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Rehabilitation of People with Intellectual Disabilities in a Resource Poor District,

Barwani, India: A Community-Based Approach

Article in Journal of Contemporary Water Research & Education · August 2013

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Rehabilitation of People with Intellectual Disabilities Journal of Contemporary Research in Education

in a Resource Poor District, Barwani, India: 2(1) 36-48
A Community-Based Approach

Ram Lakhan
Jackson State University

Abstract
People with intellectual disabilities (ID) have several rehabilitation needs, which are difficult to
address at one institution. Community-based rehabilitation (CBR) is one approach that provides
services that meet their varied needs within their own communities. Objective of this research is to
study a community-based rehabilitation program that provides comprehensive rehabilitation to people
with ID in India. People with ID were identified through a door-to-door survey in 63 villages of the
Barwani District. Patients received medical, educational, psychosocial, and vocational intervention by
a CBR team. A total of 262 subjects, 140 tribal (53.4%), 122 non-tribal (46.6%) were categorized as
borderline (5, 1.9%), mild (79, 30.1%), moderate (100, 38.1%), severe (63, 24.4%), and profound (15,
5.7%). Patients were both male (138, 52.7%) and female (124, 47.3%). Medical intervention was
provided to 100% of study subjects, inclusion to 74 (28.2%), parent training to 204 (77.8%), and
disability certificate to 225 (85.9%). CBR is a feasible and acceptable approach in poor rural settings
that enables ID people, their parents, and respective communities to promote patient rehabilitation and
inclusion.

Introduction The National Trust Act was established

a decade ago with purposes of promoting
Intellectual disability (ID) is a condition rehabilitation and facilitating guardianship to
characterized by significant limitations in both ensure legal rights of people with ID. There are
intellectual functioning and adaptive behavior numerous and complex issues involved in ID
(AAIDD, 2013). Intellectual disability not only patients’ rehabilitation. The prevalence of ID in
affects an individual’s overall life, but also their India is 2.5/1000 (Srinath & Girimaji 1999),
entire family, especially in poor rural areas in which is comparable to the reported worldwide
India where the availability of rehabilitation prevalence (Mercadante, Evans-Lacko, and
services is very limited. The Indian Ministry of Paula, 2009). The high ID incidences in rural
Social Justice and Empowerment has India (Narayanan, 1981) are most concerting.
implemented several rehabilitation programs Most rehabilitation institutes are located in
across the country, but outreach of those urban settings; thus their reach to the rural
programs is affected due to several structural population is limited by distance from home,
and practice-related issues. Developed countries poor transportation facilities, poverty, and lack
including the United States, the United of awareness (D’Costa, 2008; Klasing, 2007;
Kingdom, and several European countries utilize Lakhan, 2013a). Poverty, dearth of resources,
institutional approaches to address needs of ID low awareness, and lack of political reform stunt
individuals. Highlighted in these systems is a development of strong policies that positively
gradual movement toward ID community living intervene on behalf of ID patients’ rehabilitation.
(Thorn, Pittman, Myers and Slaughter, 2009). Therefore, a more suitable and comprehensive
India’s concern surrounding the care of ID approach is needed to address the rehabilitation
people is rising. Therefore, there has been an needs of ID people in India (Ewardraj, Mumtaj,
attempt to develop a more suitable rehabilitation Prasad, Kuruvilla, and Jacob 2010; Malik &
model to serve people with ID (Lakhan, 2013a). Harbour, 2013).
 Journal of Contemporary Research in Education 2(1)
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A previous study found that in poor challenges of ID population in resource poor

communities, people with disabilities are settings (Kumar et al., 2012).
identified by their disabilities (Burns, 2000).
People with ID have varied rehabilitation needs: Setting
they require unique medical, educational,
vocational, and social support. It is likely that This program was implemented by a
some medical needs can be addressed through non-government organization (NGO) called
the existing infrastructure; however, attitudes of Ashagram Trust (AGT) located in the district of
health workers and even professionals retain a Barwani in the state of Madhya Pradesh, India.
barrier in service delivery. Education, AGT began in 1983 for the purpose of
employment, and independent living needs are rehabilitating people with leprosy, and then
the critical areas of rehabilitation needed to expanded its services to the entire Barwani
maximize ID patients’ integration. One would district and in the other adjoining districts of
not argue that ID people need equal Khargoon, Khandawa, Dhar, and Jhabua.
socialization, educational development, and Barwani is one of the poorest district in Madhya
community inclusion, which are all severely Pradesh, and the Department of International
underdeveloped in poor rural communities Development (DFID) lists it among the 100
(Rashikj and Trajkovski, 2006; Kumar, Roy & poorest districts in India (Sarma Committee,
Kar, 2012) 1997). Barwani is considered a tribal district
because of its larger tribal population (68%
Community-based rehabilitation tribal, 32% non-tribal) (Census 2011). More
provides rehabilitation to people with than 50% of the district population lives below
disabilities. The World Health Organization the poverty line. Health and education facilities
(CBR, 2004) proposed this initiative, which has are very poor (Lakhan, 2013a; JSY, 2010). Until
reported success in developing countries. It 1999, this region of five districts did not have
includes local resources and local participation any rehabilitation facility. People with
(Crishna, 1999), and is ultimately a CBR based intellectual disabilities are living in very poor,
social model of rehabilitation that recognizes unhygienic, and depressing conditions.
medical intervention importance. CBR is Historically, ID has been mythologized in
considered accessible and cost-effective religion and culture and resultantly shaped
(Velema and Fuzikawa, 2008) and enhances communications, customs, practices, and
utility to implement resources into poor settings. behaviors (Smith, 2002). Many themed patients
CBR is flexible and sensitive to the cultural are victim of isolation and stigma due to poor
needs (Dawad & Jobson, 2011; Crishna, 1999), awareness, myths, and misbelieves in
and the program can be customized to the local communities (Kishore, Nizamie, Nizamie &
needs and available community resources. Jahan, 2004; Kumar, Das, Bhandary, Soans,
Grounds of developing CBR are based on Kumar & Kotian, 2008).
participation and ownership of community at
every program stage. CBR can be beneficial for Objective: To briefly discuss the process of
rehabilitating people with ID in developing implementing a CBR program and evaluate its
countries (Mirza, Tareen, Davidson, and larger impact for ID people in the resource-poor
Rahman, 2009; Lakhan, 2013b). CBR creates district of Barwani, India.
awareness, facilitates service availability, and
empowers disabled people, parents, and Method
community through capacity building initiatives.
Presently, CBR is popular and being followed in Demographic and Sampling
90 developing countries (Gupta and Singhal,
2004; Robertson, Emerson, Hatton, & Yasmy, This research implies participatory
2012; Finkenflugel1, Wolffers, and Huijsman, action methods and was a long-term extension of
2005). CBR can be a great option to address the a community-based mental health project of
AGT that was previously implemented in a few

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villages of the Barwani district. Sixty-three included community acceptance of CBRWs and
villages of the Barwani block were included in literacy. Selection criteria were that CBRWs
the CBR project. Of those, 23 villages consisted should be able to read and write and have a high
of a 99% tribal population, and the remaining school level of education. However, in tribal
villages had a 10-20% of tribal population. After populations, we could not find people with a
approval of the project, a meeting was high school education, and therefore we
conducted with village leaders (Surpanch) at compromised with this requirement and
Ashagram Campus (Rain Basira). Participants recruited a few CBRWs who only had a 5th
were oriented about the project and were asked grade education. Female candidates did not
to participate in the program. Consent for data come voluntarily, so we approached their
collection through surveys, focus group parents / spouse and encouraged them to join the
interviews, and key informant surveys were CBR team.
obtained. The Surpanches of all villages selected Data Collection: Consent, Focus Group
for the project were oriented about the project. Discussion & Survey: Disability data for project
Professionals on the CBR team, including a villages was obtained from the concerned
psychiatrist, specialist in intellectual disability, district department. These data were found to be
psychologist, and physiotherapist collectively inaccurate when the CBR team visited project
developed a survey form. This form included villages and tried to interact with those who
screening schedules for mental illness as well as were listed on the government list as disabled.
intellectual, physical, visual, and hearing The team realized the importance of identifying
assessments of the disabled. Communality-based each ID person living in the community. Two
rehabilitation workers (CBRWs) were given one approaches were used: a) focus group discussion
week of training on the survey form and on (FGD), in which a CBRW and a professional in
characteristics of disabilities. Findings of the intellectual disability conducted FGDs, and b) a
door-to-door survey were compiled and door-to-door survey.
tabulated. A total of 64,800 people were covered
in this survey. The project was financially In the door-to-door survey we used a
supported by Action Aid India for 10 years Hindi translation of the “National Institute for
(1999-2010). the Mentally Handicapped Developmental
Screening Schedule (NIMH-DDS)” developed
Process of implementation by Madhwan, Menon, Kalyan, Narayan and
Subbarao (1988) at the National Institute for the
Preparatory Phase Mentally Handicapped (NIMH) India. The
This process took 6 months. The CBR team “NIMH-DDS” has three screening schedules
conducted numerous team meetings, most designed for specific age groups. Schedule 1
starting in the morning around 8 am and ended covers children below age 3; Schedule 2 is for 3-
around 11 pm. Discussion and idea sharing 6-year-olds; and Schedule 3 is for children from
included funding organization members and age 7 and above. Schedule 1 compares
disability experts. milestones, while Schedules 2 and 3 have
questions with yes or no answers. This screening
Team Building: Professionals included a tool can be used by CBRWs and other lower
psychiatrist, clinical psychologist, two level disability and public health workers in
specialists in intellectual disability, a speech rural populations in India (Robertson, Hatton
therapist, physiotherapist, two social workers, an and Emerson, 2009). This instrument has great
accountant, and a computer operator cum clerk. sensitivity (0.79), specificity (0.99), and overall
Five CBRWs employed by the CMHP project screening accuracy (0.98) (Saroj, 1991).
were also transferred to the program. These
CBRWs visited CBR villages with the CBR professionals provided a short
professionals. There, they conducted meetings FGD training and survey to CBRWs. Training
with villagers and asked them to recommend comprised of highlighting features and
people who could work as CBRWs. Criteria characteristics of ID, overview of administration

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_____________________________________________________________________________________

tools, and facilitating group discussions. Village officials in terms of advocacy for service
leaders (Sarpunch) were contacted and oriented delivery.
with the project. Written consent for surveys
was obtained from each village leader and from Figure 1
every household that included a disabled person.
CBR Team
These politically elected members, Sarpunch,
were requested to support the program. During
the survey, the CBR team attempted to identify
Specialist in ID
key community persons helpful in initiating the
CBR process. Data was tabulated and recorded
by computer, and a village-wide list was given
to respective CBRWs. All CBR villages were Training of CBRWs on ID

divided into 10 clusters based on respective

geography and population, and each cluster was
comprised of a 5 village mean (3 minimum to 7 Preliminary visit of CBRWs to the family

maximum). At least two CBRWs were assigned

to each cluster, was and each cluster was
supervised by a senior CBRW designated as Professional visit to family with CBRWs
cluster supervisor.

Capacity building of professionals and

CBRWs: Each CBR team was qualified to CBRWs visits Capacity building of
provide rehabilitation intervention in an the parents

institutional setting, but lacked understanding of

a community-based approach. Thus, they Community
attended other organizations’ workshops to gain meetings, Community School
exposure to the CBR method and were Committee activities
formation to
additionally encouraged to develop their CBR facilitate
understanding by reading related literature. inclusion
Awareness activities in villages
CBRWs also completed a seven-day training
module to identify the needs of ID people,
conduct meetings, and offer information on
Figure 1: Diagram highlighting different
disability related schemes and benefits. CBRWs
also shadowed CBRs in other organizations. components of CBR implementation for ID
Working as a CBR involves human interaction
at various levels; therefore, understanding the Field Visits: every member of a CBR team
types of human relationships is crucial (Perkins conducted field visits on a regular bases for
& Tice, 1995) for building a positive attitude. A intervention and program monitoring.
team must believe that the task in which they are a) Professional Visits: Professionals of
engaged is achievable. CBR team attitudes are intellectual disability, also referred to as ID
pivotal developing mentorship relations with experts, accompanied CBRWs to their field
clients (Kendall, Buys and Larner, 2000) and visits. ID experts conducted assessments of ID
ultimately determine program success. patients. Each ID person took at least two
diagnostic tests: 1) Developmental Screening
Interventional Phase Test (DST) (Bharatraj, 1998) and 2) Vineland
CBR intervention was carried out in four Social Maturity Scale (VSMS) (Malin, 1992).
broader areas: medical, education, vocation, Scores obtained on these two tests were
and social on three different levels. Levels averaged to obtain the IQ of each individual.
included the: a) ID individual, b) parents and VSMS provides the social Quotient (SQ), which
care takers, and c) community and government itself highly correlates (0.80) with IQ on the

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Lakhan
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Stanford Binet Intelligence Test (BKT) (Kumar, expressive communication levels and disorders
Singh and Akhtar, 2009; Kishore, Nizamie, and of articulation, voice, and fluency. The
Nizamie, 2010; Lakhan, 2014). Experts used frequency and severity of maladaptive behavior
DST and VSMS because they can be problems were assessed through BASIC-MR.
administered in non-clinical settings. Following Experts found that these tests provided less
the 10th revision of International Classification significant help in a CBR setting due to their
of Disease (ICD), cases were grouped into five administration time requirements and cultural
categories of ID: borderline (IQ > 70), mild (IQ irrelevance. CBRs principally believe in training
50 – 69), moderate (IQ 35 – 49), severe (IQ 20 – CBRWs on simplified rehabilitation techniques
34), and profound (IQ < 20). ICD-10 based and tests to minimize the gap for rehabilitation
criteria were used due to popularity (Schalock, service delivery between ID and professionals.
Ruth, Luckasson, Borthwick-Duffy, Bradley et Due to poor applicability and complexity
al., 2007) and wide acceptance across member attached to administration, scoring, and
countries of the World Health Organization interpretation, the idea of using these tests was
(WHO, 2007). ID experts selected intervention abandoned. Experts could not find more user-
goals by consulting with parents and offered friendly, reliable, valid, standardized and
such intervention on site in homes with parents culturally sensitive tests to apply in a CBR
present. This process also provided hands-on setting.
training to CBRWs. In these visits, both
professionals and CBRWs interacted with b) CBRW Visit: CBRWs conducted a follow-
schoolteachers, Auxiliary Nurse Midwife up of given interventions at every visit. They
(ANMs), and other community workers of also watched and mentored parents
education and health, who were acquainted with administering interventions. Interventions were
the project and requested to support the program written in the form of task analyses on case files.
by integrating ID people in existing schemes. CBRWs also spent time with ID children,
playing and initiating interaction with other
Cases, such as other IQ tests at either the children and community members, to maximize
AGT center or in medical camps, to further exposure in a natural setting, boost learning and
determine IQ profiles and plan appropriate confidence, and socialize within a community.
intervention. Gessells Drawing Test (GDT), CBRWs visited in hopes of selecting those
Segwin Form Board (SBF) and Indian interested in forming the “village committee”
adaptation of the Alexander Pass Along Test group, a backbone of CBR. Moreover, they
(PAT) were used to obtain a quick estimation of approached schoolteachers to discuss the
a child’s intellectual functioning. A WISC possibility of integrating children with ID into
adaptation, called Malins Intelligence Scale for regular schools. Teachers willing to enroll ID
Indian Children (MISIC), was administered on children into their classrooms and to receive
children attending school because this test training on inclusion were noted.
covers academic components. The Stanford
Binet Intelligence Test (BKT) was used to c) Medical Camps: medical camps were
obtain an estimation of a child’s functioning organized in Menimata, Chikhliya, Silawad,
abilities in different areas of intelligence, such as Palaya, and Talwada-Bujurg villages. These
attention, memory, logic, and visuospatial. The villages were considered cluster villages in the
obtained scores were used to plan the project, and people from 3-4 surrounding
intervention. Initially, detailed assessment was villages participated. People with ID were
conducted using the “Functional Assessment assessed for medical conditions, such as epilepsy
Checklist for Planning (FACP), Language and psychiatric illness. A physical examination
Assessment Tool (LAT), and Behavioral was also conducted. These camps also served
Assessment Scale of Indian Children for Mental people with other disabilities, such as mental
Retardation (BASIC-MR). FACP provided an illness. Other rehabilitation services,
estimation of functioning in areas of self-help physiotherapy, speech and language training,
and academics, and LAT assessed receptive and and behavior modification were also provided to

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 Journal of Contemporary Research in Education 2(1)
_____________________________________________________________________________________

the individuals with ID during these camps and brought to AGT center for two days
(Lakhan, 2013b; Lakhan, 2014). Camps were of training. Social, environmental causes
also used for health education and awareness on of ID, government schemes, and
psychiatric disorders and disabilities to prevent advocacy skills were discussed with the
secondary disability. Disability management, objective of strengthening committees
prevention, inclusion and employment options with knowledge. Committee members
were discussed. support ID people and their parents by
asserting rights toward a disability
Trainings: Training and exposure visits were certificate, education, and equal
organized for parents, community members, and opportunity for employment.
other government grassroot workers such as
ANMs, Aganwadi (workers at integrated child Community meetings: Meetings were
development centers), and teachers to strengthen conducted consistently once a month in each
understanding about identification and village from the beginning of the program in
management of ID. 2000 until the end of the project in 2010. The
focus of the community meetings changed from
time to time. The beginning phase of the
a) Parents and caretakers: The key program from 2000 until 2004 focused on
strength of CBR depends on its social awareness, capacity building activities of
ecology in which people with CBRWs, parents and community, medical
disabilities, their parents, and intervention, disability certificates, and inclusive
community members are enabled (Sen education. During the second phase from 2004
and Goldbart, 2005; Kuipers and Doig, to 2007, the focus slightly shifted towards
2013). ID people are more vulnerable developing local leadership and enabling people
and disadvantaged than other disabled with disabilities to take leadership roles. During
individuals because of their limited the third phase from 2007 to 2010, an attempt
cognitive and communication abilities. was made to bring community forward to take
Most ID people require assistance for ownership of the program Lakhan, 2014).
personal needs and depend on parents
and siblings for care. Parent groups were Individual cases in the process of
formed so parents could voice common education inclusion were discussed. Duties were
concerns, share feelings, and morally assigned to committee members to meet with
support one another. These groups were teachers. Discussion on income generation
also trained on handling their children, activities was also done. ID experts often
taking care of their personal needs, attended these meetings and facilitated
carrying out rehabilitation intervention, discussion on prevention and management of ID.
and learning about available government These community meetings were primarily used
benefits. These trainings were conducted to form committees, create awareness, motivate
at the AGT center and both parents of parents, income generation options, and promote
ID children were encouraged to attend. health.

Awareness activities: Several awareness

b) Community: Strengthening community activities were conducted in the evenings, and in
with knowledge of ID people and their the larger villages in the afternoon on market
various needs enhances sensitivity day. Street play, puppet shows, musical nights,
towards the entire issue, helping to and distribution of pictorial pamphlets were the
foster their integration. “Village main activities. Play activities, called “child-to-
Committees” were formed by interested child activities”, were conducted in schools to
villagers willing to work on disability. sensitize non-disabled children for inclusion of
Committees of about ten people, mostly their ID peers in schools and during play in the
male, were formed in each CBR village community. Such activities were adopted

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enthusiastically by children and potentially carry out stretching, positioning, balancing, and
began to change their mindsets about disability. gait exercises for their ID children. They were
able to take up smaller goals for language
Advocacy initiatives and activities: stimulation towards enhancing their
Government advocacy on the ID issue is a key comprehension and expression. Parents were
requirement in CBR. People should be enabled also able to identify problematic behavior and
and guided through the process so villagers their handling of those situations became more
united with ID people and their parents to assert supportive and free of punishment. In a few
their rights and fight against discrimination and cases, we found that parents were using a reward
injustice, for which rallies were facilitated. system for helping their children learn good
Predominantly, village committees came behavior. Parents understood the importance of
forward and spoke freely with government regular medication for epilepsy or any other
officers. medical problems. Awareness, advocacy, and
training developed confidence in parents to
Results approach government hospitals and assert their
See Appendix rights to healthcare and medicine (Lakhan,
2014). CBR attempted to link all cases with
Medical Intervention: All 262 (100%) cases government hospitals to obtain appropriate
with or without any associated conditions such consultation and medication, but only carried out
as psychiatric disorders and epilepsy received for a small number of cases. Cases involving
appropriate intervention with regular follow up. psychiatric disorders or epilepsy could not
obtain medicine from government hospitals,
Vocational Intervention: Attention was first since these hospitals had no provisions to buy
given to those who were 18 years of age or such medicine (Lakhan, 2013b). CBR project
older. Most parents who had a child with less leaders along, together with parents and village
severe ID were able to involve them in their committees, met with district and state
agricultural work. This involvement provided no government health officers requesting medicine
monitory gain to the family, but developed a at the district hospital. Until the end of the ninth
sense of productivity in individuals with ID and project year, medicines were provided only by
a hope to their parents. In several villages, CBR and AGT through oral assurance from
committees turned out proactive and ensured government officers for arrangement.
inclusion of ID people in the National Rural
Employment Guarantee (NREG) scheme. Education for people with ID was not
Committees recommended officers of the considered important among ID parents and
scheme to assign ID people simpler tasks such communities. Few teachers contacted in the
as offering water to workers. No exact statistics project’s beginning were not at all aware about
are available, but we recall that eight people the inclusion of ID children. Those who were
with moderate to higher ID received a few days aware, however, did not have the ability to teach
of employment under NREG. Few people ID with regular students in their classrooms
obtained employment at community centers run (Parasuram, 2006; Rao, 2008; Lakhan, 2013a;
by religious groups. The parents of ID children Das, Gichuru, & Singh, 2013; Singh, Verma,
younger than 18 years of age were encouraged Das and Yeh, 2014). As the project progressed
to involve them in household chores and other and awareness activities continued, the concept
tasks in preparation for employment. of inclusion spread among parents, community,
and teachers, which was noted in meetings.
Discussion Readiness among parents and teachers to enroll
ID children in regular school came very late.
Physiotherapy as well as occupational Several meetings were conducted with district
and speech therapy were considered part of the level education officers to facilitate this
medical intervention. At the end of the project, inclusion. District officers were urged through
many parents (approximately 70%) were able to meetings and even rallies to conduct training for

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_____________________________________________________________________________________

teachers to build their capacity of teaching ID accommodate such workers. In rural areas,
children in regular classrooms. Few teachers where the process is comparatively less
showed willingness for training; those that did challenging than in an urbanized setting, the
completed three days of orientation on inclusion approach of employing ID people in assisted or
for ID at AGT on CBR cost and became more sheltered workplaces is feasible.
open and confident in teaching ID children in
their classes. A total of 74 children were able to The biggest outcome of CBR was
enroll in regular schools. The objectives of changing the mindset of people. ID people are
inclusion were set up in consultation with stigmatized (Perkisn, Holburn, Deaux, Flory and
teachers and were very low compared to their Vietze, 2002; Jahoda & Markova, 2004;
matched peers. The objectives were as follows: Cooney, Jahoda, Gumley and Knott, 2006;
the child feels motivated to come school, learn Edwardraj et al, 2010) and almost do not have
basic routines, gets an opportunity to interact their own identity in their communities. Many of
with peers, learns basic reading, writing (name them are called local names resembling mental
& address), counting, socialization, and attends disability such as Bholaram (son of God who
school regularly for at least for one academic does not know anything), Budhu (does not know
year. Initial attempts were made to enroll less anything), or Ganda (mentally ill). These
severe children. Children who could not attend stigmas are emotionally painful (Beart, Hardy
regular schools were enrolled in “Non-formal and Buchan, 2005). During meetings and
education” (NFE) centers that were started in training, a sense of connectivity, belongingness,
communities as an alternate provision for and respect toward ID individuals were all
schooling (Lakhan, 2013a). The objective of observed and recorded while interacting with the
NFE was to motivate non-school going children villagers.
through recreational activities in the afternoon or
evening when children usually stayed home. A Awareness and capacity building
community member recommended by the activities in the community helped develop a
village committee served in these NFEs and realistic image of an ID person to their parents,
received a small payment to honor their time and further reducing stigma and discrimination in
service. society and increased visibility and possibility of
inclusion. Empowerment leads to inclusion and
Employment is achievable for ID vice versa, which is a key target of CBR
people. Parents can involve their adult children (Arokiasamy, 1993). Moreover, volunteerism is
in their own occupation and compensate for time a principle of CBR, but could not be supported
and labor. Keeping employment in an in this project, which failed to sustain volunteers
independent setting is difficult even though the even for a month to support activities. CBR
PWD act states that all person with disability practitioners should make appropriate
including ID should be given equal opportunity arrangements for compensating their workers for
in job. Practically, ID people require some their services.
assistance to perform work related tasks that
need to be modified and made simpler. Conclusion & Research Implication
Additionally, they require systematic graduated
exposure and consistent reinforcement to This study demonstrates that through the
transfer into employment. The PWD Act has CBR program, parents can learn rehabilitation
neither included awareness on this matter nor skills in medical, educational, social, and
provided employers any support to modify their communication areas and they can carry out
infrastructure to accommodate ID people. physiotherapy, communication training, and
teaching. Parents can also learn to talk with
CBR has little scope for promoting schools to enroll their child. They can also
employment options for ID. Committees that understand the importance of involving their
understand the nature and characteristics of ID children with ID in household activities in order
can compromise with employers to to prepare them for future occupations. Through

43
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the CBR, parents can also learn some behavior References

modification skills.
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CBR seems to be implementable and an Developmental Disabilities (AAIDD)
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Its execution requires professional Disability. Retrieved January 8, 2014,
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Positive changes were noticed in the knowledge, Rehabilitation. Rehabilitation
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summarize the project’s impact on the lives Area. Indian Journal of Clinical
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project, most professionals left the organization
and AGT did not receive funding for a final Beart, S., Hardy, G., & Buchan, L. (2005). How
external evaluation. This process-based article People with Intellectual Disabilities
provides a descriptive and structural framework View Their Social Identity: A Review of
of implementing CBR in rural poor settings. the Literature. Journal of Applied
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The author attempted his best to keep an Karnataka, India.
objective position, but subjectivity cannot be
denied. Burns, J. (2000). Living on the edge: women
with learning disabilities. In J.M.
Acknowledgement: I thank Ashagram Trust for Ussher (Eds.), Women’s Health,
my employment on this project, and Action Aid Contemporary International perspective
for funding. I sincerely thank the ID children, (pp. 196-203), London: Wiley
their parents, community members, CBRWs and Blackwell.
all my teammates for participation in this
research. I also thank to my colleague Satyabrat Community Based Rehabilitation (2004). A
Chaudhary, a specialist in intellectual disability, Strategy for Rehabilitation, Equalization
for his input in developing interventional of Opportunities, Poverty Reduction and
strategies for ID clients. The author did not social Inclusion of People with
receive any financial support for writing this Disabilities Joint Position Paper, ILO,
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Appendix
Table 1: Profile of ID people who received CBR services

Variable/ ID Borderline ID Mild ID Moderate ID Severe ID Profound ID

(IQ>70) (IQ 69-50) (IQ 49-35) (IQ 34-20) (IQ<20)
Population

Tribal 1(0.38%) 42(16.0%) 57(21.7%) 5(13.3%) 5(1.9%)

Non-Tribal 4(1.5%) 37(14.1%) 43(16.4%) 28(10.7%) 10(3.8%)

Gender
Female 3(1.1%) 39(14.9%) 46(17.5%) 31(11.8%) 5(1.9%)

Male 2(0.8%) 40(15.3%) 54(20.6%) 32(12.2%) 10(3.8%)

Socio Economic Status*

Very Poor 0(0.0%) 30(11.5%) 36(13.7%) 28(10.7%) 3(1.1%)

Poor 2(0.8%) 35(13.3%) 43(16.4%) 20(7.6%) 5(1.9%)

Middle 3(1.1%) 12(4.6%) 19(7.2%) 14(5.3%) 6(2.3%)

Upper 0(0.0%) 2(0.8%) 2(0.8%) 1(0.38%) 1(0.38%)

Parent Education

None 1(0.38%) 58(22.1%) 80(30.5%) 52(19.8%) 9(3.4%)

Primary 0(0.0%) 12(4.6%) 4(1.5%) 1(0.38%) 0(0.0%)

Middle school 3(1.1%) 6(2.3%) 8(3.0%) 4(1.5%) 0(0.0%)

High School 1(0.38%) 1(0.38%) 0(0.0%) 5(1.9%) 3(1.1%)

Bachelor 0(0.0%) 2(0.8%) 8(3.0%) (0.38%) 3(1.1%)

Table 2: Major outcome of the CBR at the 9th year of the program

Variable/ ID Borderline ID Mild ID Moderate ID Severe ID Profound ID

(IQ>70) (IQ 69-50) (IQ 49-35) IQ 34-20) (IQ<20)
Inclusion

No 1(0.38%) 25(9.5%) 81(30.9%) 63(24.0%) 15(5.7%)

Yes 2(0.8%) 54(20.6%) 18(6.9%) 0(0%) 0(0%)

Disability Certificate

No 0(0%) 14(5.3%) 17(6.4%) 6(2.3%) 0(0%)

Yes 5(1.9%) 65(24.8%) 83(31.6%) 57(21.7%) 15(5.7%)

Parent Training

No 2(0.8%) 13(4.9%) 24(9.1%) 15(5.7%) 4(1.5%)

Yes 3(1.1%) 66(25.1%) 76(29.0%) 48(18.3%) 11(4.1%)

48

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