From Clinical Treatment To Social Integration

Rural disabled people of China are widely distributed with a large proportion and urgent need of rehabilitation and development.Under the effects of being both farmers and people with disabilities,they often face with difficulties in health,livelihood,education,social participation and rights protection.Community-based rehabilitation(CBR),as a development strategy to meet these needs and to achieve inclusive development of the community,has been developed since it was introduced into China.However,the existing intervention CBR strategies characterized by clinical treatment are insufficient,which have been the barriers of CBR development in rural China.In this context,this article focuses on the intervention strategy of CBR in rural China by taking the interpretations of different disability model theories as the analytical perspective.Defects and the causes of existing CBR strategies,which are guided by medical model of disability and featured by clinical treatment,have been described and analyzed in operation mechanism,aspects of intervention,participants,service contents and resources.In the last part,this article concludes by suggesting practical strategies on improving intervention strategies of CBR and promoting community inclusive development of rural disabled people.The long interview was used to collect data of 14 rural disabled people and 3 rural CBR service providers from three villages of W town,J county.The data analysis shows that the contradiction between the supply and demand of resources and services for rural CBR is prominent.In spite of some progress of disability service in rural areas based on basic medical rehabilitation services and special rehabilitation projects,rural CBR practice under the comprehensive effect of disability concept,discourse system and social policy concepts has shown deficiencies such as plodding development,limited service content,insufficient coverage and inadequate policy implementation,etc.Further analysis also found that the deviation of intervention strategy is the root cause of these deficiencies in rural CBR practice,which can be reflected in five aspects:the first aspect is the redundant and inefficient top-down operation system which is mainly manifested in the emphasis on administrative management and inactive community involvement;the second one is the incomplete and obstructed strategy system with imperfections of the macro,meso and primary CBR supporting systems as well as the gap between different supporting systems;the third one,is the absence or confusion of rights and responsibilities of different CBR participants;the fourth one is the mismatch between the medical oriented CBR service and the goal of community inclusive development;and the last one,is the weak support and single-source CBR resource,which show up as insufficient human resources,lack of material resources and very limited financial resources.To be more specific,the possible reasons of the problems of rural CBR strategy lie in the fact that the medical model of disability is still prevalent,fundamentally leading to the deviation of CBR practice from the policy objectives.Under the impact of developmental discourse system,rural CBR practice is still restricted by individualism methodology,which tends to attribute disability to personal misfortune and treat disability welfare as a burden of social development(mostly in economic sense).Disability policies are therefore remedial and designed to meet the most basic needs,failing to facilitating the sustainable development of rural CBRTo improve CBR program in rural areas of China,the first thing we need to do is to change traditional concepts about disability based on medical model and to advocate concepts of rights and community inclusive development based on other models of disability beyond medical treatment.Besides,the measures to develop a rural CBR supporting system aiming at community inclusive development should be adopted,including the implementation of a top-down and bottom-up operation mechanism,the improvement of three well-connected supporting systems,the support for responsible involvement of multiple participants,the promotion of more comprehensive services and the establishment of a diversified and sustainable resource supply system,etc.