CHAPTER - 5

COMMUNITY BASED REHABILITATION AND HOME

BASED SKILL TRAINING

COMMUNITY BASED REHABILITATION PROGRAM FOR THE DISABLED

In the 1950s and 1960s, a shift in the trend of services from institutions to
community for the disabled persons took place in the developed countries such
as the United States. Since then, community participation in the rehabilitation of
the disabled is gaining momentum. This change of outlook has promoted growth
of concepts like normalization, education in a least restrictive environment, home
based skill training and additional support services for parents, family and
community.

The enthusiasm generated by the community based service movements

stimulated the World Health Organisation (WHO) to bring out two technical
reports in 1958 and 1969, which suggested that rehabilitation should be a natural
and essential component of health care. The Alma Ata Declaration of 1978
further endorsed the view that rehabilitation services should be part of ‘Health for
All’ by 2000 A.D. The Community Based Rehabilitation (CBR) approach received
global recognition with the 1982 United Nation’s declaration of the Decade of
Disabled Persons and the adoption of the World Program of Action Concerning
Disabled Persons. The philosophy of CBR was to integrate disabled people into
the societal mainstream rather than create special environments for them. WHO
recommended that CBR should be set in the context of community services,
especially in relation to primary health care. Though the term CBR received
unqualified support internationally, there is a great disparity in its interpretation
and it has generated controversies over its application in practice.

Rehabilitation has been defined as the combined and coordinated use of

medical, social, educational and vocational measures for training and retraining
the individual to the highest possible level of functional ability. It includes all
measures aimed at reducing the impact of disabling conditions and enabling the
disabled to achieve social integration. Social integration has been defined as the
active participation of the disabled people in the mainstream of community life.
Rehabilitation involves intervention from disciplines such as physiotherapy,
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occupational therapy, audiology and speech therapy, psycho-social work, special

education, vocational guidance and placement. Medical treatment is also an

important aspect of rehabilitation.

By medical rehabilitation we mean restoration of functions of vital organs

or limbs of the body through medical treatment. Vocational rehabilitation means

restoration of the capacity to earn livelihood. Social rehabilitation means
restoration of family and social relationship. Psychological rehabilitation means

restoration of personal dignity and confidence of the disabled person.

Over the years, institution based services, which have a longer history,
have developed into high cost program , in most countries, and face serious
problems resulting from mounting staff costs, wastage of man power and low
efficiency of services. As a result, in many developing countries the CBR
approach is viewed as a cost efficient alternative to rehabilitation institutions. At
the same time, this approach aims at greater coverage of the population of

disabled people.

Resources for CBR program may be viewed in three perspectives:

technological, financial and, manpower. It is generally accepted that
technological resources are introduced into the community from outside.
However, there are differences in perception with regard to financial and
manpower resources. One school of thought believes in a completely self-

sustained program, while another holds that partial or complete external inputs

may be necessary. When the entire resources are expected from within the
community in a CBR program, it is also assumed that the community is an
enlightened one, where technical know-how is the only missing element in an
otherwise rehabilitation minded environment. On the other hand, when resources
are from outside the community, they tend to be available only to those

communities which are within the direct reach of resource providing

organisations. The International Labor Organisation (ILO) states in a review of its
experiences that it has not found any really effective CBR program that has
demonstrated its ability to carry on solely with local or national resources, without
support from outside agencies.

Contrary to the general belief, CBR programs are not cheap. In an

evaluation of an ILO supported Indonesian project providing community based
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vocational training and rehabilitation, two modes of interventions were

compared. In the first intervention, a mobile rehabilitation unit trained disabled

people at frequent intervals while in the other, a community based rehabilitation
service carried out a long-term training program for disabled people. During the
assessment at the end of the training, the earning capacity of the disabled
people had improved substantially in both groups. In the community based
intervention where disabled people were trained continuously, the effects of the

, training were of a better quality and more lasting. However, this method was found
to cost several times more per person than the mobile rehabilitation unit program.

At first glance, the concept of CBR would seem to promise substantial

coverage of disabled people, but there are doubts about the validity of this
assumption. The trend of progressing impoverishment of rural people and the

growing abandonment of extended family systems leave little economic or man­

power resources in families to look after the needs of their disabled members,
thereby making disabled people a burden on their families. In such a situation,
the motivation required for effectively shouldering the responsibilities of caring

for disabled people within the context of their families will not be easily found.
The burden of caring for a disabled person and the stigma attached to having a

disabled member in the family can sometimes make the community refuse to
cooperate in any rehabilitation program. An apparent advantage in coverage in

CBR programs may thus be nullified in practice.

CBR programs today exist in two forms, based on who performs the tasks
of rehabilitation functions. In the first form, the rehabilitation functions are

entrusted to the members of the family and the community without any outside

assistance -it is therefore an entirely non-institutional approach. In the second

form, the rehabilitation functions are performed with external assistance, as in

extension services of rehabilitation centers. The kind of training and manpower

required for CBR programs remain controversial issues. Though able-bodied

volunteers appear to be a readily available manpower resource within the

community, their turnover is usually high and their professional competence
often minimal. On the other hand, professionals from outside the community tend

to show less sustained motivation when they are removed from their
technologically advanced institution bases to serve the community. Integration of
rehabilitation into any existing service system may therefore run the risk of
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deteriorating into a minor facet of the existing service, with no particular priority
attached to it. The manpower difficulty may to some extent be overcome by

using disabled people as rehabilitation workers. There is still no consensus

about the level of specialization required for personnel in rehabilitation programs.

There are some who hold that rehabilitation services require generalist workers
whose training should be simplified to avoid compartmentalization and
specialization. Others believe that components of rehabilitation such as

education, medical and vocational rehabilitation are quite different from each
other and that a generalist would not be able to cope with the skills required to

carry out all these activities. In an evaluation of a CBR program, the effective­
ness of rehabilitation workers was found to differ depending on personal
attributes, suggesting that certain non-professional personal attributes may also

contribute to the efficiency of these workers.

CBR models are usually designed to suit the ideal village, assuming that

development in a community is static. In practice, however, no village is ideal

and the process of development is a dynamic one, differing from one village to

another and in the same village from time to time. The factors that may be
responsible for success of a CBR program should be viewed in the context of the
status of the development process in the community and the timing of the
intervention. A model may be viewed as a structure on which flexible strategies
have to be built. Prior to initiating an intervention, a clear and eclectic view of the

concepts of CBR may facilitate the arrangement of priorities required to be

addressed in the community. A given CBR program may choose to provide

services for an etiologically specific disability or for a disability due to a specific
organ system involvement. Equal emphasis may be given to all program
components or to a single component. Financial and manpower resources may
either be generated entirely within the community or from outside. The program
may also decide on the level of specialization required for its manpower.

However, all this has to be done with sufficient consideration for the given social
milieu in the community, the perceived needs of the community and the probable

coverage of the intervention.

After 10 years of involvement in CBR programs, the ILO commented in

1989 that it was not possible to develop one single approach to CBR which
would fit into any context. In a sum-up of its evaluation of CBR programs, the
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ILO stated that these programs have so far had only a limited success and that

the main outcome of all their experiences was perhaps a greater awareness of
the difficulties accompanying the implementation of CBR programs.

COMMUNITY BASED REHABILITATION PROGRAMS IN INDIA

The 1980s witnessed the growth of the CBR approach in India, which

sought to promote not only better coverage, but also self-sufficiency, productivity

and integration of disabled people into the societal mainstream. Coverage is an

essential principle in the CBR approach, which seeks to shift from 'everything for

a few' to 'something for everyone'. The District Rehabilitation Centre (DRC)

scheme was started by the Government of India to provide services to all

categories of disabled persons in Urban and Rural sectors through Center-based

and Camp approach respectively. But the number of DRC was quite few.

Recently the Government has started a number of programs such establishment

of ‘District Centers’, implementation of ‘National Program for the Rehabilitation of

Persons with Disability’, and ‘Education for all' in a large number of districts of

the Country. These programs are reaching a vast population of the Country in

the rural area. But the success of these programs depends upon the sincerity

and dedication of the Government officers entrusted to implement the programs.

: The Government of India is also providing grants to Non-Government

Organisations through the Ministry of Social Justice and Empowerment to run

CBR programs. But this grant is given to a very small number of Organisations.

Fund is always a constraint with the Government.

Few foreign funding agencies are providing assistance to Non-

Government Organisations for implementing CBR programs through project

approach. But the number of Organisations receiving such funding is very few.

Such funding is available for a limited period of time as a result of which most of

the programs are discontinued. If community involvement is not properly ensured

during implementation of the CBR programs, then after the end of the project, all

the service programs are discontinued.

An analysis of the present situation in India suggests that efforts of the

Non-Government organisations to implement CBR programs on their own or with

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the help of the foreign funding agencies help only a very small percentage of the
disabled persons and are demonstrative in nature. The amount funding from the
foreign agencies is also gradually decreasing. Therefore, to cater to the needs of
the disabled persons in the rural India, the Government will have to expand its
program for the community based rehabilitation of the disabled persons in a big
way. To reach people with disabilities in a significant way, the people in the
community who are.willing.to be.trained and help the disabled should be utilized
fully. The Government should plan and organize training programs for such
persons on regular basis and create an army of volunteers to help the disabled.
A review of the programs for the disabled through the District Red Gross
Societies in different part of the Country shows that it is a great success. Efforts
should be made by the Government to implement the CBR program for the
disabled through the District Red Cross Societies.

In a Country like India, with continuing extended and joint family networks
in rural areas, utilization of families for rehabilitation is feasible. Self-help groups
of families and of disabled people in the community can facilitate information
sharing and mutual support to meet day-to-day needs and to initiate other
activities. As such at present the Government is promoting the formation of self
help groups for income generation program of the poor people. The same
approach should be followed for the disabled persons and their families which
will, provide them an opportunity to generate more income for their family.
Participation in the activity of the self help groups also will give them a scope to
share their difficult experiences of managing a disabled child with similar others
and learn from their experiences.

A MODEL OF CBR PROJECT

Chetana Institute for the Mentally Handicapped, Bhubaneswar, has

developed a model CBR project for the disabled persons and implemented in
different parts of Orissa. The details of the program are described below:

Objectives of the CBR Project

On the basis of the field visits and detailed discussion regarding the
project, the following objectives for the project was finalized:
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The major Aim of the Project shall be to provide services to persons with
disability and their families living in the State of Orissa with special emphasis on
rural and tribal areas. To achieve the above Aim, the following objectives have
been proposed:

1. Survey, identification, and assessment of all categories of disabled

persons in the project area.

2. Home based Early Intervention and Special Education for all categories
of disabled persons.

3. Referral services to all categories of disabled persons.

4. Vocational Training and Rehabilitation of Handicapped Persons and

their Families.

5. Enhancement of living conditions of parents of intellectually disabled,

and other disabled persons, through Income Generation Program
conducted by the Self-Help Groups of disabled persons formed under
the CBR Program.

6. Supply of Aids and Appliances such as Hearing Aid, Braille materials,

Teaching Aid, Wheel Chair, Tricycle, Crutches etc. to the disabled persons.

7. Helping the Disabled persons to avail facilities and concessions given by

the Govt, under various schemes.

8. Sustenance of the CBR work after the end of the project period.

Activities under the CBR Program

The project proposes implementation of Community Based Rehabilitation

Program in a number of Community Development Blocks in the State of Orissa.
For the CBR Program the whole Block is taken as a unit and all categories of
disabled persons as beneficiaries. It has been proposed to appoint 2 CBR
Instructors (Special Educators), 4 Community Rehabilitation Workers, and 40
Local Level Volunteers to conduct the CBR program in each Block. The CBR
Instructors and Community Rehabilitation Workers shall be paid employees and
the Local Level Volunteers shall be unpaid Volunteers. All these people will
conduct door to door survey and identify all the disabled persons in the Block in
need of service. This will be followed by detailed assessment of each case by
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experts such as Special Educators, Psychologists, Audiologist, Physiotherapist,

and Occupational therapist. After assessment, proper service such as Early
Intervention, Special Education, and Vocational training shall be provided to the
persons with intellectual disability and other disability groups. Aids and
Appliances to persons with Visual Handicap, Hearing Handicap, Orthopedic
Handicap and Cerebral Palsy will be provided. The persons with Hearing
Handicap will be given Speech Therapy. Persons with Orthopedic Handicap and
Cerebral Palsy will be provided with Physiotherapy. Hearing Handicapped,
Visually Handicapped, and Intellectually disabled children shall be referred to
existing Special Schools for school based special education.

15-days Training Program for CBR Instructors, Community Rehabilitation

Workers (CRW), Local Level Volunteers (LLV), and their Placement
Training of Staff and Volunteers is an important component of the CBR
Program. Unless the Staff and the Volunteers are properly trained, the CBR
Program will not be a success. It is proposed to conduct 15-days training
program for the CBR Instructors, Community Rehabilitation Workers and Local
Level Volunteers. The training program includes both theoretical and practical
components. The theoretical component will be taught during the 15 days
training program. The theoretical components will include basic knowledge on all
types of disabilities and all activities of the project. Practical training will include
the methodology to conduct survey, identification, assessment, special
education, vocational training, and techniques to interact with the beneficiaries
and the community. Practical training will be imparted to the Staff and the
Volunteers at the field level.

Both the CBR Instructors will be in charge of all the CBR activities of the
whole Block. One CRW will be appointed to conduct CBR activities in 5
Panchayats. The CRW must belong to one of the 5 Panchayats in which he will
work. Two Local Level Volunteers (1 male + 1 female) will be appointed for each
Panchayat. The Local Level Volunteers must belong to the Panchayat where
they will work.

Training of Parents of Inteliectualiy Disabled and other Disabled Persons

Another objective of the CBR Program is to provide training to the parents

of intellectually disabled, and other disabled persons identified under the project.
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This training program is proposed to be conducted for a period of 3 days at

Panchayat level for convenience and better participation of the parents and
disabled persons. On the average, each Block is divided into 20 Panchayats
having a population of about 5000 in each Panchayat. Approximately, there are
about 500-1000 persons with disability in each Block. The 3 days training
program shall be used for providing basic knowledge on disability, initial
assessment of disability, and development of intervention strategies. The CBR
Instructor will prepare a schedule of parents training program for a period of 3
days. The training program will include both theoretical and practical input. All
the Panchayats of the Block are expected to be covered within 1st six months of
the project. This training program will provide basic knowledge on Disability to
the parents and disabled persons and also help the parents to develop the home
based training program for their children. In each training program at Panchayat
level, approximately 30 persons will participate.

Early Intervention Program

Early Intervention Program is very important from the point of prevention

of disability and early treatment of various disability conditions. After completion
of the initial assessment, the CBR Instructors will develop early intervention
program for all categories of disabled children. This includes medical intervention
program for visually impaired, hearing impaired, and orthopedic handicapped
children. The children with intellectual disability shall be provided with early
intervention, which includes early stimulation, enriched environment, speech
therapy, physiotherapy and training of parents and family members on how to
conduct early intervention program.

Home Based Special Education Program for Children with Intellectual

Disability
The children with Intellectual Disability will be provided with Home Based
Special Education Program. After initial assessment, the CBR Instructors will
visit the Homes of each child and develop a Home Based Special Education
Program based on educational needs of the child. They will also provide training
to the parents for implementation of the special education program in home
setting. They will also supervise the special education program implemented by
the parents regularly through family visits.
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Vocational Training of Disabled Persons in CBR Unite

One of the major objectives of the project is vocational training and

rehabilitation. Vocational training will be provided to the adult handicapped
persons in each CBR Unit. These disabled persons will be trained to engage
themselves in different vocations like Agriculture, Animal Husbandry, Poultry,
Collection of Forest Products, Grocery and other Small Business, Carpentry,
Masonry, Black Smith, Arts & Crafts etc. according to their ability and interest.
The disabled persons will work under the trainers for the respective vocations
available in the community till they develop necessary competency. After
completion of training the disabled persons will be provided with related
equipment and machinery if necessary to conduct vocational activity and live an
independent life.

Disability Assessment Camps

One of the objectives of the project is the involvement of specialists such

as Physiotherapists, Audiologists, Speech therapists, Eye specialists, and
Psychologists. These specialists will be invited to the assessment camps where
detailed assessment of disabled persons will be conducted. After the detailed
assessment, appropriate therapeutic intervention shall be prescribed by the
Specialists.

In each Block under the CBR Project, 2 Disability Assessment Camps will
be conducted during the project period. After completion of preliminary
assessment at the Panchayat level, Block level Assessment Camps will be
conducted; All the disabled persons requiring detailed assessment will be
assessed at the Block level camp by the Specialists.

Distribution of Aids and Appliances to the Disabled Persons

One of the objectives of the project is to distribute Aids and Appliances to

the disabled persons as prescribed by the Specialists in Block level assessment
camps. The Government of India has provision for free distribution of Aids and
Appliances such as Wheel Chair, Tricycle, Crutches, Walking Stick, Tape
recorder, Braille typing machine, and Stencil for writing Braille, Hearing aid etc.
to the disabled persons belonging to the Below Poverty Line (BPL) category. The
CBR Instructors will take up the matter with appropriate Govt, authorities like
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District Social Welfare Officer, District Rehabilitation Centers, Artificial Limbs

Manufacturing Corporation, and National Institute for Rehabilitation Training and
Research, Government of India, for sanction and distribution of the Aids and
Appliances to the deserving disabled persons.

’ Some times the process of procurement of Aids and Appliances from the
Government takes a long time, and may not fulfill the immediate needs of people
with disability. Therefore, the project has provided a lumpsum amount for each
Block for distribution of Aids and Appliances.

Supply of Teaching Aid

One of the objectives of the CBR Program is to provide teaching aid to the
children with intellectual disability, visual handicap, hearing handicap, and
cerebral .palsy. It has been estimated that, about 200 children in each Block will
require teaching aid. Teaching Aid for children with Intellectual Disability and
Cerebral Palsy includes:-bags, slates, exercise books, pens, pencils, pencil
crayons, picture books, charts, counting boards, alphabets in Oriya and English,
different types of educational toys, building blocks, colored cubes etc. Teaching
Aid for children with Hearing Handicap includes some of the materials already
stated above and primary school level books. Teaching Aid for children with
Visual Handicap includes Braille slate and stencil, corrective eye glasses etc.

Production and Distribution of Literature on Disability

There is a lack of relevant literature in Regional language for the

consumption of disabled persons, their parents and others concerned with the
services for the disabled persons. One of the objectives of the CBR Program is
to produce and distribute literature on disabilities in regional language to the
concerned persons as noted above. The literature will include Leaflets, folders,
and booklets, and books describing Causes, Prevention, Treatment, Special
Education, Vocational Training and Rehabilitation of all categories Disability.

Formation of the Self Help Groups

Formation of the Self Help Groups is one of the important activities of the
project. Membership of the Self Help Groups provides an opportunity to the
parents of intellectually disabled and other disabled persons to come together
and discuss about their common problems and probable solutions. Each self
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help group wiilbe provided with a revolving fund of Rs. 10,000/-. Each member
of the self help group will also pay a monthly subscription to the common fund of
the self help group which is deposited in a Nationalized Bank. When a self help
group functions successfully for a period of one year, the Government has
provision for sanction of grant to the self help group. In this way the self help
group grows stronger day by day with a better financial position. Each member
of the group is entitled to take small loans from the fund of the self help group
with a marginal interest for income generation activities and helps him to earn his
livelihood.

One of the objectives of the present project is to form and supervise the
activities of the Self-Help Groups. The parents will be encouraged to make best
use of the revolving fund for vocational and income generation activity. Better
income of the parents will lead to better living conditions.

Government Facilities and Concessions for the Disabled

One of the objectives of the project is to make the disabled persons aware
of the Govt, facilities and concessions and help them to avail of these facilities.
The Government of India and the State Governments provide a number of
facilities and concessions to the disabled persons. Most of the disabled persons
and their families do not have proper knowledge regarding these facilities and
concessions. Some of the important facilities and concessions includes:

1. Free special education with hostel facility for intellectually disabled,

visually handicapped, and hearing handicapped children from 6-18 years
in Government supported special schools.

2. Free vocational training for disabled adults in Government supported

vocational training centers.

3. Supply of aids and appliances free of cost (upto Rs. 3600/-) to the disabled
persons below poverty line (BPL) category, or with 50% cost to others.

4. Special Employment Exchanges have been established for providing

placement to persons with disabilities. 3% vacancies are reserved in
groups C & D posts in Government of India and Public Sector
Undertakings (1% each for Orthopedic Handicap, Visual Handicap, and
Hearing Handicap).
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5. Reservation of seats for Orthopedic Handicap students in Educational

Institutions.

6. Stipend to disabled students for education at school and college levels.

7. Disability pension to persons below poverty line.

8. Preferential allotment of houses from Govt, housing schemes.

9. Concessions in air, rail and bus travel.

10. Income tax exemptions for disabled persons and their parents.

11. 3% reservation of . funds for the disabled under poverty alleviation and
rural development schemes.

12. Provision of family pension to the disabled persons after the death of
pension holder parents.

Referral Services

One of the activities under the project is to provide referral services. The
Government is providing a number of services to the disabled person through
various channels. The Project Staff will refer the disabled persons to appropriate
Government agencies for the services required. Some of the referral services are:

1. Referring intellectually disabled, hearing impaired and visually impaired

children to special schools.

2. Referring all disabled persons to the office of the Chief District Medical
Officer for issue of disability certificates.

3. Referring all disabled persons to the office of the Block Development

Officer to submit applications for disability pension.

4. Referring all disabled persons to the Vocational Rehabilitation Centers

for vocational training in various trades.

5. Referring all disabled persons to the District Social Welfare Officer for
submission of applications to National Handicapped Financial
Development Corporation, Government of India, and all public sector
Banks for sanction of loans for vocational rehabilitation and income
generation activities.
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6. Referring Orthopedic handicapped persons to appropriate Government

agencies like District Rehabilitation Centers, Artificial Limbs
Manufacturing Corporation, and Fitment Centers run by the Non-
Government Organisations for supply of aids and appliances.

Continuance of the CBR Program after the Project Period and Involvement
of the Community
CBR projects are always implemented for a limited period. The duration of
the project varies from 2 to 10 years depending upon the availability of funds

from the funding agencies. In the CBR project, in addition to the members of the
Self Help Groups, Community Rehabilitation Workers, and Local Level
Volunteers will be recruited from the project area. In each Block, there will be
about 10 SHGs (a total number of 100-120 members), 40 Local Level
Volunteers, 4 CRWs, and 400 to 500 Disabled Persons and their Parents. It is
proposed that during the project period an Association of all these persons will
be formed to provide service to the disabled persons and their families after the
end of the project period. This Association will be given a suitable name and
registered under appropriate act of the Government. The members of this
Association will be motivated to continue the service programs as far as possible
including functioning of the self help groups. The Association will also fight for
the rights of the disabled in the Block and try to avail of all the facilities and
concessions due to the disabled persons under Government rules and regulations.

Meeting of the CBR Instructors

One of the objectives of the CBR Program is to conduct the meeting of

the CBR Instructors, and Community Rehabilitation Volunteers four times in a
year. This meeting is necessary for evaluation and monitoring of the progress of
the CBR work. This will help to clarify the doubts of the CBR Instructors
regarding details of implementation of the CBR Program. This provides an
opportunity to share field experiences of CBR Staff with each other. They will
also get a scope to discuss the problems faced in the field with experts and
member of the management and find acceptable solutions. The project
management also gets scope to assess implementation of the activities of the
project in time in accordance with the activity plan.
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INSTITUTION VERSUS HOME BASED SKILL TRAINING

Skill training can be given to intellectually disabled children in the

institutional setup, home setup, or a mixed setup. When a child lives on full time
basis in the school hostel, he is taught all skills in the school. When the child
lives in his . home on full time basis, the skill training is given to him in home
setup. When a child lives at home and attend a special school for intellectually
disabled, the training is called mixed type. In this setup, the child receives some
training at home and some training in school.

Out of the above three models, the Mixed Model is the best. Because in
this Model, the child remains attached to the home environment, and gets the
opportunity to learn in a special school. The home is the most important place for
the child. The love, affection, care, and facilities available in the home
environment will never be available in any other environment. The advantages of
the Special School are that the teachers in the Special Schools are
professionally trained to handle such children. There are also appropriate
teaching- learning aid available in special schools. The social environment of the
special school, and the presence of the peer group, is more helpful for the
learning and development of these children.

The Institution based Model is the worst Model available for training of
children with intellectual disability. In this model the children are dumped in the
Institution on full time basis. The parents totally disappear. The children are left
to the mercy of the caretakers and staff of the institution. If the facilities available
in the institution are good and also the staffs are good, the children get better
service and better education. Otherwise the children suffer. Sometimes the
children are abused by the staff members. Many of them lead a miserable life in
the institution. Particularly, the severe and profound level of intellectually
disabled children, suffer the most.

The home based model, is a model for education and training of

intellectually disabled, in which the children are provided with education and
rehabilitation facilities at home. Under this program the special educator goes to
the home of the intellectually disabled child and conducts the education and
training program with the help and cooperation of parents, family members, and
the community.
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HOME BASED PROGRAM FOR THE INTELLECTUALLY DISABLED

Under the home based program, training is extended to the intellectually

disabled children through working with the parents and family members who
receive direct instruction from respective professionals for systematic follow up
of training at home level. Training of parents or family members takes place in an
Institution or home, but followed up within home setting.

Home based skill training program for the intellectually disabled children is
conducted under the following conditions:

1. Where schools are not available, that is rural areas where intellectually
disabled persons are not concentrated but scattered across the villages
and establishing a school for few members in each village is not possible.

2. In case of severely disabled children who face serious difficulties in

mobility.

3. Where regular transport is not accessible.

4. Where availability of an escort for regular trips to a distant school or

institution is not possible.

5. When family members get the opportunity to be trained by professionals

and develop, competency to effectively deal with the handicapped
persons at home.

6. When the child is detected to be intellectually disabled much before the

school age, and it is necessary to conduct early intervention program.

7. When one to one attention is necessary for the child, which may not be
. always possible within the school environment.

8. When the family has many members to share the responsibility of

training the child so that the mother or any other single member is not
over stressed.

9. When it is necessary to provide help and guidance to a large number of

families having intellectually disabled children within a given time limit.

As children are identified in the rural and remote areas, it becomes clear
that traditional school based special education program is not feasible due to non­
availability of special schools in a reasonable distance. Even, if a good number of
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. children are identified within a smaller geographical area, the variance in

chronological ages, functional levels, handicapping conditions, and financial
constraints in a country like India may prevent the establishment of a special school.

ROLE OF ITINERANT TEACHER

In the home based model, an Itinerant Teacher plays an important role.

The Itinerant Teacher has received specialized training in a particular category
of disability and provides services to homebound students. Although teaching
is the major responsibility of itinerant teachers, they are involved in related
activities such as procurement of special materials, training of parents, and
assessment of students.
I

Itinerant Teachers have larger case loads than special education teachers
working in a classroom setup, which usually have an established teacher-pupil
ratio prescribed by state law. The larger case load often prevents the itinerant
teacher from becoming completely familiar with the child. Parents often complain
that their children are not receiving adequate attention from the Itinerant
. Teacher. They also take the physical burden of transporting resource materials
to the homes of the handicapped children.

Advantage to employ an Itinerant Teacher is that due to his experience of

working with many children exhibiting different types of educational and
behavioral problems, he is in a better position to guide the parents and handle
. handicapped children.

Another important advantage is the effect of changing the attitude of the

parents in dealing with the special child. Due to lack of knowledge and exposure,
many parents have negative attitude towards their handicapped child. Many of
them, particularly in the rural area, think that these children are not capable of
. learning any thing. The Itinerant Teacher demonstrates to the parents that these
children are capable of learning many skills. This changes the attitude of the
parents towards their children with a better understanding of their abilities.

In this model of service, the special educator visits the homes of

handicapped children on regular basis and provides special education. This
model is cost effective where full time teacher cannot be appointed due to
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economic constraints. However, the success of the itinerant teaching services

depend on the sincerity and cooperation of the parents and family members in
conducting the home based special education program as directed by the
Itinerant Teacher.

PROCEDURE FOR HOME BASED PROGRAM

1. Comprehensive assessment of the. child is conducted by the relevant

experts, such as Special Educator, Psychologist, Physiotherapist, and
Speech Therapist.

2. Assessment of the abilities of the parents and family members to

conduct the home based program is done.

3. Parents and family members are given basic training on intellectual

disability, home based skill training, physiotherapy and speech therapy
needs, and behavior management of the child.

4. Individualized Education Program including prioritization of goals for the

child is finalized in consultation with the parents and implementation of
the program is demonstrated by the Itinerant Teacher. Training in selected
skills is conducted in phases suitable to the convenience of parents.

5. A schedule for the follow up of the skills trained is decided in consultation

with the parents.

SOME IMPORTANT CONSIDERATIONS IN HOME BASED PROGRAM

One of the important considerations of home based program is the

ability of the parents to follow the instructions given by the Itinerant Teacher
for conduction of the individualized education program. That means the
parents should have the minimum educational level to understand the
procedure of IEP and also should be able to conduct the skill training program
in accordance with the IEP.

Economic condition of the family is also another important aspect of home

based special education program. The parents and family members should have
sufficient time in hand to devote for the education of the child. For example, if the
family does not have any other adult member, and both the parents are daily
laborers, then both of them will go to work early in the morning and come back
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tired in the evening. They will not have the time, energy and interest to devote for

the education of their handicapped child. Moreover, the child also will keep
roaming through out the day with out any meaningful activity. In the process he

may create problems for himself and others and learn a number of problem

behaviors.

Therefore, the economic condition of the family should permit at least one

of the parents to devote enough time for the education of their handicapped
child. It appears that home based special education program may not be a

success in a family with low economic status.

The skills selected for training should have functional importance. It

should help the child to function independently in his environment. The skills

taught should mostly belong to .activities of daily living, social skills, language
and communication skills, functional academics, recreation and leisure time

activities, and vocational skills. All the above skills have functional importance
and help the future placement of the child in a vocational activity available in his

own environment.

In the home based intervention model, learning occurs in the natural

environment of parents and children, therefore, typical problem of coordination

between the home and the classroom do not exist, There is no need to take the
trouble of transferring the classroom learning to home. As the child is taught in
his natural environment, there is a direct and a constant access to behavior as it
occurs, which helps the selection and implementation of more functional skills.

It is more likely that the learned behaviours will generalize and maintain if

the behaviours are learned in the child’s natural environment and taught by his

parents and family members.