CBR Training: International Approaches Professor Gwynnyth Llewellyn and Alexandra Lewis-Gargett 2nd CBR World Congress Kuala Lumpur 26-29 September 2016

Background History of CBR health rehabilitation focus in many countries community development model in other countries CBR programs, and hence the training of CBR workers, looks very different around the world The release of the WHO CBR Guidelines (2010) offers a universal model and framework for CBR as a multifactorial community inclusive development approach

Themes in CBR training literature Underlying concept of disability Health medical model – rehabilitation skills Social empowerment – community inclusive development approach and skills Expected role of CBR personnel Rehabilitation assistant vs Community development

Themes in CBR training literature Breadth of skills required Specific skills set rather than building workforce by staff type (MacLachlan et al 2010)1 Set of skills required for the health component of the CBR Matrix proposed by O’Dowd (2015)2 Rehabilitation skills and knowledge vs Problem solving for empowerment Expectations of the training program Style of learning: What do participants expect? Is this the same as the trainers? (Wirz 2000)3 MacLachlan, M., Mannan, H., & McAuliffe, E. (2011). Staff skills not staff types for community-based rehabilitation. The Lancet, 377(9782); 1988-1989. O’Dowd, J., MacLachlan, M., Khasnabis, C. & Geiser, P. (2015). Towards a core set of clinical skills for health-related community-based rehabilitation in low and middle income countries. Disability, CBR and Inclusive Development, 26(3); 5-43. Wirz, S. (2000). Training of CBR personnel. Asia Pacific Disability Rehabilitation Journal, 11(1); 100-112.

Purpose of Scoping Review Identify CBR field and training resources easily accessible on the web Analyse for alignment with the WHO CBR Matrix Guidelines and Matrix

Search Method Hand searched key websites: INGOs specialising in disability and development – CBM / Handicap International INGOs providing CBR training - AIFO / Enablement Australian Disability and Development Consortium (ADDC) International Disability and Development Consortium (IDDC) AskSource Google scholar search using following terms: ‘community-based rehabilitation’ and fieldworker and manual ‘community-based rehabilitation’ and resources ‘community-based rehabilitation’ and skills and manual

Search Results Community level resources on specific topics Numerous and cover a wide range of topics across all components of the CBR Matrix Very well indexed on AskSource Training guides and manuals for CBR practitioners Spanned several decades – pre and post release of the WHO CBR Guidelines (2010) These were analysed to understand how CBR workers have been trained to date, the type of skills considered important and the conceptual framework within which they have been taught. Two categories of resources

Screening Manuals screened against inclusion criteria - Post - 2010 WHO CBR Guidelines with attention to content of CBR Matrix - Readily accessible via the internet and/ or in text form - Utilised adult learning principles - Applicable for learning in new and familiar contexts - Resource rich to enable further learning · Content applicable to CBR fieldworkers undergoing training (short course, certificate or diploma level) as well as experienced CBR fieldworkers   Two manuals included for further analysis CBR Training Manual Light for the World (2010) https://www.light-for-the- world.org/downloads/educa tion The Dream of Inclusion for All Cornielje & Vedman, Enablement (2011) http://www.enablement.nl/i ndex.php/80/The_Dream_o f_Inclusion_for_All.html

CBR Training Manual Light for the World (2010) https://www.light-for-the-world.org/downloads/education

CBR Training Manual (2010), Light for the World Published after release of the WHO CBR Guidelines (2010) to build on existing resources for health in CBR Relevant for CBR practitioners (fieldworkers, supervisors, managers) who do not have prior knowledge or experience of WHO CBR Guidelines (2010) Framed around the WHO CBR Guidelines (2010) and has 13 modules with detailed lesson plans. Modules cover all components of the CBR Matrix except health as stated purpose is to build on existing CBR health resources Also has modules that build community development knowledge and skills – eg. UN Convention Each learning module states for whom it is most appropriate.

Findings – CBR Training Manual (2010), Light for the World Prescriptive lesson outlines means training can be run with minimal preparation and planning. Freely available on the Light for the World website https://www.light-for-the-world.org/downloads/education Useful for participants new to CBR or those who have not been introduced to the ‘new’ way of thinking about CBR If used with experienced CBR practitioners need to consider how to build on their experience and field knowledge within the training sessions

The Dream of Inclusion for All Huib Cornielje & Evert Veldman, Enablement (2011) http://www.enablement.nl/index.php/80/The_Dream_of_Inclusion_for_All.html

Findings – Dream of Inclusion for All (2011), Enablement Designed to be used in CBR training programs to enable “participants to critically review their own practice, learn from others and start thinking more critically” (p 19) Field workers and CBR Managers with field experience 27 real life case studies from around the world followed by group discussion points Material aligned with the WHO CBR Guidelines (2010) Requires a working knowledge of the guidelines and CBR Matrix to identify the components in each case study

Findings – Dream of Inclusion for All (2011), Enablement case studies from different programs encourages problem solving and strategies to address real life challenges invites participants’ to draw on their existing field knowledge and experience does not include foundational knowledge of CBR or community development can be downloaded chapter by chapter from the Enablement website free of charge http://www.enablement.nl/index.php/80/The_Dream_of_Inclusion_for_All.html Will become available at http://www.who.int/disabilities/include/en/ hard copies (including DVD) can be ordered from Enablement at a cost of €25 incl postage (Europe, North America, Australia) or €20 (all other countries)

Conclusions and Recommendations CBR training materials need to be: Aligned with WHOC CBR Guidelines and matrix Readily accessible in different formats Have separate sections/ modules for program managers and field workers Case study approach well accepted Case studies build depth and breadth of expertise Case studies from participants’ experiences can be brought into the training

WHO Collaborating Centre in Health Workforce Development in Rehabilitation and Long Term Care http://sydney.edu.au/health-sciences/whocc-rehabilitation/ E-mail: whocc.healthworkforce@sydney.edu.au Phone: +61 2 9351 9533 E-mail: gwynnyth.llewellyn@sydney.edu.au