Introduction to Disabilities for Professional Social Workers

Abstract
The article states that disability can affect all persons at any age. The different nomenclatures of disability are described and the author prefers the pwd (persons with disabilities) because of the emphasis on Person. The UN Convention on the Rights of Persons with Disability is discussed in the article along with the legal framework in India. The paradigm shift in understanding disability and the extent of the problem of disability are also described in the article. The NSSO estimates and the educational levels of the disabled in India also form part of the article. An important feature of the article is the national programme on the rehabilitation of pwds.

Introduction
Disability is as old as humanity. It is spread across all ethnic, economic, religious and tribal groups with varying incidence. While even certain diseases skip certain sections of the society, disability is omnipresent in all sections, even though the causes and incidence may be different. In India, with its different nutritional and health distribution, the incidence is higher in the rural areas than in the urban areas. While there are many social problems such as poverty, criminality, medical and psychiatric issues, rural - urban divide, caste, etc. that the general population faces calling for social engineering through a professional approach, disability compounds these issues in several and unpredictable ways. A meaningful intervention with professional finesse brings about the best in the persons with disabilities and helps them integrate comprehensively. Persons with disabilities (pwd) have been facing multiple physical, psychological and social barriers. However, over the past few decades the government and NGOs have been taking enormous interest in providing relief to pwd.

The process of rehabilitation of the disabled starts with prevention, early identification, intervention and integration, finally leading to rehabilitation and assimilation. Because of several interventions by the Govt and NGOs at professional levels, the services to persons with disabilities (pwd) have taken a paradigm change since the past half a century. Professional social work can impact the lives of persons with disabilities in all these areas from early intervention to geriatric assistance.

Social workers challenge social injustice. Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people (NASW, 2008, Ethical principles). Social workers have a responsibility to promote social justice, in relation to society generally, and in relation to the people with whom they work (IFSW & IASSW, 2012).

Nomenclature
While the persons with disabilities have been given different names through history and even confined to enclosures, and “handicapped” as an all-inclusive word for them, of late new names have been “assigned” especially in India quite possibly by generous recognition of their residual abilities. The names generally used are: vikalang, physically handicapped, differently abled, specially abled, physically challenged and now divyang inspired by political correctness. This nomenclature leaves out several other disabilities that are not necessarily physical. The internationally accepted word, after decades of discussion and wrangling, is “Person with disabilities” (pwd), with emphasis on Person (a typical social work practice term) includes all disabilities, physical and intellectual. All other names do not emphasize Person and therefore are not of significance. 

The Persons with Disabilities Act (1995) has categorized eight disabilities (actual words used in the Act) : blindness, low vision, hearing impairment, locomotor disability including cerebral palsy, mental illness, mental retardation, cured of leprosy, and multiple disability. The Rights of Persons with Disabilities Bill 2014 considers 18 disabilities including Thalassemia, autism, cerebral palsy, hemophilia, deaf-blindness, and muscular dystrophy. This is now under the consideration of the Group of Ministers headed by the Home Minister. 

Three words are indiscriminately or alternatively used by public and non- professionals for the condition of the Persons with Disabilities. 

Impairment: Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function. This condition could be mild to severe or temporary or permanent. Improper vision for example is an impairment corrected by external lens or any other treatment to reduce or remove impairment. 

Disability:  A disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Difficulty in reading ordinary print in the above example is a disability. 

Handicap: A handicap is a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factor) for that individual. Complete absence of visual perception that renders an individual to perform tasks requiring seeing is an example.  

United Nations Convention on the Rights of Persons with Disabilities (UNCRDP)
The United Nations General Assembly adopted the Convention on 13 December, 2006. When it was opened for signature on 30 March 2007, there were as many as 80 signatories, making it the fastest in negotiations (4 years).  India was one of the first to ratify the Convention (October 2007). This makes the country legally and morally binding to provide all the services agreed to in the Convention. The Convention has come into force in May 2008. As on June 2015 there are 158 signatories to the Convention and 147 ratifications to the Convention. The Convention provides the pwd with indivisible cycle of rights to living independently, informed consent, physical and mental integrity, right to health, absence of coercion for treatment, full legal capacity, and right to life and liberty. As signatory to the Convention (UNCRPD), India is obliged to provide legal, physical, communicative and social framework to make the living of the pwd all inclusive like any other person.

Legislative Framework  
The following legislations are in place dealing directly with the disabilities in addition to the several other laws concerned with the general population

Paradigm Shift
Over the past five decades, there has been a paradigm shift both in perceptions and management of disabilities. While the perception has changed from the sympathy/charity model to empathy/opportunity model to full participation to equal rights model, the management of pwd also has shifted from hospital – “medical management” model to “social and comprehensive inclusion” model. This is an area where Rehabilitation Social Work has a major intervention role to play. 

Extent of Problem

• Prevalence of disability in India is high but its data base is poor. There are only two sources which provide data on disability, i.e., National Sample Survey Organization (NSSO) and the Registrar General of India (Census). All others are based on local research or other international bodies with different mandates. World Health Organization (WHO), for example, quotes 10% which include disabilities caused by cardiac and respiratory conditions. International Labour Organization uses temporary disability due to industrial accidents (as in the case of Employees State Insurance Scheme in India)
• So far NSSO has carried out three special rounds of survey during the years 1981, 1991 and 2002. 
• The Registrar General of India included ‘disability’ for the first time in its 2001 Census. Seven disabilities were included in the Census, 2011. 
• As per the 2011 Census there are 26.8 million pwd constituting 2.21% of the population, about 4 million more than the entire population of Australia. 

NSSO Estimates

• The estimates made have shown that the number of disabled population has increased from 20.8 million in the year 2002 (NSSO) to 26.8 million as per Census 2011. 
• It is also observed that during the years 2002 to 2016, there will be some shift in the disability composition. Locomotor disability will increase from 51.9 per cent to 56.67 per cent because of the increase in road accidents, industrial hazards, changes in life style, etc. 
• Hearing and speech disabilities and visual disabilities are expected to decrease by about 2.6 per cent owing to the different corrective measures adopted using latest technology.

Literacy Levels
Hardly 45% of pwd are literate and only 9.2% have completed high school as compared to the national literacy average of 65.4%. The highest is among the locomotor disabled (NSSO, 2002).

Convergence
Different services provided by the government are elaborated below to give an idea of the areas in which social work intervention is possible. The services to the disabled are an inter-ministerial task with the Division of Empowerment of Persons with Disabilities, headed by Secretary to GOI, under the Ministry of Social Justice and Empowerment acting as the coordinating Ministry.   

• Ministry of Health: Early detection, early intervention, development of guidelines for evaluation of disability, constitution of Medical Boards for medical certificates and for training of health personnel. 
• Ministry of HRD: Early intervention through mainstream pre-school system, training pre-school and primary school teachers, development of inclusive schools, development of teaching/ learning materials, and curriculum modification. 
• Ministry of Skill Development: Vocational training, placement and development of inclusive work places. 
• Ministry of Labour: Enabling work environment, career counselling, employment and entrepreneurship
• Ministry of Urban Development: Standards for accessible buildings, employment of persons with disabilities through schemes for poverty alleviation. 
• Ministry of Rural Development : Employment of persons with disabilities through poverty alleviation and for inclusion in the panchyati raj system  
• Surface Transport : Ensuring accessible transport 
• Ministry of Railways: Concessional travel, accessible railway stations and railway coaches. 
• Ministry of Civil Aviation : Concessional travel by air, access to airport and aircraft
• Ministry of Finance:  Tax benefits and tax exemption of customs duty on assistive and mobility devices. 
• Department of Personnel and Training : Creating rosters for employment of persons with disabilities 

National Programme on Rehabilitation of Persons with Disabilities (NPRPD)

• Emphasis on community-based rehabilitation as well as institution-based rehabilitation. 
• All national programmes/policies in the area of education, information technology, transportation, etc. should also reflect the concerns of pwd.
• Goal of rehabilitation for all
• Create awareness on preventive aspects in the society including medical and paramedical professionals
• Infrastructure to be set up to assist health education, panchayati raj welfare and rural development organizations
• Access to appropriate education at pre-school, primary and secondary levels and also necessary support systems beyond.
• Make education child-centred 
• Special and inclusive education, and suitable teacher training 
• Enhance work participation rate of the disabled persons through

        -    Vocational training, and on-the-job training
        -    Ensure staffing of identified posts
        -    Incentives and awards, tax exemptions to 
           encourage private sector employers to induct the 
           disabled

• Other alternative employment avenues such as home bound programmes, self-employment, group rehabilitation programmes etc.
• Ensure utilization of 3% of poverty alleviation programmes for the disabled
• Manpower development of rehabilitation professionals
• Access to transport of all categories and places of study, work and recreation
• Social security and concessions
• Setting up of hierarchical rehabilitation service delivery system through community participation 
• Care of the severely disabled 
• Education as Fundamental Right (Brought in through RTE Act)
• Sarvodaya Vidyalaya Sanghatan to establish 50 Special/ Composite Schools with hostels
• Pre-school education
• 1 million teachers to be trained
• College of Rehabilitation Sciences to be established
• Vocationalization of education
• Special Employment Exchanges to be strengthened
• All States/UTs to have Vocational Rehabilitation Centres for the handicapped

Other Schemes

• National Handicapped Finance Development Corporation (NHFDC) has been established for providing educational loans and micro-credit to pwd for self-employment ventures 
• National Institutes (7), Regional Rehabilitation Training Centres (4), Composite Rehabilitation Centres (6), Artificial Limbs Manufacturing Corporation, District Disability Rehabilitation Centres (129)
• Indian Sign Language Research & Training Centre, Delhi
• Vocational Rehabilitation Centres for the Handicapped (21) have been established to be facilitators of services
• 40 Special Employment Exchanges, 41 Special Cells 
• Poverty alleviation programmes to be extended to the pwd
• Barrier free access to all buildings, transport and institutions : architectural, attitudinal & technological
• 5 new Regional Colleges for the deaf are proposed in Five Regions
• Proposal for the National Institute for Inclusive & Universal Design 
• Skill Development Council to focus on vocational training and entrepreneurship to empower pwd 

References

1. National Sample Survey Organization. (2002). New Delhi : Ministry of Programme Planning & Implementation.
2. Registrar General. (2011). Census of India. New Delhi.

Narasimham Rayadurgam
Chairman, Expert Committee on Vocational Rehabilitation & Allied subjects – Rehabilitation Council of India