Inclusiveness Handout PDF

CHAPTER 1: UNDERSTANDING DISABILITIES AND VULNERABILITIES Definitions of Basic Terms (Impairment, Disability and Handicap) Impairment Impairment means a lack/abnormality of an anatomic, physiological or psychological structure or function or deviation on a person. It refers to any loss or abnormal...

CHAPTER 1: UNDERSTANDING DISABILITIES AND VULNERABILITIES Definitions of Basic Terms (Impairment, Disability and Handicap) Impairment Impairment means a lack/abnormality of an anatomic, physiological or psychological structure or function or deviation on a person. It refers to any loss or abnormality of physiological, psychological or anatomical structure or function. It is the absence of particular body part or organ. It could also a condition in which the body exists but doesn‘t function. Some children, for instance, have impairments such as eyes that do not see well, arms and legs that are deformed, or a brain not developing in a typical way etc. Disability The term disability is ambiguous as there is no single agreement on the concept (Mitra, 2006). It is not synonymous with AKAL-GUDATENGA (የአካል ጉዳተኛ) meaning impairment The concept of disability is complex, dynamic, multidimensional, and contested (WHO and World Bank, 2011). The full inclusion of people with impairments in society can be inhibited by:  Attitudinal (societal barriers, such as stigma)  Physical barriers (environmental barriers, such as absence of stairs), and  Policy barriers (systemic barriers), Where all together can create a disabling effect and inhibit disability inclusive development. They are disabling factors. If these problems addressed, impairment may not lead to disability. Where all together can create a disabling effect and inhibit disability inclusive development. Societal, environmental, and systemic barriers are the most popular disabling factors:  A disabled persons  Persons with disability What is disability? 1. Medical Approach Disability is pathology (physiological, biological and intellectual). Disability means functional limitations due to physical, intellectual or psychic impairment, health or psychic disorders on a person (WHO, 1996). The medical definition has given rise to the idea that people are individual objects to be treated, changed" or improved" and made more normal. The medical definition views the disabled person as needing to fit in rather than thinking about how society itself should change. This medical definition does not adequately explain the interaction between societal conditions or expectations and unique circumstances of an individual The social definition of disability: Disability is a highly varied and complex condition with a range of implications for social identity and behaviour. Disability largely depends on the context and is a consequence of discrimination, prejudice and exclusion. 1  Emphasizes the shortcomings in the environment and in many organized activities in society, for example on information, communication and education, which prevent persons with disabilities from participating on equal terms. Medical model: Social model: Child is faulty Child is valued Diagnosis and labelling Strengths and needs identified Impairment is focus of attention Barriers identified and solutions developed Medical model: Social model: Segregation and alternative services Resources made available Re-entry if normal enough or permanent exclusion Diversity welcomed; child is welcomed Society remains unchanged Society evolves Causes of disability Some people, especially in the past times, wrongly believe that disability is a punishment from God. There are some who still believe that disability is a form of personal punishment for individual with disability, a kind of karma for their past mistakes, which is totally unacceptable now days. Disability can be caused by the following factors. Genetic Causes Abnormalities in genes and genetic inheritance can cause intellectual disability in children. In some countries, Down syndrome is the most common genetic condition. Sometimes, diseases, illnesses, and over-exposure to x-rays can cause a genetic disorder.. Environmental Poverty and malnutrition in pregnant mothers can cause a deficiency in vital minerals and result in deformation issues in the unborn child. After birth, poverty and malnutrition can also cause poor development of vital organs in the child, which can eventually lead to disability. The use of drugs, alcohol, tobacco, the exposure to certain toxic chemicals and illnesses, toxoplasmosis, cytomegalovirus, rubella and syphilis by a pregnant mother can cause intellectual disability to the child. Childhood diseases such as a whooping cough, measles, and chicken pox may lead to meningitis and encephalitis. This can cause damage to the brain of the child. Toxic material such as lead and mercury can damage the brain too. Unfortunate life events such as drowning, automobile accidents, falls and so on can result in people losing their sight, hearing, limbs and other vital parts of their body and cause disability. Unknown Causes The human body is a phenomenal thing. Scientists have still not figured out what and how some things in the body, cells, brain, and genes come about. Humans have still not found all the answers to all the defects in the human body. Inaccessible environments Sometimes society makes it difficult for people with some impairment to function freely. When society develops infrastructure such as houses, roads, parks and other public places without consideration to 2 people with impairment, the basically make it impossible for them to take care of themselves. For example, if a school is built with a ramp in addition to stairs, it makes it easy for people with wheelchairs to move about freely. This way, their impairment is not made worse. Lack of education, support services, health and opportunities for people with impairment can cause additional disability to people with disabilities and even people with no disability. Type of Disabilities 1. Visual Impairment Visual impairment in general designates two sub- classifications. These are blindness and low vision. Blindness:- total or partial inability to see because of disease or disorder of the eye, optic nerve, or brain. The term blindness typically refers to vision loss that is not correctable with eyeglasses or contact lenses. Blindness may not mean a total absence of sight, however. Some people who are considered blind may be able to perceive slowly moving lights or colours. The term low vision is used for moderately impaired vision. People with low vision may have a visual impairment that affects only central vision the area directly in front of the eyes or peripheral vision the area to either side of and slightly behind the eyes. 2. Hearing Impairment Different people define the term hearing impairment differently. The definitions given to hearing impairment convey different meaning to different people. Different definitions and terminologies may be used in different countries for different purpose. Pasonella and Carat from legal point of view, define hearing impairment as a generic term indicating a continuum of hearing loss from mild to profound, which includes the sub-classifications of the hard of hearing and deaf. Hard of Hearing: "A hearing impairment, whether permanent of fluctuating, which adversely affects a child's educational performance but which is not included under the definition of 'deaf'." Whelan, R. J. (1988). This term can also be used to describe persons with enough (usually with hearing aids) as a primary modality of acquisition of language and in communication with others. Deaf: Those who have difficulty understanding speech, even with hearing aids but can successfully communicate in sign language. Cultural definitions of deafness, on the other hand, emphasize an individual‘s various abilities, use of sign language, and connections with the culturally deaf community. 3. Specific Learning Disability Specific Learning Disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. The term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include learning problems that are primarily the result of visual, hearing, or motor disabilities; of intellectual disability; of emotional disturbance; or of environmental, cultural, or economic disadvantage. Learning disabilities should not be confused with 3 learning problems which are primarily the result of visual, hearing, or motor handicaps; of intellectual disability; of emotional disturbance; or of environmental, cultural or economic disadvantages. Generally speaking, people with learning disabilities are of average or above average intelligence. There often appears to be a gap between the individual‘s potential and actual achievement. This is why learning disabilities are referred to as hidden disabilities‖: the person looks perfectly normal and seems to be a very bright and intelligent person, yet may be unable to demonstrate the skill level expected from someone of a similar age. A learning disability cannot be cured or fixed; it is a lifelong challenge. However, with appropriate support and intervention, people with learning disabilities can achieve success in school, at work, in relationships, and in the community. Types of Specific Learning Disabilities A. Auditory Processing Disorder (APD) Also known as Central Auditory Processing Disorder, this is a condition that adversely affects how sound that travels unimpeded through the ear is processed or interpreted by the brain. Individuals with APD do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. They can also find it difficult to tell where sounds are coming from, to make sense of the order of sounds, or to block out competing background noises. B. Dyscalculia Dyscalculia is a specific learning disability that affects a person‘s ability to understand numbers and learn math. Individuals with this type of LD may also have poor comprehension of math symbols, may struggle with memorizing and organizing numbers, have difficulty telling time, or have trouble with counting. C. Dysgraphia Dyscalculia is a specific learning disability that affects a person‘s handwriting ability and fine motor skills. Problems may include illegible handwriting, inconsistent spacing, poor spatial planning on paper, poor spelling, and difficulty composing writing as well as thinking and writing at the same time. D. Dyslexia Dyslexia is a specific learning disability that affects reading and related language-based processing skills. The severity can differ in each individual but can affect reading fluency; decoding, reading comprehension, recall, writing, spelling, and sometimes speech and can exist along with other related disorders. Dyslexia is sometimes referred to as a Language-Based Learning Disability. E. Language Processing Disorder Language Processing Disorder is a specific type of Auditory Processing Disorder (APD) in which there is difficulty attaching meaning to sound groups that form words, sentences and stories. While an APD affects the interpretation of all sounds coming into the brain, a Language Processing Disorder (LPD) relates only to the processing of language. LPD can affect expressive language and/or receptive language. F. Non-Verbal Learning Disabilities 4 Non-Verbal Learning Disabilities is a disorder which is usually characterized by a significant discrepancy between higher verbal skills and weaker motor, visual-spatial and social skills. Typically, an individual with NLD (or NVLD) has trouble interpreting nonverbal cues like facial expressions or body language, and may have poor coordination. F. Visual Perceptual/Visual Motor Deficit Visual Perceptual/Visual Motor Deficit is a disorder that affects the understanding of information that a person sees, or the ability to draw or copy. A characteristic seen in people with learning disabilities such as Dysgraphia or Non-verbal LD, it can result in missing subtle differences in shapes or printed letters, losing place frequently, struggles with cutting, holding pencil too tightly, or poor eye/hand coordination. 4. Speech and Language Impairments Speech and language impairment means a communication disorder such as stuttering, impaired articulation, language impairment, or a voice impairment that adversely affects a child‘s educational performance. It is disorder that adversely affects the child's ability to talk, understand, read, and write. This disability category can be divided into two groups: speech impairments and language impairments. Speech Impairments There are three basic types of speech impairments: articulation disorders, fluency disorders, and voice disorders. Articulation disorders are errors in the production of speech sounds that may be related to anatomical or physiological limitations in the skeletal, muscular, or neuromuscular support for speech production. These disorders include: Omissions: (bo for boat) Substitutions: (wabbit for rabbit) Distortions: (shlip for sip) Fluency disorders are difficulties with the rhythm and timing of speech characterized by hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases. Common fluency disorders include: Stuttering: rapid-fire repetitions of consonant or vowel sounds especially at the beginning of words, prolongations, hesitations, interjections, and complete verbal blocks Cluttering: excessively fast and jerky speech Voice disorders are problems with the quality or use of one's voice resulting from disorders in the larynx. Voice disorders are characterized by abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration. Language Impairments There are five basic areas of language impairments: phonological disorders, morphological disorders, semantic disorders, syntactical deficits, and pragmatic difficulties. Phonological disorders are defined as the abnormal organization of the phonological system, or a significant deficit in speech production or perception. A child with a phonological disorder may be described as hard to understand or as not saying the sounds correctly. Apraxia of speech is a specific phonological disorder where the student may want to speak but has difficulty planning what to say and the motor movements to use. Morphological disorders are defined as difficulties with morphological inflections (inflections on nouns, verbs, and adjectives that signal different kinds of meanings). 5 Semantic disorders are characterized by poor vocabulary development, inappropriate use of word meanings, and/or inability to comprehend word meanings. These students will demonstrate restrictions in word meanings, difficulty with multiple word meanings, excessive use of nonspecific terms (e.g., thing and stuff), and indefinite references (e.g., that and there). Syntactic deficits are characterized by difficulty in acquiring the rules that govern word order and others aspects of grammar such as subject-verb agreement. Typically, these students produce shorter and less elaborate sentences with fewer cohesive conjunctions than their peers. Pragmatic difficulties are characterized as problems in understanding and using language in different social contexts. These students may lack an understanding of the rules for making eye contact, respecting personal space, requesting information, and introducing topics. 5. Autism Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three that adversely affects a child‘s educational performance. Other characteristics often associated with autism are engaging in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term autism does not apply if the child‘s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in #5 below. A child who shows the characteristics of autism after age 3 could be diagnosed as having autism if the criteria above are satisfied. Autism is a neurodevelopment disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behaviour and interest (Landa, 2007). Autism is pervasive developmental disorder characterized by lack of normal sociability, impaired communication and repetitive obsessive behaviour such as politeness, turn-taking (Young & Nettlebeck , 2005). Linked to Profound Learning Disability (PLDs) are further impairments in the production of speech. Among these are (i) personal pronouns reversal for instance the use of I instead of you and vice-versa, (ii) the misuse of such prepositions as in, on, under, next to‖ (...), and (iii) the prevalence, in speech, of echolalia formal repetition of other‘s utterances (Arron and Gittens, 1999). Children with autism vary literally in their use of words, (Rutter, 1966). Communication deficiencies may leave a lasting mark of social retardation on the child. The link, between social skills and language is made evident by the often spontaneous appearance of affectionate and dependent behaviour in these children after they have been trained to speak (Churchill, 1966 & Hewett, 1965). 6. Emotional and Behavioural Disorders According to Individuals with Disabilities Education Act (IDEA), the term Emotional and behavioural Disorders means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects educational performance 1) An inability to learn that cannot be explained by intellectual, sensory, or health factors; 2) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers; 3) Inappropriate types of behaviour or feelings under normal circumstances; 4) A general pervasive mood of unhappiness or depression; or 6  5) A tendency to develop physical symptoms or fears associated with personal or school problems. Classification of behavioural and emotional disorders An individual having behavioural or emotional disorders can exhibit widely varied types of behaviour. Therefore, different classification systems of behavioural and emotional disorders can be used for special education. Different professionals have developed a classification system, which shows some promise for educational practice. These include: Conduct disorder: individuals may seek attention, are disruptive and act out. The disorder is classified by type: overt (with violence or tantrums) versus covert (with lying, stealing, and/or drug use). Socialized aggression: individuals join subculture group of peers who are openly disrespectful to their peers, teachers, and parents. Common are delinquency and dropping out of school. Early symptoms include stealing, running away from home, habitual lying, cruelty to animals, and fire setting. Attention problems- These individuals may have attention deficit, are easily destructible and have poor concentration. They are frequently impulsive and may not think the consequence of their actions. Anxiety/Withdrawn- These individuals are self-conscious, reserved, and unsure of themselves. They typically have low self-esteem and withdraw from immediate activities. They are also anxious and frequently depressed. Psychotic behaviour: These individuals show more bizarre behaviour. They may hallucinate, deal in a fantasy world and may even talk in gibberish. Motor excess: These students are hyperactive. They cannot sit nor listen to others nor keep their attention focused. Kauffman (1993) conclude that emotion or behavioural disorders fall into two broad classifications: 1) Externalizing Behaviour: also called under controlled disorder, include such problems disobedience, disruptiveness, fighting, tempers tantrums, irresponsibility, jealous, anger, attention seeking etc… 2) Internalizing Behaviour: also known as over controlled disorders, include such problems anxiety, immaturity, shyness, social withdrawal, feeling of inadequacy (inferiority), guilt, depression and worries a great deal Causes of behavioural and emotional disorders Behavioural and emotion disorders result from many causes, these includes the following. 1. Biological- includes genetic disorders, brain damage, and malnutrition, allergies, temperament and damage to the central nervous system. 2. Family factors- include family interactions, family influence, child abuse, neglect, and poor disciplinary practices at home. 3. Cultural factors- include some traditional and cultural negative practices, for example watching violence and sexually oriented movies and TV programs. 4. Environmental factors- include peer pressure, living in impoverished areas, and schooling practices that are unresponsive to individual needs. 7  7. Intellectual Disability Intellectual disability is a disability characterized by significant limitations in both intellectual functioning and in adaptive behaviour, which covers many everyday social and practical skills. This disability originates before the age of 18. An individual is considered to have an intellectual disability based on the following three criteria:  Sub average intellectual functioning: It refers to general mental capacity, such as learning, reasoning, problem solving, and so on. One way to measure intellectual functioning is an IQ test. Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning.  Significant limitations exist in two or more adaptive skill areas: It is the collection of conceptual, social, and practical skills that are learned and performed by people in their everyday lives.  Conceptual skills:- language and literacy; money, time, and number concepts; and self- direction.  Social skills:- interpersonal skills, social responsibility, self-esteem, gullibility, innocence (i.e., suspicion), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized.  Practical skills:- activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.  People with intellectual disabilities academic learning can be affected, as well as their ability to adapt to home, school, and community environments are presented under the following sub- headings:  General Cognition: People with intellectual disabilities vary physically and emotionally, as well as by personality, disposition, and beliefs. Their apparent slowness in learning may be related to the delayed rate of intellectual development (Wehman, 1997).  Learning and Memory: The learning and memory capabilities of people with intellectual disabilities are significantly below average in comparison to peers without disabilities. Children with intellectual disabilities may not spontaneously use appropriate learning or memory retention strategies and may have difficulty in realizing the conditions or actions that aid learning and memory. However, these strategies can be taught (Fletcher, Huffman, & Bray, 2003; Hunt & Marshall, 2002; Werts, Wolery, Holocombe, & Gast, 1995; Wolery & Schuster, 1997).  Attention: To acquire information, children must attend to the learning task for the required length of time and control distractions. Children with intellectual disabilities may have difficulty distinguishing and attending to relevant questions in both learning and social situations (Saunders, 2001). The problem is not that the student will not pay attention, but rather that the student does not understand or does not filter the information to get to the salient features (Hunt & Marshall, 2002; Meyen & Skrtic, 1988).  Adaptive Skills: The adaptive skills of people with intellectual disabilities are often not comparable to those of their peers without disabilities. A child with intellectual disabilities may have difficulty in both learning and applying skills for a number of reasons, including a higher level of distractibility, inattentiveness, failure to read social cues, and impulsive behaviour (Hardman et al., 2008). The lack or underdevelopment of these skills notably affects memory, rehearsal skills, organizational ability, and being in control of the process of learning (Erez & Peled, 2001; Hunt & Marshall, 2002). 8   Speech and Language: People with intellectual disabilities may have delayed speech, language comprehension and formulation difficulties. Language problems are generally associated with delays in language development rather than with a bizarre use of language (Beirne-Smith et al., 2006; Moore-Brown & Montgomery, 2006). People with intellectual disabilities may show delayed functioning on pragmatic aspects of language, such as turn taking, selecting acceptable topics for conversation, knowing when to speak knowing when to be silent, and similar contextual skills (Haring, McCormick, & Haring, 1994; Yoder, Retish, & Wade, 1996).  Motivation: People with intellectual disabilities are often described as lacking motivation, or outer-directed behavior. Past experiences of failure and the anxiety generated by those failures may make them appear to be fewer goals directed and lacking in motivation. The result of failure is often learned helplessness. The history of failure is likely to lead to dependence on external sources of reinforcement or reward rather than on internal sources of reward. They are less likely to self-starters motivated by self-approval (Beirne-Smith et al., 2002; Taylor et al., 2005).  Academic Achievement: The cognitive difficulties of children with mild to moderate intellectual disabilities lead to persistent problems in academic achievement (Hughes et al., 2002; Macmillan, Siperstein, & Gresham, 1996; Quenemoen, Thompson, & Thurlow, 2003; Turnbull et al., 2004), unless intensive and extensive supports are provided.  Physical characteristics: Children with intellectual disabilities with differing biological etiologies, may exhibit coexisting problems, such as physical, motor, orthopedic, visual and auditory impairments, and health problems (Hallahan & Kauffman, 2006). A relationship exists between the severity of the intellectual disabilities and the extent of physical differences for the individual (Drew & Hardman, 2007; Horvat, 2000). The majority of children with severe and profound intellectual disabilities have multiple disabilities that affect nearly every aspect of intellectual and physical development (Westling & Fox, 2004). Levels of support for individuals with intellectual disabilities Levels of support range from intermittent (just occasional or as needed‖ for specific activities) to pervasive (continuous in all realms of living). Levels and areas of support for intellectual disabilities Level of Duration of Frequency of Setting of Amount of professional support support support support assistance Intermittent Only as needed Occasional or Usually only Occasional consultation or infrequent one or two (e.g. monitoring by professional 1–2 classes or activities) Limited As needed, but Regular, but Several settings, Occasional or regular sometimes frequency but not usually contact with professionals continuing varies all Extensive Usually Regular, but Several settings, Regular contact with continuing frequency but not usually professionals at least once varies all a week Pervasive May be lifelong Frequent or Nearly all Continuous contact and continuous settings monitoring by professionals Source: American Association on Mental Retardation, 2002: Schalock & Luckassen, 2004. 9  8. Physical disability/Orthopedic Impairment and Health impairment Physical disability is a condition that interferes with the individual‘s ability to use his or her body. Many but not all, physical disabilities are orthopedic impairments. (The term orthopedic impairment generally refers to conditions of muscular or skeletal system and sometimes to physical disabling conditions of the nervous system). Health impairment is a condition that requires ongoing medical attention. It includes asthma, heart defects, cancer, diabetes, haemophilia. HIV/AIDS, etc. Classification and Characteristics Physical disabilities:- based on the impact of physical disability on mobility and motor skills, it is divided into three. These are:- A. Mild physical disability:- these individuals are able to walk without aids and may make normal developmental progress. B. Moderate physical disability:- individuals can walk with braces and crutches and may have difficulty with fine-motor skills and speech production. C. Severe physical disability:-these are individuals who are wheel-chair dependent and may need special help to achieve regular development. The physical disability could be broadly classified in to two I. The neurological system (the brain, spinal cord & nerve) related problems. II. Musculoskeletal system (the muscles, bones and joints) are deficient due to various causes. I. Neurological system:-with a neurological condition like cerebral palsy or a traumatic brain injury, the brain either sends the wrong instructions or interprets feedback incorrectly. In both cases, the result is poorly coordinated movement. With the spinal cord injury or deformity, the path ways between the brain and the muscles are interrupted, so messages are transmitted but never received. The result is muscle paralysis and loss of sensation beyond the point where the spinal cord or the nerve is damaged. These individuals may have motor skill deficits that can range from mild in coordination to paralysis of the entire body. The most severely affected children are totally dependent on other people or sophisticated equipment to carry out academic and self-care task. Additional problems that can be associated with cerebral palsy include learning disabilities, mental retardation. Seizures, speech impairments, eating problems, sensory impairments, and joint and bone deformities such as spinal curvatures and contractures (permanently fixed, tight muscles and joints). Approximately 40 percent of those with cerebral palsy have normal intelligence; the remainders have from mild to severe retardation. This is an extremely heterogeneous group having unique abilities and needs. Epilepsy:-is disorder that occurs when the brain cells are not working properly and is often called a seizure disorder. Some children and youth will epilepsy have only a momentary loss of attention (petit mal seizures); others fall to the floor and then move uncontrollably. Fortunately, once epilepsy is diagnosed, it can usually be controlled with medication and does not interfere with performance in school. Most individuals with epilepsy have normal intelligence. Epilepsy is a condition that affects 1 to 10 2 percent of the population. It is characterized by recurring seizures, which are spontaneous abnormal discharge of electrical impulses of the brain. Spinal bifida and spinal cord injury:- damage to the spinal cord leads to paralysis and loss of sensation in the affected areas of the body. The spinal bifida is a birth defect of the backbone (spinal column). The cause is unknown but it usually occurs in the first twenty-six days of pregnancy. II. Musculoskeletal system: - it includes the muscles and their supporting framework and the skeleton. The problem includes Progressive muscle weakness (muscular dystrophy); Inflammation of the joints (arthritis), or Loss of various parts of the body (amputation). The list of the impairment and associated with musculoskeletal malformation are the following: A. Muscular dystrophy:- is an inherited condition accruing mainly in males, in which the muscles weaken and deteriorate. The weakness usually appears around 3 to 4 years of age and worsens progressively. By age 11 most victims can to longer walk. Death usually comes between the ages of 25 and 35 from respiratory failure or cardiac arrest. B. Arthritis:-is an inflammation of the joints. Symptoms include swollen and stiff joints, fever, and pain in the joints during acute periods. Prolonged inflammation can lead joint deformities that can eventually affect mobility. C. Amputation:- a small number of children have missing limbs because of congenital abnormalities or injury or disease (malignant bone tumours in the limbs). These children can use customized prosthetic devices (artificial hands, arms, or legs) to replace limp functions and increase independence in daily activities. Other muscle-skeletal disorders are:- D. Marfan syndrome is a genetic disorder in which the muscles are poorly developed and the spine is curved. Individuals with marfan syndrome may have either long, thin limbs, prominent shoulder blades, spinal curvature, flat feet, or long fingers & thumbs. The heart and blood vessels are usually affected. The greatest danger is damage to aorta, which can lead to heart failure. Individuals with marfan syndrome need to avoid heavy exercise and lifting heavy objects. E. Achondroplasis:- is a genetic disorder that affects 1 in 10,000 births. Children with this disorder usually develop a normal torso but have a straight upper back and a curved lower back (sway back). These children are at risk of sudden death during sleep from compression of the spinal cord interfering with their breathing. The disability may be lessened through the use of the back braces or by surgery. F. Polio:- is viral disease that invade the brain and cause severe paralysis of the total body system. In its mild form results in partial paralysis. Post-polio muscles that were previously damaged weaken, and in some persons, other muscles that were not previously affected weaken as well. G. Club foot:- is a major orthopedic problem affecting about 9,000 infants each year. This term is used to describe various ankle or foot deformities, i.e Twisting inward (equino varus), the most severe form Sharply angled at the heel (calcanel vaigus), most common 11  The front part of the foot turned inward. These conditions can be treated with physical therapy, and a cast on the foot can solve the problem in most instances. In more severe cases, surgery is necessary. With early treatment, most children can wear regular shoes and take part in all school activities. H. Cleft lip and cleft palate:- are openings in the lip or roof of the mouth, respectively, that fail to close before birth, the cause is unknown. Most cleft problems can be repaired through surgery. Health Impairments Any disease that interferes with learning can make students eligible for special services. These disease caused problems are as follow. 1. Heart disease:- this is common among young people. It is caused by improper circulation of blood by the heart some of the disorders are congenital) present at birth); others are the product of inflammatory heart disease. Some students have heart value disorders; others have disorders of the blood vessels. His time heart implantation helps children to get cured. 2. Cystic fibrosis:- is a hereditary disease that affects the lungs and pancreas. It leads to recurrent respiratory and digestive problems including abnormal amounts of thick mucus, sweet and saliva. The disease is so progressive and few who have it survive beyond age 20. Children with such disease often spend significant timeout of school. 3. Acquired immune deficiency syndrome (AIDS):- is a very severe disease caused by human immunodeficiency virus (HIV) infection and transmitted primarily through exchange of bodily fluids in transfusions or unprotected sex, and by contaminated needles in addictive drug use. 4. Haemophilia:- is a hereditary disease in which the blood clots very slowly or not all. The disorder is transmitted by sex-linked recessive gene and nearly always occurs in males. 5. Asthma: is a chronic respiratory condition characterized by repeated eplosde of breathing difficulties especially while exhaling. 6. Diabetes: Developmental or hereditary disorder characterized by inadequate secretion or use of insulin 7. Nephrosis & Nephritis:- Kidney disorders or diseases caused by infections, poisoning, burns, accidents or other diseases 8. Sickle-cell anaemia:- Hereditary and chronic blood disease (occurring primarily in African Americans) characterized by red blood cells that are distored and that do not circulate properly 9. Leukaemia: Disease characterized by excessive production of white blood Cells 10. Lead poisoning Disorder caused by ingesting lead-based paint chips or other substances containing lead 11. Rheumatic fever:- Disease characterized by painful swelling and inflammation of the joints that can spread to the hear and central nervous system. 12. Tuberculosis Infectious disease that commonly affects the lungs and may affect other tissues of the body. 13. Cancer Abnormal growth of cells that can affect any organ system. 12  9. Vulnerability Vulnerable means being at risk of being harmed. Everyone can be harmed, so being vulnerable is part of being human. In principle, everyone is vulnerable to some adverse event or circumstance, but some people are more vulnerable than others. For instance, people with disabilities are more likely as a group to experience greater vulnerability. They are also often more severely affected by the vulnerability they experience. Based on the existing literature, vulnerability can be generally defined as a complex phenomenon that refers to the following dimensions: 1. Economic difficulties/lack of financial resources: poverty, low living standards, housing problems (e.g. too damp, too expensive, too cold or difficult to heat) etc.; 2. Social exclusion: limited access to facilities such as transportation, schools, libraries or medical services; 3. Lack of social support from social networks: no assistance from family members, friends, neighbours or colleagues (referring to practical help as well as emotional support) like highly gifted individuals; 4. Stigmatization: being a victim of stereotypes, being devalued, confronted with disgraceful behaviour because of belonging to a particular social or ethnic group; 5. Health difficulties: disadvantages resulting from poor mental health, physical health or disabilities; 6. Being a victim of crime: in family context especially of violence. Causes of Vulnerability Vulnerability may be causes by rapid population growth, poverty and hunger, poor health, low levels of education, gender inequality, fragile and hazardous location, and lack of access to resources and services, including knowledge and technological means, disintegration of social patterns (social vulnerability). Other causes includes; lack of access to information and knowledge, lack of public awareness, limited access to political power and representation (political vulnerability), (Aysan,1993). When people are socially disadvantaged or lack political voice, their vulnerability is exacerbated further. The economic vulnerability is related to a number of interacting elements, including its importance in the overall national economy, trade and foreign-exchange earnings, aid and investments, international prices of commodities and inputs, and production and consumption patterns. Environmental vulnerability concerns land degradation, earthquake, flood, hurricane, drought, storms (Monsoon rain, El Niño), water scarcity, deforestation, and the other threats to biodiversity. Characteristics of Vulnerable People The following are thought to be characteristics of vulnerable people (with examples of groups of potentially vulnerable people): 1. Less physically or mentally capable (infants, older adults, people with disabilities) 2. Fewer material and/or financial resources (low-income households, homeless) 3. Less knowledge or experience (children, illiterate, foreigners, tourists) 4. Restricted by society to grow and develop according to their needs and potentials People who are helped by others (who are then restricted by commitments) are still vulnerable people, which includes the following extracted from various researches. 13 A. Women: particularly women in developing nations and those who are living in rural areas are vulnerable for many backward traditional practices. These women are oppressed by the culture and do not get access to education and employment B. Children: Significant number of children are vulnerable and at risk for development. Children are vulnerable for psychological and physical abuse This include illegally working children, children who are pregnant or become mothers, children born out of marriage, children from a single-parent, delinquent children, homeless children, HIV-infected children, uneducated children, institutionalized children, married children, mentally ill children, migrant children, orphans, sexually exploited children, street children, war-affected children…etc. C. Minorities: some people are vulnerable due to their minority background; particularly ethnic (cultural and linguistic minority), religious minority. These people are political and socially discriminated. D. Poverty: People are vulnerable for many undesirable phenomena due to poverty. This may be resulted in, poor households and large households, inequality, absences of access to health services, important resources for life, lack of access to education, information, financial and natural resources and lack of social networks. E. Disabilities: People with disabilities very much vulnerable for many kind of risks. This includes abuses, poverty, illiteracy, health problems, psychological and social problems. F. Age: Old people or very young children are vulnerable for all kinds evils. G. Illiteracy and less education: People with high rates of illiteracy and lack quality educational opportunities are vulnerable for absence all kinds of developments. H. Sickness: Uncured health problems for example people living with HIV/AIDS are much vulnerable for psychosocial problems, poverty and health. I. Gifted and Talentedness: Gifted and talented children are vulnerable for socio-emotional developments. Due to lack of psychological support they may feel isolation as they are pulled from their regular classrooms and given instruction in separate settings and due to myths and expectations of themselves and the public. 14 CHAPTER 2: CONCEPT OF INCLUSION 2.1. Definition of Inclusion Inclusion in education/service refers to an on-going process aimed at offering quality education/services for all while respecting diversity and the different needs and abilities, characteristics and learning expectations of the students and communities and eliminating all forms of discrimination. Inclusive services at any level are quality provisions without discrimination or partiality and meeting the diverse needs of people. Inclusion is seen as a process of addressing and responding to the diversity of needs of all persons through increasing participation in learning, employment, services, cultures and communities, and reducing exclusion at all social contexts. It involves changes and modifications in content, approaches, structures and strategies, with a common vision which covers all people, a conviction that it is the responsibility of the social system to educate all children (UNESCO 2005), employ and provide social services. Besides, inclusion is defined as having a wide range of strategies, activities and processes that seek to make a reality of the universal right to quality, relevant and appropriate education and services. It acknowledges that learning begins at birth and continues throughout life, and includes learning in the home, the community, and in formal, informal and non-formal situations. It seeks to enable communities, systems and structures in all cultures and contexts to combat discrimination, celebrate diversity, promote participation and overcome barriers to learning and participation for all people. It is part of a wider strategy promoting inclusive development, with the goal of creating a world where there is peace, tolerance, and sustainable use of resources, social justice, and where the basic needs and rights of all are met. This definition has the following components: 1) Concepts about learners Education is a fundamental human right for all people Learning begins at birth and continues throughout life All children have a right to education within their own community Everyone can learn, and any child can experience difficulties in learning All learners need their learning supported child-focused teaching benefits all children. 2) Concepts about the education system and schools It is broader than formal schooling it is flexible, responsive educational systems It creates enabling and welcoming educational environments It promotes school improvement – makes effective schools It involves whole school approach and collaboration between partners. 3) Concepts about diversity and discrimination It promotes combating discrimination and exclusionary pressures at any social sectors It enables responding to/embracing diversity as a resource not as a problem It prepares learners for an inclusive society that respects and values difference. 4) Concepts about processes to promote inclusion It helps to identifying and overcoming barriers to participation and exclusionary pressures It increases real participation of all collaboration, partnership between all stakeholders 15  It promotes participatory methodology, action research, collaborative enquiry and other related activities 5) Concepts about resources Promotes unlocking and fully using local resources redistributing existing resources It helps to perceive people (children, parents, teachers, members of marginalized groups, etc) as key resources It helps to use appropriate resources and support within schools and at local levels for the needs of different children, e.g. mother tongue tuition, Braille, assistive devices. McLeskey and Waldron (2000) have identified inclusion and non-inclusive practices. According to them inclusion includes the following components: Students with disabilities and vulnerability attend their neighbourhood schools Each student is in an age-appropriate general education classroom Every student is accepted and regarded as a full and valued member of the class and the school community. Special education supports are provided to each student with a disability within the context of the general education classroom. All students receive an education that addresses their individual needs No student is excluded based on type or degree of disability. All members of the school (e.g., administration, staff, students, and parents) promote cooperative/collaborative teaching arrangements There is school-based planning, problem-solving, and ownership of all students and programs Employed according to their capacities without discriminations On the other hand, they argue that inclusion does not mean:  Placing students with disabilities into general education classrooms without careful planning and adequate support.  Reducing services or funding for special education services.  Placing all students who have disabilities or who are at risk in one or a few designated classrooms.  Teachers spending a disproportionate amount of time teaching or adapting the curriculum for students with disabilities.  Isolating students with disabilities socially, physically, or academically within the general education school or classroom.  Endangering the achievement of general education students through slower instruction or a less challenging curriculum.  Relegating special education teachers to the role of assistants in the general education classroom.  Requiring general and special education teachers to team together without careful planning and well-defined responsibilities. 2.2. Principles of Inclusion The fundamental principle of inclusion is that all persons should learn, work and live together wherever possible, regardless of any difficulties or differences they may have. Inclusive education extends beyond 16 special needs arising from disabilities, and includes consideration of other sources of disadvantage and marginalization, such as gender, poverty, language, ethnicity, and geographic isolation. The complex inter-relationships that exist among these factors and their interactions with disability must also be a focus of attention. Besides, inclusion begins with the premise that all persons have unique characteristics, interests, abilities and particular learning needs and, further, that all persons have equal access education, employment and services. Inclusion implies transition from separate, segregated learning and working environments for persons with disabilities to community based systems. Moreover, effective transitions from segregated services to inclusive system requires careful planning and structural changes to ensure that persons with disabilities are provided with appropriate accommodation and supports that ensure an inclusive learning and working environment. Furthermore, UNESCO (2005) has provided four major inclusion principles that support inclusive practice. These include: 1. Inclusion is a process. It has to be seen as a never-ending search to find better ways of responding to diversity. It is about learning how to live with difference and learning how to learn from difference. Differences come to be seen more positively as a stimulus for fostering learning amongst children and adults. 2. Inclusion is concerned with the identification and removal of barriers that hinders the development of persons with disabilities. It involves collecting, collating and evaluating information from a wide variety of sources in order to plan for improvements in policy and practice. It is about using evidence of various kinds to stimulate creativity and problem - solving. 3. Inclusion is about the presence, participation and achievement of all persons. ‘Presence’ is concerned with where persons are provided and how reliably and punctually they attend; ‘participation’ relates to the quality of their experiences and must incorporate the views of learners/and or workers and ‘achievement’ is about the outcomes of learning across the curriculum, not just test and exam results. 4. Inclusion invokes a particular emphasis on those who may be at risk of marginalization, exclusion or underachievement. This indicates the moral responsibility to ensure that those ‘at risk’ are carefully monitored, and that steps are taken to ensure their presence, participation and achievement. 2.3. Rationale for Inclusion Rationales for Inclusion and Their Respective Descriptions Educational Foundations Children do better academically, psychologically and socially in inclusive settings. A more efficient use of education resources. Decreases dropouts and repetitions Teachers competency( knowledge, skills, collaboration, satisfaction Social Foundation Segregation teaches individuals to be fearful, ignorant and breeds prejudice. All individuals need an education that will help them develop relationships and prepare them for life in the wider community. 17  Only inclusion has the potential to reduce fear and to build friendship, respect and understanding. Legal Foundations All individuals have the right to learn and live together. Human being shouldn‘t be devalued or discriminated against by being excluded or sent away because of their disability. There are no legitimate reasons to separate children for their education Economic Foundation Inclusive education has economic benefit, both for individual and for society. Inclusive education is more cost-effective than the creation of special schools across the country. Children with disabilities go to local schools Reduce wastage of repetition and dropout Children with disabilities live with their family use community infrastructure Better employment and job creation opportunities for people with disabilities Foundations for Building Inclusive Society Formation of mutual understanding and appreciation of diversity Building up empathy, tolerance and cooperation Promotion of sustainable development 2.4. Factors that Influenced Development of Inclusion Inclusiveness originated from three major ideas. These include: inclusive education is a basic human right; quality education results from inclusion of students with diverse needs and ability differences, and there is no clear demarcation between the characteristics of students with and without disabilities and vulnerabilities. Therefore, separate provisions for such students cannot be justified. Moreover, inclusion has got the world‘s attention because it is supposed to solve the world‘s major problems occurring in social, economic, religious, educational and other areas of the world. For instance, it is supposed to : counteract-social, political, economic and educational challenges that happen due to globalization impact; enhance psychosocial, academic and other benefits to students with and without special needs education; help all citizens exercise educational and human rights; enhance quality education for all in regular class rooms through inclusion; create sustainable environmental development that is suitable for all human beings; create democratic and productive society that promote sustainable development; build an attitude of respecting and valuing of differences in human beings; and ultimately build an inclusive society. Inclusive education is facilitated by many influencing actors. Some of the major drivers include: 1. Communities: pre-colonial and indigenous approaches to education and community-based programs movement that favour inclusion of their community members. 2. Activists and advocates: the combined voices of primary stakeholders – representatives of groups of learners often excluded and marginalized from education (e.g. disabled activists; parents advocating for their children; child rights advocates; and those advocating for women/girls and minority ethnic groups). 3. The quality education and school improvement movement: in both North and South, the issues of quality, access and inclusion are strongly linked, and contribute to the understanding and practice of inclusive education as being the responsibility of education systems and schools. 18 4. Special educational needs movement: the ‘new thinking’ of the special needs education movement ‘as demonstrated in the Salamanca Statement’ has been a positive influence on inclusive education, enabling schools and systems to really respond to a wide range of diversity. 5. Involvement of International agencies: the UN is a major influence on the development of inclusive education policy and practice. Major donors have formed a partnership – the Fast Track Initiative – to speed progress towards the EFA goals. E.g. UNESCO, etc. 6. Involvement of NGOs movements, networks and campaigns: a wide range of civil society initiatives, such as the Global Campaign for Education, seek to bring policy and practice together and involve all stakeholders based on different situations 7. Other factors: the current world situation and practical experiences in education. The current world situation presents challenges such as the spread of HIV/AIDS, political instability, trends in resource distribution, diversity of population, and social inclusion. This necessitates implementation of inclusion to solve the problems. On the other hand, practical experiences in education offers lessons learned from failure and success in mainstream, special and inclusive education. Moreover, practical demonstrations of successful inclusive education in different cultures and contexts are a strong influence on its development 2.5. Benefits of Inclusion It is now understood that inclusion benefits communities, families, teachers, and students by ensuring that children with disabilities attend school with their peers and providing them with adequate support to succeed both academically and socially. 1. Benefits for Students with Special Needs Education In inclusive settings people will develop:  Appropriate models of behaviour. They can observe and imitate socially acceptable behaviors of the students without special needs  Improved friendships with the social environment  Increased social initiations, interactions, relationships and networks  Gain peer role models for academic, social and behavior skills  Increased achievement of individualized educational program (IEP) goals  Greater access to general curriculum  Enhanced skill acquisition and generalization in their learning  improved academic achievement which leads to quality education service s  Attending inclusive schools increases the probability that students with SEN will continue to participate in a variety of integrated settings throughout their lives (increased inclusion in future environments that contribute building of inclusive society).  Improved school staff collaboration to meet these students‘ needs and ability differences  Increased parental participation to meet these students‘ needs and ability differences  Enhanced families integration into the community 2. Benefits for persons without Special Needs Education Students without special educational needs (SEN) will: 19   Have a variety of opportunities for interacting with their age peers who experience SEN in inclusive school settings.  serve as peer tutors during instructional activities  Play the role of a special ‘buddy’ during lunch, in the bus or playground.  Gain knowledge of a good deal about tolerance, individual difference, and human exceptionality.  Learn that students with SEN have many positive characteristics and abilities.  Have chance to learn about many of the human service profession such as special education, speech therapy, physical therapy, recreation therapy, and vocational rehabilitation. For some, exposure to these areas may lead to career choices.  Have increased appreciation, acceptance and respect of individual differences among human beings that leads to increased understanding and acceptance of diversity  Get greater opportunities to master activities by practicing and teaching others  Have increased academic outcomes  have opportunity to learn to communicate, and deal effectively with a wide range of individuals; this prepares them to fully participate in society when they are adults that make them build an inclusive society 3. Benefits for Teachers and Parents/Family  Inclusive education has benefit to teachers. The benefit includes: developing their knowledge and skills that meet diverse students’ needs and ability differences to enhancing their skills to work with their stakeholders; and gaining satisfaction in their profession and other aspects.  Similarly, parents/family benefit from inclusive education. For example, parents benefit from implementation of inclusive education in developing their positive attitude towards their children‘s education, positive feeling toward their participation, and appreciation to differences among humankinds and so on. For detailed information, see the table below. when they participate in inclusive education of their children. 20  Benefits of inclusion for Teachers and Parents/Family Benefits for Teachers Benefits for Parents/Family  They have more opportunities to learn new They: ways to teach different kinds of students.  They gain new knowledge, such as the  Learn more about how their children are being different ways children learn and can be educated in schools with their peers in an taught. inclusive environment  They develop more positive attitudes and  Become personally involved and feel a greater approaches towards different people with sense of accomplishment in helping their diverse needs. children to learn.  They have greater opportunities to explore  Feel valued and consider themselves as equal new ideas by communicating more often partners in providing quality learning with others from within and outside their opportunities for children. school, such as in school clusters or teacher  Learn how to deal better with their children at networks, or with parents and community home by using techniques that the teachers use members. in school.  They can encourage their students to be  Find out ways to interact with others in the more interested, more creative and more community, as well as to understand and help attentive solve each other‘s problems.  They can experience greater job satisfaction  Know that their children and ALL children are and a higher sense of accomplishment when receiving a quality education. ALL children are succeeding in school to  Experience positive attitude about themselves the best of their abilities. and their children by seeing their children  They get opportunities to exchange accepted by others, successful in the inclusive information about instructional activities setting, and belonging to the community where and teaching strategies, thus expanding the they live skills of both general and special educators  They benefit from develop Developing teamwork and collaborative problem- solving skills to creatively address challenges regarding student learning  Develop positive attitude that help them promoting the recognition and appreciation that all students have strengths and are contributing members of the school community as well as the society 4. Benefits for Society Inclusion goes beyond education and should involve consideration of employment, recreation, health and living conditions. It should therefore involve transformations across all government and other agencies at all levels of society. When students with special needs and without special needs are educated through quality inclusive education, it not only benefits students, teachers and parents it also benefits the society. Some of the major benefits may include: 21  Introduction of students with disabilities and vulnerabilities into mainstream schools bring in the students into local communities and neighbourhoods and helps break down barriers and prejudice that prevail in the society towards persons with disability.  Communities become more accepting of difference, and everyone benefits from a friendlier, open environment that values and appreciates differences in human beings.  Meaningful participation in the economic, social, political and cultural life of communities own cost effective non-segregated schooling system that services both students with and without special needs education. 2.6. Ultimate Goal of Inclusion The goal of inclusive education is to create schools where everyone belongs. By creating inclusive schools, we ensure that there‘s a welcoming place in the community for everyone after their school year‘s end. Students educated together have a greater understanding of difference and diversity. Students educated together have fewer fears about difference and disability. An inclusive school culture creates better long-term outcomes for all students. Typical students who are educated alongside peers with developmental disabilities understand more about the ways that they‘re all alike. These are the students who will be our children‘s peer group and friends. These students hold the promise of creating inclusive communities in the future for all our children. These students will be the teachers, principals, doctors, lawyers, and parents who build communities where everyone belongs. Inclusive society is a necessary precondition for inclusive growth is a society which does not exclude or discriminate against its citizens on the basis of disability, caste, race, gender, family or community, a society which levels the playing field for investment‘ and leaves no one behind. Thus, Inclusive growth which is equitable that offers equality of opportunity to all as well as protection in market and employment transitions results from inclusive society. Features of Inclusive Environment An inclusive environment is one in which members feel respected by and connected to one another. An inclusive environment is an environment that welcomes all people, regardless of their disability and other vulnerabilities. It recognizes and uses their skills and strengthens their abilities. An inclusive service environment is respectful, supportive, and equalizing. An inclusive environment reaches out to and includes individuals with disabilities and vulnerabilities at all levels from first time participants to board members. It has the following major characteristics:  it ensures the respect and dignity of individuals with disabilities  it meets current accessibility standards to the greatest extent possible to all people with special needs  provides accommodations willingly and proactively  Persons with disabilities are welcomed and are valued for their contributions as individuals. 2.7. Inclusive Environments An inclusive environment is a place that is adjusted to individuals’ needs and not vice versa that individuals are adjusted to the environmental needs. It acknowledges that individual differences among 22 individuals are a source of richness and diversity, and not a problem, and that various needs and the individual pace of learning and development can be met successfully with a wide range of flexible approaches. Besides, the environment should involve continuous process of changes directed towards strengthening and encouraging different ways of participation of all members of the community. An inclusive environment is also directed towards developing culture, policy and practice which meet pupils’ diversities, towards identifying and removing obstacles in learning and participating, towards developing a suitable provisions and supporting individuals. Therefore, successful environment has the following characteristics: It develops whole-school/environment processes that promote inclusiveness and quality provisions and practice that are responsive to the individual needs and diversities It recognizes and responds to the diverse needs of their individuals and ensuring quality provisions for all through appropriate accommodations, organizational arrangements, resource use and partnerships with their community. It is committed to serve all individuals together regardless of differences. It is also deeply committed to the belief that all persons can learn, work and be productive. It involves restructuring environment, culture, policy, and practice. It promoting pro-social activities It makes provides services and facilities equally accessible to all people It involves mobilizing resources within the community It is alert to and uses a range of multi-skilled personnel to assist people in their learning and working environment. It strives to create strong links with, clinicians, caregivers, and staff in local schools, work place, disability services providers and relevant support agencies within the wider community. It develops social relationships as an equal member of the class. It is also the classroom responsive to the diversity of individuals’ academic, social and personal learning needs. Barriers to Inclusion Though many countries seem committed to inclusion their rhetoric, and even in their legislation and policies, practices often fall short. Reasons for the policy-practice gap in inclusion are diverse. The major barriers include:  Problems related with societal values and beliefs- particularly the community and policy makers 5negative attitude towards students with disability and vulnerabilities. Inclusion cannot flourish in a society that has prejudice and negative attitude towards persons with disability.  Economic factors- this is mainly related with poverty of family, community and society at large  Lack of taking measures to ensure conformity of implementation of inclusion practice with policies  Lack of stakeholders taking responsibility in their cooperation as well as collaboration for inclusion  Conservative traditions among the community members about inclusion  Lack of knowledge and skills among teachers regarding inclusive education  Rigid curricula, teaching method and examination systems that do not consider students with dives needs and ability differences.  Fragile democratic institutions that could not promote inclusion  Inadequate resources and inaccessibility of social and physical environments 23  Large class sizes that make teachers and stakeholders meet students‘ diverse needs  Globalization and free market policy that make students engage in fierce completion, individualism and individuals’ excellence rather than teaching through cooperation, collaboration and group excellence.  Using inclusive models that may be imported from other countries. 24 CHAPTER 3: IDENTIFICATION AND DIFFERENTIATED SERVICES Impact of Disability and Vulnerability on daily life 1. Factors related to the person People respond to disabilities in different ways. Some react negatively and thus their quality of life is negatively affected. Others choose to focus on their abilities as opposed to their disabilities and continue to live a productive life. There are several factors that affect the impact a disability has on an individual. The following are often considered the most significant factors in determining a disability's impact on an individual. 1. The Nature of the Disability: Disability can be acquired (a result of an accident, or acquired disease) or congenital (present at birth). If the disability is acquired, it is more likely to cause a negative reaction than a congenital disability. Congenital disabilities are disabilities that have always been present, thus requiring less of an adjustment than an acquired disability. 2. The Individual’s Personality - the individual personality can be typically positive or negative, dependent or independent, goal-oriented or laissez-faire. Someone with a positive outlook is more likely to embrace a disability then someone with a negative outlook. Someone who is independent will continue to be independent and someone who is goal-oriented will continue to set and pursue goals. 3. The Meaning of the Disability to the Individual - Does the individual define himself/herself by his/her looks or physical characteristics? If so, he/she is more likely to feel defined by his/her disability and thus it will have a negative impact. 4. The Individual’s Current Life Circumstances - The individual‘s independence or dependence on others (parents). The economic status of the individual or the individual's caregivers, the individual’s education level. If the individual is happy with their current life circumstance, they are more likely to embrace their disability, whereas if they are not happy with their circumstances, they often blame their disability. 5. The Individual's Support System - The individual‘s support from family, a significant other, friends, or social groups. If so, he/she will have an easier time coping with a disability and thus will not be affected negatively by their disability. Common effects of a disability may include but not limited to health conditions of the person; mental health issues including anxiety and depression; loss of freedom and independence; frustration and anger at having to rely on other people; practical problems including transport, choice of activities, accessing buildings; unemployment; problems with learning and academic study; loss of self-esteem and confidence, especially in social situations. But all these negative effects are due to restricted environments, not due to impairments. The disability experience resulting from the interaction of health conditions, personal factors, and environmental factors varies greatly. Persons with disabilities are diverse and heterogeneous, while stereotypical views of disability emphasize wheelchair users and a few other classic groups such as blind people and deaf people. Disability encompasses the child born with a congenital condition such as cerebral palsy or the young soldier who loses his leg to a land-mine, or the middle-aged woman with severe arthritis, or the older person with dementia, among many others. Health conditions can be visible 25 or invisible; temporary or long term; static, episodic, or degenerating; painful or inconsequential. Note that many people with disabilities do not consider themselves to be unhealthy. Generalizations about disability or people with disabilities can mislead. Persons with disabilities have diverse personal factors with differences in gender, age, language, socioeconomic status, sexuality, ethnicity, or cultural heritage. Each has his or her personal preferences and responses to disability. Also while disability correlates with disadvantage, not all people with disabilities are equally disadvantaged. Women with disabilities experience the combined disadvantages associated with gender as well as disability, and may be less likely to marry than non-disabled women. People who experience mental health conditions or intellectual impairments appear to be more disadvantaged in many settings than those who experience physical or sensory impairments. People with more severe impairments often experience greater disadvantage. Conversely, wealth and status can help overcome activity limitations and participation restrictions. People with disabilities and vulnerabilities live with challenges that impact their abilities to conduct Activities of Daily Living (ADL). Disability and vulnerabilities can limit or restrict one or more ADLs, including moving from one place to another (e.g., navigation, locomotion, transfer), maintaining a position (e.g., standing, sitting, sleeping), interacting with the environment (e.g., controlling systems, gripping objects), communicating (e.g., speaking, writing, hand gestures), feeding (chewing, swallowing, etc.), and perceiving the external world (by movement of the eyes, the head, etc.), due to inaccessible environment. Many older persons face one or more impairments. Their situation is often similar to that of people with disabilities. Their needs are similar to those people with multiple disabilities with a decrease in the muscular, vision, hearing and cognitive capacities. 2. Economic Factors and Disability There is clear evidence that people with few economic assets are more likely to acquire pathologies that may be disabling. This is true even in advanced economies and in economies with greater levels of income equality. The impact of absolute or relative economic deprivation on the onset of pathology crosscuts conditions with radically different etiologies, encompassing infectious diseases and most common chronic conditions. Similarly, economic status affects whether pathology will proceed to impairment. Examples include such phenomena as a complete lack of access to or a delay in presentation for medical care for treatable conditions (e.g., untreated breast cancer is more likely to require radical mastectomy) or inadequate access to state-of-the-art care (e.g., persons with rheumatoid arthritis may experience a worsened range of motion and joint function because disease-modifying drugs are not used by most primary care physicians). In turn, a lack of resources can adversely affect the ability of an individual to function with a disabling condition. For example, someone with an amputated leg who has little money or poor health insurance may not be able to obtain a proper prosthesis, in which case the absence of the limb may then force the individual to withdraw from jobs that require these capacities. Similarly, economic resources can limit the options and abilities of someone who requires personal assistance services or certain physical accommodations. The individual also may not be able to access the appropriate rehabilitation services to reduce the degree of potential disability either because they cannot afford the services themselves or cannot afford the cost of specialized transportation services. 26 The economic status of the community may have a more profound impact than the status of the individual on the probability that disability will result from impairment or other disabling conditions. Research on employment among persons with disabilities indicates, for example, that such persons in communities undergoing rapid economic expansion will be much more likely to secure jobs than those in communities with depressed or contracting labour markets. Similarly, wealthy communities are more able to provide environmental supports such as accessible public transportation and public buildings or support payments for personal assistance benefits. Community can be defined in terms of the microsystem (the local area of the person with the disabling conditions), the meso system (the area beyond the immediate neighbourhood, perhaps encompassing the town), and the macro system (a region or nation). Clearly, the economic status of the region or nation as a whole may play a more important role than the immediate microenvironment for certain kinds of disabling conditions. For example, access to employment among people with disabling conditions is determined by a combination of the national and regional labour markets, but the impact of differences across small neighbourhoods is unlikely to be very great. In contrast, the economic status of a neighbourhood will play a larger role in determining whether there are physical accommodations in the built environment that would facilitate mobility for people with impairments or functional limitations, or both. Finally, economic factors also can affect disability by creating incentives to define oneself as disabled. For example, disability compensation programs often pay nearly as much as many of the jobs available to people with disabling conditions, especially given that such programs also provide health insurance and many lower-paying jobs do not. Moreover, disability compensation programs often make an attempt to return to work risky, since health insurance is withdrawn soon after earnings begin and procuring a job with good health insurance benefits is often difficult in the presence of disabling conditions. Thus, disability compensation programs are said to significantly reduce the number of people with impairments who work by creating incentives to leave the labour force and also creating disincentives to return to work. Political Factors and Disability The political system, through its role in designing public policy, can and does have a profound impact on the extent to which impairments and other potentially disabling conditions will result in disability. If the political system is well enforced it will profoundly improve the prospects of people with disabling conditions for achieving a much fuller participation in society, in effect reducing the font of disability in work and every other domain of human activity. The extent to which the built environment impedes people with disabling conditions is a function of public funds spent to make buildings and transportation systems accessible and public laws requiring the private sector to make these accommodations in non- public buildings. The extent to which people with impairments and functional limitations will participate in the labour force is a function of the funds spent in training programs, in the way that health care is financed, and in the ways that job accommodations are mandated and paid for. Similarly, for those with severe disabling conditions, access to personal assistance services may be required for participation in almost all activities, and such access is dependent on the availability of funding for such services through either direct payment or tax credits. Thus, the potential mechanisms of public policy are diverse, 27 ranging from the direct effects of funds from the public purse, to creating tax incentives so that private parties may finance efforts themselves, to the passage of civil rights legislation and providing adequate enforcement. The sum of the mechanisms used can and does have a profound impact on the functioning of people with disabling conditions. Factors Psychological of Disability This section focuses on the impact of psychological factors on how disability and disabling conditions are perceived and experienced. The argument in support of the influence of the psychological environment is congruent with the key assumption in this chapter that the physical and social environments are fundamentally important to the expression of disability. Several constructs can be used to describe one's psychological environment, including personal resources, personality traits, and cognition. These constructs affect both the expression of disability and an individual's ability to adapt to and react to it. An exhaustive review of the literature on the impact of psychological factors on disability is beyond the scope of this chapter. However, for illustrative purposes four psychological constructs will be briefly discussed: three cognitive processes (self-efficacy beliefs, psychological control, and coping patterns) and one personality disposition (optimism). Each section provides examples illustrating the influence of these constructs on the experience of disability. a) Social Cognitive Processes Cognition consists of thoughts, feelings, beliefs, and ways of viewing the world, others, and ourselves. Three interrelated cognitive processes have been selected to illustrate the direct and interactive effects of cognition on disability. These are self-efficacy beliefs, psychological control, and coping patterns which all these are socially constructed. b) Self-Efficacy Beliefs Self-efficacy beliefs are concerned with whether or not a person believes that he or she can accomplish a desired outcome (Bandura, 1977, 1986). Beliefs about one's abilities affect what a person chooses to do, how much effort is put into a task, and how long an individual will endure when there are difficulties. Self-efficacy beliefs also affect the person's affective and emotional responses. Under conditions of high self-efficacy, a person's outlook and mental health status will remain positive even under stressful and aversive situations. Under conditions of low self-efficacy, mental health may suffer even when environmental conditions are favourable. The findings from several studies provide evidence of improved behavioural and functional outcomes under efficacious conditions for individuals with and without disabling conditions (Maddux, 1996). How do self-efficacy beliefs affect disability? Following a stroke, for example, an individual with high self-efficacy beliefs will be more likely to feel and subsequently exert effort toward reducing the disability that could accompany any stroke-related impairment or functional limitation. The highly self-efficacious individual would work harder at tasks (i.e., in physical or speech therapy), be less likely to give up when there is a relapse (i.e., continue therapy sessions even when there is no immediate improvement), and in general, feel more confident and optimistic about recovery and rehabilitation. These self-efficacy beliefs will thus mediate the relationship between impairment and disability such that the individual would experience better functional outcomes and less disability. The development of self-efficacy of the individual is much affected by the environmental factors. 28  c) Psychological Control Psychological control, or control beliefs, is akin to self-efficacy beliefs in that they are thoughts, feelings, and beliefs regarding one's ability to exert control or change a situation. Self-generated feelings of control improve outcomes for diverse groups of individuals with physical disabilities and chronic illnesses. The onset of a disabling condition is often followed by a loss or a potential loss of control. What is most critical for adaptive functioning is how a person responds to this and what efforts the person puts forth to regain control. Perceptions of control will influence whether disabling environmental conditions are seen as stressful and consequently whether it becomes disabling. The individuals control over themselves depends on the provision of the environments: accessibility or inaccessibility. d) Coping Patterns Coping patterns refer to behavioural and cognitive efforts to manage specific internal or external demands that tax or exceed a person's resources to adjust. Generally, coping has been studied within the context of stress. Having a disabling condition may create stress and demand additional efforts because of interpersonal or environmental conditions that are not supportive. Several coping strategies may be used when a person confronts a stressful situation. These strategies may include the following: seeking information, cognitive restructuring, emotional expression, catastrophizing, wish-fulfilling fantasizing, threat minimization, relaxation, distraction, and self-blame. The effects of certain coping efforts on adaptive and functional outcomes benefits individuals with disabling conditions. In general, among people with disabling conditions, there is evidence that passive, avoidant, emotion-focused cognitive strategies (e.g., catastrophizing and wishful thinking) are associated with poorer outcomes, whereas active, problem-focused attempts to redefine thoughts to become more positive are associated with favourable outcomes. An adaptive coping pattern would involve the use of primary and secondary control strategies. What seems useful is the flexibility to change strategies and to have several strategies available. Active coping is a significant predictor of mental health and employment-related outcomes. Under conditions in which individuals with disabling conditions use active and problem-solving coping strategies to manage their life circumstances, there will be better functional outcomes across several dimensions (e.g., activities of daily living, and employment) than when passive coping strategies are used. An important component in the coping process is appraisal. Appraisals involve beliefs about one's ability to deal with a situation. Take, for example, two people with identical levels of impairment. The appraisal that the impairment is disabling will result in more disability than the appraisal that the impairment is not disabling, regardless of the objective type and level of impairment. Appraisal is related to self-efficacy in the sense that one's thoughts and cognition control how one reacts to a potentially negative situation. When a person feels that he or she can execute a desired outcome (e.g., learn how to use crutches for mobility), the person is more likely to do just that. Similarly, under conditions in which an individual appraises his or her disabling conditions and other life circumstances as manageable, the person will use coping strategies that will lead to a manageable life (i.e., better functional outcomes). e) Personality Disposition 29 Optimism is a personality disposition that is included in this chapter as an example of a personality disposition or trait that can mediate how disabling conditions are experienced. Several other interrelated personality factors could be discussed (e.g., self-esteem, hostility, and Type A personality). Optimism (in contrast to pessimism) is used for illustrative purposes because it relates to many other personality traits. Optimism is the general tendency to view the world, others, and oneself favorably. People with an optimistic orientation rather than a pessimistic orientation are far better across several dimensions. Optimists tend to have better self-esteem and less hostility toward others and tend to use more adaptive coping strategies than pessimists. Optimism is a significant predictor of coping efforts and of recovery from surgery. Individuals with optimistic orientations have a faster rate of recovery during hospitalization and a faster rate of return to normal life activities after discharge. There was also a strong relationship between optimism and postsurgical quality of life, with optimists doing better than pessimists. Optimism may reduce symptoms and improve adjustment to illness, because it is associated with the use of effective coping strategies. This same analogy can be extended to impairment. Optimistic individuals are more likely to cope with impairment by using the active adaptive coping strategies discussed earlier. These in turn will lead to reduced disability. The four constructs of the psychological environment (i.e., self-efficacy beliefs, psychological control, coping patterns, and optimism) were highlighted to illustrate the influence of these factors on disability and the enabling-disabling process. These psychological constructs are interrelated and are influenced to a large extent by the external social and physical environments. The reason for the inclusion of the psychological environment in this topic is to assert that just as the physical and social environments can be changed to support people with disabling conditions, so can the psychological environment. Psychological interventions directed at altering cognition lead to improved outcomes (i.e., achievement, interpersonal relationships, work productivity, and health) across diverse populations and dimensions. 3. The Family and Disability The family can be either an enabling or a disabling factor for a person with a disabling condition. Although most people have a wide network of friends, the networks of people with disabilities are more likely to be dominated by family members. Even among people with disabilities who maintain a large network of friends, family relationships often are most central and families often provide the main sources of support. This support may be instrumental (errand-running), informational (providing advice or referrals), or emotional (giving love and support). Families can be enabling to people with functional limitations by providing such tangible services as housekeeping and transportation and by providing personal assistance in activities of daily living. Families can also provide economic support to help with the purchase of assistive technologies and to pay for personal assistance. Perhaps most importantly, they can provide emotional support. Emotional support is positively related to well-being across a number of conditions. In all of these areas, friends and neighbours can supplement the support provided by the family. It is important to note, however, that families may also be disabling. Some families promote dependency. Others fatalistically accept functional limitations and conditions that are amenable to 30 change with a supportive environment. In both of these situations, the person with the potentially disabling condition is not allowed to develop to his or her fullest potential. Families may also not provide needed environmental services and resources. For example, families of deaf children frequently do not learn to sign, in the process impeding their children's ability to communicate as effectively as possible. Similarly, some well-meaning families prematurely take over the household chores of people with angina, thereby limiting the opportunity for healthy exercise that can lead to recovery. 4. Needs of Persons with Disabilities and Vulnerabilities Needs of persons with disabilities and vulnerabilities depends on different factors. People with disabilities do not all share a single experience, even of the same impairment; likewise, professionals in the same discipline (sector)do not follow a single approach or hold the same values. Exciting new directions will arise from individual professionals (sectors) working with persons with disabilities and vulnerabilities on particular briefs. This will produce different responses each time, complementary and even contradictory directions, but this richness is needed. Analysing the human beings, Maslow has identified five categories of needs, with different priority levels (Fig. 3.1), in the following order: survival (physiological), safety, social needs, esteem, and self- actualization (fulfilment). Maslow‘s model is also valid for persons with disabilities and vulnerabilities, whose needs are similar to those of ordinary persons. Nevertheless, many of these needs are not fulfilled, so disabilities and vulnerabilities seek to fulfil these needs and reach a state of wellbeing. Initially, disabilities and vulnerabilities attempt to fulfil the first level of needs (survival). The survival needs are formed by the physiological needs and include the biological requirements for feeding, performing hygiene, sleeping, ADL, and so on. When disabilities and vulnerabilities fulfil their survival needs, they will look for situations that keep them safe, before moving up the chain and fulfil their needs to be part of society and to achieve. As an example of needs in terms of safety, consider a person with visual impairment who wishes to cross the street safely. In contrast, for the elderly, at risk and street children safety might represent the ability to obtain emergency help after falling and not being able to stand again. Social need is a key element that disabi