Chapter 3: Identification and Differentiated services

Chapter Overview
The onset of disability is accompanied by a complex series of shocks to the individual and to
everyone around him. The impact of disability and vulnerability take many form. The
immediate effects are often physical pain, limitation of mobility, disorientation, confusion,
uncertainty and a disruption of roles and patterns of social interaction. Peoples with
disabilities and vulnerabilities have survival (physiological), safety, social, esteem, and self-
actualization (fulfillment) needs like persons without disabilities.
This chapter begins with the overview of the impacts of disability on daily life of peoples
with disabilities and vulnerabilities and their needs for inclusive service provisions. It
describes diverse needs of persons with disabilities and vulnerabilities followed by
differentiated intervention and rehabilitation approaches. The chapter further discusses
inclusiveness from different perspectives such as; health services provision, accessibility of
technologies, employment and economic independence, disability and rural life and access to
education for peoples with disabilities and vulnerabilities in brief.

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. There are several factors that affect the
impact a disability has on an individual. The following are often considered the most
significant factors in determining a disability's impact on an individual.

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. Congenital
disabilities are disabilities that have always been present, thus requiring less of an
adjustment than an acquired disability.
The Individual’s Personality - the individual personality can be typically positive or
negative, dependent or independent, goal-oriented or laissez-faire. Someone with a positive
outlook is more likely to embrace a disability then someone with a negative outlook.
Someone who is independent will continue to be independent and someone who is goal-
oriented will continue to set and pursue goals.

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 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.
The Individual’s Current Life Circumstances - The individual‘s independence or
dependence on others (parents). The economic status of the individual or the individual's
caregivers, 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.

Common effects of a disability may include but not limited to health conditions of the
person; mental health issues including anxiety and depression; loss of freedom and
independence; frustration and anger at having to rely on other people; practical problems
including transport, choice of activities, accessing buildings; unemployment; problems with
learning and academic study; loss of self-esteem and confidence, especially in social
situations. But all these negative effects are due to restricted environments, not due to
impairments.

The disability experience resulting from the interaction of health conditions, personal
factors, and environmental factors varies greatly. Persons with disabilities are diverse and
heterogeneous, while stereotypical views of disability emphasize wheelchair users and a few
other ―classic‖ groups such as blind people and deaf people. Disability encompasses the
child born with a congenital condition such as cerebral palsy or the young soldier who loses
his leg to a land-mine, or the middle-aged woman with severe arthritis, or the older person
with dementia, among many others. Health conditions can be visible or invisible; temporary
or long term; static, episodic, or degenerating; painful or inconsequential. Note that many
people with disabilities do not consider themselves to be unhealthy. Generalizations about
―disability‖ or ―people with disabilities‖ can mislead. Persons with disabilities have diverse
personal factors with differences in gender, age, language, socioeconomic status, sexuality,
ethnicity, or cultural heritage. Each has his or her personal preferences and responses to
disability. Also while disability correlates with disadvantage, not all people with disabilities
are equally disadvantaged. Women with disabilities experience the combined disadvantages
associated with gender as well as disability, and may be less likely to marry than non-
disabled women. People who experience mental health conditions or intellectual impairments

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 appear to be more disadvantaged in many settings than those who experience physical or
sensory impairments. People with more severe impairments often experience greater
disadvantage. Conversely, wealth and status can help overcome activity limitations and
participation restrictions.
People with disabilities and vulnerabilities live with challenges that impact their abilities
to conduct Activities of Daily Living (ADL). Disability and vulnerabilities can limit or restrict
one or more ADLs, including moving from one place to another (e.g., navigation, locomotion,
transfer), maintaining a position (e.g., standing, sitting, sleeping), interacting with the
environment (e.g., controlling systems, gripping objects), communicating (e.g., speaking,
writing, hand gestures), feeding (chewing, swallowing, etc.), and perceiving the external
world (by movement of the eyes, the head, etc.), due to inaccessible environment.
Economic Factors and Disability

There is clear evidence that people with few economic assets are more likely to acquire
pathologies that may be disabling. This is true even in advanced economies and in economies
with greater levels of income equality.
Similarly, economic resources can limit the options and abilities of someone who requires
personal assistance services or certain physical accommodations. The individual also may not be
able to access the appropriate rehabilitation services to reduce the degree of potential disability
either because they cannot afford the services themselves or cannot afford the cost of specialized
transportation services.
The economic status of the community may have a more profound impact than the status of the
individual on the probability that disability will result from impairment or other disabling
conditions. Research on employment among persons with disabilities indicates, for example, that
such persons in communities undergoing rapid economic expansion will be much more likely to
secure jobs than those in communities with depressed or contracting
labor markets. Similarly, wealthy communities are more able to provide environmental supports
such as accessible public transportation and public buildings or support payments for personal
assistance benefits.

Community can be defined in terms of the microsystem (the local area of the person
with the disabling conditions), the mesosystem (the area beyond the immediate
neighborhood, perhaps encompassing the town), and the macrosystem (a region or nation).
Clearly, the economic status of the region or nation as a whole may play a more important
role than the immediate microenvironment for certain kinds of disabling conditions.

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 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. The extent to which the built environment impedes people
with disabling conditions is a function of public funds spent to make buildings and
transportation systems accessible and public laws requiring the private sector to make these
accommodations in nonpublic buildings. 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. The sum of the mechanisms used can and does
have a profound impact on the functioning of people with disabling conditions.

Psychological Factors of Disability

This section focuses on the impact of psychological factors on how disability and disabling
conditions are perceived and experienced. The argument in support of the influence of the
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. An exhaustive
review of the literature on the impact of psychological factors on disability is beyond the
scope of this chapter. However, for illustrative purposes four psychological constructs will be
briefly discussed: three cognitive processes (self-efficacy beliefs, psychological control, and
coping patterns) and one personality disposition (optimism). Each section provides examples
illustrating the influence of these constructs on the experience of disability.
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.

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 a) Self-Efficacy Beliefs

Self-efficacy beliefs are concerned with whether or not a person believes that he or she can
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. These self-efficacy beliefs will thus mediate the relationship
between impairment and disability such that the individual would experience better
functional outcomes and less disability. The development of self-efficacy of the individual is
much affected by the environmental factors.
b) Psychological Control

Psychological control, or control beliefs, is akin 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. What is 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. Generally, coping has
been studied within the context of stress. Having a disabling condition may create stress and
demand additional efforts because of interpersonal or environmental conditions that are not
supportive. Several coping strategies may be used when a person confronts a stressful
situation. These strategies may include the following: seeking information, cognitive
restructuring, emotional expression, catastrophizing, wish-fulfilling fantasizing, threat
minimization, relaxation, distraction, and self-blame.

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 Appraisal is related to self-efficacy in the sense that one's thoughts and cognition
control how one reacts to a potentially negative situation. When a person feels that he or she
can execute a desired outcome (e.g., learn how to use crutches for mobility), the person is
more likely to do just that. Similarly, under conditions in which an individual appraises his or
her disabling conditions and other life circumstances as manageable, the person will use
coping strategies that will lead to a manageable life (i.e., better functional outcomes).
Personality Disposition

Optimism is a personality disposition that is included in this chapter as an example of a

personality disposition or trait that can mediate how disabling conditions are experienced.
Several other interrelated personality factors could be discussed (e.g., self-esteem, hostility,
and Type A personality). 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.
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. There was also a strong
relationship between optimism and postsurgical quality of life, with optimists doing better
than pessimists. Optimism may reduce symptoms and improve adjustment to illness, because
it is associated with the use of effective coping strategies. This same analogy can be extended
to impairment. Optimistic individuals are more likely to cope with impairment by using the
active adaptive coping strategies discussed earlier. These in turn will lead to reduced
disability.
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).

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 Families can be enabling to people with functional limitations by providing such
tangible services as 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.
Needs of Persons with Disabilities and Vulnerabilities.
Needs of persons with disabilities and vulnerabilities depends on different factors. People with
disabilities do not all share a single experience, even of the same impairment.
Analyzing the human beings, Maslow has identified five categories of needs, with different
priority levels (Fig. 3.1), 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). The survival needs are formed by the physiological
needs and include the biological requirements for feeding, performing hygiene, sleeping, ADL,
and so on. When disabilities and vulnerabilities fulfill their survival needs, they will look for
situations that keep them safe, before moving up the chain and fulfill their needs to be part of
society and to achieve. As 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. In particular, disabilities and vulnerabilities in a
dependent situation feel the need for increased autonomy, as well as the opportunity to prove
their worth to themselves and others through work or other activities.

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 Fig.3.1 Abraham‘s Maslow Hierarchy
Persons with disabilities and vulnerabilities have socio-emotional, psychological, physical and
social environmental and economic needs in general. The following list but not last are basic
needs of persons with disabilities and vulnerabilities to ensure equality for all within our
society.
Full access to the Environment Equal opportunities for Employment
(towns, countryside & buildings)
Appropriate and accessible
An accessible Transport system Information
Technical aids and equipment Advocacy (towards self-advocacy)
Accessible/adapted housing Counseling
Personal Assistance and support Appropriate and Accessible Health
Care
Inclusive Education and Training
adequate Income
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; thus reducing levels of poverty and vulnerability. Moreover, mainstream and/or
specific social protection schemes concerning persons with disabilities can have a major role in
promoting their independence and inclusion by meeting their specific needs and supporting their

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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.
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. When the work interests of men
with disabilities are similar to those of others around them, their identity as a ‗man‘ becomes
more valuable to the community. However, there are issues around how masculinity in rural
areas is constituted. Finding ways to express this through involvement in common activities can
be difficult. 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. Being
excluded from these latter tasks because of others‘ protective or controlling views is particularly
difficult for some women in asserting their identities as women and exploring these types of
gendered practices.

Identity and disability

The relational nature of identity seems to be of central importance to people with disabilities and
a rural environment in some instances provides a different way for people to be perceived by
others and by themselves.
Disability as part of an individual‘s identity is seen by some as a struggle. This is often twofold:
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. Relations with family,
friends and communities often provided a contradictory landscape, where a person has to
negotiate his or her new disabled identity yet, at the same time, is able to draw upon previous
shared experiences to become re-embedded in friendships and communities. Finding ways to
gain ‗value‘ in the local community with a disability is an ongoing and, too often, difficult
journey. It is these very journeys that create one‘s identity and the relational nature of this
identity to the rural landscape.

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 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. Belonging is also an
internal sense of being at home in one‘s own body and mind. 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. This internal negotiation and navigation shape their
engagement with their social worlds, particularly in rural communities. Persons with disabilities
in rural areas should have a strong attachment to place, somewhere familiar and known where
they can feel safe, find their ways alone, exercise autonomy and express their embodied selves.
The possibility of making change happen in an environment, where one‘s voice is heard, is also
seen as a part of belonging in a community. While this is sometimes a struggle, there is a sense
that people can use their personal contacts and friends to get change to happen when it is needed.
Family relationships as a means of connecting to community and being known by others, and
knowing others outside the family are important. Different kinds of relationship contributed to
this sense of belonging, ranging from the more superficial nodding acquaintances to specific
informal support from known others, to the intimacy of close friends and kin.

[Link] 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. Religious values that shape the way disability is constituted in some
countries are a powerful influence on the way people with disabilities are able to live their lives.
These values intersect with societal expectations of gender roles. Many peoples with disabilities
are subjected to being viewed as objects of pity and prevailing myths about their capacities,
socially and individually. These social myths are key sites of struggle and, as suggested earlier,
are deeply intertwined with a person‘s own subjective understandings of gendered identities and
sense of belonging as a person with a disability.

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Poverty has impact on living a decent life with a disability in a rural landscape, a life that they
have defined and desired. In a number of cases this is centered on the need for paid work and the
difficulties in finding it where employment is often scarce or highly exclusionary due to farming
practices. Some contributors emphasize the importance of familial social networks and the
additional support these provide, alongside belonging to a community where one is known, in
enabling people with disabilities to counter the negative aspects of poverty. Given the changing
welfare environment, including the growing insecurity of disability support landscapes, many of
the contributors express fears of the future. Particular concerns are the very real possibility of a
time when services or family support may not be available, alongside the impact of diminished
access to social security with the onset of austerity.
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. For example, a recent survey of people with serious mental disorders,
showed that between 35% and 50% of people in developed countries, and between 76% and 85%
in developing countries, received no treatment in the year prior to the study.
People with disabilities are particularly vulnerable to deficiencies in health care services.
Depending on the group and setting, persons with disabilities may experience greater
vulnerability to secondary conditions, co-morbid conditions, age-related conditions, engaging in
health risk behaviors and higher rates of premature death.
Secondary conditions: conditions occur in addition to (and are related to) a primary health
condition, and are both predictable and therefore preventable. Examples include pressure ulcers,
urinary tract infections, osteoporosis and pain.
Co-morbid conditions: conditions occur in addition to (and are unrelated to) a primary health
condition associated with disability. For example the prevalence of diabetes in people with
schizophrenia is around 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. For example some people with developmental disabilities show signs of
premature ageing in their 40s and 50s.
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

People with disabilities encounter a range of barriers when they attempt to access health care
including the following.

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Prohibitive costs: Affordability of health services and transportation are two main reasons why
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 facilities.
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, four
times more likely to report being treated badly and nearly three times more likely to report being
denied care.
Addressing for Inclusive Barriers to Health Care

Governments and professionals can improve health outcomes for people with disabilities by
improving access to quality, affordable health care services, which make the best use of available
resources. As several factors interact to inhibit access to health care, reforms in all the interacting
components of the health care system are required.

Policy and legislation: Assess existing policies and services, identify priorities to reduce health
inequalities and plan improvements for access and inclusion. Make changes to comply with the
CRPD. Establish health care standards related to care of persons with disabilities with
enforcement mechanisms.
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 health care programs.
Service delivery: Provide a broad range of modifications and adjustments (reasonable
accommodation) to facilitate access to health care 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 have been replaced by

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models in which 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 are constituted and then focus
on a few—but not all—of the elements of the environment to provide examples of how the
environment affects the degree of disability. 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 provided to people with disabling conditions and the extent to which the physical, built
environment is accommodating or not accommodating to the particular disabling condition.
Because societies differ in their willingness to provide the available technology and, indeed, their
willingness to provide the resources to improve that technology, disability ultimately must been
seen as a function of society, not of a physical or medical process.
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. For any given limitation (i.e., potential
disability), the amount of actual disability experienced by a person will depend on the nature of
the environment, that is, whether the environment is positive and enabling (and serves to
compensate for the condition, ameliorate the limitation, or facilitate one's functional activities) or
negative and disabling (and serves to worsen the condition, enhance the limitation, or restrict
one's functional activities). Human competencies interact with the environment in a dynamic
reciprocal relationship that shapes performance. When functional limitations exist, social
participation is possible only when environmental support is present. If there is no environmental
support, the distance between what the people can do and what the environment affords creates a
barrier that limits social participation.
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.
The environmental mat may be conceived of as having two major parts: the physical
environment and the social and psychological environments. The physical environment may be
further subdivided conceptually into the natural environment and the built environment. Both
affect the extent to which a disabling condition will be experienced by the person as a disability.

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Three types of attributes of the 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 with visual impairments to change their location.
The Natural Environment
The natural environment may have a major impact on whether a limitation is disabling. The
natural environment, including topography and climate, affect whether or to what degree a
functional limitation will be disabling.
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

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. Rurality must be considered as more than an
issue of context or setting. Instead, rurality professionals in rural should prioritize the voices and
experiences of those who live rurally, and that the specific characteristics or aspects of the
particular rural communities to which they belong.
Since larger population of Ethiopia (more than 85%) are agricultural community, life and
aspirations of disabilities and vulnerable groups highlight both the pull and the push of rural
living without appropriate services and supports.

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Persons with disabilities, vulnerable and marginalized groups living in rural areas have double
disadvantaged due to their impairments and vulnerabilities and unfavorable physical and social
environment. Professionals who are working in rural areas should work in collaboration
accordingly. More specifically, these group of people have been excluded from agricultural
works (productivity) due its nature high demand to labour and lack of technologies and well
organized support from professional.
Creating Welcoming (Inclusive) Environment

External environmental modifications can take many forms. These can include assistive devices,
alterations of a physical structure, object modification, and task modification. The role of
environmental modification as a prevention strategy has not been systematically evaluated, and
its role in preventing secondary conditions and disability that accompany a poor fit between
human abilities and the environment should be studied. Environmental strategies may ease the
burden of care experienced by a family member who has the responsibility of providing the day-
to-day support for an individual who does not have the capacity for social participation and
independent living in the community. These environmental modifications may well be an effort
at primary prevention because the equipment may provide a safety net and prevent disabling
conditions that can occur through lifting and transfer of individuals who may not be able to do it
by themselves.
Rehabilitation must place emphasis on addressing the environmental needs of people with
disabling conditions. Environmental strategies can be effective in helping people function
independently and not be limited in their social participation, in work, leisure or social
interactions as a spouse, parent, friend, or coworker.
Examples of Environmental Modification

Mobility aids Safety bars

Hand Orthosis
Nonskid floors
Mouth stick
Sound-reflective building
Prosthetic limb materials
Wheelchair (manual and/or Enhanced lighting
motorized)
Electrical sockets that meet
Canes appropriate reach ranges
Crutches Hardwired flashing alerting
systems Increased textural
Braces
contrast
Accessible structural elements
Ramps Elevators Accessible features
Built up handles
Wide doors
Voice-activated computer
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 Automobile hand controls
Job accommodations Communication aids
Simplification of task Telephone amplifier or TDD
Voice-activated computer
Flexible work hours Closed or real-time captioning
Rest breaks Computer-assisted note taker
Splitting job into parts Print enlarger
Relegate nonessential functions to Reading machines
others Books on tape
Sign language or oral
6. Differential use of personnel interpreters
Personal care assistants Braille writer
Cochlear implant
Note takers Communication boards FM,
Secretaries Editors audio-induction loop, or
Sign language interpreters infrared system

Culture and the Disabling Process

Culture affects the enabling-disabling process at each stage; it also affects the transition from one
stage to another.
Definition of Culture
Definition of 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. Cultures also specify punishments for rule-
breaking, exceptions to rules, and occasions when exceptions are permitted. The role of
nonmaterial culture for humans has been compared to the role of instincts for animals or to the
role of a road map for a traveler. It provides the knowledge that permits people to be able to
function in both old and new situations.
Enabling and Disabling Factors
lement of Social and Psychological Environment
Type

FactorE
of

Culture Psychological Political Economic

Tax credits to hire people
Expecting people Having an active Mandating relay with
with disabling coping strategy systems in all states disabling conditions
conditions to be
productive
Enabling

Targeted earned income

Expecting everyone Cognitive Banning discrimination tax
to know sign restructuring against people who can Credits
language perform the essential
functions of the job

16
 Economic disincentives to
Stigmatizing people Catastrophizing Segregating children get
off Social Security
Disabling with disabling with mobility Disability
conditions impairments in schools Income benefits

No subsidies or tax credits

Valuing physical Denial Voting against for
purchasing assistive
beauty paratransit system technology

Pathway from Pathology to Impairment to Functional Limitation

Culture can affect the likelihood of the transition from pathology to impairment. A
subculture, such as that of well-educated society, in which health advice is valued, in
which breast cancer screening timetables are followed, and in which early detection is
likely, which breast tumors are less likely to move from pathology to impairments. In a
subculture in which this is not true, one would likely see more impairments arising from
the pathologies.
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. For
example, 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. Thus, their culture lessens the likelihood that their pathology will be cured and therefore
increases the likelihood that the pathology will become impairment.
Culture clearly has an impact on whether a particular impairment will become a functional
limitation. Impairments do not become limiting automatically. Rather, cultures affect the
perception that the impairment is in fact the cause of the limitation, and they affect the
perception that the impairment is in fact limiting.
If a society believes that witchcraft is the reason that a woman cannot have children, medical
facts about her body become irrelevant. She may in fact have fibroids, but if that culture sees
limitation as coming from the actions of a person, there is no recognition of a linkage between
the impairment and the functional limitation. Rather, any enabling-disabling process must go
through culturally prescribed processes relating to witches; medically or technologically based
enabling-disabling processes will not be acceptable.
Pathway from Functional Limitation to Disability

Here, the most important consideration is the ways in which the transition from functional
limitation to disability is affected by culture. A condition that is limiting must be defined as
17
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. If certain actions
are not necessary for a role, then the person who is limited in ability to perform those actions
does not have a disability. 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. In this case, the
functional limitation would not become a disability. For a secretary who would be unable to
type, on the other hand, the functional limitation would become a disability in the work sphere.
A disability can exist without functional limitation, as in the case of a person with a facial
disfigurement living in cultures such as that in the United States, whose standards of beauty
cannot encompass such physical anomalies. Culture is thus relevant to the existence of
disabilities: it defines what is considered disabling. Additionally, culture determines in which
roles a person might be disabled by a particular functional limitation. For example, a farmer in a
small village may have no disability in work roles caused by a hearing loss; however, that person
may experience disabilities in family or other personal relationships. On the other hand, a
profoundly deaf, signing person married to another profoundly deaf, signing person may have no
disability in family-related areas, although there may be a disability in work-related areas. Thus,
culture affects not just whether there is a disability caused by the functional limitation but also
where in the person's life the disability will occur. Culture is therefore part of the mat; as such, it
can protect a person from the disabling process and can slow it down or speed it up. Culture,
however, has a second function in the disabling process.
Although there is a direct path from culture to disability, there is an also indirect path. The
indirect function acts by influencing other aspects of personal and social organization in a
society. That is, the culture of a society or a subculture influences the types of personality or
intrapsychic processes that are acceptable and influences the institutions that make up the social
organization of a society. These institutions include the economic system, the family system, the
educational system, the health care system, and the political system. In all these areas, culture
sets the boundaries for what is debatable or negotiable and what is not. Each of these societal
institutions also affects the degree to which functional limitations will be experienced by
individuals as disabling.

All of the ways in which intrapsychic processes or societal institutions affect the enabling-
disabling process cannot be considered here. However, the remainder of this section presents

18
some examples of how the enabling-disabling process can be affected by three factors:
economic, political, and psychological.

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. 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.
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. To reach ambitious targets
for the general population, as well as targeted care for persons with disabilities and vulnerable
groups, we need differentiated service delivery.

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, while at the same time (2) providing targeted disability-
specific support to persons with disabilities.
The two tracks reinforce each other. When mainstream programs and services, such as health and
education services, are disability-inclusive and aware, this can help facilitate both prevention of
impairments, as well as early identification of children and persons with disabilities who can
then be referred to disability-specific services. And the provision of disability-specific supports,
such as assistive devices, can help facilitate more effective inclusion of persons with disabilities
in mainstream services.

19
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).
iii) 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).
Primary prevention issues are considering as crucial to improved overall health of countries
populations. Viewing disability as a human rights issue is not incompatible with prevention of
health conditions as long as prevention respects the rights and dignity of people with disabilities,
for example, in the use of language and imagery. Preventing disability and vulnerability should
be regarded as a multidimensional strategy that includes prevention of disabling barriers as well
as prevention and treatment of underlying health conditions.

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

20
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 and adhere to protection standards and inclusion principles. A Sector‘s
organizational structures and human resources on disability inclusion should aim to reflect this
twin-track approach. In particular, each sector should have disability program officers in all
fields working to implement disability-specific support activities.
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 will help to overcome the challenges 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.
Education and vocational training –Inclusive Educationrealize the universal right to education
for all, meaning all mainstream education services need to be supporting children and persons
with disabilities.
Health – vulnerable groups and persons with disabilities have the same health-care needs as all
other peoples and health sector services can also play an important prevention and early
identification role to ensure children and persons with impairments have timely access to health
services and referral rehabilitation support.
Relief and social services – the two-way link between poverty and disability means that
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 must be considered in all infrastructure and construction
programs and projects.
Livelihoods, employment and microfinance – vulnerable groups and people with disabilities
face numerous barriers to achieving an independent livelihood, it is crucial that specific sectors
21
responsible for livelihood programs and 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, avocational, 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.
Medical rehabilitation is often considered separately, and is focused on recognition, diagnosis,
and treatment of health conditions (e.g., medication for treatment of fatigue in multiple sclerosis,
botulinum injections for spasticity management in brain injury); on reducing further impairment
(e.g., treatment of ongoing shoulder adhesive capsulitis in stroke, management of osteoarthritis
of the remaining knee in above-knee amputation); and on preventing or treating associated,
secondary, or complicating conditions (e.g., neurogenic bladder management with intermittent
catheterization in spinal cord injury, diagnosis of cervical spinal stenosis in an adult with
cerebral palsy). Although medical rehabilitation does use rehabilitation interventions and
espouses the principles of rehabilitation, medical aspects are additive to rehabilitation
interventions and principles, with common goals of improved function and outcomes.
There is convincing evidence that the rehabilitation process and interventions improve the
functional outcomes of people with a variety of injuries, medical conditions, and disabilities.
Assistive technology is often used in conjunction with rehabilitation interventions; this topic is
covered in the Assistive Technology and Science volume in this series. Rehabilitation
interventions are associated with social participation (e.g., access to education using
22
rehabilitation interventions) and career planning and employment (e.g., long-term goal of
rehabilitation interventions). These topics are covered in the Education and Employment and
Work volumes. There are additional efforts not covered in this volume that may also be a part of
rehabilitation interventions and processes, which include the discrete areas of mental health and
addiction rehabilitation. These are important areas that have crossover with rehabilitation
interventions, have defined sets of standards and regulation, and have robust histories of
development.
Rehabilitation was conceived within the more traditional model of medical care, but it is
increasingly obvious that disability issues are more than medically driven. The social justice and
civil rights model of disability is important to understand, and elements must be incorporated
into rehabilitation interventions, especially as they relate to accessibility of environments and
services. Of all the medical specialties and programs, rehabilitation is the one most based on
quality of life and functioning within the community. Inequalities and differences must be
addressed within the structures of funding and spheres of influence. Increasingly, insurance plans
determine the availability of rehabilitation services, equipment and assistive devices, and
community-based resources; government funding is more limited for education, especially for
those with special needs; and businesses and workers‘ compensation programs are more
restrictive with flexibility and coverage policies.
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 on many forms. The following is a description of the individual components that, when
combined, comprise the process and activity of rehabilitation.
Multiple Disciplines
Rehabilitation interventions usually involve multiple disciplines. Although some focused
interventions may be identified by a single service—such as cognitive retraining by a
psychologist or speech pathologist, and audiologic rehabilitation through hearing-aid evaluation
and dispensing—sole service does not engender the rehabilitation concept of a team approach,
and it is often differentiated as therapy or medical service rather than rehabilitation. There are a
variety of professionals who participate in and contribute to the rehabilitation process within a
team approach. The list is long, and it includes (although is not limited to) such professionals as
the following:
Physicians

23
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 Therapists
Occupational therapists (OTs) typically work with patients/consumers through functional
activities in order to 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.
Physical Therapists
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.
Speech and Language Therapist
Speech and language therapist assess, treat, and help to prevent disorders related to speech,
language, cognition, voice, communication, swallowing, and fluency.
Audiologists
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.
Rehabilitation Nurses

The rehabilitation nurse usually takes the role of educator and taskmaster throughout
rehabilitation, but these professionals have most prominence within inpatient rehabilitation
programs.
Social Workers
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; assist patients with
access to entitlement benefits, transportation assistance, or community-based services.
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
24
nursing background. These professionals collaborate with all service providers and link the needs
and values of the patient/consumer with appropriate services and providers within the continuum
of health care.
Rehabilitation Psychologists

Rehabilitation psychology 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).
This profession is an integral part of rehabilitation, and it involves assessment and intervention
that is tailored to the person‘s level of impairment and is set within an interdisciplinary
framework.
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
Recreational therapists, also referred to as therapeutic recreation specialists, provide treatment
services and recreation activities for individuals with disabilities or illnesses.
Rehabilitation Counselors
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
the function of those with neuromuscular or musculoskeletal impairments, or to stabilize an
injury or impairment through the healing process. The prosthetist works with individuals with
partial or total limb absence or amputation to enhance their function by use of a prosthesis (i.e.,
artificial limb, prosthetic device).

Additional Rehabilitation Professionals

Other rehabilitation professionals who might be considered members of the team include
nutritionist, spiritual care, rehabilitation engineer, music therapist, dance therapist, child-life
25
specialist, hospital-based school teacher, massage therapist, kinesiologist, and trainer, among
others.
Person with the Disability and His or Her Family
The person with the disability and his or her family members are partners in this team process. In
fact, they are key members of the team. Personal and family/support system goals, family/friend
support, and community resources are driving forces regarding goals and discharge planning
within the rehabilitation 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.

According to the view of World Health Organization (WHO) and United Nations Education,
Scientific and Cultural Organization (UNESCO), 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. Community based rehabilitation is a combination of two important
words; community and rehabilitation. Thus in order to get clear concept about the definition of
CBR, let us first define the two terms separately.

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 or 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.

If you give a person a fish,

He/she will eat for a day;
If you teach him/her to fish,
He/she eat for a lifetime.‖

26
Based on the above definition of key words, CBR is therefore, a systematized approach within
general community development whereby Persons with Disabilities are enabled to live a
fulfilling life within their own community, making maximum use of local resources and helping
the community become aware of its responsibility in ensuring the inclusion and equal
participation of ―Persons with Disabilities‖ (PWDs). In the process, PWDs are also made aware
of their own role and responsibility, as they are part of the community.
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. It is implemented through the
combined efforts of people with disabilities themselves, their families and communities, and the
appropriate health, education, vocational and social services.

This definition particularly advocates a broad approach for developing programs that involves
the following elements:

A. The participation of people with disabilities and their representatives at all stages of
the development of the program

B. The formulation and implementation of national policies to support the equal

participation of people with disabilities
C. The establishment of a system for program management

D. The multi-sectoral collaboration of governmental and nongovernmental sectors to

support communities as they assume responsibility for the inclusion of their members
who experience disabilities.

E. CBR focuses on strengthening the capacity of peoples with disabilities, and their families.

F. CBR focuses on challenging negative views and barriers in society to enable equal
rights and opportunities.
Currently, three main meanings are attached to the notion of CBR: People taking care of
themselves, a concept and an ideology and community based rehabilitation
1. People Taking Care of Themselves
Services for people with disabilities in most regions in developing countries are still limited to
what people can do for themselves. This is the "real" CBR: all the activities that people with

27
disability, their family members and other community members do in their own community for
persons with disability.

2. 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.

3. 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 program tries to
promote and facilitate community based rehabilitation. Unfortunately, such CBR programs
often consider 'local culture' as an obstacle, rather than as a condition towards progress.
Major Objectives of Community Based Rehabilitation
The major objective 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. Thus,
 Community based rehabilitation promotes the human rights of people with
disabilities through attitude changes within the community.
 Community based rehabilitation aims to include people who have disabilities from
all types of impairments, including difficulty hearing, speaking, moving, learning or
behaving.
 Community based rehabilitation also includes all age groups: children, youth, adults
and older people.
Implement Technologies for Disability Inclusion
Inclusiveness and Information Technology (ICT)
Inclusiveness and Information Technology examines the extent to which regulatory frameworks
for information and communication technologies (ICTs) safeguard the rights of persons with
disabilities and vulnerabilities as citizenship rights. 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, given the
increased role played by ICTs in everyday life. For persons with disabilities and vulnerabilities,
technological developments such as the proliferation of the Internet and the provision of services
for accessing digital television such as audio description (video description), closed signing, and

28
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.
Inclusiveness and Assistive Technology
Worldwide the number of persons with disabilities, vulnerabilities and marginalized groups is
increasing alarmingly because of population aging, accident, global warming and climate
change, medical advancement, humanitarian crises, natural disaster, conflict and increases in
chronic health conditions, among other causes. Over a billion people, about 15% of the world's
population, have some form of disability. Between 110 million and 190 million adults have
significant difficulties in functioning. Technologies promote independence for people with
disabilities and vulnerability. The use of devices, computers, robots, and other established
assistive technology (AT) can potentially increase the autonomy of people with disabilities and
vulnerability, by compensating for physical limitations and circumventing difficulties with
normal activities of daily living (ADL).
Wellbeing or quality of life is an important concern for persons with disabilities, vulnerabilities
and marginalized groups, who, like every person, is seeking to be well, happy, healthy, and
prosperous. Persons with disabilities, vulnerabilities and marginalized groups have several
important components of wellbeing. A key activity is independent living with convenient access
to goods and services, as well as being socially active and enjoying self-esteem and dignity.
Assistive Technologies (AT)
Surgery, generic therapy, rehabilitation, human assistance, and the use of assistive technology
(AT) help disabled people cope with their disabilities. AT can increase the autonomy,
independence, and quality of life for Persons with disabilities and vulnerabilities and can also
enable the integration of social, professional, and environmental aspects of life for Persons with
disabilities and vulnerabilities populations.
AT Definitions
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. AT also includes systems that
restore personal functionality, such as external prostheses and ortheses. There are various
organizational definitions for assistive technology: The international standard ISO 9999 defines
29
AT (refering to AT as ―technical aid‖) as ―any product, instrument, equipment or technical
system used by a disabled person, especially produced or generally available, preventing,
compensating, monitoring, relieving or neutralizing the impairment, disability or handicap‖ . In
the United States, the Technology Act and Assistive Technology Act define an AT device as
―any item, piece of equipment or product system, whether acquired commercially, modified, or
customized, that is used to increase, maintain, or improve functional capabilities of individuals
with disabilities.‖ These Acts also define an assistive technology service as ―any service that
directly assists an individual with a disability in the selection, acquisition, or use, of an assistive
technology device.‖
AT and Daily Living of Persons with disabilities and Vulnerabilities
Assistive technology affords Persons with disabilities and vulnerabilities greater equality of
opportunity, by 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. Typically, AT works by compensating for absent or nonfunctional skills, by
maintaining or enhancing existing abilities. Persons with disabilities and vulnerabilities utilize
AT to enhance the performance of their daily living tasks, including communication, vision,
hearing, recreation, movement, seating and mobility, reading, learning, writing, and studying, as
well as controlling and accessing their environment.
Assistive Technology varies from low-tech devices such as a cane or adapted loop, to high-tech
systems such as assistive robotics or smart spaces. Currently, most popular technologies for
Persons with disabilities and Vulnerabilities are simple; or examples of mobility-enhancing
equipment include wheelchairs, communication via mobile telephones and computers, and voice-
activated smart devices to enhance environmental control. Advances in communication and
information technologies further support the development of new, more complex technologies
such as utilization of smart wheelchairs, assistive robots, and smart spaces.
AT and User Needs: A Classification Scheme
Examples of AT user needs and classification
A. People with Communication Disabilities refers to be multiple difficulties including: Speech
mechanism problem, Language processing, Hearing, Vision, Motor skills
Needs & Barriers: Safety Technologies, Self-care and medication management, 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.

30
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
videoconferences). 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

Assistive technologies 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)

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
AT and the Marketplace
Markets for assistive technologies follow the general marketing rule that products introduced
into a market influence the demand and growth of markets for such products. In practice, AT
products can either represent a barrier to demand or become an engine of demand. This
relationship between Persons with disabilities and Vulnerabilities and AT in the marketplace
follows one of two strategies: (1) trivialization or (2) specialization, which are discussed as
follows:
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

31
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. The exceptionto this rule is products for elderly retired people, which
have significantly higher incomes and a much larger market.
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. Given requirements for safety and comfort, these products and services are designed
to be modified or adapted to meet Persons with disabilities and Vulnerabilities needs. This
strategy targets a much larger market but does not consider user satisfaction among Persons with
disabilities and Vulnerabilities.
AT 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, which are discussed as follows: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. The
intensity of this involvement varies with the stage of research and product development. Often,
the developed AT meets persons with disabilities satisfaction. However, this design method is
expensive in terms of resources and time expended by engineers and domain experts. It is also
difficult to recruit potential end users and to interact with them, especially when these end users
are older people, or people with disabilities (see also Chapter 34).
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, transgenerational applicability, and/or universal applicability or

32
appeal. Universal design does not emphasize differences among persons with disabilities, or
between persons with disabilities and the general population.
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.

Universal Design
It is frequently the case that the built environment can be modified permanently so that
functional limitations become less disabling and personal or temporary assistive technologies are
not needed. For example, the presence of ramps increases the ability of wheelchair users to get
around and thus decreases the degree to which the condition that led to their use of a wheelchair
is disabling. The presence of ramps will increase frequency of trips out of the house and into the
community for wheelchair users when ramps are installed in their houses. Wider doors, lower
bathroom sinks, and grab bars are other examples of modifications to build environments that
decrease the degree to which a building itself may be disabling. Lighting patterns and the
materials used for walls and ceilings affect the visual ability of all people, even though the
largest impact may be on improving the ability of the person who is hard of hearing to hear in a
particular room or the ability of a person who is deaf to see an interpreter or other signers.
Universal design is based on the principle that the built environments and instruments used for
everyday living can be ergonomically designed so that everyone can use them. Traditionally,
architecture and everyday products have been designed for market appeal, with a greater focus
on fashion rather than function. However, as the population of older adults and people with
disabling conditions increases, there has been a greater trend toward universal design.

Today, with the influence of consumer demand and through thoughtful disability policy, greater
emphasis is placed on the development of built materials that are ergonomically friendly to users,
regardless of their abilities. 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. For example, people who were deaf previously had
to purchase an expensive closed-captioning unit to attach to their television sets to view closed-
captioned programs. Today, as a result of new federal legislation, all new television sets are
manufactured with a closed-captioning microchip that allows any user access to broadcast closed
captioning. Thus, it is useful not only for deaf users but also for other vulnerable groups, such as
older individuals who are starting to lose their audio acuity, or a person watching a late-night talk
show in the bedroom who does not want to wake his or her partner.
33
In all of these ways, the environment affects the degree to which a functional limitation is
disabling for a person. However, decisions about the use of technology or built environments are
social decisions. The next major section considers the effects of the social and psychological
environments on the extent to which a particular functional limitation will be disabling or not.

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. Despite the fact that the majority of jobs can be performed by individuals
with disabilities, the pathways to their employment are often strewn with barriers. An OECD
study of its members showed that persons without disabilities were nearly three times more
likely than persons with disabilities to participate in the labor market.2 Evidence suggests the
same is true for countries in the Asia and Pacific region, although data to illustrate the full extent
of this trend is scarce. The employment gaps suggested above are likely to understate the
divergent work experiences of persons with and without disabilities, since they do not factor in
differences in type of employment. Persons with disabilities and vulnerabilities are more likely to
be own-account workers and occupy jobs in the informal sector, often without the security
offered by work contracts, salaries, pension schemes, health insurance and other benefits. Even
when persons with disabilities are formally employed, they are more likely to be in low-paid,
low-level positions with poor prospects for career development. Simple comparisons of the
employment rates for persons with and without disabilities can therefore be misleading.
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 for vulnerable groups

Barriers to the employment of persons with disabilities take many forms and operate at many
levels, both within and beyond the workplace itself. Persons with disabilities may be prevented
from working due to inaccessible transportation services; the lack of accessible information and
34
communications services; the preference of employers for candidates without disabilities; legal
stipulations that prevent individuals with particular impairments from working in certain fields;
or the discouragement of family and community members. Whilst these obstacles are often
interconnected, and act collectively to limit employment opportunities for persons with
disabilities, it is essential to distinguish between different barriers in order to develop effective
policy responses. The major types of barriers are described below.
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. At a wider level, social attitudes that cast persons
with disabilities as objects of pity and need perpetuate the assumption that they should not work.
In some cultures, people view disabilities as being indicative of wrongdoing in a past life, or are
simply uncomfortable around people who seem different. Persons with disabilities may also be
discouraged from working by their families, often out of a sense of shame or a well-intentioned
but stifling desire not to impose additional burden on their family members.
Though there are laws and regulations in some sectors, majority of social and economic sectors
in Ethiopian do not yet have anti-discrimination legislation that specifically targets the
employment of persons with disabilities. Discrimination is a major barrier faced by persons with
disabilities in their efforts to find employment in the labour market. Clearly, there needs to be
greater awareness about the need to break down barriers faced by persons with disabilities — be
it lack of accessibility features in public services or of laws that protect persons with disabilities
from discrimination by employers.
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. Lack of access to sign language interpretation or captioning services
can inhibit the employment of deaf people. In addition to the informational and physical design
of the workplace itself, the broader inaccessibility of public environments and crucially,
transport, can prevent persons with disabilities from being able to travel to work, receive
information about job opportunities, and communicate with employers.
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 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, and when they do
they are less likely to stay in school.18 In Indonesia, children with disabilities are one third less
likely to complete their primary education as those without a disability. In India in 2007, close to
40 per cent of children with disabilities were not enrolled in school, compared to only between 8
and 10 per cent of children in scheduled tribes or castes — groups that also face high levels of
discrimination and poorer socio-economic outcomes. Notwithstanding the numerous other
barriers they face, persons with disabilities are thus often prevented from being able to acquire
the human capital necessary to effectively compete for jobs. 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. A key benefit brought by
employment itself is the building of social relationships with colleagues, clients and business
partners. As a result of the barriers they face in entering and retaining work, many persons with
disabilities are also denied the possibility of expanding their networks at the workplace itself.
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, as well as men with disabilities. Women with disabilities are also
less likely to receive education and vocational training, and those women who do access
education and attain a degree of financial stability are more likely to have done so before
acquiring their disability. However, it remains difficult to quantify these trends as a result of the
limited availability of reliable data that is disaggregated by both sex and disability. Notonly the
36
particular difficulties faced by women with disabilities as they search for work, but also the
significance of social networks in sharing potential employment opportunities. The governments
and NGOs must ultimately step up to improve the precarious economic situation many women
with disabilities find themselves in.
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. In some countries, people must be considered ‗physically and
mentally healthy‘ or ‗sound‘ to represent oneself in a court of law, to occupy official positions,
or to use certain public services.25 Such laws effectively rule out large numbers of persons with
disabilities from accessing employment, based on the blanket assumption that they are incapable
of doing particular jobs effectively. Japan is one country that previously had such laws, but has
taken action to rectify them.
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. Persons with disabilities may have particular transportation issues or
other needs that require a slightly different work day. An employer‘s willingness to rearrange the
responsibilities and schedules associated with a particular job can mean the difference between
employment and unemployment for many persons with disabilities. 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.
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. Several countries, such as Iran, offer
rehabilitation programs and services to help dismissed workers to find new employment.
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
Another obstacle to the employment of persons with disabilities can 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
37
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 with more generous benefit
schemes. The situation in most of the region‘s middle-to-low income countries is entirely
different. However, it is vital for governments to avoid creating strong work disincentives.
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, vulnerable and
marginalized groups. In addition, private sector initiatives that have been demonstrated to
improve the employment experiences of persons with in these groups are also discussed
below.
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. Anti-discrimination laws challenge collectively held discriminatory attitudes against
persons with disabilities by influencing ‗the nexus between law, norms and social mores‘.26
Anti-discrimination laws can be made stronger when they include mandates for reasonable
accommodations that remove additional barriers to employment for persons with disabilities.
Crucially, however, these laws must outline clear enforcement mechanisms.
When penalties are neither stipulated nor enforced, employers are left free to discriminate with
impunity.
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.27 as discussed in Chapter 2, persons with disabilities often
have limited opportunities to build skills and knowledge that are relevant to the labor market. A
vital first step in improving access to employment for persons with disabilities is therefore to
ensure that employment support and vocational programs are as inclusive as possible. Such

38
programs should also be held in accessible locations, and reasonable accommodations should be
made to improve the access of persons with disabilities. Some persons with disabilities may not
be able to attend mainstream training programs. In such situations, to allow them to participate,
programs targeted at persons with disabilities may be required. It is crucial; however, that the
content of such training programs is geared to labor market demands, and not determined by
prior beliefs about what persons with disabilities should do or are capable of doing.
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. It is vital that care is
taken in determining the eligibility, amount and duration of subsidies, to avoid the subsidies
exceeding the actual gap in productivity between persons with and without disabilities.
Studies on the impact of subsides show mixed results on employment rates. Most studies
suggest, however, that both workers and employers are satisfied with wage subsidy schemes.
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.
Coaches also help persons with disabilities adjust to their working environment, and assist in
determining which accessibility accommodations are necessary. Supported employment has
been shown to be particularly cost-effective for people with intellectual and psychosocial
disabilities, in terms of productivity and health related costs. 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. 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. This strategy may,
however, be less effective for small businesses with cash flow issues or limited tax liability.
Another strategy is to provide full or partial funds for reasonable accommodations for
39
employees with disabilities. Such funding can be provided in various ways, either through
employment agencies, using fines from quota systems, or by offering grants to employers
from separate Government agencies. Investment in assistive equipment for employees
returned costs by about eight times through increased productivity and reduced absenteeism.
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. Generally, workers compensation operates through insurance programs - either
through public insurance programs, or private or even self-insurance at large firms. Because
employer premiums are experience rated, they are higher for firms with more accidents.
Thus, the approach incentivizes workplace safety and encourages employers to support
employees who acquire disabilities at work to be able to return to their jobs. In many
countries, employers are legally mandated to establish workers compensation programs.
G) Quota Systems
Quota systems mandate that firms hire at minimum a certain percentage of persons with
disabilities. Typically, quotas apply only to large employers. Empirical data points to only
small net employment gains of persons with disabilities. In addition, quotas can prove
difficult to both monitor and enforce. Moreover, by obliging employers to hire a specific
number of persons with disabilities, quota systems perpetuate the prejudice that persons with
disabilities are not really equivalent to others in their capacity to be productive.
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. In reality,
however, employees with disabilities are rarely supported to make this transition. Employees
are generally paid poorly, and the workshops in which they work are seen as charitable
enterprises and are funded as such, with revenues being a function not of sales but of the
number of employees. Rather than promoting sheltered workshops, governments can serve
their citizens with disabilities better by removing barriers towards their employment in the
open labor market. Persons with severe disabilities may find it difficult to enter the open
labor market, even if other barriers to their employment are removed. In certain cases
therefore, programs that create non-competitive job opportunities may be necessary.
Government and public agencies should be mandated by law to preferentially procure certain
products from such workshops in order to guarantee a stable income for their employees with
severe disabilities.

40
 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. Sometimes these
organizations are established in response to the creation of a quota policy, sometimes out of a
sense of corporate social responsibility, and sometimes because of a compelling business
case for being more inclusive.
The main activities of employer organizations include:
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;
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.
Disability-Inclusive Business—a number of large employers should be proactive in
promoting disability inclusion within their businesses. Many of these businesses draw on
their positive experiences of hiring persons with disabilities to demonstrate the business case
for inclusive employment, citing that persons with disabilities:
Have higher retention and lower accident rates than employees without
disabilities, and comparable productivity;
Represent an untapped source of skills and talent and transferable problem-
solving skills developed in daily life;
Often have valuable skills and experiences learned on the job prior to having a
disability;

41
 Can provide unique insights to help firms to develop their products or services
to customers and clients with disabilities;
Can improve the company‘s image, increasing morale, creating links to the
community, and appealing to potential customers who have a disability or
whose family members have a disability.
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, and
also influence wider social change. Box 10 shows an example of a disability-inclusive social
enterprise.
M) Support Persons with Disabilities in the Workplace
Governments can enhance the working experiences of persons with disabilities firstly by
leading by example in terms of public sector employment practices, and secondly
byestablishing programs and services that support persons with disabilities to do their jobs
effectively. 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.
N) Building a More Inclusive Society
By creating more accessible physical environments, public transport and knowledge, information
and communication services, governments can facilitate opportunities for persons with
disabilities to work, as well as society at large. It is recommended that governments:
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.

42
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.
O) Boost Education and Training Opportunities
Education and training is vital for all individuals to develop their human capital, and to acquire
skills and knowledge relevant to the labor market. Governments must therefore ensure that
persons with disabilities are able to access education and training on an equal basis with others.
It is recommended that governments:
Make education systems more inclusive, both to make schools more accessible to children with
disabilities, and to modify instruction to meet the needs of all children. Mainstream disability
inclusion into technical vocational education and training (TVET) programs, to support persons
with disabilities to acquire knowledge and skills necessary to find and retain decent work.
P) Break Down Attitudinal Barriers and Challenge Discrimination
Discriminatory attitudes towards persons with disabilities inform and produce other
barriers to the full and equal participation of persons with disabilities in society, including
in employment. For governments to better understand and challenge attitudinal barriers, it
is essential to:
Undertake research to examine the causes and manifestations of discriminatory
attitudes towards persons with disabilities across society.
Launch public awareness campaigns and programs to promote the rights of persons
with disabilities and to challenge discriminatory attitudes surrounding disability.
Conduct disability awareness training such as Disability Equality Training for public
employees at the national and local levels.
Q) Improve Data Collection on Disability and Employment
Designing, monitoring and evaluating policies to promote decent work for persons
with disabilities requires timely and high quality information. It is recommended that
governments:
Include the six core Washington Group questions on disability in labor force
surveys so that reliable, internationally comparable indicators on employment and
disability can be generated on a regular basis.
Conduct disability-dedicated surveys to improve the quality of data and
understanding on barriers to employment and in turn develop more responsive
policies.

43
 Take a consistent approach to disability identification so that multiple data sources
can be used in conjunction to get a more complete picture of the experiences of
persons with disabilities.

Chapter Summary
Persons with disabilities and vulnerable groups have diverse needs such as; social-
emotional, psychological, physical and economic. Factors affecting the needs of
persons with disabilities vary depending on the nature of disability, personality trait
of the person, the meaning the that person gives for the disability, the individual‘s
current life condition, type of support provided, the family, community and society,
political and economic system of the country at large.
The basic needs of persons with disabilities and vulnerabilities to ensure equality for
all within our society are: 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), counselling,, appropriate
and accessible health care
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; thus reducing levels of poverty and vulnerability

Health outcomes for people with disabilities should be access to quality, affordable health care
services, which make the best use of available resources.
As several factors interact to inhibit access to health care, reforms in all the interacting
components of the health care system such as policy and legislations, financing, services delivery
and human resources training in line with inclusiveness perspectives.
Disability is the result of the interaction between the characteristics of individuals with
disabilities and the characteristics of their environment.
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 provided to people with disabling
conditions and the extent to which the physical, built environment is accommodating or not
accommodating to the particular disabling condition.
Human competencies interact with the environment in a dynamic reciprocal
relationship that shapes performance.

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 The physical and social environments comprise factors external to the individual,
including family, institutions, community, geography, and the political climate
Environmental factors must be seen to include the natural environment, the human
made environment, culture, the economic system, the political system, and
psychological factors.
Persons with disabilities, vulnerable and marginalized groups living in rural areas
have double disadvantaged due to their impairments and vulnerabilities and
unfavorable physical and social environment.

Environmental strategies can be effective in helping people function independently

and not be limited in their social participation, in work, leisure or social interactions
as a spouse, parent, friend, or coworker.
The culture of a society or a subculture influences the types of personality or
intrapsychic processes that are acceptable and influences the institutions that make up
the social organization of a society.
Multi-sectorial and multi-disciplinary approach to prevention, intervention and
rehabilitation strategies are effective in building process of disability inclusive society.
Inclusiveness promotes equity, respect, peace, democracy, and inclusive development.

Chapter 4: Promoting Inclusive Culture

Definition of Inclusive Culture
Inclusion is a sense of belonging, connection and community at work. And inclusive
organizations help people feel welcomed, known, valued and encouraged to bring their whole,
unique selves to work.
Culture is ―the ideas, customs, and social behavior of a particular people or society.‖ An
organization‘s culture is the culmination of the priorities, values and behaviors, which support
their employees in how they work singularly, in teams and with clients. Culture plays a huge role
in shifting the diversity needle and forming truly inclusive environments. Hence, An inclusive
culture involves the full and successful integration of diverse people into a workplace or
industry. Additionally, inclusive cultures extend beyond basic or token presence of workers who
have disabilities. They encompass both formal and informal policies and practices, and involve
several core values:
Representation: The presence of people with disabilities across a range of employee roles and
leadership positions
Receptivity: Respect for differences in working styles and flexibility in tailoring positions to the
strengths and abilities of employees and
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Fairness: Equitable access to all resources, opportunities, networks and decision making
processes.
Dimensions of Inclusive culture
There are three dimensions/ elements of an inclusive culture:
Universal Design
Recruitment, Training and Advancement Opportunities
Workplace Accommodations and Accessibility: Policy & Practice
1. Universal Design
One of the most heralded concepts in disability advocacy and cultures in the last decade is the
concept of “universal design”.
Universal design refers to the construction of structures, spaces, services, communications and
resources that are organically accessible to a range of people with and without disabilities,
without further need for modification or accommodation.
While accommodations procedures remain a needed function of most contemporary institutions
and industries, forward-thinking approaches to disability inclusion will frequently involve
developing sites and resources that require no accommodation to be fully usable and receptive to
people with disabilities.
A few examples of ways universal design practices may apply in the workplace include:
Routinely providing manuals, materials and forms to all employees in a variety of digital formats
that are as readily accessible to people who use adaptive computer technologies as to other
employees. Build workspaces accessible to people who use wheelchairs or other assistive
devices; as well as to all other employees and provide employees with a variety of flexible
schedule and work options. This allows employees who have energy or functionality limitations
to organize their time and strengths, and all employees are better able to manage time and
life/work balance.
Recruitment, Training, & Advancement Opportunities A.
Recruitment:
Effective recruitment of people with disabilities involves two components: Accessible outreach
and hiring practices and Targeted recruitment of workers with disabilities.
Accessible outreach and hiring practices essentially entail making sure that outreach materials,
networking and recruitment sites, communications, and application processes all include a range
of accessible options, or are free of barriers that might inhibit people with disabilities from
participating. Wherever possible, outreach and hiring resources generally should be equally
accessible to workers with and without disabilities.
For example, making recruitment literature and job applications readily available in digital and
large-print formats, or holding outreach events in spaces without stairs or other barriers and with

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accessible communications technology, helps to ensure that people with disabilities will be
included in recruitment practices.
Targeted recruitment involves specific outreach to people with disabilities. Although making
general recruitment practices more accessible goes a long way towards building an inclusive
hiring structure, individual employers are not always able to overcome existing barriers for
instance, when recruiting via externally sponsored job fairs that are not accessible. Therefore,
targeted recruitment enables employers to reach and interview qualified people with disabilities.
In turn, having accessible recruitment practices relative to hiring, materials and
communications helps to ensure that targeted recruitment will be successful not just in
identifying qualified candidates, but by making sure there are no barriers to effective
outreach and eventual employment.
B. Training: Training plays a dual role in the creation of inclusive workplace culture. The
first consideration involves the degree to which people with disabilities have equitable access
to training sites, events, and materials.
The second concern relates to the training of managers, particularly middle management, and
human resources staff, to work effectively with all people, including those with disabilities.
The consequences of inadequate training are substantial, in reducing job satisfaction, with
corresponding negative consequences for productivity and retention. In turn, companies
favored by employees with disabilities make a concerted effort to create equitable and
accessible training resources.
C. Advancement: Research demonstrates that in order to have equitable opportunities for
promotion and professional development, like most employees, workers with disabilities
typically require access to mentoring.
As with recruitment, mentoring and coaching involves a dual dynamic in which:
Existing mentoring programs are advertised, implemented and maintained with attention
to inclusion of workers with disabilities, and
Targeted mentoring and coaching programs specifically assist employees with
disabilities. These may include the creation of explicit disability affirmative action
policies related to promotion, targeted professional networking opportunities, and the
establishment of disability affinity networks and related supports to encourage full
integration into the workplace culture.
Workplace Accommodations and Accessibility: Policy & Practice
Policy plays a critical role in generating meaningful inclusion of people with disabilities. In
addition to recruitment, training and advancement, workplace policies need to carefully plan for
the provision of reasonable accommodations.
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When assessing the effectiveness of existing accommodations policies, employee experiences
can be described based on two measures of equity.
The first indicator of an inclusive workplace culture involves the perception of ―procedural
justice‖, meaning that employees with disabilities perceive the accommodations policy as fair,
accessible and functional.
The practice of negotiating and providing accommodations constitutes an additional opportunity
for generating an experience of ―interactional justice‖. Interactional justice refers to the
experience of feeling that the managers or colleagues with whom one is interacting are behaving
fairly, reasonably and respectfully.
Experiential and Bottom Line Outcomes: The Benefits of Inclusive cultures are specifically
beneficial for employees with disabilities, but also have positive results for all employees, as
they include a number of elements of a healthy work environment.
Specific positive outcomes include: Reduced expenses corresponding to reduced employee turn-
over Increased worker commitment to and identification with organizational success Improved
employee health and well-being Improved productivity Increased employee investment in work
performance Reduced perception of discrimination and inequity Improved cooperation and
collaboration between co-workers, and between employees and management.
Creating an inclusive organizational culture is challenging but extremely advantageous. Here's
why and how, however, the business benefits and the outcomes of an inclusive organization
fairness and respect, value and belonging, safe and open, and empowerment and growth should
be compelling enough to push forward. These are some of the benefits of an Inclusive
organization that needs to be considered:

Higher Job Satisfaction

Lower Turnover.
Higher Productivity
Higher Employee Morale Improved Creativity and Innovation Improved Problem-
Solving
Increased Organizational Flexibility.
Inclusive education, when practiced well, is very important because all children are able to be
part of their community and develop a sense of belonging and become better prepared for life in
the community as children and adults. It provides all children with opportunities to develop
friendships with one another.
4.3 Building inclusive community
What is an inclusive community?
An inclusive community:
Does everything that it can to respect all its citizens, gives them full access to resources, and
promotes equal treatment and opportunity, Works to eliminate all forms of discrimination,
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Engages all its citizens in decision-making processes that affect their lives, Values diversity and
Responds quickly to racist and other discriminating incidents?
An inclusive society aims at empowering and promoting the social, economic, and political
inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, economic, or
other status. It is a society that leaves no one behind. We work to ensure that societies are open
and inclusive to all.
Here are things an organization can do to create a more inclusive workplace and, therefore, a
more appealing place to work:
Appropriately Connect with Employees
Interact with Different People
Create Employee Resource Groups
Place Importance on Inclusion
Hold Better Meetings
Invest in Diversity Training
People have opportunities to experience a variety of social roles that include friendships
contributing to the community and gaining new skills. Some of the benefits of inclusion to the
person are: Improved feelings of well-being and self-esteem.
Why is building an inclusive community important?
Acts of exclusion and injustice based on group identity and other factors should not be allowed
to occur and/or continue.
All people have the right to be part of decisions that affect their lives and the groups they belong
to and Diversity enriches our lives, so it is worth our while to value our community's diversity.
An inclusive community can be built at any time. The need to have an inclusive community,
however, is most obvious when there has been a decision or an incident that caused harm to a
particular group of people.
It is important to consider the motivation behind an individual, a group, or a community's desire
to build an inclusive community because the motivation affects the following:
Types and sequence of strategies selected: if there were a crisis, you might have to start with a
strategy that transforms the conflict. If there were no crisis, but rather the vision of a community
leader that sparked the effort, you might consider starting with a public education campaign.
Resources available: more resources could be mobilized if the motivation came from a large
institution or a local foundation.
Amount of support and obstruction: if the dominant group in the community is just as motivated
as any other group, there is likely to be more support. If, however, the dominant group has no
interest in changing the status quo, there are likely to be more barriers.

49
Rate of progress: if the major leaders and groups support the effort, progress is likely to be
faster.
Expected outcomes: if the goal is to raise awareness, everyone involved is likely to be satisfied if
they learned new things about other groups. If the goal is to promote fair treatment of every
group, everyone involved is more likely to be satisfied by policy change.
Characteristics of an Inclusive Community

Inclusive communities do have the following set of characteristics:

Integrative and cooperative: inclusive communities bring people together and are places
where people and organizations work together.
Interactive: inclusive communities have accessible community spaces and open public
places as well as groups and organizations that support social interaction and community
activity, including celebrating community life.
Invested: inclusive communities are places where both the public and private sectors
commit resources for the social and economic health and well-being of the whole
community.
Diverse: inclusive communities welcome and incorporate diverse people and cultures into
the structures, processes and functions of daily community life.
Equitable: inclusive communities make sure that everyone has the means to live in decent
conditions (i.e. income supports, employment, good housing) and the opportunity to develop
one‘s capacities and to participate actively in community life.
Accessible and Sensitive: inclusive communities have an array of readily available and
accessible supports and services for the social, health, and developmental needs of their
populations and provide such supports in culturally sensitive and appropriate ways /essential
services identified include good schools, recreation, childcare, libraries, public transit,
affordable housing and supportive housing, home care, crisis and emergency supports, well
coordinated and comprehensive settlement supports/.
Participatory: inclusive communities encourage and support the involvement of all their
members in the planning and decision-making that affects community conditions and
development, including having an effective voice with senior levels of government and Safe:
inclusive communities ensure both individual and broad community safety and security
so that no one feels at risk in their homes or moving around the neighborhood and city.
Means of establish inclusive culture
An organization is inclusive when everyone has a sense of belonging; feels respected, valued and
seen for who they are as individuals; and feels a level of supportive energy and commitment
from leaders, colleagues and others so that all people, individually and collectively can do their
best work.
To create an inclusive culture in which everyone feels they belong and is comfortable expressing
their uniqueness,
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There are four key inclusive leadership behaviors:
Empowerment: Enable team members to grow and excel by encouraging them to solve
problems, come up with new ideas and develop new skills.
Accountability: Show confidence in team members by holding them responsible for aspects of
their performance that are within their control.
Courage: Stand up for what you believe is right, even when it means taking a risk.
Humility: Admit mistakes, learn from criticism and different points of view, and overcome your
limitations by seeking contributions from team members.
How inclusive culture establish?
There are five stages in establishing inclusive culture:
1. Consider what you want to achieve and what the benefits will be.
This first stage of the process involves looking at your organization: its size, the type of work it
does, where it is located, who it employs, who uses its services, and what its goals are; and
thinking about how it could become more inclusive.
2. Undertake an inclusion review of your workplace
When reviewing inclusion and equality in your organization, you should consider the following
areas:
The demographics of your organization and customer base.
All organizations are different, so the first thing you will need to do is examine what the
demographic make-up of your workplace is. Compiling and analyzing data on your staff by age,
gender, ethnic group, religion or belief, sexual orientation and disability, and noting where in the
organization‘s structure employees belonging to different groups work, will help you to identify
any under- represented groups and areas of occupational segregation. You should check
employees’ salaries according to membership of different groups, and check rates of progression
within and through the grades. It is also useful to look at retention and exit rates by these groups.
If possible, you should also collect information on the make-up of your customers. Finding out
who uses your services and what their needs are is important if you are to ensure you have the
right people, skills and approaches to meet these needs.
The formal policies and practices of your organization can tell you a lot about how much you
have previously thought about inclusion, human rights and equality. When reviewing these
policies, you will find it helpful to look at: Policies to deal with discrimination, bullying and
harassment Procedures to deal with tensions and difference between groups Informal or
unwritten working practices and Arrangements for staff consultation and participation

3. Decide where work is needed and create an action plan.

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Having reviewed your workplace in terms of equality and inclusion, the next stage is to decide
upon the action you will take. Set out the key changes you would like to make as a result of your
review. Prioritize these changes to help you decide where to start. Some measures you may wish
to consider as part of your action plan are:
Actively involve all employees
Consultation and participation
Encourage employees to take part in monitoring, and promote the reasons for doing so.
Extra measures and adjustments
Build a culture of inclusion and respect
Ensure the organization‘s core values include a commitment to equality, human rights and
inclusive working.
Create, extend or improve policies on equality and human rights and make sure other policies are
equality proofed.
Take immediate action to address and tackle discrimination, harassment and bullying.
Ensure the organization‘s core values include a commitment to equality, human rights and
inclusive working.
Create, extend or improve policies on equality and human rights and make sure other policies are
equality proofed.
Take immediate action to address and tackle discrimination, harassment and bullying. Train all
staff on inclusive working, human rights and equality.

Make inclusion a key management approach.

Encourage and appoint equality and human rights champions.
Encourage employee networks and forums.
Promote culture-changing initiatives.
Take an inclusive approach to recruitment, promotion and development
Make equality, diversity, human rights and inclusive working part of job descriptions.
Monitor applicants and staff at different levels within the organization.
Equality and human rights training for all staff involved in recruitment and a fair and
transparent selection process.
Attract candidates from the widest pool available.
Reward talent and achievement rather than stereotypical indicators of success.
Value skills achieved outside the workplace.
Encourage and enable development for all.
Offer mentoring opportunities to junior and new staff.
Offer work placements
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 Conduct exit interviews
Encourage engagement with the local community
Employer assisted volunteering.

4. Communicate the plan with staff and put the plan into action.
Actively involve all groups of employees
In order to create a working culture of inclusion, respect and opportunity for all, it is essential
that everyone in the organization, from senior management to the most junior staff, is engaged
with and involved in the process of creating this culture, and feels that their opinions and
experiences are valued. Measures to promote inclusive working need to be thought of positively
among employees, not as something that is ‗done‘ to them. There are several things to think
about in this respect.
Participation and consultation
Before drawing up a plan of action it is essential to involve and consult employees to find out
about their experiences, what they feel are the key issues affecting them and what action they
would like to see taken to address these issues. Staff and any unions or other employee
representatives should also be consulted at different stages in the plan‘s implementation, in order
to get their feedback on the progress being made. The action plan should be a living document,
capable of being adapted and developed over time.
There are many different ways that you can consult and involve employees and their
representatives. Some examples are: Staff surveys can be used to gather information on a range
of subjects, including the make-up of the workforce, responses and attitudes towards equality
and human rights issues, and levels of job satisfaction among employees. Surveys can be
designed so that responses can be analyzed according to membership of equality group or other
relevant factors. Confidential surveys will attract a higher response rate.
Focus groups provide more opportunity for in-depth consultation and debate with a smaller
number of employees. They could be a useful forum in which to collect feedback on draft
policies and action plans, and can be an indicator of wider staff attitudes.
Engagement with employee networks and forums can utilize an important representative voice
of staff from minority groups and can provide useful input into policies and action plans.
Review, monitor and evaluate the plan’s impact and use what you find to plan future action
Ten Characteristics of an Inclusive Organization
1. It accepts diversity and inclusion as a way of life.
In an inclusive organization, one sees diversity at every level within the institution. Many
cultures, traditions, beliefs, languages, and lifestyles are prevalent in both the workforce as well
as the customer populations, and are respected without judgment. People are viewed as
53
individuals who have come together to coordinate action towards the achievement of common
goals.
It evaluates individual and group performance on the basis of observable and measurable
behaviors and competencies.
Employees have a clear understanding of their roles and responsibilities. They are evaluated
based upon their actions, not the opinions of others. Goals and expectations are achievable.
3. It operates under transparent policies and procedures.
There are no hidden rules of behavior that may be apparent to some groups and unknown to
others.
4. It is consistent in its interactions with everyone.
There is no double standard. Rules are applied appropriately and regularly throughout the
institution. No one group is favored over another.
5. It creates and maintains a learning culture.
Career development is encouraged and supported for all employees by management.
Mentoring programs are robust, and include both formal and informal systems that meet the
individual learning needs of all employees. Mistakes are recognized, and their consequences
addressed, but they are viewed as learning opportunities rather than character flaws.
6. It has a comprehensive and easily accessible system of conflict resolution at all levels.
It recognizes that conflict is inevitable in a complex multicultural organization, and it has
systems in place to address conflict in a non-confrontational manner that respects the dignity
and confidentiality of all parties.
7. It recognizes that it is part of the community that it serves.
Employees, managers, and customers all come from the community. An inclusive
organization is an active participant in community activities, and plays a vital role in
addressing its needs.
8. It lives its mission and core values.
People work for an organization because they believe in its purpose and goals.
An organization that promises one thing and delivers other risks losing the trust and
confidence of its workforce as well as its customers.
9. It values earned privilege over unearned privilege.
Employees are recognized for their actions and accomplishments, not simply because of their
titles or degrees. Customers are treated with respect regardless of their socioeconomic status
or class.
10. It accepts and embraces change.
Change is inevitable. An inclusive organization recognizes that current and past practices
must constantly be reviewed and updated to meet the changing demands and needs of the
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 industry, workforce, and customers.
Inclusive values
Inclusion is most importantly seen as putting inclusive values into action. It is a commitment to
particular values which accounts for a wish to overcome exclusion and promote participation.
The seven Pillars of Inclusion:
Access: Access explores the importance of a welcoming environment and the habits that create
it.
Attitude: Attitude looks at how willing people are to embrace inclusion and diversity and to take
meaningful action.
Choice, partnership, communication, policy and opportunity
Values are fundamental guides and prompts to action. They spur us forward, give us a sense of
direction and define a destination. We know that we are doing, or have done, the right thing
through understanding the relationship between our actions and our values. For all actions
affecting others are underpinned by values. Every such action becomes a moral argument
whether or not we are aware of it. It is a way of saying ‗this is the right thing to do‘.
Hence, inclusive values are appreciating diversity, equality and equity, cooperativeness,
participation, community, and sustainability are examples of inclusive values that are
fundamental for successful inclusive education.
Appreciating diversity, equality and equity, cooperativeness, participation, community, and
sustainability are examples of inclusive values that are fundamental for successful inclusive
education.
A careful piecing together of a framework of values has resulted in a list of headings concerned
with equality, rights, participation, community, respect for diversity, sustainability, non-violence,
trust, compassion, honesty, courage, joy, love, hope/optimism, and beauty. A values framework
can be considered as a universe of interconnected meanings.

55
The term “Indigenous‖ refers to a better understanding of, and respect for, indigenous cultures
develops an enriched appreciation of the existing cultural heritage.

Indigenous ways of knowing were often discounted and discredited as non-scientific because
they were rooted in the story of the people, their language, culture, art, mythology and
spirituality. It was important to recognize the right of indigenous peoples to land, resources and
sacred sites.
Incorporating Indigenous ways of learning into educational practices has potential to benefit
both Indigenous and non-Indigenous learners. The 21st century skills needed in modern
curriculum include: collaboration, creativity, innovation, problem-solving, inquiry,
multicultural literacy, etc.
What is indigenous inclusion?
Indigenous inclusion defined as an organizational state that is embraced as a cultural norm, with
enterprise-wide workplace strategies as well as a culture which invites the full participation of
indigenous people into all aspects of business operations.
It is where leadership and employees are welcoming of indigenous people, their experience and
outlooks, where diversity is valued, the spirit of reconciliation has been embraced and calls to
action have been acted on in meaningful ways.
Features of an indigenous inclusion:
1. Inclusion has been embraced as a core competency and embedded into the
organizational culture;
2. Companies share their organization‘s experience and achievements with inclusion and
explain how it has helped their performance;
3. Human rights and responsibilities are promoted and respected. Employees are free of
concerns related to basic equity issues;
4. Comprehensive Indigenous procurement, recruitment and corporate social
responsibility strategies have been developed as part of an enterprise-wide
coordinated approach;
5. Indigenous people are employed and retained in all areas of the organization including
the senior leadership and executive positions;
6. There are significant revenues and jobs gained by Indigenous people and businesses
through the organization‘s supply chain;
56
 Indigenes community sustainable gains have been realized as a result of the
relationships built between the company and the community;
8. High levels of Indigenous employee engagement are seen and experienced in the
organization;
9. Leadership has put into place the resources needed to sustain its Indigenous inclusion
strategy and it may have introduced an inclusion policy framework or statement;
10. Indigenous inclusion is integral to the mission and vision of the organization.
A seven stage model to indigenous inclusion:
Indigenous Works has developed a 7-stage workplace model of Indigenous inclusion which is
called the Inclusion Continuum.
The model depicts the roadmap that organizations follow to become more inclusive, gradually
enabling more effective workplace and employment strategies to be developed. The Continuum
describes the organizational features and competencies needed at each stage to achieve elevated
levels of performance in Indigenous employment, business development, community relations,
etc. Movement along the continuum depends on companies developing their cultural
competencies, improving their understanding of Indigenous people, their history and culture.
Company’s position on the Inclusion Continuum can be measured from year to year to track and
assess progress.
Types of indigenous inclusion policies
There are quite a range of Indigenous inclusion policies in use by companies and organizations
throughout Ontario and Canada. The diagram below illustrates how some of those policies align
with workplace needs. Some inclusion policies have a targeted application to specific areas of
the workplace such as employment, Indigenous community relations, Indigenous business
development or procurement. Other inclusion policies strike across the organization, providing
an ‗enterprise-wide approach to inclusion.
What are inclusive practices?
Inclusive practice is an approach to teaching that recognizes the diversity of students, enabling
all students to access course content, fully participate in learning activities and demonstrate their
knowledge and strengths at assessment.
The aim of inclusion is to embrace all people irrespective of race, gender, disability, medical or
other need. It is about giving equal access and opportunities and getting rid of discrimination and
intolerance (removal of barriers). It affects all aspects of public life.
Inclusive practice is about the attitudes, approaches strategies talent to ensure that people are not
excluded or isolated. It means supporting diversity by accepting welcoming people‘s differences,

57
promoting equality by equal opportunities for all. In addition inclusive practice involves having
an understanding of the impact that discrimination, inequality, social exclusion can have on an
individual. Having an understanding of this ensures appropriate personalized care, support can be
given. This enables the individual to develop self-respect, self-worth, also to maintain a valued
role in society, the environment surrounding them.
When we compare inclusive practice with practice which excludes an individual, inclusive
practice gives an individual more confidence in the care that they were receiving, it gives them
the option to have an input with the care they are having as they are being given the opportunity
to do so. In the long run, this could improve the service user‘s health as they still have
confidence in the careers. Practice that excludes the service user could have consequences on
their own health, for example if they spoke English and were provided with a care worker that
spoke and understood poor English could result in them not being able to communicate, from
that they would like for dinner to whether they are feeling ill and may need to see a doctor
meaning that their health could deteriorate
Inclusive practices in education are based on seven principles:
Diversity enriches and strengthens all communities, all learners‘, different learning styles, and
achievements are equally valued, respected and celebrated by society
All learners are enabled to fulfill their potential by taking into account individual requirements
and needs Support is guaranteed and fully resourced across the whole learning experience

All learners need friendship and support from people of their own age
All children and young people are educated together as equals in their local communities
Inclusive teaching strategies refer to any number of teaching approaches that address the needs
of students with a variety of backgrounds, learning modalities, and abilities. These strategies
contribute to an overall inclusive learning environment in which students feel equally valued.
Chapter Summary
An inclusive culture involves the full and successful integration of diverse people into a
workplace or industry. Additionally, inclusive cultures extend beyond basic or token presence of
workers who have disabilities.
There are three dimensions/ elements of an inclusive culture: these are Universal Design,
Recruitment, Training and Advancement Opportunities and Workplace Accommodations and
Accessibility: Policy & Practice
Inclusion has been directly advocated since the Universal Declaration of Human Rights in 1948
and has been acted at all phases in a number of key UN declarations and conventions.
An inclusive society aims at empowering and promoting the social, economic, and political
inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, economic, or
58
other status. It is a society that leaves no one behind. We work to ensure that societies are open
and inclusive to all.
An inclusive community can be built at any time. The need to have an inclusive community,
however, is most obvious when there has been a decision or an incident that caused harm to a
particular group of people.
Major Characteristics of Inclusive communities are Integrative and cooperative, Interactive,
Invested, Diverse, Equitable, Accessible and Sensitive, Participatory and Safe
An organization is inclusive when everyone has a sense of belonging; feels respected, valued and
seen for who they are as individuals; and feels a level of supportive energy and commitment
from leaders, colleagues and others so that all people, individually and collectively can do their
best work.
There are four key inclusive leadership behaviors: (i.e., Empowerment, Accountability, Courage
and Humility)
Inclusive values are appreciating diversity, equality and equity, cooperativeness, participation,
community, and sustainability are examples of inclusive values that are fundamental for
successful inclusive education.
Appreciating diversity, equality and equity, cooperativeness, participation, community, and
sustainability are examples of inclusive values that are fundamental for successful inclusive
education.
Indigenous inclusion defined as an organizational state that is embraced as a cultural norm, with
enterprise-wide workplace strategies as well as a culture which invites the full participation of
indigenous people into all aspects of business operations.
Inclusive practice is an approach to teaching that recognizes the diversity of students, enabling
all students to access course content, fully participate in learning activities and demonstrate their
knowledge and strengths at assessment.
Inclusive teaching strategies refer to any number of teaching approaches that address the needs
of students with a variety of backgrounds, learning modalities, and abilities. These strategies
contribute to an overall inclusive learning environment in which students feel equally valued.

Chapter 8: Collaborative (Cooperative) Partnerships with

stakeholders
Introduction

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 An individual or an institute cannot do everything they want for the success of inclusiveness.
They require collaboration and partnership. Collaborative is becoming an effective team
player for the intended success. Collaboration referred to as collaborative consultation,
cooperative planning, implementation, assessment, co-teaching and any kind of team-based
services or community of practice. It has potential to create synergy – where the whole is
greater than the sum of the parts. It has the potential to provide opportunities for you to learn
new ways of addressing barriers to learning, working, living and for colleagues to learn from
each other. Collaboration should be with all human being for the success of inclusiveness.
Collaboration should be based on avoiding stereotype thinking that discriminate or
undermine the capacities of human being, demands equality, equity and creating mutual
respect. Besides collaboration, cooperation is also vital for human being to meet life goal.
Definition of collaboration, partnership and stack holder

Collaboration is defined as ―the act of working together to produce or create something

according to the capacities and abilities of individuals. Each individual‘s collaboration is
based on his knowledge and skills. A person should not be discriminated due to mismatch
with other people‘s abilities; because he has his own quality in other perspectives.
Collaboration means 'to work with another person or group in order to achieve accomplish
intended goals. Collaboration provides every team member with equal opportunities to
participate and communicate their ideas. Collaboration in the workplace is when two or
more people (often groups) work together through idea sharing and thinking to accomplish a
common goal. It is simply teamwork taken to a higher level. The phrase 'putting our heads
together' would be a good example of this important element of collaboration.
Collaboration enables individuals to work together to achieve a defined and common
business purpose. It exists in two forms:
Synchronous, where everyone interacts in real time, as in through telephone, email, online
meetings, through instant texts messages, or via Viber, andthe team sees value in working
together as the common goal gives them a meaningful reason to work together, along with
receiving mutual benefits for the institution as well as the team.
The advantages of collaboration can also be seen in terms of individual output. Creating a
sense of teamwork and building bonds encourages team members to work for the collective
rather than just themselves.
Key elements of successful collaboration

The relationship includes a commitment to: mutual relationships and goals; a jointly developed
structure and shared responsibility; mutual authority and accountability for success; and sharing

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of resources and rewards. A Collaboration Checklist What factors are helping or hindering your
collaboration efforts? We've got the four most important elements of teamwork to help you
build a team that will lead your company to success.
Respect:- This one should be a no-brainer. ...
Communication:- While respect is probably the most important element of teamwork, it is the
tool that will generate that respect. ...
Delegation. ...
Support.
Collaboration in the workplace is when two or more people work together through idea sharing
and thinking to achieve a common goal.
Here are a few qualities that a successful team possesses.
They communicate well They offer each other
with each other. ... support. ...
They focus on goals and Team members are
results. ... diverse. ...
Everyone contributes Good leadership. ...
their fair share. ... They're organized. ...
They have fun.

General principles of collaboration

Establish clear common goals for the collaboration.

Define your respective roles and who is accountable for what, but accept joint
responsibility for the decisions and their outcomes
Take a problem-solving approach – with a sense that all those in the collaborative
arrangement share ownership of the problem and its solution.
Establish an atmosphere of trust and mutual respect for each others‘ expertise.
Aim for consensus decision-making.
Ask for and give immediate and objective feedback to others in a nonthreatening and
non-judgmental manner.
Give credit to others for their ideas and accomplishments
Develop procedures for resolving conflicts and manage these processes skillfully.
Better still, anticipate possible conflicts and take steps to avoid them as far as
possible. This is not to say that disagreements can, or even should, be avoided.
Arrange periodic meetings to review progress in the collaborative arrangements.
What are the advantages of collaboration?
Higher employee productivity
The advantages of collaboration can also be seen in terms of individual output.
Creating a sense of teamwork and building bonds encourages team members to work
for the collective rather than just themselves
Benefits of collaboration
Greater efficiency and less duplicated effort.
Access to additional resources or lower costs through sharing resources such as office
space, administration or other aspects of an organization‘s operation.
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 Improved service coordination across agencies, with better pathways or
referral systems for service users.
Challenges to Team Collaboration
Indecisive decision-makers. Ironic, isn't it? ...
"E-fail" This is a little term used for when email straight up fails. ...
Mis (sing) communication. When collaborating, there is always room for
misinterpretation and miscommunication.
Process sinking vs. process syncing.
Too many cooks.
Negative Nancy.

Cooperativeness
Cooperation is one of the components of collaboration. As an
adjective, cooperative describes working together agreeably for a common purpose or goal as in
cooperative play or cooperative employee. As a noun, a cooperative is a jointly-owned
business or enterprise where members pool their resources to purchase, do work, and/or
distribute things. Cooperativeness helps individuals to willing learn from each other.

Learners work together in small groups, helping each other to carry out individual and group
tasks. Interdependence: all group members seek to achieve a group goal and help each others‘
achievement; Individual accountability: each member of the group is held responsible for his or
her own learning, which in turn contributes to the group goal; Cooperation: the learners discuss,
problem-solve and collaborate with each other; Face to face interaction and establish consensus;
and Evaluation: members of the group review and evaluate how they worked together and make
changes as needed. It requires interdependence, which can take one or more forms that help to
create inclusiveness:
1. Goal interdependence: the group has a single goal.
Reward interdependence: the whole group receives acknowledgement for achieving
the goal
Resource interdependence: each group member has different resources (knowledge
or materials) that must be combined to complete a task
Role interdependence: each group member is assigned a different role (e.g, leader,
reporter, time-keeper)

In cooperative learning and works, the strategies for effective co-planning and team working
are very important. The following steps will help you and your group to work effectively
together.

Have clear objectives

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 At each stage you should try to agree on goals
Set ground rules
Communicate efficiently
Build consensus
Define roles
Clarify your plans, process and achievements all the time
Keep good records
Stick to the plan
Stakeholder
Definition of a Stakeholder
A stakeholder is any person, organization, social group, or society at large that has a stake in the
business. Thus, stakeholders can be internal or external to the business. A stake is a vital interest
in the business or its activities. Be both affected by a business and affect a business. A business
is any organization where people work together. In a business, people work to make and sell
products or services. A business can earn a profit for the products and services it offers. The
word business comes from the word busy, and means doing things. It works on regular basis. All
human being can participate in any kind of business equally without discrimination based on
their disability, culture, language, religion, gender, rural, urban and the like.
Stakeholders can affect or be affected by the organization's actions, objectives and policies.
Some examples of key stakeholders are creditors, directors, employees, government (and its
agencies), owners (shareholders), suppliers, unions, and the community from which the business
draws its resources.
In business, a stakeholder is usually an investor in your company whose actions determine
the outcome of your business decisions. Stakeholders don't have to be equity shareholders.
They can also be your employees, who have a stake in your company's success and incentive
for your products to succeed.
Roles of Stakeholders in a Project

Stakeholders are usually parties who have a stake in a project and have a great influence on
its success or failure. They may be equity or preference shareholders, employees, the
government agencies, contractors, financial institutions, competitors, suppliers and the
general public
What are the benefits of stakeholder participation?
Provide all stakeholders with full opportunities to share their views, needs and
knowledge on flood management.

Build consensus through bringing together a diverse range of stakeholders to share needs,
information, ideas and knowledge and harmonize the objectives of individual groups to reach

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common societal goals.

Characteristics of successful stockholders partnerships

Existence of an agreement: Partnership is the outcome of an agreement between two or more

persons to carry on business or offer services for the community
Sharing of profits or stratification for the services offered to the community
Establishing equal and equitable relationship, Membership without discrimination
Nature of liability, Fusion of ownership and control, Non-transferability of interest
Trust. Without trust there can be no productive conflict, commitment, or
accountability Common values. I believe that having common values is the very
foundation of the successful partnership Defined expectations Mutual respect
Synergy What qualities make for a great business
Great two-way communications partner?
What makes a good strategic alliance Passion
partner? Reliability
They have a similar audience Compatibility
They are not your competitors The Ability to Build Strong Relationships
They can give you access to new customers Fiscal Responsibility
and prospects Creativity
They want to work with you Open-Mindedness
They want something you can offer Comfort with Risk.
What are the main features of a partnership?

Participants described the right partnership behaviors principally as being effective co-
ordination and chairing, and a set of personal skills and qualities including good listening, clear
communication, honesty, patience, enthusiasm, acceptance and love. strategic alliance implies
that: the success of the alliance impacts one or more major business or service goals. The success
of the alliance develops or reinforces a core competency, especially one which provides a
competitive advantage and / or blocks a competitive threat Strategies for community
involvement inclusive development Commit to participation of all persons with
diversitiesEstablish non-discriminative effective communication with all people with divers
back ground
Expect to do most of the work yourself following the inclusive principle
Tap into local networks, culture and indigenous experiences of inclusiveness
Use all possible communication channel including sign language for deaf people

Community development is about the inclusive involvement of all people, regardless of their
diversities, enhancing equality, respecting their full right in terms of educational opportunities
and employability. The creation of opportunities to enable all members of a community to
actively contribute to and influence the development process and to share equitably in the fruits
of any development endeavors. Participation has an intrinsic value for participants and a catalyst
for further development; encourages a sense of responsibility; guarantees that a felt need is
involved; ensures things are done the right way; uses valuable indigenous knowledge; frees
people from dependence on others' skills; and makes people more independent and productive
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