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Introduction
In most countries in the Asia Region services for the disabled have been
built around single disabilities. Most training programmes for professionals
also concentrate on meeting needs in a specific area of disability.
However in 1986 the Hong Kong Society for the Blind established a Day
Activity Centre-cum-Hostel for "the Mentally Handicapped Blind"
under government subvention. It remains the only centre that provides
rehabilitation services specifically designed to meet the training needs
of persons with multiple disability and visual impairment (MDVI) in Hong
Kong.
The Morning Glory Day Activity Centre cum Hostel has a current capacity
of 62. Since we came into operation we have used a Functional Assessment
Checklist developed by the world renowned Perkins School for the Blind
as the major assessment tool for our service users. The assessment results
form the basis for the development of an Individual Education Plan (IEP)
(otherwise known as the Individual Training Plan) and an Individual Service
Plan (ISP) for each service user designed to meet their needs and develop
their potential. Both the IEP &ISP are reviewed annually to see if
the goals set have been achieved and to modify the service objectives
according to the changing needs and potentials of the service users.
Although the Morning Glory Day Activity Centre cum Hostel was initially
established to serve visually impaired adults with mental retardation,
over the past eighteen years we have been serving visually impaired adults
with multiple disabilities including those with dual sensory (Deafblindness)
epilepsy or paraplegia.
An Innovative Approach to the Rehabilitation and Training of Persons with
MDVI In helping persons who have MDVI, conventional mode of service delivery
is based upon a highly structured environment with activity based "training"
classes. Schedules are usually fixed and clients are directed to various
activities. Clients tend to be passive and learning is rarely found to
be self-directed.
Since 2000, we have adopted a new rehabilitation approach that aims to
stimulate the realization an individualís full potential as far
as possible, irrespective of their degree of disability.
Learning with "CHOICE"
C - Clients' choice
H - Happiness - the programme provides happiness to client
O - Ownership - the client is the owner of the programme
I - Innovation
C - Community integration
E - Empowerment
The CHOICE approach has focused on a continuum of care, a client-centered
approach, and the promotion of self-motivation in service users. It aims
to develop in clients a positive life experience, to help them to face
their difficulties and be ready for risk-taking so as to mingle with normal
people. It is an ongoing life process.
2. Enhancement of Individual Functioning
a. Integrating technology and adaptive equipment for training and communication
Communication is a two way process. To enable the disabled to be an active
participant, objects of reference and tactual signs are used to build
up their understanding of surroundings. Furthermore, we believe technical
aids can increase motivation, attention, verbal communication, language
skills and academic skills of the service users. Therefore, an extensive
use of technical aids and adaptive equipment in training sessions, leisure
time and social communication is encouraged
b. Reactive & Multi-Sensory Environments Due to multiple handicaps,
the service users may be passive to their surroundings. The provision
of a "Reactive environment" that the disabled would become aware
of how their actions will make things happen is promoted. Trainees can
explore objects by themselves at their own pace and in their own time.
They are given the opportunity to look at or listen to objects and leisure
equipment, which they have selected. They begin to understand that this
particular environment is a safe place within which to experiment. A Multisensory
training room, supported by the Queen's Elizabeth Foundation for the Mentally
Handicapped in Hong Kong, was established in 2003 to conduct multisensory
training for the MDVI.
3. Family Partnership
Family members are our partners in the service delivery process for service
users. Right from intake assessment, family members are involved as partners
to gather information about the client and to set goals for the Individual
Training and Service Plans. They are encouraged to attend case conferences,
training programmes as volunteer instructors to strengthen their skills
in handling their handicapped members of the family and join social and
recreational activities together with the multiply handicapped service
users. Partnership is thus built upon mutual help and support.
To make partnership a success, a Parent-staff Committee and Parents Association
have been formed in the early 90s to review the services of our Morning
Glory Day Activity Centre cum Hostel from time to time and to set up strategic
plan for its service development. Parents always know their children better
than anyone else. They have the right to obtain first hand information
about the services their children are receiving. They work in partnership
with our staff members and professionals.
4. Integration into the community
Community integration is our ultimate goal for the rehabilitation of the
MDVI. It can be done through the mobilization of volunteer service to
promote understanding of the MDVI among the people living in the community,
as well as to demonstrate the potential of our MDVI trainees by encouraging
them to provide simple volunteer service to community in return.
Community and Rehabilitation Networking Close liaison with different community-based
service teams has been pursued to provide a wide range of care and support
services that assist the MDVI to integrate to the community and maintain
their independence, dignity and quality of life as far as their potentials
permit. Consultation service in the form of case conference, inter-professional
consultation and collaboration for joint programmes have been launched
to promote the general well being of the MDVI adults.
To prepare MDVI trainees for transition to higher level of training, we
have started to engage them in some form of supported employment some
years ago. Since 1999, six trainees have been arranged to take turn on
alternate days to do cleaning for the Parents Resource Centre for the
Visually Impaired Children located in a commercial center near to our
Morning Glory Day Activity Centre cum Hostel.
5. Staff Training & Experience sharing
The training of the MDVI with deaf blindness has been a difficult task.
However, since early 1992, the Hong Kong Society For the Blind had started
to send staff to the Perkins School for the Blind for training in deaf
blind rehabilitation. With support from the Community Chest in Hong Kong,
the Deaf Blind Rehabilitation Project was started for adults at the Hong
Kong Society for the Blind. Realizing that communication is essential
in facilitating the link between the deaf blind and the people around
them, a set of tactual signs that modified from local sign language used
by the deaf people in Hong Kong was developed between 1993 and 1996. In
year 1999, a pilot study was launched with the Ebenezer Training Centre
and the Caritas Jockey Club Lok Yan School on the teaching of tactual
signs for deaf blind children at school age. In 1994, 1998 and again 2003,
we are pleased to have invited experts from the Perkins School for the
Blind to conduct staff training for our rehabilitation instructors and
special school teachers in MDVI training. Through such training, new ideas
and new training approaches have been adopted to improve the performance
and progress of our service users. In addition, the Perkins experts came
to Hong Kong from time to time to review our training programme and to
cultivate staff with new insights that can be adapted to fit the local
context. We had learnt a lot from the experts and had been able to improve
and strengthen our outcome effectiveness in MDVI rehabilitation. Hence,
we are always on the forefront in the service. On the other hand, we receive
visitors from other NGOs serving in related service units for an exchange
of experience from time to time. Also, we carry out training for the rehabilitation
workers who wish to acquire knowledge and skills in handling multiply
handicapped clients with visual impairment for knowledge and experience
sharing. In 2003, we published a training manual on deaf blind rehabilitation
in Simplified Chinese and Traditional Chinese, and produced a CD-rom on
Tactual Signs in both Cantonese and Mandarin versions. The training manual
and CD-rom is considered as a good reference for people working with the
multiply handicapped persons including the deaf blind. They are distributed
to rehabilitation personnel in Hong Kong through sale. People working
with MDVI in the Asian region who can read Chinese and listen to Cantonese
or Mandarin may find it a useful reference.
Conclusion
Due to disparity in social and economic developments, there are different
approaches to
training of MDVI in different regions of the World. However, apart from
learning from the experts, we believe that an experience sharing and exchange
through ìThe Educatorî published by the ICEVI is an important
means to learn from each other to upgrade our service and to promote the
well-being of the clients we are serving. We welcome feedback from readers,
as views expressed by the professionals working with the multiply handicapped
may give us further insight in trying out new approaches that would yield
better outcome in the rehabilitation of MDVI. If you have any comments
to the article presented or you wish to share with us your views regarding
rehabilitation of MDVI, please write to genadmin@hksb.org.hk
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