Community based rehabilitation (CBR) as engagement: context, parameters and potential

Abstract

Paradigms in rehabilitation and disability service delivery in economically developed countries are currently being challenged and reviewed. An analysis of rehabilitation and disability literature arising from these countries, identified a number of issues of concern. Utilising a systems framework, adapted from the work of Urie Bronfenbrenner, the analysis indicated that certain aspects of current paradigms, may have adverse impacts on people with disabilities. It was determined that new paradigms should be explored. An analysis of current trends of relevance to the disability sector, identified a number of important directions, particularly the significance of the community paradigm. Community Based Rehabilitation (CBR), a disability service delivery approach which has arisen in developing countries, was proposed as an approach which was consistent with the identified trends and the community paradigm, and which constituted a constructive response to the identified concerns. It was noted however, that CBR lacked a strong research base and that fundamental principles had not been clearly elucidated. Based on the current literature, a detailed description and analysis of CBR was undertaken, and strategies, benefits and limitations of the approach were documented. The description of the parameters of CBR resulted in the elucidation of an evolutionary process, and the identification of key principles. It was proposed that the defining concept of CBR is ‘engagement’ between people with disabilities and their local communities. This concept was seen as having greater import, beyond the traditional contexts in which CBR has traditionally been employed. The possible application of CBR to economically developed countries was considered at a theoretical level. In order to explore the potential of the notion of engagement, two multi-phase, qualitative studies were devised and conducted in South East Queensland. The inductive phase of the research, which involved both studies, resulted in the development of a model consisting of five bipolar axes. This ‘model for enhancing engagement’, described the process by which engagement between users of human services (specifically people with disabilities) and their local communities might be maximised. The subsequent deductive phase of the research consisted of an exploration of the potential utility of this model through the two studies. Within the limitations of the qualitative design, the research indicated that the model had practical utility in the current context. In order to confirm concepts within the model, and consider its congruence with the field of CBR, a final verificatory phase was employed. This phase drew data from other sources to provide a degree of confirmation of the concepts within the model. The primary outcome of the research was the development of the ‘model for enhancing engagement’ between people with disabilities and their local communities. This model was described and its potential application was considered at a conceptual level. Three subsidiary outcomes were also seen as contributions of the research. First, a descriptive and conceptual framework, based on the work of Urie Bronfenbrenner, developed and applied in the current studies may have further utility. Second, a detailed analysis of the CBR literature resulted in the documentation of an evolutionary process in CBR, the identification of key principles, and the proposal of the notion of engagement. Third, a comprehensive, multi-phase, qualitative research process devised for the research which meets requirements for rigour and effective data presentation.