Rehabilitation Philosophy for Persons with Disabilities

I believe that a good indicator of health is when one gets to fulfill life roles and to participate in activities that are meaningful to him or her. Health should be appreciated not just from a medical perspective. It is very much influenced by contextual conditions surrounding the person. For instance, a person with mobility issues may be able to navigate his/her way around the community if appropriate pieces of assistive device are given to him/her. Similarly, persons with autism with speech limitations may be able to express themselves more effectively if their communication partners drop social prejudices and take time to appreciate their non-verbal communication such as gestures, facial expressions and/or picture exchange systems. This said, physical barriers and the wrongful attitudes of people can be more disabling than a personís disorder or medical condition per se. 

In my opinion, persons with disabilities in the Philippines and in other countries for that matter, will benefit from a rehabilitation philosophy that is more social and ecological. Interventions should be client-centered wherein health care providers involve the client and his/her family in the assessment, goal-setting, therapy implementation and discharge planning phases of the rehabilitation process. For youth with developmental conditions such as autism, down syndrome, cerebral palsy and intellectual disabilities, I believe that their educational curriculum should place more emphasis on teaching practical life skills rather than on abstract academic concepts. Likewise, integrating therapeutic principles in the teaching strategies will make their learning experience more holistic. This is one of my motivations for establishing the Independent Living Learning Centre (ILLC) in 2003. The ILLC aims to enable its students to attain their optimum level of functioning to be integrated, productive and happy members of society. Itís transition education and job readiness programs teach students to be more independent in self-care, socialization and work. In ILLC, interventions are geared towards optimizing the learnerís potential not just by remediating his/her impairments but by managing environmental barriers as well. 

Inspired by a vision of a more inclusive educational system, I established the Academia Progresiva de Manila, (APDM) in 2013. The APDM is a duly accredited school which caters to all types of learners. As ILLCís sister school, the APDM accommodates learners with special needs for inclusion and mainstreaming. It takes pride in espousing progressive educational principles such as child-centered teaching, life-based instruction and respect for diversity.

Apart from philosophical barriers, prevailing pragmatic concerns revolving around the issue of poverty make access to much needed services difficult for many Filipinos with disabilities. It will be impossible for families who struggle to put food on their table to afford costly comprehensive medical, therapy and educational services for a child with special needs. Government health facilities, despite their sincerest efforts, are simply overwhelmed by the complex needs of millions of Filipinos living with some form of disability. 

The dire need for accessible and quality services for children with disabilities in poor communities led me to establish the Rehabilitation and Empowerment of Adults and Children with Handicap (REACH) Foundation, Inc. shortly after ILLC. The REACH Foundation, Inc. embarks on partnering with both the public and private sector in establishing community-based rehabilitation programs which render free services to the poorest of the poor. Here, families are empowered with competencies to care for their children with disabilities more effectively. To prevent a dole-out culture, parents of the beneficiaries engage in community-service to advance projects for the communityís benefit and in turn, develop a sense of pride and ownership over the program. 

Strengthening Community Partnership

Discharge planning should commence on the day a client is admitted in the hospital. Ideally, this should be a collaborative process. A team conference attended by all the professionals working with the client, family members, advocates and if possible, the person himself/herself, must be present. In this meeting, specific, measureable, attainable, relevant and timely goals have to be set. As a team, they should formulate a plan that is deemed feasible by everyone. Each of the stakeholdersí role has to be defined and documented so as to prevent redundancy and to establish accountability. A good practice to consider is availing the expertise of a case-manager to coordinate with the client and the stakeholders and to monitor the extent in which the clientís rehabilitation program is impacting on his/her health and well-being.

Recognizing the crucial role of the family in the care of a person with disability especially in remote areas, the TheraFree, a nation-wide volunteer mission program was organized in 2002. Rehabilitation professionals such as occupational, physical and speech therapists volunteer to visit remote areas to assess adults and children of varying disabilities and develop home therapy programs for them. The therapists devote time to demonstrate and explain the therapy procedures to the caregivers to help ensure proper carry-over of instructions at home.

Overcoming Challenges

I feel most blessed for being able to practice my passion and expertise. Certainly, I experienced birthing pains in establishing the organizations and programs such as those mentioned above. Considering the radical and progressive educational paradigm employed by ILLC, only four students initially enrolled despite their parentsí prior expressed confirmation. The initial enrollment turnout was way less than the projected and expected number needed to meet the schoolís operational expenses. This was understandably a threat to the programís sustainability considering that ILLC did not receive external funding from government nor from other private funding institutions. To this date, ILLC remains to be self-sustaining. 

Firmly believing in ILLCís curriculum, I endeavored to provide my four pioneering students the best intervention possible. I personally attended to the studentsí needs and diligently updated their parents about their progress. With Godís grace, hard work, creativity and a happy attitude towards serving, my students achieved favorable performance outcomes. This swayed apprehensive and skeptical parents to finally try ILLC for their kids. This has enabled me to increase our talented and compassionate pool of personnel. Supported with good administrative and management approaches, ILLC has grown substantially. From four students, more than 1,500 children have already benefited from its programs. From renting a small house, ILLC has been able to acquire its own property and construct a building at the heart of the City. Amidst all this growth, families appreciate how ILLC has managed to preserve its warmth and community spirit. 

Cognizant that majority of Filipino youth with special needs come from poor families, I established the REACH Foundation, Inc. With little resources available to hire staff, I personally went to informal settlements to lay the groundwork for a community-based rehabilitation program. Here, I trained volunteer moms to serve as my ëassistants.í We conducted therapy sessions. Soon enough, the project grew and the number of families coming has increased exponentially. With the REACH Foundation, Inc.ís impact becoming more palpable, we have been able to attract the interest and support of funding agencies and local government heads. For instance, the local government of Mandaluyong City in Metro Manila has partnered with the REACH Foundation, Inc. in establishing Project Therapy, Education and Assimilation of Children with Handicaps (Project TEACH), a comprehensive community-based program that regularly offers free services to more than 700 children. This program has attained national and international recognition as a best practice model. The most recent of which was the United Nations Public Service Awards. With this, various local and foreign government leaders and advocates have learned about our work and have come to study our framework for replication benefitting hundreds if not thousands in their respective communities.

Since its launch in 2002, the logistical costs of organizing TheraFree volunteer missions have increased. This made it more challenging for us at the University of the Philippines, College of Allied Medical Professions ñ Alumni Association to reach out to people from remote areas where help is most direly needed. But this did not discourage us from finding ways. With perseverance and a sincere heart to serve, the Unilab Foundation, Inc., a multinational organization saw how aligned our visions were and partnered with us. Through this partnership, we were able to set up an online portal for volunteer recruitment, community organization and data management. 

Although the ILLC, the REACH Foundation, Inc and TheraFree have made notable progress in past 15 years, we are the first to acknowledge that we still have so much work to do. From our mistakes, we get to polish our rough edges. Maintaining this attitude towards challenges and believing that failure is just a phase towards bigger success has helped me become steadfast in my work. 

Empowering Patients and their Carers

I am a strong advocate of client and family centered practice. Health practitioners have to cease seeing themselves as the sole experts and ultimate decision makers in patient care. Patients and their carers have to be involved throughout the rehabilitation process. As far as implementing therapy procedures are concerned, even institution-based health facilities such as hospitals should consider employing a more social service model wherein a core objective among therapists should be transferring knowledge and skills to the patient and to their carers. For instance, upon receiving adequate training from therapists, carers should be expected to conduct the management procedures on/with the patients as the therapists supervise and give them feedback for improvement. Additionally, I believe that especially in countries with an aging population, fostering balanced values of independence and communal spirit among its people is important so as not to encourage learned helplessness among persons with disabilities and apathy among their carers.

The Advent of Technology

The internet is indeed a convenient source of information but what is out in the world-wide web wonít necessarily be helpful for everyone. Therefore, it is crucial for health providers and consumers alike to be able to appraise information to determine the level of evidence that could support or disprove the effectiveness and practicality of certain treatments and interventions. Bookmarking credible and peer-reviewed websites is a good first step for novice appraisers of information.

With regards to adaptive technology, therapists must carefully assess the clientís capacities, contexts and activity demands first in order to help determine a goodness of fit between the client and the assistive device, whether it be high or low technology. A good practice is having a client trial the recommended technology first before he/she or a funding entity invests on it. This will help prevent wasting time and resources in purchasing unsuitable technology. In communities where resources are limited, health providers and consumers can be creative in indigenizing assistive technology. 

The Best Work of Life that Creates Sustainable Impact

Many teachers or therapists who specialize in children with special needs are lured abroad by the promise of better pay and benefits. With vast years of work experience, a good educational background and offers to work abroad, I opted to stay in my country and continue to find deep meaning in actively working towards helping children with special needs from all walks of life to become better equipped for life. 

Throughout my career, I have always felt most passionate about establishing programs for the underprivileged. Most of these programs were launched with no fan fair, yet through everyoneís support, these have managed to stay pertinent through the years. Sustainable impact rather than spot-lighted activities should be the benchmark for inspired service. 

Message to Millennials Striving for a Life Well-lived

It is important for the youth to have a good sense of self, equity and justice. It is about knowing what is right for oneself and happily pursuing oneís aspirations sustainably.  

From Compassion to Action | From Ordinary to Extraordinary

Compassion yields meaning only when service is put to work. Therefore, we must do more than simply hope and must take inspired action. Realizing our goals will require hard work and as we venture further into our lives, we will need to make personal sacrifices. When we stumble and rise in service of others, we become better equipped for bigger success not just for ourselves, but for humanity. 

As an educator, I try my best to teach my students to cultivate their potential to become outstanding and we can begin by doing ordinary things extraordinarily well. We should not be afraid to challenge established thinking in order to give way for progress and innovation.