important prevention and early identification, access to health
services and referral rehabilitation support.
• Relief and social services to reduce poverty vulnerable group and peoples with
disabilities and their families need to be able to access relief support.
• Infrastructure and camp improvement, shelter, water and sanitation and
environmental health – universal design concepts
• Livelihoods, employment and microfinance –to achieving an independent
livelihood, projects to make accessible to all vulnerable and people with
disabilities.
• Protection – marginalized groups and people with disabilities may face risks
and vulnerabilities to experiencing violence, exploitation, abuse, neglect and
violation of rights and therefore need to be specifically considered and included
in protection programs and projects.
• Humanitarian and emergency response – the disproportionate effect of
emergency and humanitarian situations on vulnerable groups and people with
disabilities should be reflected in the design and implementation of the
humanitarian projects.
 Implement effective Intervention and Rehabilitation
• Rehabilitation interventions promote a comprehensive process
to facilitate attainment of the optimal physical, psychological,
cognitive, behavioral, social, vocational, and educational status
within the capacity allowed by the anatomic or physiologic
impairment, personal desires and life plans, and environmental
(dis)advantages for a person with a disability.
• Consumers/patients, families, and professionals work together
as a team to identify realistic goals and develop strategies to
achieve the highest possible functional outcome, in some cases
in the face of a permanent disability, impairment, or pathologic
process.
• Although rehabilitation interventions are developed within
medical and health care models, treatments are not typically
curative. Professionals have the knowledge and background to
anticipate outcomes from the interventions, with a certain
degree of both optimism and cynicism, drawn from past
experiences.
 Cont…
• Rehabilitation requires goal-based activities and, more
recently, measurement of outcomes.
• The professionals, usually with the patient/ consumer and/or
family, develop goals of the interventions to help mark
progress or identify the need to re-assess the treatment plan.
• Broad goals and anticipated outcomes should include
increased independence, prevention of further functional
losses or additional medical conditions when possible,
improved quality of life, and effective and efficient use of
health care systems.
• Consideration of accessibility of environments and social
participation can, and increasingly should, be included within
the scope of outcomes and goals for independence.
• A broad range of measurement tools have been developed for
use within rehabilitation, and these standardized tools, along
with objective measures of performance (e.g., distance
walked, ability to perform a task independently),
 Components of Rehabilitation Interventions
• Rehabilitation is a process designed to optimize
function and improve the quality of life of those
with disabilities.
• Consequently, it is not a simple process. It
involves multiple participants, and it can take
many forms.
• comprise the process and activity of
rehabilitation.
 Cont…
 Multiple Disciplines: Rehabilitation interventions usually involve multiple
disciplines. Such as
 The Physician’s role is to manage the medical and health conditions of the
patient/consumer within the rehabilitation process, providing diagnosis, treatment,
or management of disability-specific issues.
 Occupational Therapist (OTs) increase their ability to participate in activities of
daily living (ADLs) and instrumental activities of daily living (IADLs), in school and
work environments, using a variety of techniques. Typical techniques include
functional training, exercise, splinting, cognitive strategies, vision activities,
computer programs and activities, recommendation of specially designed or
commercially available adaptive equipment, and home/education/work site
assessments and recommendations.
 Physical Therapists (PTs) assess movement dysfunction and use treatment
interventions such as exercise, functional training, manual therapy techniques, gait
and balance training, assistive and adaptive devices and equipment, and physical
agents, including electrotherapy, massage, and manual traction. The outcome focus
of interventions is improved mobility, decreased pain, and reduced physical
disability.
 Cont….
 Speech and Language Therapist assess, treat, and help to prevent disorders
related to speech, language, cognition, voice, communication, swallowing, and
fluency.
 Audiologists identify, assess, manage, and interpret test results related to
disorders of hearing, balance, and other systems related to hearing. Hearing
screens and more technologically advanced testing systems fall under the areas
of practice. Audiologic rehabilitation interventions include developing auditory
and central processing skills, evaluating and fitting for a variety of hearing aids
and supports, training for use of hearing prosthetics, including cochlear implants,
and counseling for adjustment to hearing loss or newly acquired hearing.
Although sign language is a technique used to assist with communication for
those with hearing impairments, competency is not required for audiologists.
 Rehabilitation Nurse usually takes the role of educator and taskmaster
throughout rehabilitation, but these professionals have most prominence within
inpatient rehabilitation programs. They are expert at bladder management,
bowel management, and skin care, and they provide education to patients and
families about these important areas
 Social Workers in health settings may provide case management or coordination
for persons with complex medical conditions and needs; help patients navigate
the paths between different levels of care; refer patients to legal, financial,
housing, or employment services.
 Cont…
 Case Managers: case management is a relatively new concept that has come
about with the survival of patients/consumers with complex medical problems
and disabilities, and with the development of a more complex health care
system. Case managers possess skills and credentials within other health
professions, such as nursing, counseling, or therapies, although they usually have
a nursing background.
 Rehabilitation Psychologist is a specialized area of psychology that assists the
individual (and family) with any injury, illness, or disability that may be chronic,
traumatic, and/or congenital in achieving optimal physical, psychological, and
interpersonal functioning (Scherer et al.,2004).
 Neuropsychologists: neuropsychology is another specialized area within
psychology, and it is of particular importance in the care of individuals who have
sustained brain injuries. These professionals possess specialized skills in testing
procedures and methods that assess various aspects of cognition (e.g., memory,
attention, language), emotions, behaviors, personality, effort, motivation, and
symptom validity.
 Therapeutic Recreation Specialists provide treatment services and recreation
activities for individuals with disabilities or illnesses. They use a variety of
techniques to improve and maintain the physical, mental, and emotional well-
being of their clients, with the typical broad goals of greater independence and
integration into the community. Therapists promote community-based leisure
activities as a complement to other therapeutic interventions, and as a means to
practice those clinic- or hospital-based activities within a real-world context.
 Cont…
 Rehabilitation Counselors (previously known as vocational
counselors) assist persons with both physical and mental disabilities,
and cover the vocational, psychological, social, and medical aspects
of disability, through a partnership with the individuals served.
 Orthotists and Prosthetists
 These professionals practice within a unique area of rehabilitation,
combining technical and some clinical skills. The orthotist fabricates
and designs custom braces or orthotics. To improve partial or total
limb absence or amputation to enhance their function by use of a
prosthesis (i.e., artificial limb, prosthetic device).
 Additional/Other/Rehabilitation Professionals who might be
considered members of the team include nutritionist, spiritual care,
rehabilitation engineer, music therapist, dance therapist, child-life
specialist, hospital-based school teacher, massage therapist,
kinesiologist, and trainer, among others.
 PWD and His or Her Family members are partners in this team
process.
 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
 Cont…
• 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. (WHO &UNESCO,2004)
• 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.
• 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.
 Cont….
 Community-consists of people living together in
some form of social organization sharing political,
economic, social and cultural characteristics in
varying degrees.
 Rehabilitation-includes all measures aimed at
reducing the impact of disability for an individual
enabling him or her to achieve independence,
social integration, a better quality of life and self-
actualization
 It refers to measures which aim to enable persons
with disabilities to attain and maintain maximum
independence, full physical, mental, social and
vocational ability, and full inclusion and
participation in all aspects of life.
 Cont…
• This definition particularly advocates a broad approach
elements:
• The participation of people with disabilities and their
representatives at all stages of the development of the
program
• The formulation and implementation of national policies
to support the equal participation of people with
disabilities
• The establishment of a system for program management
• The multi-sectoral collaboration of governmental and
nongovernmental sectors
• CBR focuses on strengthening the capacity of peoples with
disabilities, and their families.
• CBR focuses on challenging negative views and barriers in
society to enable equal rights and opportunities
 CBR meaning attached with;
 People Taking Care of Themselves
 This is the "real" CBR: all the activities that people with disability, their
family members and other community members do in their own
community for persons with disability,.
 A Concept and an Ideology.As a concept and an ideology, it promotes a
decentralized approach to rehabilitation service-delivery, whereby, it is
assumed that community members are willing and able to mobilize local
resources and to provide appropriate services to people with disabilities.
 Community Based Rehabilitation: is mostly in a form of Non-
Governmental Organizations (NGOs). Recognizing the human and
material limitations of people with disabilities, their family members and
other community members, CBR programs often consider 'local culture'
as an obstacle, rather than as a condition towards progress.
 Major Objectives of Community Based Rehabilitation is to ensure that
people with disabilities are empowered to maximize their physical and
mental abilities, have access to regular services and opportunities and
become active, contributing members of their communities and then
societies.
 Implement Technologies for Disability
• Inclusiveness and Information Technology (ICT) the rights of persons with
disabilities and vulnerabilities.
• Effective access to information is crucial in facilitating the participation of
citizens in civil society. Accessibility concerns in the information and
communications technologies (ICTs) sector have become particularly
important.
• provision of services for accessing digital television such as audio description
(video description), closed signing, and the availability of subtitles (captions)
in live broadcasts enabled by speech-to text technologies can make an
important contribution to facilitating independent living.
• Unfortunately, persons with disabilities and vulnerabilities still face
significant barriers in accessing ICTs. These barriers include, inter alia, poorly
designed Web sites (e.g., with graphics not readable by computerized screen
readers, with information that can be accessed only by the use of the mouse
rather than the keyboard), limited availability of subtitles on webcasts, the
use of multiple remote controls for digital television, and difficult to navigate
on-screen displays.
• These access barriers have the potential to affect persons with disabilities,
including persons with sensory disabilities (visual and/ or hearing), mobility
disabilities, or cognitive disabilities. The objective to ensure equal access to
information should play a central role in any regulatory framework for the
ICT sector.
 Inclusiveness and Assistive Technology
• Assistive Technology encompasses all systems that
are designed for Persons with disabilities and
Vulnerabilities, and that attempt to compensate the
handicapped. This includes robotic tele
manipulators, wheelchairs, or navigation systems for
the blind.
• Surgery, generic therapy, rehabilitation, human
assistance, and the use of assistive technology (AT)
help disabled people cope with their disabilities.
• Rehabilitation develops and adapts residual
capabilities, while human assistance aids Persons
with disabilities and vulnerabilities in their daily
living activities
 Cont…
• Assistive Technology and Daily Living of
Persons with disabilities and Vulnerabilities
• enhancing and expanding their
communication, learning, participation, and
achievement with higher levels of
independence, wellbeing, and quality of life.
Such assistive technologies are essential for
helping Persons with disabilities and
vulnerabilities with severe physical, sensorial,
or mental limitations to become more
independent, and to improve their quality of
life.
 AT and User Needs: A Classification Scheme Examples
of AT user needs and classification
A. People with Communication Disabilities
• Needs & Barriers: social needs socialization, access to information technology,
communication and interaction with environment, access to public
administration and facilities (authorities, banks, public services), shopping
recreation and leisure problems with speech, writing, esteem independence and
employment.
• Assistive technologies: Mobile systems [phones, wearable electronics,
computers, augmentative and alliterative communication (including I/O
interfaces) (adaptable/configurable interfaces, tactile interfaces), vibrotactile
displays reading screen, speech technologies, augmentative–alliterative
communication. Socialization and entertainment tools (special games, virtual
companion‘s video conferences).
• Medication organizers (medication reminder/management). Speech technology
(audio technology for I/O interfaces and control, writing translators, text–speech
translators, transportation (public transportation facilities, smart environments
home control, pervasive computing, context awareness, middleware) Shopping
tools (Internet access) and education tools
B. People with Cognitive Disabilities:
• The impairments may include: Cognition, memory loss and forgetfulness
• Needs & Barriers are survival, hygiene (toileting, bathing, laundry); feeding
(food preparation, eating, drinking), remembering, housekeeping—home
cleaning, safety, safety technologies, safety of environment, self-care and
medication management, social needs, socialization, navigation, access to
information technology, education, communication and interaction with
environment, shopping, esteem, independence, employment, recreation and
leisure
• AT may include Mobile systems (phones, wearable electronics, and computers),
socialization and entertainment tools (special games, virtual companions,
videoconferences), augmentative and alliterative communication (including I/O
interfaces), adaptable/configurable interfaces, organizer and reminder assistants
for timekeeping), medications,(appointments, hygiene, etc., electronic
organizers, medication reminder/management, procedure assistants,
transportation public transportation facilities) Communication aids
(communicators, multimedia procedure, assistants, large-screen programmable
phones, electronic information organizers, electronic mail)
C. People with Motor Disabilities impairment include Upper-limbs difficulties/
dexterity, lower- limb deficiencies
• Needs & Barriers are the need for mobility, working in the inaccessible
environment Assistive technologies may include orthotics (cognitive orthotics),
smart environments, home control, shopping tools (internet access) and
education tools
 Assistive Technology and the Marketplace
• Specialization is based on the development of products or services that
are adapted for Persons with disabilities. In practice, the AT industry
considers Persons with disability populations as solvent autonomous
markets. Developed products are adapted for Persons with disabilities
needs, so the satisfaction of each target population or subpopulation is
good, thereby supporting further product development or adaptation.
Nonetheless, the market for such AT is not growing quickly, owing to (1)
development costs, (2) high price of the final product, and (3) generally
low income of people with disabilities
• Trivialization considers Persons with disabilities as an augmentation of
the market for devices used by people without disabilities. In this
strategy, industry does not target Persons with disabilities and
Vulnerabilities populations directly. Instead, the products for Persons
with disabilities and Vulnerabilities are of standardized type, that is,
generic with multipurpose capabilities.
 Assistive Technology and Design Methods
• Given the requirements of functionality, safety, and
comfort, the design of AT for Persons with
disabilities and Vulnerabilities requires both
excellent engineering capacities and relevant
knowledge about Persons with disabilities and
Vulnerabilities characteristics.
• Product developers must be fully aware of needs,
wants, and capabilities of Persons with disabilities
and Vulnerabilities populations, as well as
limitations associated with each handicap.
Numerous design methods have been suggested to
assist in the process of AT development. Most
widely known are user centered design and
universal design.
 Cont…
• User-centered design is a set of techniques and processes that enable
developers to focus on users, within the design process. In practice, users
are involved in the development process, depending on their skills and
experience, and their interaction is facilitated by a domain expert. Often, the
developed AT meets persons with disabilities satisfaction.
• Universal design (also called design for all) is the design of products and
environments to be usable by all people, to the greatest extent possible,
without the need for adaptation or specialized design. Here, the design
process is guided and constrained by a number of objectives: accessibility,
adaptability, trans generational applicability, and/or universal applicability or
appeal.
• Instead, the ideas of adapting products, services, or the environment are
extended to users at large. In practice, products are developed to meet the
needs of average users. If a user is different, significantly, from the average
population, (e.g., a person with a significant handicap), then, the product
will provide poor user satisfaction.
• Architecture and everyday products have been designed for market appeal,
with a greater focus on fashion rather than function.
• Universal design is an enabling factor in the environment that allows the
user with a functional limitation to become more independent, yet without
an additional cost or stigma attached to the particular product.
 Implement Inclusive Job Opportunities and
Employment
• The right to work is fundamental to being a full and
equal member of society, and it applies to all
persons, regardless of whether or not they have a
disability.
• A decent job in the open labor market is a key
bulwark against poverty. It also enables people to
build self-esteem, form social relationships, and to
gain skills and knowledge. Moreover, a productive
workforce is essential for overall economic growth.
Barriers to employment thus not only affect
individuals‘ lives, but the entire economy.
 Cont…
• A decent job in the open labor market is a key
bulwark/protection against poverty. It also
enables people to build self-esteem, form social
relationships, and to gain skills and knowledge.
• Moreover, a productive workforce is essential for
overall economic growth. Barriers to
employment thus not only affect individuals‘
lives, but the entire economy.
 Cont…
• The recently adopted 2030 Agenda for
Sustainable Development calls on governments
around the world to promote full employment
and decent work for all, including persons with
disabilities and vulnerabilities.
• Besides directly targeting employment, the 2030
Agenda and the accompanying SDGs also
emphasize the need to guarantee the rights of
persons with disabilities and vulnerabilities to
equal and accessible education; social, economic
and political inclusion, and access to cities,
transport systems and public space.
 Barriers of employment
• Barriers to the employment of persons with
disabilities take many forms and operate at
many levels, both within and beyond the
workplace itself.
A) Attitudes and Discrimination
• Employers may be reluctant to hire persons
with disabilities based on the perception that
they are less productive or less capable of
carrying out their jobs than others. Colleagues
of persons with disabilities may also hold
prejudicial attitudes.
 B) Accessibility

• The accessibility of the following areas are crucial

to the employment of persons with disabilities: the
physical environment; transportation; information
and communications; and other facilities open to
the public. In the workplace itself, a lack of physical
features such as ramps and elevators can prevent
persons with mobility disabilities from being able
to work.
• Similarly, the lack of accessible information and
communication infrastructure in workplaces such
as clear signage, computers equipped with
software such as screen-readers, and devices such
as Braille displays can prevent persons with print
and intellectual disabilities from being able to gain
employment.
 C) Education and Training

• Persons with disabilities have disproportionately

restricted access to education and training.
• This severely limits their job opportunities due
to a lack of skills and knowledge that are
relevant to find or retain a job.
• Children with disabilities are less likely to attend
school.
• In addition, young persons with disabilities who
have attended school may not get the support
they need when transitioning from school to
work.
 D) Social Networks
• Another barrier to employment for persons with
disabilities can be their more limited social networks.
Social networks greatly aid the process of searching
for work, the lack of which is likely to limit options for
persons with disabilities.
• As part of their broader exclusion from many
important social activities, persons with disabilities
often therefore lack the opportunity to build social
relationships with those who may be in a position to
offer suggestions for potential work opportunities.
• These limited networks are part of the broader
cultural and attitudinal barriers that inhibit
participation in social, leisure, civic, and religious
activities.
 E) Women Disabilities

• In many developing countries including Ethiopia,

as a result of continued prejudices both towards
women and surrounding disability, women with
disabilities are doubly discriminated against in
the labor market.
• Study found that in many developing countries,
women with disabilities are only half as likely as
men with disabilities to have a job.
• Moreover, when they are employed, women
with disabilities encounter worse working
conditions and lower pay as compared with
other women.
 Cont…
F) Legal Barriers
• As a result of discriminatory attitudes about the
perceived capabilities of persons with disabilities, some
countries impose legal restrictions on their participation
in certain types of employment or processes.
G) Inflexible Work Arrangements
• Another common obstacle to the employment of persons
with disabilities is the inflexibility of work arrangements.
In some cases, persons with disabilities might prove to be
competent and productive employees, but are
nonetheless unable to perform certain tasks. The same is
true for scheduling the work day. Indeed, a greater
degree of flexibility of working arrangements can boost
the morale and productivity of any employee, regardless
of whether or not they have a disability.
 Cont…
H)Dismissal on the Basis of Disability
• Workers who are injured and acquire a disability on
the job may face unaccommodating policies and a
lack of rehabilitative services, which limit their
ability to return to work.
• The absence of anti-discrimination legislation in
the majority of countries in the region thus allows
employers to dismiss staff on the basis of disability
with impunity. Ultimately though, legislation which
protects the rights of workers from dismissal on the
basis of disability is also needed to more
comprehensively tackle the problem
 I) The Benefit Trap

• ironically be imposed by social protection schemes

ultimately designed to support them. These schemes can
encourage individuals to stay out of the labor force if they
are structured in such a way as to make the receipt of
benefits contingent on the inability to work.
• Therefore, even if persons with disabilities believe that
they can work, they may choose not to in order to
continue receiving disability benefits.
• Even if working could offer them a higher level of income,
persons with disabilities may still choose to receive
benefits because of the risk of attempting to hold down a
job that does not provide adequate support, or is not
flexible towards their needs. It is important to stress that
this ‗benefit trap‘ is mainly relevant to more developed
countries.
 Strategies to Improve Employment for Persons with
Disabilities and Vulnerabilities
• There a number of strategies that is available to governments in
respective sector as they work to improve the employment prospects
of persons with disabilities such as
A) Anti-Discrimination Legislation
• These laws make it illegal to discriminate against an individual on the
basis of disability in a range of areas including: employment;
education; access to public buildings; the provision of goods and
services, and political processes. With regard to employment, anti-
discrimination laws protect persons with disabilities from
discriminatory actions in hiring and termination of contracts and affirm
the right of persons with disabilities to access employment on an equal
basis with others.
B) Vocational Education And Training
• Technical vocational education and training (TVET) programs can help
to ensure that the workforce has the skills and knowledge necessary to
obtain and retain a job, while also driving productivity and economic
growth.
C) Wage Subsidies
• Wage subsidies cover a portion of employees‘ wages, usually for a limited
period of time, as a way to lessen the risk perceived by employers of hiring
persons with disabilities. Since wage subsidies directly target the recruitment
process of private firms, they enable employers to overcome their
reservations about hiring employees with disabilities..
D) Supported Employment
• These programs integrate persons with disabilities into the open labor
market by providing direct, on-the-job support to employees with disabilities.
Supports are usually offered for a limited period of time. One common type
of support is a job coach. Job coaches provide on- site, individually tailored
assistance to help persons with disabilities perform their jobs. Supported
employment requires employers to be open to having such services on site,
and to be willing to work cooperatively with job coaches and other service
providers. Employment support services and job coaches require special
training.
E )Workplace Accommodation Schemes
• These schemes reduce the costs to employers of making workplaces more
accessible to persons with disabilities. In so doing, workplace
accommodation schemes seek to minimize employer reluctance to hire
persons with disabilities.
 Cont…
• There are two ways Government programs can
decrease or even eliminate those costs. The
first is by offering tax breaks or tax credits for
expenditures undertaken to make such
adjustments.
• Another strategy is to provide full or partial
funds for reasonable accommodations for
employees with disabilities.
F) Workers’ Compensation
• These programs are designed to address the issue of
occupational injuries and illnesses. They provide cash
and medical benefits to employees whose disability is
acquired in the workplace.
G) QuotaSystems
• Quota systems mandate that firms hire at minimum a
certain percentage of persons with disabilities. Typically,
quotas apply only to large employers.
H) Sheltered Workshops
• These programs only hire persons with disabilities, and
structure jobs around the perceived abilities of each
employee. Sometimes the stated goal of sheltered
workshops is to serve as a training ground for the
eventual transition of employees to the open labor
market.
I) Private Sector Initiatives
• In addition to government-driven strategies, a number
of private-sector initiatives also serve to illustrate the
need for action to be taken not only by governments,
but by employers themselves.
J) Employer Networks
• A number of networks of private companies around
the world have initiated their own programs to
promote the employment of persons with disabilities.
– Raising awareness and building capacity on disability
inclusion;
– Providing information and tools on disability and
employment;
– Influencing policy on the employment and training of
persons with disabilities;
– Providing career development opportunities and
organizing vocational training;
– Linking jobseekers with disabilities and employers;
 K)Support Disability-Inclusive Business
• Private employers can play an important role in
developing policies and programs to boost
employment for persons with disabilities, as well as
their own bottom line. It is recommended that
governments:

Introduce programs to raise awareness among
private employers of the business case for hiring
persons with disabilities.

Support employers‘ organizations and networks to
share inclusion practices and build their capacities
to harness the potential of employees with
disabilities.
 L) Social Enterprises
• Social enterprises are businesses that seek to
advance a social cause whilst being financially
self-sustainable.
• Rather than being driven solely by the desire
to make profits, these businesses also aim to
maximize social impact.
• Social enterprises that consciously seek to hire
persons with disabilities, or address issues and
barriers affecting the lives of persons with
disabilities can therefore help to boost the
employment of persons with disabilities,
 M) Support Persons with Disabilities in the
Workplace
• It is therefore recommended that governments:
• Promote flexible working arrangements to ensure that
qualified, productive individuals are not unnecessarily
prevented from doing certain jobs.
• Provide funding support and tax incentives to start ups
and social enterprise initiatives that aim to hire persons
with disabilities or address specific needs of persons with
disabilities.
• Provide subsidies or tax incentives that support the
inclusion of persons with disabilities in the workplace.
• Develop job coach accreditation and training standards
and provide job coaching services to enable persons
with disabilities to do their jobs effectively and
productively.
 Building a More Inclusive Society
 Develop and implement accessibility standards for the
physical environment in line with universal design,
including public buildings and transport services, to
ensure that individuals with mobility disabilities are not
denied employment opportunities.
 Promote and provide knowledge, information and
communication services in accessible formats, in line
with universal design, to meet the needs of persons with
sensory, intellectual and psychosocial disabilities to apply
for and retain a job.
 Foster greater social inclusion by establishing links with
disabled persons‘ organizations, including groups of
women with disabilities, and working to promote
employment opportunities
Thank you!