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What Is Good Rehabilitation?

This article is intended to promote discussion of what model or models of rehabilitation we want here in Canada. My biases will be very plain. I believe that the most effective method of rehabilitation is the one used by the training centres operated by the National Federation of the Blind in the United States. I think it is important that readers understand my bias in order to evaluate my comments. However, I have attempted to describe the other models of rehabilitation accurately and fairly. My hope is that readers will submit articles expressing their own views concerning the kind of rehabilitation blind Canadians need.

Good training and equal opportunity-with them blindness can be reduced to the level of a nuisance. That's what we say in the Federation. But what is good training? How can we, as consumers of rehabilitation services, ensure that we get what we really need?

Good rehabilitation is more than just a collection of courses. It is the development of a point of view. When a blind person stops asking "Can I do that?" and begins saying "I think I can figure out how to do that" the most important hurdle on the path to good rehabilitation has been leapt. Getting from fear to self-confidence and from self-doubt to self-assuredness is what the "journey" of rehabilitation is all about.

There are three or four general ways in which blindness rehabilitation has been done. These "service delivery models" as social service professionals like to call them, have different underlying assumptions, different recipients of service, and vastly different outcomes.

Home Teaching or Community Rehabilitation

In theory, it would be nice if no one ever had to leave home to get training in the skills of blindness. A teacher could simply come to a client's home, spend a few hours once or twice a week, or even once every two weeks, and teach all that was needed. If the real problem of blindness was simply the loss of eyesight, this approach might work well. An extremely motivated student could follow up on each lesson and practice independently. The teacher would be there as a guide, but the student would work in much the same way as a college student taking correspondence courses.

But, since loss of eyesight is not the real problem of blindness, home rehabilitation teaching is rarely the complete solution. Those rare individuals who begin their training with a high level of self-confidence can gain a great deal from an itinerant teacher. But if confidence is lacking, or relatives undermine the program, a few hours with a teacher on an intermittent basis are not enough to overcome attitudinal barriers. The best role for a home rehabilitation teacher is to prepare a student for more intensive training or to work with students whose rehabilitation goals are limited. Many seniors find that home rehabilitation teaching is sufficient to help them remain in their homes with support from family, friends, and community agencies.

Independent Living Centre Model

In this approach consumers of services are given a list of choices. They pick the services that appeal to them and design their own program with a combination of classes (e.g. Braille, cane travel) and ongoing support (e.g. reader services). Again, this seems like an ideal system. The blind person is firmly in control and has absolute choice. The consumer remains in his or her own home for the training and can count on continued support from centre personnel. Because the centre is in the consumers' community, access is almost immediate.

The difficulty with this approach arises once again because the real problem with blindness is not the physical loss of eyesight. A consumer of services may choose a program designed to increase the level of comfort with blindness. If expectations are low, achieving comfort may not be in the consumer's long term best interest. A frightened student may deliberately avoid participating in classes or activities that cause fear, but by so doing may miss the opportunity to make the emotional breakthrough that could lead to true self-confidence. If the independent living centre deals with a variety of disabilities, staff may not have expertise in blindness. They may recommend on-going support from centre personnel instead of encouraging the development of skills and attitudes which would make total independence from the centre possible.

Traditional Residential Rehabilitation Centre

The traditional centre has the advantage of bringing students into a congregated setting for intensive work on blindness skills. In three or four months of intensive classes, the centre can accomplish as much as a home rehabilitation teacher or an independent living centre can accomplish in a year. Students are given instruction in a core curriculum. They leave the centre with at least some familiarity in a wide range of blindness skills.

The shortcoming of this approach is that it is almost totally focused on building specific skills. Although lip service is given to instilling confidence, students are constantly reminded that the professional staff is THE source of expertise. No attention at all is paid to the concept of working with other blind people to solve common problems and change public attitudes.

NFB Training Centres

Centres which operate using NFB philosophy include three inter-related goals: development of the skills of blindness; creation of a positive attitude about blindness and the effectiveness of those skills; and collective action to improve public attitudes and increase opportunities for all blind people. Without the combination of all three elements, rehabilitation cannot be truly successful.

Blind people are a part of general society and frequently adopt society's limited expectations of the blind. Because fear and self-doubt often cause students to limit their own options, NFB Centres require students to participate in the entire range of classes. Someone who has no interest at all in woodworking is expected to take a shop class because working safely inches away from a whirring power saw helps break down fear and instil confidence. It doesn't matter whether the student ever pounds another nail after leaving the program. The hammers and saws are simply a means to a more confident end.

A student who hates to cook is still expected to plan, prepare, and serve a meal for forty people. The purpose is to build confidence and to break down attitudinal barriers. Water skiing, technical rock climbing, sewing, drama and the production of plays, public speaking about blindness, are all a part of the curriculum. Anything which can stretch the student's experience and broaden their notion of what is possible for blind people is a potential "class".

A student who is learning Braille is expected to use Braille skills to write a grocery list, travel skills to shop for the items on the list, and homemaking skills to prepare the food. Classes are not isolated experiences-they are an integral part of the student's life.

Students with some remaining vision are blindfolded throughout the program. The purpose is to build confidence and to make it unnecessary for the student to return for retraining whenever vision changes. Students with some remaining vision often believe that they are able to function because of that vision. Wearing blindfolds proves that competence is possible without any vision at all. Later, when the training is over, students are free to use whatever combination of visual and blindness techniques is most effective for each individual. It takes time working without sight to truly rely on non-visual techniques.

Some people complain that it is patronizing and disrespectful to require adults to take courses in which they have no interest. The same could be said about law schools which require students interested in becoming prosecutors to take classes in tax, corporate, and torte law. Because students are often influenced in their thinking about the law by melodramatic television shows, their understanding of what the practice of law really means may be faulty. If those melodramatic television shows are American rather than Canadian, students from this country may not have a clear concept of the legal system they are entering. The same is true of blind people exposed to faulty concepts concerning blindness. They may have mapped a course without thoroughly understanding the territory. Also, they may later find that the class they didn't want to take, helps them in unexpected ways.

Perhaps the biggest drawback of the NFB centre approach is that it takes from nine months to a year for a student to complete the program. Because it is a residential program, students must endure lengthy separations from their families. For some people who could benefit from the training, the separation makes attendance at an NFB centre impractical. Some NFB centres have modified programs to make it possible for seniors to attend weekly sessions. The centres have also devised summer programs for youth. Although these modified programs are not as comprehensive as the full centre course, they are a valuable service for many individuals who are not prepared to invest nine months. Those students who find a way to attend a residential program almost universally agree that the investment in time and effort is well worth it.

Where Do We Go From Here?

Beginning with the NFB:AE seminar held in New Orleans this past summer, and continuing at the NFB:AE Convention in Vancouver February 1998, the best possible rehabilitation services for blind Canadians will be discussed. Future issues of the Canadian Blind Monitor will carry articles about those discussions. We need the best thinking from all blind Canadians if we are to advocate changes in rehabilitation in this country. We invite you to participate.