Article 26 – Habilitation and rehabilitation - Article 26

Convention Text

 1.1 States Parties shall take effective and appropriate measures, including through peer support (R1), to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life (R2). To that end, States Parties shall organize, strengthen and extend comprehensive habilitation and rehabilitation services and programmes, particularly in the areas of health, employment, education and social services (R3), in such a way that these services and programmes:

(a) Begin at the earliest possible stage, and are based on the multidisciplinary assessment of individual needs and strengths; R4

(b) Support participation and inclusion in the community and all aspects of society, are voluntary, and are available to persons with disabilities as close as possible to their own communities, including in rural areas; R5.

1.2 States Parties shall promote the development of initial and continuing training for professionals and staff working in habilitation and rehabilitation services; R6.

1.3 States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.

Declaration of Needs and Characteristics

2.1 Those whose visual disability occurred at birth, childhood or during adolescence sometimes experience difficulties in making the transition from school/college life to working life and habilitation can help to ensure that blind and partially-sighted young people have the opportunity to develop and achieve their full potential.

2.2 People who become blind and partially-sighted during their working lives have to learn new communication, daily living and travel skills and how to overcome the difficulties of access to information. These skills and coping strategies have to be acquired at the same time as psychological and emotional adjustments are made to visual loss. Blind and partially-sighted people may also need additional vocational training before they return to work. It is essential for those in employment when visual disability occurs to remain on the payroll of their employers during their rehabilitation and training. This will help to ensure that they have the opportunity to return to their former post or one similar to it if this is practicable.

2.3 The highest incidence of visual disability occurs in later life; the prospects of becoming blind or partially-sighted increases substantially with age. Although older people face similar challenges as adults of working age when adjusting to visual loss - learning communication, daily living and travel skills as well as making an emotional adjustment - for most people the imperative to return to work does not arise. Consequently, it is essential for rehabilitation services for this group of people to be focussed on helping blind and partially-sighted people to continue to have the opportunity to lead fully inclusive lives in the community and to continue to contribute to family life.

2.4 Older blind and partially-sighted people face an additional challenge. As people become older their general health, hearing, physical and/or mental abilities diminish. Deteriorating abilities interact with visual disability to progressively reduce the capacity to lead a full and active life. Rehabilitation services must be designed and delivered to enable blind and partially-sighted people to adjust to the impact of ageing, so that optimum independence and activity can be sustained.

2.5 Sometimes, visual disability is caused by health conditions which also have an adverse effect on other abilities. For example, diabetes can effect eyesight and touch sensitivity. Head injuries can affect the ability to see as well as result in memory loss and learning difficulties. A substantial proportion of blind and partially-sighted people, especially older people, also have a hearing disability. The concomitant effect of dual sensory loss on a person's communication, daily living and travel capabilities can be very significant. Rehabilitation services must be capable of assisting blind and partially-sighted people with other health conditions and/or disabilities to lead inclusive lives in the community that are commensurate with their functional abilities.

2.6 Whilst the primary task of all blind and partially-sighted people's rehabilitation services must be to help blind and partially-sighted people to adjust to visual loss and to learn communication, daily living, information access and travel skills, it is also essential that these services help to ensure that the environments that blind and partially-sighted people interact with are appropriate to their requirements. Rehabilitation services should, for example, help to ensure that the lighting in a partially-sighted person's kitchen or workplace facilitates optimum use of residual vision. Rehabilitation services must also be ready and willing to campaign, for example, for the installation of a safe crossing at a busy road junction used by a blind person to visit local shops. If such environmental aspects are not addressed, the value and effectiveness of individuals' rehabilitation programmes are correspondingly reduced. The ability of blind and partially-sighted people to live inclusive lives in their communities is also diminished.

2.7 Blind and partially-sighted people also need equipment to overcome the communication, information, daily living and travel difficulties they experience. Governments have a responsibility to ensure that rehabilitation services provide such equipment at an affordable cost. Particular attention should be placed on IT provision for people with sight loss. There is a wide range of IT equipment available which can help people to access information on the internet, magnify text of letters, household bills etc. This equipment is often expensive and seldom provided to blind or partially sighted people when assessed for social care. The availability of such equipment can greatly increase the independence of a person with sight loss and reduce the isolation felt by blind or partially-sighted people, which can lead to depression and ill-health.

2.8 The approach to habilitation and rehabilitation for blind and for partially-sighted people is fundamentally different. The spectrum of visual loss encapsulates high levels of visual ability and total blindness. Some individuals' visual status enables them to function effectively in all aspects of daily life by utilising their residual vision. This is achieved by the use of low vision aids, controlling ambient and task lighting and learning to optimise the use of residual eyesight. However, people with little or no vision have to learn to utilise hearing, tactual and other senses. Their habilitation and rehabilitation must include instruction in Braille or other tactile scripts, in daily living skills that apply touch and kinaesthetic senses, as well as in travel skills, utilising a white cane or guide dog. Some people's habilitation and rehabilitation will require the application of a combination of these two distinct approaches.

2.9 Sometimes visual loss occurs over a period of many years and this requires continual adjustment. As individuals' eyesight deteriorates, new skills and coping strategies have to be acquired to maintain functional effectiveness in study, employment and daily life. This requires corresponding continuing access to rehabilitation services that are sensitive to academic, vocational, family, leisure, community and other interests, roles and requirements.

Important Aspects of Convention Text

3.1 Convention text - R1 Peer support.

3.2 Requirement - A compatible blind or partially-sighted person who has participated in a rehabilitation programme should be selected.

3.3 Convention text - R2 Attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.

3.4 Requirement - Equipment and instruction is required to acquire and maintain levels of reading, daily living and travel skills, using appropriate formats and techniques, including access technology, which must take account of the level of visual disability, visual prognosis, and present and future educational, employment, life status and goals.

3.5 Convention text - R3 Shall organise, strengthen and extend comprehensive habilitation and rehabilitation services and programmes, particularly in the areas of health, employment, education and social services.

3.6 Requirement - Rehabilitation services that are specifically designed for blind and partially-sighted people should be organised and delivered locally, involve the family, be provided either in people's own homes or at centres where groups of blind and/or partially-sighted people with similar habilitation or rehabilitation needs receive individual and group instruction and can provide mutual support. Centres should have recourse to a comprehensive range of rehabilitation assessment and tuition expertise .

3.7 Convention text - R4 Based on the multidisciplinary assessment of individual needs and strengths.

3.8 Requirement - The assessment team is to include professional staff qualified to determine rehabilitation needs from the perspective of the impact of visual loss on all aspects of an individual's life and well being. The assessment is to establish the extent to which instruction in communication, daily living and mobility skills should be based on the concepts of vision substitution, vision enhancement, or a combination of both.

3.9 Convention text - R5 Support participation and inclusion in the community and all aspects of society.

3.10 Requirement - Rehabilitation programmes and services should assist individuals to address the barriers to full participation and inclusion that blind and partially-sighted people face when making the transition from habilitation and rehabilitation to education and/or work and life in the community.

3.11 Convention text - R6 Promote the development of initial and continuing training for professionals and staff working in habilitation and rehabilitation services.

3.12 Requirement - Those employed to assist blind and partially-sighted people to adjust to visual disabilities must receive training that addresses the issues identified in Section 2 above. It is especially important that they have the ability to:

• Appreciate the relationship between blind or partially-sighted people and their environments;
• understand what action is required to remove the barriers to full inclusion and participation in the community;
• assist blind and partially-sighted people to adjust emotionally and psychologically to visual loss;
• provide instruction in the skills required by blind and partially-sighted people to overcome communication, information, daily living and travel difficulties that are an inevitable consequence of visual loss.

3.13 Requirement – Provision to enable those blind and partially-sighted people who can, through their own experiences and achievements, make a substantial professional contribution to the habilitation and rehabilitation of other blind and partially-sighted people.