Development and evaluation of a community-based rehabilitation programme for pre-school disabled children in Guyana
[Thesis]
O'Toole, Brian John
Institute of Education, University of London
1989
Ph.D.
Institute of Education, University of London
1989
There are millions of disabled persons in the world. AnInstitutionally-Based model of rehabilitation alone cannot meetthe challenge. The World Health Organisation (WHO) have offeredCommunity-Based Rehabilitation(CBR) as an alternative approach.CBR advocates a simplified form of rehabilitation , mobilisingresources that exist within the community.This project examines the relevance and effectiveness of a CBRproject implemented in two rural areas of Guyana over a twoyear period.The programme is facilitated by a Local Supervisor (LS) whoworks in the child's home alongside a family member. Twogroups of LSs were recruited, one comprised 26 volunteers fromthe community and the other constituted 25 nursery teachers.Disabled children were identified by surveys and by referralsby parents and professionals.A Multiple-Baseline Design was adopted to assess the child'sprogress. The children were assessed fortnightly on thePortage Checklist and pre, post and at a 6 month follow-up onthe Griffiths Test of Mental Development. The quantitativegains were balanced with a qualitative analysis ofquestionnaire and interview data.The majority of parents participated actively in the programme,however for others the role was too demanding.An analysis of Portage scores revealed a gain of .67 items permonth per subtest under baseline conditions, 1.95 items undertreatment conditions and 1.02 items under control! follow-upconditions.The Griffiths results were significant at post-testand 6 month follow-up test (p= .01 for both groups ofchildren.) The mothers observed changes in themselves feelingmore relaxed and confident, and less depressed. The changeswere however more characteristic of the 'volunteer' mothersthan the 'nursery' mothers. 4/26 volunteers and 12/25 nurseryteachers were not involved in the programme.Progress was seen in the physically and mentally handicappedchildren, others with severe speech and hearing problems mayneed more intensive help than that offered by this approach.A local committee created a resource unit for the disabledchildren of their area. The cost of the programme, excludingthe cost of referral services, was £27 per child, per year.The thesis analyses; key features of introducing an innovation;ways in which the WHO approach was modified; limitations of theCBR model, and suggestions for further study.