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BRIEF REPORTS THE RELATIONSHIP BETWEEN INCLUSIVE EDUCATION AND COMMUNITY BASED REHABILITATION Prue Chalker* and Sheila Wirz INTRODUCTION Much has been written about the advantages of inclusive education and more recently about the ways in which CBR and inclusive education (IE) complement each other as approaches to enrich the lives of all children, whether or not they have a disability. The opportunity arose in summer 1996 to hold a small seminar of people with experience of CBR and IE to discuss the relationship between CBR and IE. This short article is a summary of that seminar. CBR, SPECIAL EDUCATION AND INCLUSIVE EDUCATION In the early 1980s CBR was promoted in response to the scale of need of disabled people, and due to the inadequacy and lack of sustainability of institution based rehabilitation. As the philosophy of CBR implies the full participation of disabled people and their families within the community, the attendance of disabled children into their regular neighbourhood schools has been seen by many as a natural extension of this inclusion. Alternative provision in the form of special schools has not been an option for the vast majority of disabled children in poor countries, primarily for financial reasons. Thus, both a philosophical standpoint and pragmatism have played a part in the trend towards inclusive education in the developing world. UN estimates suggest that of the 600 million disabled people in the world, 150 million are children under 15 years of age. Less than 2 per cent of these children receive any education or training (1). Definitions of CBR, Special Education and Inclusive Education CBR, as promoted by the World Health Organisation (WHO), was designed to be integrated into the primary health care system. The WHO model of CBR has had a "impairment" bias, focusing largely on the transference of basic rehabilitation techniques to community level workers, disabled people and their families. Over time, definitions of CBR have shifted away from an impairment based focus towards `community development'. In 1994 WHO, ILO and UNESCO issued their Joint Position Paper with the following definition of CBR. 'Community based rehabilitation is a strategy within community development for the rehabilitation, equalisation of opportunities and social integration of all people with disabilities. CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health education, vocational and social services' (2). This is accepted by many people as a working definition. It moves away from the idea that CBR is somehow a form of "community therapy". It is perfectly possible for services to move their geographical location "to the community" but retain identical practice to that which is used in a clinical setting. The authors suggest that such activity is community based therapy, where there is little, if any, empowerment of disabled people and their families. The professional, though now "in the community" retains control. In contrast, one can differentiate those services which move "to the community" but also revise their practice, by, for example, listening to disabled people and their families, assessing perceived needs rather than the observed needs of the professional, and working in partnership with disabled people. This method, the authors suggest, is the community disability service that is desired. Unfortunately CBR is a generic label used for community based therapy as well as empowering community disability services. "CBR should also include thinking about issues of disabled people's lives at all times, and not exclusively about rehabilitation. Disabled people should also have access to all services which are available to other people in the community, such as community health services, child health programmes, social welfare and education.(SW)" It is increasingly recognised after many decades of experience of large scale institutions, that the lessons learned through them are not on the whole, positive either in terms of quality of impact or sustainability. Hence, of late, there has been a shift towards the CBR model. Likewise, with the segregated special education provision, the lessons learned on the whole, are not positive, and therefore the increasing recognition of the importance of inclusive education. Early definitions of special education talked about an "enriched form of general education" without which many disabled people would "live well below their level of potential" (3). In the past this has been interpreted as a need for specially trained personnel and equipment, with education most frequently taking place in separate schools, determined by the child's impairment. Many advocates of inclusive education, of both disabled and non disabled people, would suggest that there has been little thought on how this type of education prepares for the child's future. Even with vast amounts of special teaching and equipment, the majority of disabled people in the UK, for example, live below the poverty line, are not employed, experience discrimination and find many buildings and much public transport inaccessible. They are living below their potential because of attitudes and barriers in society (4). Many disabled people feel that separation from regular schooling contributes to negative attitudes in society, and that exclusion from mainstream education is one more barrier to overcome. "I keep thinking that in the West one has too many resources and a lot of their problems are due to too much money being used to segregate and separate disabled people without adequate reason. When institutions for disabled children were first built they were not there to educate the children but to keep them away. The result of this strategy has been to break the relationships between able bodied people and disabled people. The dreadful separation of disabled children at younger and younger ages, some believed, was part of the whole idea to perpetuate the segregation, so that people never learned to love disabled children, particularly their mothers" (MM). Early concepts of special education that originated in Europe and North America have been challenged, and to an increasing extent rejected, in their countries of origin. But not before they have been exported to other countries where they have been introduced, often with inaccurate transmission, a lack of debate, and into an inappropriate cultural context (4). It is also the case that senior special educators and policy makers have often had part of their education abroad in colleges which provide special education courses. This collusion by western universities to export a model not used in their own settings is regrettable. "In Vietnam, in some quarters, there is a great commitment to integrated education but others believe that when Vietnam becomes more prosperous it can have a 'proper' special education system, that is, a segregated system" (PC) "Syria has just come up with this 'new' idea for setting up special schools" (JW). The term `inclusive education' has generally replaced `integrated education' The concept of `inclusive education' is wider ranging. It does not only address the needs of children excluded because of an impairment, but is concerned with all children who are not benefiting from existing educational systems. There may be children who are too poor to go to school, girl children, and children from ethnic minorities. It also implies a different vision of education that is more responsive to all children's needs. Inclusive education considers how to make schools welcoming to all children. Oliver argues that what is needed is a moral commitment to the inclusion of all children into a single education system as part of a wider commitment to the inclusion of all disabled people into society. "Translating this moral commitment into political rights is something that can only be achieved by supporting disabled people and the parents of children with special needs as they struggle to empower themselves" (5). "Inclusive education is not a 'bolt on' with separate costing. If one is going to have good inclusive education it must be seen as an integral part of the whole education system. One is resistant to the idea of separate costs, because this is seen as reinstating barriers". (SH) However, it may be that inclusive education is also cost effective. A World Bank report stated that if segregated special education is to be provided for all children with special educational needs, "the cost will be enormous and prohibitive for developing counties. If integrated in-class provision with a support teacher system is envisaged for the vast majority of children with special educational needs, then the additional costs can be marginal, if not negligible" (6). Some seminar participants warned of the dangers of `pseudo integration' or `dumping' by which it is implied that there is a lack of planning for children with differing needs. This will lead to difficulties such as children repeating grades in education systems that only allow movement up through the school on passing end of the year examinations. In contrast, some of the successes of segregated schools are also need to be highlighted here. One participants spoke of; "mainstreaming children with cerebral palsy from the age of 15, after several years of separate provision, and seeing some attain degrees at university" (MA). Context in implementation of CBR and integrated education Many people recognise the difficulty in initiating a programme which challenges deeply held beliefs and prejudices. "The problems that stand in the way of integration of disabled people into their communities are religious beliefs and customs, lack of information and a lack of awareness about disability, extreme poverty, and the shame and stigma attached to disability " (MA) A more optimistic view was that "My vision is that IE will work in any case for school improvement, so that all children will benefit, just as CBR benefits the entire community, so IE benefits schools" (SM) "If we can engineer enlightened social attitudes in the community, all other things can be achieved." (SHA) Some positive changes are already occurring in regular schools, as well as in professional and community attitudes. For example, a Vietnamese teacher said "I cannot force this (disabled) child to learn. I need to persuade her" .In Nepal, Yemen, Palestine, and Vietnam the `Child-to-Child' approach is helping to make schools more child centred, teaching more active, and schools more welcoming to all children. "Before the introduction of IE in Lesotho, there was a huge failure and high drop out rates. Things have improved because teachers started tackling individual needs in the classroom. For example by responding to children with learning difficulties these teachers now have developed strategies for many more children in their classes" (SM). "In Anhui Province of China, the didactic system of learning was changed from kindergarten level. This change helped teachers become aware of individual differences. They planned their lessons differently and as a result have now become better teachers" (SH). "In Nepal many children do not get opportunities to learn whether they are disabled or not. Where there is a CBR programme the situation is different. Parents give priority to their disabled children. Mothers often say, 'She must have an education because she cannot work on the farm land with her disabilities'. But in the initial stages, in 1986, it was very difficult, because most of the disabled children were hidden. Over the years, the programme tried to work with people's religious beliefs and not against them. At first mothers felt it was all their fault and were blamed by their parents-in-law. After many meetings when the parents came together with their children they saw that they were not alone, and that no one was to blame" (NB). CONCLUSION Table 1 lists the main commonalties that exist between CBR and IE, their indicators of success and their training needs Table 1. The commonalties between CBR and 'Inclusive Education'.
. Disabled people have fought to take back control of their lives from 'experts'. What the disabled people really need is physical help from another human being, even though sometimes one has to pay for it, and sometimes friends do it for them. In the end most things are terribly simple. *Centre for International Child Health,Institute of Child Health, University College London,30 Guilford St, London WC1N 1EH, UK ACKNOWLEDGEMENT The authors acknowledge Mr. Richard Lansdown, Ms. Mithu Alur, Ms. Susie Miles, Ms. Madhuri Pai, Mr. Seamus Heggarty, Ms. Sally Hartley, Ms. Micheline Mason, Ms. Nupur Bhattachariya, Ms. Linda Shaw, Ms. Jean Westmacott, Ms. Molly Chib and Ms. Sue Stubbs for their contributions during the seminar which forms the background for this paper. REFERENCES 1. World Conference on Special Needs 1994 "The Final Report,: Access and Quality," Salamanca, Spain, 2 ILO, WHO,UNESCO, 1994 "The Joint Declaration". Geneva : 3. UNESCO 1973 "The Present Situation of Special Education" Paris 4. Stubbs S. 1997 "Poverty and Membership of the Mainstream:Lessons from the South- Can Poverty Facilitate Inclusion? Asia Pacific Disability rehabilitation Journal Vol 8/1 5. Oliver M. 1995 "Does Special Education Have a Role to Play in the Twenty First Century? REACH J. of Special Needs Ed. in Ireland Vol 8/2 pp67/76 6.Vaughn M. 1997. "Inclusive Education: a framework for change. National and International Perspectives". Bristol : CSIE |