Disability, Handicap & Society

ISSN: 0267-4645 (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/cdso19

A curriculum model for a community development

approach to community-based rehabilitation

Robyn L. Twible & Elizabeth C. Henley

To cite this article: Robyn L. Twible & Elizabeth C. Henley (1993) A curriculum model for a
community development approach to community-based rehabilitation, Disability, Handicap &
Society, 8:1, 43-57, DOI: 10.1080/02674649366780031

To link to this article: https://doi.org/10.1080/02674649366780031

Published online: 23 Feb 2007.

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Disability, Handicap & Society, Vol . 8, No. 1, 1993 43

A Curriculum Model for a

Community Development Approach
to Community-based Rehabilitation
ROBYN L. TWIBLE & ELIZABETH C . HENLEY
Faculty of Health Sciences, University of Sydney, Cumberland College,
Lidcombe 2141, New South Wales, Australia

ABSTRACT Community-based rehabilitation (CBR) is not a new concept but has become the
focus for groups such as the World Health Organisation and other international aid agencies in
facilitating the availability of rehabilitation services in developing countries throughout the
world. Although much of the literature debates institutional versus community-based services
and auxiliary versus fully trained personnel, little information is available to address the
curriculum issues relating to training personnel to undertake CBR activities . The purpose of
this paper is to present a curriculum model for preparing and implementing short programme
workshops to encourage the development of CBR in different cultural settings . The curriculum
model has foundations which are firmly rooted in curriculum and educational theory and
concepts. It provides a flexible adult learning approach to introduce the broad concepts of CBR,
providing the participants with culturally relevant, concrete, practical tools to allow the
implementation of CBR activities. The workshop model has been used successfully with
participants from diverse or homogeneous backgrounds .

Introduction

Community-based rehabilitation (CBR) is not a new concept but has become the
focus for groups such as the World Health Organisation (WHO) and other
international aid agencies in facilitating the availability of rehabilitation services in
developing countries throughout the world . Most of these countries provided little
or no rehabilitation services for people with disabilities, especially in remote rural
environments . WHO introduced the concept of CBR in 1976 as a means of
accomplishing "Health for all by the year 2000" (WHO, 1976) . The primary
concept of the WHO model is that rehabilitation should be home based, thus giving
the responsibility, care and management of the person with the disability to the
family and family helpers . Local supervisors, who are most often health workers,
start, supervise and train the family member using the WHO manual for reference
(Helander et al., 1983) .
Although WHO may have coined the phrase CBR, during the preceding 15
years there were community oriented rehabilitation projects being undertaken in
44 R. L . Twible & E. C. Henley

many parts of the world (Miles, 1985) . Such programmes included education of
deaf children in India (Ghosh, 1974), paediatric physiothaerapy in South Africa
(Levitt, 1976) . From 1961 Huckstep was managing polio and developing resources
in rural Uganda (Huckstep, 1975), while from 1969 onwards similar work for
developmentally delayed persons was being undertaken in rural USA (Jesien, 1982) .
While numerous variations of the WHO model can be found, there are features and
recommendations common to all community oriented rehabilitation programmes .
These are : the existing social and community infrastructure is utilised ; an effective
referral and support system is part of the development process ; simplified, appropri-
ate technology is recommended for use ; and community resources form the nucleus
for service delivery (Mitchell et al., 1989) .
Some field-workers have been critical of the WHO approach to CBR, including
criticism of the unwieldy, detailed manual which is often difficult to comprehend,
inappropriate in many situations, and often sits on a shelf unused . Another concern
deals with the training: the WHO CBR model trains local supervisors, giving them a
few weeks' training; the supervisors, in turn, find family trainers and provide them
with a few hours' training, while the main font of wisdom is the CBR manual
(Miles, 1985) . There is a danger in teaching complex technical skills to an untrained
individual in that these skills cannot be applied to all situations . Because the newly
trained supervisors train a family member, there is the potential of compounding
further the transfer of misinformation, especially in societies where there is no
tradition of reading, assimilating and referring back to the printed word . Often the
individual chosen to be trained as the local supervisor is the community health
worker who is, in most cases, already too busy with her own work to adequately
attend to the extra demands imposed by rehabilitation clients (Ogilvie, 1989) . Miles
(1985) and Ogilvie (1989) suggest an alternative approach of choosing interested
community members and providing longer training programmes of several months
duration under supervision of rehabilitation specialists . In Lahore, the village health
workers had been given the knowledge and skills in managing musculoskeletal
problems, during a 9 month training programme (Ogilvie, 1989) . They returned to
their communities and although not working as intended because of other commit-
ments, they are being used as resource persons . Whatever training programme is
adopted, the newly trained rehabilitation technicians, having returned to the com-
munity, should continue to have access to the knowledge and expertise of the
specialists for consultation . There needs to be adequate regional support base of
persons with professional rehabilitation skills to support and advise the front-line
community providers of rehabilitation services .
Miles (1985) stresses that there is no single programme of service delivery that
can suit all areas, whether that be different countries or different areas within
countries . The type of programme is dependent on the administrative structure, the
legislative provisions, population and population distribution, economic and cultural
conditions, human resources and the local consciousness of disability as a priority
problem . Peat (1991a) concurs that the focus of CBR should be determined by the
community that it serves . It is worthwhile finding out what local communities want
and are prepared to sustain in the long term and the community priorities all across
 Community-based Rehabilitation 45

the disability field. Emphasis should be placed on mobilising resources to meet the
needs identified by the community first, while planning a programme over time to
cover other areas of disability (Berman & Sisler, 1984 ; Vidyasagara, personal
communication 1991) .
Cumberland College of Health Sciences, a WHO Collaborative Centre for
Rehabilitation, was invited to develop and implement workshops to introduce the
concept of CBR in the Solomon Islands and Fiji . Workshops have been conducted
on a regular basis since 1988, including rural and urban centres, with both diverse
and homogeneous groups of participants . These workshops were conducted in
response to requests from government and non-government organisations in the two
countries, where limited facilities and health personnel make it difficult to provide
sufficient traditional hospital-based rehabilitation services .
The authors, as educators from backgrounds of occupational and physical
therapy, were concerned that there were dangers inherent in conducting short-term
workshops where the emphasis was placed on providing specific rehabilitation
techniques . Given the time constraints of 1-2 weeks, we were challenged to provide
the participants with concrete practical tools encompassing case management,
problem-solving and community development strategies, teaching and treatment
skills . These strategies and skills were provided to enable the participants to plan
and implement CBR activities and to educate others .
The purpose of this paper is to present the workshop `model' which was
developed, based on the experience of the authors in the Solomon Islands and Fiji .
The model is designed for preparing and implementing short programme workshops
to encourage the development of CBR in different cultural settings . In attempting to
address some of the previously mentioned issues, the development of the curriculum
includes consideration of cultural sensitivities and locally available resources .
Essentially, CBR is concerned with teaching people with disabilities new skills
and how to maximise their current skills and abilities, as well as helping the
community to understand that people with disabilities can be active and equal
members in their communities (Henley & Twible, 1990) . It encourages the recogni-
tion of people with disabilities as people with skills and abilities . CBR provides
people with a knowledge of the possibilities for self care, work and leisure activities
which people with disabilities can learn to use, and a network of people who can
help the disabled person to believe that there is life after disability ; that is, there are
new skills that can be learned which will help to meet the new challenges to be faced
in living as an active and equal member of the community .

Curriculum Issues

Before describing the model, some of the key issues of curriculum development
need to be reviewed; in particular it is essential to examine what is meant by
curriculum . In describing a curriculum Taba (1977), the renowned curriculum
theorist, states that a curriculum should contain certain certain key elements : aims
and objectives, content, and learning experiences and evaluation . An effective design
46 R. L. Twible & E. C. Henley

makes clear whether a curriculum's objectives are derived from consideration of the
social needs as determined by an analysis of the society, and consideration of the
needs of the individuals as revealed by an analysis of the nature of the learners and
their needs as individual learners . In the same way, both the choice and organisation
of content must be accounted for by an analysis of the unique characteristics of the
knowledge and the learning process relevant to the field being studied . When
considering the relationships among the key elements, it is especially important to
make clear the interconnections and interrelationships of the elements . In summary,
Taba (1977) recommends organising the curriculum around ideas and learner skills,
rather than by subjects and content topics. With ideas as the centre of curriculum
organisation, teachers can be free to select and adapt their own content rather than
submit to fixed, uniform and static content .
Many curriculum designs pay too little attention to the needs of society, or the
perspective on these needs, because of inadequate analysis of the data on culture
and society . To understand the structure and function of the curriculum, it is
necessary to understand what is meant by culture, what the essential elements of
culture are and how these are organised and interrelated . A culture is the fabric of
ideas, ideals, beliefs, skills, tools, aesthetic objects, methods of thinking, customs,
and institutions into which each member of society is born . With respect to culture,
education when defined in its broadest sense refers to "the entire social process by
which individuals acquire ways, beliefs and` standards of society" (Smith et al., 1957,
p . 1) . Inherent in all actions taken when developing a curriculum are tha attitudes
and values of the organisations and the individuals involved . The person oriented
curriculum model described by Koop (1980) reflects the signficance of societal and
individual values and therefore strongly influences the curriculum model described
in this paper. The features and beliefs inherent in a person oriented curriculum are
described in terms of the individual learner, the design and learning process and the
teacher. Within the context of our curriculum the individual is also considered in
relation to his or her culture .
The person oriented curriculum is not only concerned with the values of the
developers in relation to the curriculum design, but also places importance on the
relationship between the teacher and the students in the implementation phase of
the curriculum. This relationship is similar to the concept of the `therapeutic
relationship' as described in occupational therapy literature (Burke, 1977 ; Wilson,
1980; Devereaux, 1984) . Twible (1986) identified 15 components of the therapeutic
relationship : caring, touch, dignity and worth of the individual, the potential for
growth and change, positive attitudes, communication, perception, values, motiva-
tion, concept of control and personal power, belief in skills, sense of efficacy,
provision of a barracker, sense of humour and fun and pleasure seeking .
Other educational concepts relevant to the model are those pertaining to
education and learning, specifically adult learning and transfer of learning . In 1973
Knowles introduced the concept of andragogy (adult learning) . Though the concept
has been modified since its introduction, it basically represents the following view of
adults and learning. Firstly, adults have extensive pragmatic life experiences which
tend to structure and limit new learning . Secondly, learning focuses largely on the
 Community-based Rehabilitation 47

transformation or extension of the meanings, values, skills and strategies acquired in

previous experience . Thirdly, the major pressure for change comes from factors
related to social and work roles and expectations, and to a personal need for
continuing productivity and self definition (Smith, 1981) . Broadly speaking, trans-
fer of learning can be defined as any process in which a student learns under one
condition and then performs under another condition which is noticeably different
(Ellis, 1969) .
In summary, the literature implies that adults learn and transfer learning when
they are actively involved in the learning process . The learning must be seen as
meaningful to the individual and should ideally take place in a setting close to the
real world situation in which the learner will use these newly learned skills . These
concepts in the process of adult learning continue to be advocated by many
educationalists in attempting to provide the ideal learning environment in which
students learn (Boud, 1988 ; Candy, 1991 ; Hammond & Collins, 1991) .
In today's world it is not sufficient to provide only knowledge and skills related
to rehabilitation ; additionally one must address the issue of empowerment versus
delivery of service (Fried, 1980) . Simply stated, empowerment means helping
people take charge of their lives ; people who have been restrained by social or
political forces from assuming such control heretofore . Freire (1973), cited in Fried
(1980), states that "the important thing is to help men (nations) help themselves to
place them in consciously critical confrontation with their problems, to make them
agents of their own recuperation" (p. 8) .
Empowerment, then, means helping people gain the strength and gather the
resources to begin to bring about what they feel to be the good life in a good society
(Fried, 1980) . Obviously, not all one's needs can be met by self care. Skilled
professionals are needed, in the sense that they assist people, individually and
collectively, to make the most of their abilities . Learning for empowerment is a
matter both of helping people discover their own strength to pursue learning as a
lifelong activity and of bringing the potential learning resources of the entire
community to bear in creating new learning experiences .
To a large extent, empowering approaches to human needs are interdependent ;
for example, the social skills and self-assurance resulting from successfully partici-
pating in one self-help effort makes that person more receptive to taking control of
other aspects of their lives (Fried, 1980) . Finally, it must be emphasised that
empowerment is for everyone, not just poor people, disabled people, and the so-
called disadvantaged people . Empowering individuals provides them with the
attitude and some of the skills which they will need to empower people within the
community, the community within the region, the region within the nation, etc . ;
thus empowerment can allow the development of social change and ultimately a new
societal attitude towards the disabled .

The Workshop Model

The workshop can be used with participants from diverse or homogeneous back-
grounds . In a situation where the participants are primarily trained health personnel
48 R. L . Twible & E. C. Henley

the complexity of the material presented, the group interaction and the level and
method of problem-solving are different as opposed to the situation where the
participants are from a more diverse background, for instance from the community
comprising disabled people, village chiefs, community leaders, volunteers and
people with limited literacy skills even in their own language . This workshop model
has been successfully used in rural and urban centres in Fiji and the Solomon
Islands and can operate independently from or in liaison with formal medical
support facilities .
Inherent in the curriculum design is the pre-workshop phase of consultation
and contact with service providers and disabled people's groups within the commu-
nity who could directly or indirectly influence the outcome of CBR activities . The
facilitators should spend time with the local people, further developing their
understanding of the culture, the environment and the structure of the health and
welfare systems and the economic and political situations currently prevailing . It is
vital that the facilitators have up-to-date knowledge and awareness of the specific
environment and society in which they will work, as this information will be used in
the coming weeks .
The curriculum model (Fig . 1) has foundations which are firmly rooted in
curriculum and educational theory and concepts as previously described . The model
reflects the authors' approaches to teaching and incorporates the principles of: the
curriculum framework (Taba, 1977), person oriented curriculum design (Koop,
1980), adult learning (Smith, 1981 ; Boud 1988), transfer of learning (Ellis, 1969)
and empowerment (Friere, 1973, cited in Fried 1980 ; Fried, 1980; Roger, 1983) .
Arising from the curriculum foundations are four cornerstones (concepts and
beliefs) that underpin the design. The cornerstones are : cultural relevance, demysti-
fication of disability; leaders as facilitators; and teaching transferable skills and
strategies .
The first cornerstone is that the curriculum framework is based on a concept
which we call `cultural relevance' . The curriculum is designed to allow the
participants to define terms and to determine content details and learning experi-
ences that are intensely relevant and highly specific to their culture and community .
The facilitators should deliberately take care not to impose their cultural values, but
to allow the participants to disclose their own values . This is an ongoing process
throughout the workshop, in allowing the participant to become involved in defining
and evaluating the curriculum, through open communication and sharing by
students and teachers around the broadly defined curriculum content .
The second cornerstone is the demystification of disability . Demystification is
initially achieved by encouraging the participants to identify their own functional
assets, limitations and deficits. Having then put disability into context, the partici-
pants are asked to describe the meaning of disability within the community and the
culture at large . The impact of disability is kept in context, reinforced throughout
the workshop process by the participants viewing and experiencing situations from
the disabled persons' perspective . Individuals gain insight through interaction with
their internal (self) and external (image of the world) environments .
The next cornerstone is that the workshop leaders act as facilitators to guide
 Community-based Rehabilitation 49

CBR activity plans

Culturally appropriate media

Empowerment (Friere, Fried)

Adult learning (Knowles, Smith)

Curriculum design (Taba, Koop)

Fio . 1 . CBR workshop model.

the participants through the workshop process . Koop (1980) describes the facilitator
as one who is primarily concerned with freeing, assisting, releasing and growing,
rather than controlling and manipulating . Experiential learning (Kolb, 1984) and
problem-solving are the main teaching techniques of the workshop as well as the
primary strategies used for the development of the CBR activities . The facilitators
continually encourage and reinforce active participation, communication and co-
operation between the consumer, the service providers and the community .
The final cornerstone entails the teaching of transferable skills, strategies and
tools to execute CBR activities : for example skills in networking, community
development, teaching, group, decision-making and facilitation . Knowledge and
skills are acquired when the content being taught is valued and meaningful, and
when the participants are encouraged to question, to explore ideas and to take risks .

The Curriculum Process and Products

All aspects of the curriculum process of this workshop model reflect the corner-
stones . Fundamental concepts are initially introduced to lay the groundwork for the
later introduction of more complex concepts and strategies . For example, the basic
 R

50 . L. Twible & E. C. Henley

skill of activity analysis would be introduced before teaching how to teach .

Throughout the workshop process the participants go back to draw upon previously
learned information to deal with the demands of the next learning activity . At each
stage of the process newly introduced strategies and skills incorporate earlier
factors ; thus, horizontal and vertical integration of knowledge, skills and attitudes is
accomplished (see Fig . 2) .

Teaching
how to
teach

Problem
solving
case

Mobility'

FiG . 2. Horizontal and vertical integration-an example . * Any Skill.

Table I lists the day-by-day outline of the workshop content and can be
referred to throughout this section, to illustrate the concepts discussed in the
curriculum process . One of the initial activities of the curriculum involves the
participants' identification and description of the physical environment of the
community, as well as the socio-cultural roles and functional tasks which are
specific to individuals and groups within the community . The participants also
identify the nature and extent of specific disabilities in the community and the
impact of these disabilities on the individual, the family and the community . In
addition, the workshop facilitators continually promote and reinforce a positive
awareness of people with disabilities and focus on what these people can do and how
they can contribute to the community . The content presented encourages par-
ticipants to identify physical, psychological and socio-cultural barriers and explores
strategies to remove those barriers that can contribute to or cause problems for
people with disabilities. The workshop gradually guides and facilitates the par-
ticipants to develop CBR activities that are relevant, realistic and achievable for


Community-based Rehabilitation 51

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52 R. L. Twible & E. C. Henley

their community, given the available resources and current political, cultural and
economic climate .
The participants actually determine the application of the workshop content,
by using their own local case studies . This includes the presentation of material,
concepts and use of terminology, all of which are presented in a form that is
culturally correct and socio-educationally accessible to all participants . As such,
participants produce media resources and suggest networks and strategies to imple-
ment CBR activities which are `consumer friendly', culturally appropriate and
economically affordable . Thus, the participants act effectively on their own behalf;
that is, they exercise power and claim ownership of their products and ideas . The
final phase of the workshop is the development of strategies which will encourage,
support and facilitate community action to implement and evaluate their CBR plan .
Inherent in such plans are time frames for implementation of strategies, which allow
for evaluation of effectiveness .
Table I outlines a typical 5-day workshop, although the sequencing and content
can be rearranged to suit different audiences . The facilitators must recognise the
importance of allowing flexibility in terms of content, teaching strategies, complex-
ity and sequencing of content . Adaptability is seen as one of the keys to successful
completion of the workshop process .
From the authors' experience, a workshop involves the following sessions : DAY
1 is concerned with `setting the scene' . After an introductory session of `who's who',
discussion revolves around `what is CBR? The process continues by getting the
participants to identify and deal with their own perceptions of and attitudes towards
disability. Discussion also include the role of the person with disability in the
community, and the impact of disability on the person, the family and the society .
This process helps the participants to focus their attention and to identify what
services already exist and what contributions disabled people already give to their
community. "The major difficulty facing implementation of CBR is the acceptance
by health professionals of the principle of community involvement" (Peat, 1991a,
p . 236) . Finally the day ends by simulating disabilities such as stiff knees,
amputated limbs and visual defects, by which the participants are able to experience
and deal with some of the problems associated with functional daily activities .
DAY 2 commences with story writing, that is, describing the day-to-day life of
a person with a disability who lives in one of the villages, which may be seaside or
inland, or in a larger urban centre . The locally designed case scenarios are then used
by the participants in all future sessions . Although suggestions are given for specific
disaiblities, for example, a young mother with a blind child or an elderly man who
has suffered a stroke, the participants themselves complete the details of family life,
the role played in the community, work profile and so on . In this way the
participants own the stories and can make them relevant to their lifestyles, traditions
and culture, so reducing the possibility of the facilitators forcing their own attitudes
and values on the workshop participants .
A lecture format is used to give partipants information about the problem-
solving process and principles of activity analysis . After this the participants, in
small groups, apply this information to the developed case studies . Participants also
 Community-based Rehabilitation 53

undertake an exercise where they identify strategies for community development

and conclude the day by developing media suitable for community education (See
Fig. 3) .

Poster-Ability Awareness Programme

by : Meli Sakuwai Apenisa Koroitamana (Fiji Workshop, 1991)

FIG . 3. Examples of media resources developed by participants .

On DAY 3, after lectures on the principles of teaching and training skills, and
management principles for working with visually impaired people, the participants
practise how to teach and train someone to perform a motor task, for example
sitting to standing. Primarily mobility and visual problems are used for these
practical sessions . This is followed by lecture-demonstrations on the topics of
positioning for function and counselling to encourage independence . The remainder
of the afternoon is devoted to applying the problem-solving process to the case
studies .
DAY 4 commences with an overview of the principles of community develop-
ment, followed by a practical session where participants develop a plan for
community education . The participants are also given free time to design and adapt
a piece of equipment, describe an environmental adaptation, or practise demon-
stration of a skill which they think will be valuable in solving some of the problems
associated with their case study . Part of the afternoon is spent reviewing CBR
evaluation strategies . The remaining time is allocated to discussing in detail and
demonstrating solutions to the case studies . (Occasionally, in the evenings the
participants have `performed' their case studies, in the form of message stories, to
54 R. L . Twible & E. C. Henley

the local people as a strategy to educate the community about the potential of
disabled people.)
DAY 5, the final day, is focused around planning CBR activities for the local
community . Participants work in small homogenous groups to identify realistic,
achievable CBR activities which they can implement within the limitations of their
current resources. Resources for supporting CBR are identified and each group
develops CBR activity plans . Each plan features goals and objectives, actions to be
taken, by whom, the time frame, and the support and resources required to
implement the plan. Additionally, barriers to implementation are identified and
strategies to overcome these barriers are explored by participants . During an
extended lunch break the participants share their personal resources (media, tech-
niques, equipment and contacts) in a display and demonstration session . The
afternoon is spent presenting CBR activity plans to the group and, whenever
possible, to the visiting dignitaries who are invited to the closing ceremony . The
final activity is the workshop evaluation . The day concludes with a closing
ceremony where participants are presented with attendance certificates .

Evaluation

To date subjective evaluation of the workshop process has been undertaken after
each workshop . The evaluation is multifaceted but focuses on two dimensions,
which are the workshop process and outcomes and impacts . The workshop process
is concerned with the participants' evaluation of the workshop in terms of
knowledge, skills and attitudes acquired, content, and presentation . Outcomes and
impacts include: development and implementation of CBR activities, anecdotal
evidence, and long range, unexpected or indirect results of the workshop . The
results of the process evaluation of both the Solomon Islands and Fiji workshops
have been valuable in the modification and fine tuning of the model .
Evaluation of the outcomes of such workshops is fraught with difficulties
because of the problems inherent in attempting to apply rigorous theoretical
evaluation principles to such a complex multifaceted system of service delivery .
Henley & Twible (1991) describe a conceptual evaluation model for CBR work-
shops and activities . The grid design of this evaluation model permits consideration
of the complex and diverse features that need to be addressed when evaluating CBR
workshops and programmes . Work continues in the development of measurement
instruments for the evaluation of CBR activities, based on this model. The authors
would also emphasise that rigorous evaluation will help to identify deficits or gaps in
current projects and locally designed CBR activities, the factors that cause or
contribute to failure, and whether these factors are within the control or able to be
influenced by the participants .

Feedback-workshop process and outcomes

An example of the results from the Solomon Islands workshops in terms of what the
participants learned is demonstrated in the following quotes : " . . . the importance of
 Community-based Rehabilitation 55

how to help disabled people as an ongoing part of everyday life ; . . . at any time to
make myself available not looking at their disability but at the person" ; and, " . . . a
bit about how disabled people cope in the villages and a lot about people's attitudes
to disability" .
Interviews of the participants were performed by an independent evaluator
following the 1989 workshop in the Solomon Islands (Walker, 1989) . Jacinta Gedi,
community education officer and Nelson Rofo, representative of the Disabled
Persons Rehabilitation Association, both of whom attended the workshop, made
favourable comments . The content had relevance to the community and was
feasible, given the existing resources; the workshop was useful in changing partici-
pants' attitudes and actions towards the disabled . Both felt that duplicating the
workshop in other villages and provinces was the most effective means of develop-
ing community awareness on the issue and changing local attitudes towards people
with disabilities .
Evaluation of the Fiji workshops of 1988 involved several formats, including
immediate feedback regarding the workshop process, 6-month follow-up question-
naires and structured interviews by an independent evaluator . The questionnaires
were sent via the local organiser to each of the 25 participants of the Suva
workshop . Nine questionnaires were returned and the results showed that since the
workshop the following CBR activities had been undertaken: radio and press
releases pertaining to disabled peoples' rights and their current activities in the
community; two different newspaper supplements on the opening of Fiji Disabled
People's Association office and the Equipment Exhibition ; training sessions on basic
activities of daily living techniques, assessment, exercise, referral methods, resources
and problem-solving methods have been conducted for both health workers and care
givers .
One participant commented that maximum use should be made of local
professional people, as well as people with disabilities, as resources for information
and expertise . Fiji is mainly a `verbal' society, so administrative and writing details
should be kept to a minimum . This respondent also commented that one cannot
assume that all people in the village, or even in one house are willing, available or
committed to providing the necessary assistance to the person with disability . Thus
it is essential to teach the disable person to be as independent as possible .

Conclusion

Although there appears to be no common position on the methods of implementa-

tion of CBR, there is a consensus on the general principles of community oriented
rehabilitation (Peat, 1991b) . Empowerment of the individuals and the community is
an essential component of any CBR programme . The curriculum model which we
have described provides a flexible, adult learning approach to introduce the broad
concepts of CBR . The primary objectives of this workshop model are to provide
participants with concrete, practical tools to allow the implementation of case
management principles, problem-solving, community development, teaching and
treatment strategies . This is the first step in the introduction of CBR to an area
56 R. L . Twible & E. C. Henley

where no such facilities exist . Once ownership for the concept is claimed by the
community, then establishment of a project which is tailor-made for that environ-
ment can be undertaken.

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