Chapter 3

Identification of the Impact of Disability

and Differentiated Services

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 The Impact of Disability and
Vulnerability on Daily Life

 People respond to disabilities in different

ways. Some react negatively.
 Thus, in this situation the quality of life of
PWDs will be negatively affected.
 Others prefer to focus on their abilities as
opposed to their disabilities and
continue to live a productive life.
 There are several factors that affect and
impact of the life an individual with disability.

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 The following are considered as the most known
factors in determining the impact of disability on
an individual.
 The Nature of impairment
 The Individual’s Personality
 The Meaning of the impairment to the
Individual
 The Individual’s Current Life Circumstances
 The Individual's Support System
 Economic Factors and Disability
 Political Factors and Disability
 Psychological Factors of Disability
 The Family and Disability
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 The Nature of impairment
 Impairment can be acquired as a result of an
accident, or disease that may be congenital
or acquired (pre-natal, or post-natal).
 If the impairment is acquired, it is more
likely to cause a negative reaction than a
congenital impairment.
 The acquired impairment requires more
rehabilitation service than the congenital
ones.
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 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 impairment 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 impairment
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 impairment and
thus it will have a negative impact.
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 The Individual’s Current Life
Circumstances
 The influence of this situation manifests through the
following factors:
 The condition that the individual is independent or
dependent on others (parents) in his/her living;
 The economic and academic status of the individual with
disability or his/her caregivers;
 If the individuals with impairments are happy with their
current life circumstance, they are more likely to
embrace their impairment, whereas, if they are not
happy with their circumstances, they often blame their
impairment.
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The Individual's Support System
 The individual’s support from family, a significant
other, friends, or social groups contribute to
minimize the impact of impairment on their overall
personality

Common effects of impairment/disability may include:

 Limited to health conditions of the person;
 Mental health issues including anxiety and
depression;
 Loss of freedom and independence;

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 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.
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 Economic Factors and Disability

 There is clear evidence that people living with poverty

are exposed to health problems that may cause
impairment and disabling environment.
 This is true even in advanced economies.
 The impact of absolute or relative economic
deprivation on the onset of pathology crosscuts
conditions with radically different etiologies,
encompassing infectious diseases and most common
chronic conditions.
 The lack of resources can adversely affect the ability of
an individual to function with a disabling condition.
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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.
 If the political system is well enforced it will profoundly
improve the prospects of people with disabling conditions for
achieving a much fuller participation in society, in effect
reducing the font of disability in work and every other domain
of human activity.
 Thus, the political good will of the government that manifests
at policy and implementation level creates enabling
environment for full and effective participation of PWDs in all
aspects of life of the society by reducing the impact of the
impairment and forms of impediments.
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 Psychological Factors of Disability
 There are five constructs that may result in
psychological influence on the psychological makeup of
PWDs in reference to disabling conditions.
 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. 12
II. 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).
III. Psychological Control
 Psychological control, or control beliefs, is akin to
self-efficacy beliefs in that they beliefs regarding
one's ability to exert control or change a situation.
IV. 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.
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 Personality Disposition
 Optimism in contrast to pessimism 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 towards others and tend to
use more adaptive coping strategies than
pessimists.
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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 informational (providing advice
or referrals), or emotional (giving love and support).
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 Special Needs of Persons with
Disabilities and other Vulnerable
Groups

 The special needs of PWDs are emanated from

different factors.
 These are:
- Personal experience of individuals with
impairments;
- Type of the impairment;
- Severity /degree of the impairment; and
- Onset of the impairment.

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Abraham’s Maslow Hierarchy

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To ensure their equal participation in
all activities of the society:

- Full access to the environment (towns,

countryside & buildings);
- Accessible transport system;
- Technical aids and equipment;
- Accessible/adapted housing;
- Personal assistance and support;
- Inclusive education and training;
- Adequate income;
- Equal opportunity for employment;
- Appropriate and accessible information;
- Advocacy (towards their human right);
- Counseling;
- Appropriate and accessible
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health care;
- Assistive appliances.
Belongingness and disability

 Historically for people with disabilities, rurality was

once the site of exclusion, rather than belonging,
where identity and gender were disregarded in favor
of ensuring protection of people with disabilities and of
the society in which they lived.
 People with disabilities and marginalized groups feel
isolated.
 Some persons with disabilities have actively sought to
migrate to urban environments, to escape from the
confines and constraints of small rural environments
and to build broader social networks away from the
farm.
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Disability Inclusive Intervention
and Rehabilitation Services

 A ‘One-size-fits-all’ approach to provide

services for persons with disabilities and
vulnerable 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.
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 Disability inclusion means provision of differentiated
services for persons with disabilities and other
vulnerable groups.
 This includes the availability of accommodative public
services in infrastructure, health care, education,
social protection etc.
 Persons with disabilities and other vulnerable groups
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.
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Definition and components of Rehabilitation
Intervention

 Rehabilitation is a process designed to optimize function and

improve the quality of life of those with disabilities.
 The conduct of rehabilitation intervention 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;
 Physicians;
 Occupational Therapists;
 Physical Therapists;
 Speech and Language Therapist;
 Audiologists;
 Rehabilitation Nurses;
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 Social Workers;
 Case Managers;
 Rehabilitation Psychologists;
 Neuropsychologists;
 Therapeutic Recreation Specialists;
 Rehabilitation Counselors;
 Orthotists and Prosthetists;
 Additional Rehabilitation Professionals;
 Persons with the Disability and His or
Her Family;
 Community Based Rehabilitation
Workers. 23
Strategies to Disability Inclusive Intervention
and Rehabilitation

 Prevention
 Implementing the Twin-track Approach
 Implement Disability Inclusive Project/
Program
 Inclusiveness and Assistive Technology
 Implement Inclusive Job Opportunities
and Employment

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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.

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This includes primary Prevention (Action intended to

avoid the causes of impairment),

i) 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).

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ii) 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).

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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).

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Implementing the Twin-track Approach
 One of the strategies relevant for the
implementation of inclusion in terms of disability
is Twin-track approach.
 The twin-track approach involves:
Track 1 Ensuring all mainstream programs and
services are inclusive and accessible, non
discriminator, equitable to persons with disabilities
and other vulnerable groups time; and
Track 2 Providing targeted disability-specific
support to persons with disabilities.
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 Implement Disability Inclusive Project/ Program
 As public service provider 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 ensures the mainstreaming and implementation
of disability issues at program level.
 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
special needs of people with disabilities, and other
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vulnerable groups.
Community Based Rehabilitation (CBR)
 Community Based Rehabilitation (CBR) is a
strategy crafted for developing countries with
an intention to bringing children with disabilities
who are kept at home to public services such
as: education, self-employment, health care etc.
through providing them multi-dimensional
home-based rehabilitation services.
 For this purpose, there is a need to recruit and
deploy CBR workers from and within the local
communities respectively.
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Inclusiveness and Assistive Technology
There are various organizational definitions for
assistive technology:
The international standard ISO 9999 defines AT
(referring 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”.
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 Assistive technology affords Persons with disabilities
and other vulnerable groups’ greater equality of
opportunity, by enhancing and expanding their
communication, learning, participation, and
achievement with higher levels of independence,
wellbeing, and quality of life.
 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.
 Assistive technology encompasses all systems that
are designed for Persons with disabilities and other
vulnerable groups, and that attempt to compensate
the handicapped.
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 In modern societies, persons with disabilities, vulnerabilities and

marginalized groups can attain some components of wellbeing

such as access to services using assistive technology (AT).

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 Surgery, genetic therapy, rehabilitation, human assistance, and the use of assistive technology

(AT) help disabled people cope with their disabilities.

 Surgery (medical intervention) helps decrease deficiency and, in some cases, restores

capability.

 Genetic therapy attempts to remediate genes responsible for a given disease or disorder.

 Rehabilitation develops and adapts residual capabilities, while human assistance aids Persons

with disabilities and vulnerabilities in their daily living activities.

 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 with35disabilities and vulnerabilities populations.

 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.
 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.
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Barriers of employment

A) Attitudes and Discrimination

B) Accessibility (the physical environment; transportation; information and

communications; and other facilities open to the public )

C) Education and Training

D) Social Networks ( more limited social networks)

E) Women Disabilities

F) Legal Barriers (some countries impose legal restrictions on their participation

in certain types of employment or processes)

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H) Inflexible Work Arrangements

I) Dismissal on the Basis of Disability (employers to dismiss staff on the basis of disability with impunity )

J) The Benefit Trap (choosing not to do in order to continue receiving disability benefits )

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 The following are key strategies needed for the promotion of
job opportunity for PWDs and other vulnerable groups.
 Anti-Discrimination Legislation;
 Vocational Education and Training
 Wage Subsidies
 Workplace Accommodation Schemes
 Workers’ Compensation
 Quota Systems
 Sheltered Workshops
 Private Sector Initiatives
 Employer Networks
 Support Disability-Inclusive Business;
 Support Persons with Disabilities in the Workplace
 Building a More Inclusive Society
 Improve Data Collection on Disability and Employment.
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End of Chapter Three

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