What is the recommended approach for supporting individuals with disabilities through Community-Based Rehabilitation (CBR)?

Community-Based Rehabilitation (CBR) for Individuals with Disabilities

The recommended approach for supporting individuals with disabilities through Community-Based Rehabilitation (CBR) is a coordinated, multidisciplinary team-based intervention that promotes participation and inclusion in family and community settings while addressing specific functional rehabilitation needs. 1

Core Components of Effective CBR

Multidisciplinary Team Approach

• A specialized interprofessional rehabilitation team is essential for effective CBR implementation 1
• Team should include:
  • Physicians (often coordinating medical aspects)
  • Physical therapists (addressing mobility and movement)
  • Occupational therapists (focusing on daily living skills)
  • Speech-language pathologists (for communication disorders)
  • Social workers (facilitating community reintegration)
  • Rehabilitation nurses (reinforcing therapy techniques)
  • Recreational therapists (promoting leisure activities)
  • Psychologists (addressing cognitive and behavioral issues) 1

Timing and Intensity

• CBR services should be available within 48 hours of discharge from acute hospital or within 72 hours of discharge from inpatient rehabilitation 1
• Therapy should be of appropriate intensity and duration, individually designed to meet specific needs for optimal recovery and tolerance levels 1
• Services should include repetitive and intense practice of functional tasks that challenge the patient to acquire necessary skills 1

Setting Selection

• The optimal environment should be determined based on:
  • Patient's functional rehabilitation needs
  • Participation-related goals
  • Availability of family/social support
  • Patient preferences 1
• Options include:
  • Home-based rehabilitation services (like "Early Supported Discharge" teams)
  • Facility-based outpatient services
  • Community-based programs 1

Implementation Framework

Assessment and Planning

• Use a standardized multidisciplinary assessment procedure for all patients 1
• Develop rehabilitation plans that are:
  • Patient-centered
  • Based on shared decision-making
  • Culturally appropriate
  • Incorporating agreed-upon goals of patient, family, caregivers and healthcare team 1

Service Delivery Model

• Early Supported Discharge (ESD) is effective for appropriate candidates:
  • Accelerates transition from hospital to home
  • Provides rehabilitation therapies by interprofessional team in community
  • Achieves similar outcomes to inpatient rehabilitation for milder cases 1
• Best results occur when community-based therapists are the same ones who treated patients in hospital 1

Key Focus Areas (Based on CBR Matrix)

• Health: Ensure access to medical services and rehabilitation
• Education: Support inclusion in educational settings
• Social: Promote family and community participation
• Livelihood: Facilitate employment and economic self-sufficiency
• Empowerment: Encourage advocacy and self-determination 2

Evidence of Effectiveness

• CBR has demonstrated positive impacts on:
  • Well-being of persons with disabilities
  • Participation within family and society
  • Individual and collective capabilities
  • Individual, agency and social empowerment 3
• Organized, interdisciplinary rehabilitation reduces:
  • Mortality rates
  • Likelihood of institutional care
  • Long-term disability
  • While enhancing recovery and increasing independence in activities of daily living 1

Addressing Barriers to Participation

• CBR programs help overcome barriers through:
  • Providing information about available services
  • Facilitating access to existing support
  • Helping persons in communities take collective action 4
• Common barriers addressed include:
  • Isolation and neglect
  • Lack of access to social, health, education and livelihood opportunities
  • Family-level barriers (often the first barriers encountered) 4

Supporting Caregivers and Family

• Caregiver support is critical as caregiving can be physically and emotionally taxing 1
• Potential adverse effects on caregivers include:
  • Increased risk of depression
  • Increased use of health services
  • Self-administration of medications prescribed for the patient 1
• Provide opportunities for respite care 1
• Work with patient and caregivers to:
  • Avoid negative effects
  • Promote problem solving
  • Facilitate reintegration into valued family and social roles 1

Discharge Readiness from Inpatient to Community

A patient is ready for community-based rehabilitation when:

• No skilled nursing needs exist or can be met by caregiver/community support
• Regular physician care is not required
• A supportive environment is available or can be modified
• Patient is functionally independent or assistance can be provided by family/caregiver
• Additional rehabilitation services are available in the community 1

Pitfalls to Avoid

• Failing to consider the full impact of disability on daily life
• Focusing only on physical rehabilitation while neglecting cognitive, emotional and social aspects
• Discontinuing therapy at discharge rather than extending to home/community settings
• Neglecting caregiver training and support
• Overlooking the importance of leisure activities in quality of life 1
• Assuming all barriers can be addressed at the individual level without community involvement 4