research on the needs of community based rehabilitation (cbr) for disabled persons in thailand

8/6/2019 Research on the Needs of Community Based Rehabilitation (CBR) for Disabled Persons in Thailand

1/93

Research on the Needs of Communlty BasedRehabilitation (CBR) for Disabled Persons

in Thailand

Som-arch Wongkhomthong, M.DChongkolnee Chutimatavin, IVIA

ASEANI Institute for Health DevelopmentMahidol UniversitY

1998

Funded by Natlonal Rehabllltatton Center forDlsabled Persons JaPart


2/93

Research on the Needs of Community BasedRehabilitation (CBR) for Disabled Persons

in Thailand

Som-arch Wongkhomthong, M.DChongkolnee Chutimatavin, MA

ASEAI{ Institute for Health DevelopmentMahidol University

1998

Funded by National Rehabilitation Center forDisabled Persons Japan

'ffit-


3/93

The Needs of Community Based Rehabilitation (CBR) forDisabled Persons in Thailand

By Som-arch Wongkhomthong, Chonkolnee ChutimatavinISBN: 974-661-593-9

First Edition 1998Printed by : Printing DivisionASEAN Institute for Health DevelopmentMahidol University, SalayaNakornpathom 7 3170, Thailand

Som-arch WongkhomthongResearch on the needs of community based rehabilitation (CBR) for disabledpersons in Thailand /Som-arch Wongkhomthong, Chongkolnee Chutimatavinl.Rehabilitation-Thail and. 2. Handicapped. 3. Research.

I. Chongkolnee Chutimatavin. II. Title.w8320. JT3 5693 1998ISBN :974-661-593-9


4/93

Acknowledgements

In regards to the success of this research project, I would like to thankand acknowledge the kind assistance and cooperation of people andorganization concerned. Many thanks to the Director of Sirindhron NationalMedical Rehabilitation Centre of Department of Medical Service, MOPH andher team, The Director of Office of the Committee on Rehabilitation forDisabled Persons of the Department of Public Welfare and his team. Alsothanks to the Provincial Chief Medical Officer, Kanchanaburi Province, HeadDepartment of Personnel Development and Primary Health Care and theHeads of the Health Center.

our special thanks to Assoc. Prof. Dr. Boongium Tragoolvongse forproviding information and his helpful opinions, Mr. Kevin Anthony Noble for hisassistance in language editing. Last but not least, our thanks to those whosenames we have not mentioned, for their kind cooperation during theinterviewing, and data collecting processes.

Som-arch Won gkhomthongChon g kol nee Chutimatavi n

August 3, 1998.


5/93

Executive Summary

A cross-sectional descriptive study to identify the situation and needs ofcommunity-based rehabilitation (CBR) for disabled persons in Thialand wascarried out during June 29 - August 3, 1998. The research study has threespecific objectives: identifying the general situation of disabilities andimpairments, the situation and needs for community-based rehabilitation andpossible areas for international cooperation for CBR in Thailand. The researchmethodologies consist of three methods; a literature survey from publishedand non-published documents from organizations working in this field, visits tonine institutions in Thailand as well as personal interviews of twenty-four Thaiauthorities, using unstructured questionnaires. The research results weresummarized under six topics: basic statisties, CBR services, the needs ofCBR, foreign assistance for CBR and the potential uses and limitations of CBRmodel in Thailand. In summary, the research results show that:

1. Basic Statistics: there were approximately '1 p24,12O (1-7 Yo of totalpopulation) disabled persons of all ages. Some sources of information citedhigher figures, 4,825,682 persons (8.08 %) of the total population as beingdisabled. Most of the disabled were scattered in rural areas. The majority ofdisabled persons were in the Northeast, followed by the North and Centralregions respectively. The South had the least compared to all regions. Thecaurses of disability are mostly due to congenital anomalies, accidents andunidentified causes.

2. CBR Services: In 1991, the government has issued six decrees inThe Rehabilitation of Disabled Person Act which consist of policies to provideequity between disabled persons and non-disabled person in society,Furthermore, the law entitles and encourages disabled person who have


6/93

ill

registered under the "Rehabilitation Act" to receive rehabilitation services freeof charge, providing all levels of education as considered appropriate. Thehandicapped also received vocational training with no charge. The problemare: (a) the total registration of disabled persons in only 3.49 - 16.40% of allthe disabled, and (b) there are no prosthetist nor orthotists in Thailand. Thisresults in low production standards of artificial body parts.

3. Needs of CBR: Since the CBR concept has earned exceptance andis considered as essential for disabled person who want to live happily in theirown communities, the Medical Service Department (MDS) has begun bytranslating a rehabilitation manual. Now the MDS is in the process of pilot-testing a model of "lndependent Living Unit". CBR by the Public WelfareDepartment were established by selecting 10 provincial pilot projects and willbe expanded to 15 provinces in 1997. There are some problems in creatingjobs for disabled persons so that they are economically independent-independent living in community-such as the educational limitations thatprevent them from enrolling in the vocational training program once they enteras well as the ability to complete the vocational training program, The trainingtools is insufficiency, the information being taught is not keeping up withmodern technology and there is a severe shortage of "workshop trainers".Moreover, CBR is often inadequately supported by the referral system.

4. The Potential use and Limitation of the CBR Model: The potential ofCBR the model for Thailand is that it will be utilized by Village HealthVolunteers (VHV) who will have the role of giving information and the provisionof basic medical services. VHVs will detect disabling symptoms and reportthem to the Health Center in order to give training to the handicapped people.This model has the best potential for success for CBR. At present, there is apilot test of the model in some provinces. There are also some limitations of


7/93

IV

CBR model, i.e, shortage of staff, and health centers do not have a prominentrole in rehabilitating the disabled. The key to success is to have clear policieswith a sufficient budget for providing training. Also, the success will dependupon the efficiency of each individual health center.

5. Request for International Co-operation: This research has found thatthe disabled have obvious problems in all aspects of rehabilitation. The mosturgent needs concern the inadequacy of vocational and medicalrehabilitation. These point are: (a) people working with the disabled need aspecial school for prosthetists and orthotists which would not only benefitThailand but also neighbouring countries, (b) provide scholarships to P&OTechnicians for advance training, (c) need updated equipment to improvevocational training, and (d) specialists are needed to help train vocationaltrainers.

CBR concepts have already taken hold among GOs, NGOs, and Self -Help Groups, as well as the disabled people themselves. These efforts havelead to programs for research and development, brainstorming seminars andcollective effort on drawing a master plan for CBR in Thailand.

The next stage on CBR in Thailand has now been undertaken byvarious pilot projects. This is a sigificent stage. lf the model from the pilotprojects is expanded on a large scale, it will need good collaboration amongthe networking parties and sufficient financial support to accommodate itsimplementation. The goal of CBR will then be attained, leading to theassistance to disabled people in Thailand in sustainable ways.


8/93

Table of Contents

AcknowledgementExecutive SummaryTable of ContentsList of Tablesl. Introductionll. Research ObjectivesI ll. Research MethodologieslV. Research PeriodV. Research Results5.1 Basic Statistic

5.1.1. lndicators of health and population5.1.2. Competent authorities on health services5.1.3. Health policies and planning5.1.4. The present conditions of people with disability5.1.5. Summary of the latest survey5.1 .6. Networking among administrative organizations5.1 .7 . Specialist in the rehabilitation field5.1.8. Main organization of CBR

5.2 CBR Services5.2.1. The policies for people with disabilities5.2.2. The actual condition of medical rehabilitation5.2.3 The education for handicapped5.2.4 fhe condition of employment and vocational training5.2.5. The present condition of supply of prosthesis and orthosis

5.3 The Needs of CBR5.3.1. Training for staff and specialist

Pagei

ii-ivv-vi

vii1

1-2222

3-56

6-77-10

1114

14-1515

14-2829

29-4544-4950-52

53-55


9/93

5.3.2. Distribution of primary health care in the district5.3.3. Vocational training for economicue independence5.3.4. Information network system5.3.5. Seminar and meeting for specialist5.3.6. Present condition of CDR implementation

Foreign Assistance for CBR1. International organizations providing education support2. Operating agencies for people with physical disability5.4 The Possibility and Limitation of CBR Model

5.4.1. Model A : Support team by handicapped people (Mexico case) 705.4.2. Model B : Mobile rehabilitation unit (lndonesia case) 705.4.3. Model C : Community volunteer system (Philippines case) 715.4.4. CBR Model for Thailand 72-74

5.5 Request for International Gooperation 74-75Annex 1: List of References 76Annex 2: List of Institutional Visits 77Annex 3: List of Interviewees 78-82

vi

55-5656-61

6161-66

66

676B-69


10/93

vii

List of Tables

Page1, Total population (Latest reported) 32. Livebirths and Deaths 43. First 10 leading cause group of death 54. Population reported disabled by age, sex and area 85. Population reported disabled by type of disability I6. Population reported disabled when the impairment occured 107. Total of disabled person and ratio of registration 118. Causes of disabilities: data from thesis 129. Causes and type of disabilities: NSO survey 1310. Government budget plan for special education 2311. Government sponsored school for special education 30l2.Teachers in special education program 3113. School and classrooms for children with disability 3414. School with integration program of Bangkok area 3815. School with integration program outside Bangkok 39l6.Teacher college with special education program 4317. Short course teacher training in special education 4518. Opinions of handicapped on vocational training 5619. Knowledge acquired from vocational training 5720. Reason on why the knowledge acquired from training was not enough 5721. Occupational choice of the disabled 5822. Assistance needs in self-employed business 5823. Total handicapped enrolled and completed training program 60


11/93

The Needs of Community -Based Rehabilitation (CBR)in Thailand

l. IntroductionThailand, similar to other countries in South-east Asia, is in the

transition period from an agricultural society to a newly industrializedcountry. During this transition period, it is expected that Thailand will face alot of problems, ie, traffic and other kinds of accidents, occupational diseaseand others, which will lead to disabilities and impairments. Those disabilitiesand impairments also caused by other factors such as congenitalabnormalities, other types of communicable and non - communicablediseases, mental illness, chronic alcoholism and drug addiction, malnutritionand disability from environment factors,( ie, taken a wrong drug, beingexposed to loud noise). In previous research, researchers have identifiedthe magnitude of the problems as well as organizations that deal withdisabilities and impairments in Thailand, In this report, the researchers willexamine in - depth the situation and the needs of community - basedrehabilitation (CBR) programs in Thailand. The result of the study will helppolicy makers as well as national and international organizations dealingwith disabilities and impairments to set up appropriate measures to improvethe situation of CBR programs in Thailand.

ll. Research ObjectivesGeneral objective: To identify the situation and needs of community - basedrehabilitation (CBR) programs in Thailand.


12/93

2

Specific objectives:1. To identify the general situation of disabilities and impairments.

2. To identify the situation and needs for community - basedrehabilitation (CBR).3. To identify possible areas for international cooperation for CBR.

lll. Research Methodologies.The research methodologies consist of the following methods.1. Literature survey from published and non-published, ie, internal,

documents of related organizations, both in Thai and in English ( see Annex| - List of References).

2. Institutional visits to observe certain activities as well as to gathersome unpublished information ( see Annex ll - List of lnstitutional Visits).

3. Personal Interviews: A total of 24 persons were interviewedindividually by using unstructured questionnaires ( see Annex lll - List oflnterviewees). The twenty four interviewees were purposively selectedaccording to their direct involvement in rehabilitation.

lV. Research Period : June 29 - August 3, 1998.V. Research Results

The results were summarized under the following six topics:1. Basic statistics2. CBR services3. The needs of CBR4. Foreign assistance for CBR5. The possibility and limitation of CBR model


13/93

3

6. Request for International cooperation to National RehabilitationCenter for the Disabled in Japan

5.1 Basic Statistics

1. Indicators of health and population

Table 1: Total Population ( latest reported, January 1998)No. Population Total Number

1.2.

3.4.5.

6.

Total populationTotal population classified by sex- Male- FemaleTotal population in urban areaTotal population in fural areaTotal population classified by region- North- Northeast- South- Central (not included BKK)- BangkokTotal oopulation classified bv oroup of aoe

60,763,000

30,363,00030,400,00019,127,00041,636,000

11,363,00020,72A,0008,021,00013,550,0007,109,000

16,375,00039,282,0005.106.000

- Under 1 5- 15-59- 60 and above

Source : Institute of Population and Social Research


14/93

4

Table 2 : Live births and Deaths by Sex, Number and Rate per 1,000Population (1 982-1 994)

rate per 1,000Year Live births Live birth

RateDeaths Death

Rateotal Male Female Total Male Female19821983198419851986

198719881 98919901991

199219931994

1,075,6321,055,802956,680973,624945,827

884,043873,842905,837956,237960,556

964,557957,832960,248

548,643535,074489,114498,001482,972

452,508447,750465,51549't ,010493,753

493,900491,243494,485

526,989520,728467,566475,623462,855

431,535426,092440,322465,227466,803

470,657466,589465,763

22.221.319,018.818.0

'16.516.016.317.017.O

16.816.516.3

247,402525,552225,282225,088218,025

232,968231,227246,570zcz,c tz264,350

275,313285,731305,526

144,066144,816130,849128,977125,086

133,179133,721143,'156147,887155,198

162,546170,747184,480

103,336107,77694,43396,1'r192,939

99,78997,506103,414104,625109,152

112,767114,984121,046

5.1c. l4,54.44.1

4.34.24.44.54.7

4.84,95.2


15/93

b

Table 3 : First 10 Leading Cause Groups of Death by Rate Per100,000 Population According to ICD Mortality TabulationList,1, 1Oth Revision 1994

Cause Group Order Total Male FemaleNumber Rate Number Rate Number Rate

l.Diseases of thecirculatory system

2.Other accidents, includingsequelael

3.Neoplasms

4.Diseases of therespiratory system

S.Certain infections andparasitic diseases

6.Diseases of the digestivesystem

T.Diseases of thegenitourinary system

S.Diseases of the nervoussystem

9.Endocrine, nutritional andmetabolic diseases

l0.Axsault

z

1

q

J

4

o

Io

10

51,936

36,155

28,741

20,772

'15,961

10,618

6,338

6,334

4,520

4,161

88.5

61.6

48.9

35.4

27.2

18.1

10.8

10.8

7.7

'7 Itl

32,079

28,833

17,216

14,102

10,609

7,381

3,467

4,156

1,892

3,481

109.2

98.1

58.6

48.0

JO. I

25.1

'1'1.8

14.1

6.4

'1 1.9

19,857

7,322

11,525

6,670

5,352

3,237

2,871

2,178

2,628

680

67.6

25.0

39.3

22.7

18.2

11.0

9.8

7.4

9.0

2.3


16/93

o

2. Competent authorities on health services: principle organizationsMinistry of Public Health-Provincial Hospital Division( under the Office of The Permanent Secretary)

-Rural Health Division( under the Office of The Permanent Secretary)

-Department of Medical ServicesBangkok Metropolitan Administration-Department of Medical ServicesMinistry of University Affairs-University Hospitals

Collaboration among organizationsAll organizations have a defined common goal that is to serve people

in the country including disabled persons; despite some organizations thatmay have varied ideas and action plans, all still maintain the goal ofachieving benefits for the people.

However, although they have had good collaboration at the policylevel, to some extent on the operational level, they still need to cooperatemore efficiency.

3. Health policies and planning: the present policies by central and localgovernments.

According to the 8th National Development Plan (1997-2001) thereare four main policies in public health development as summarized belows :

a) HUMAN RESORCE DEVELOPMENT: To develop human resourcesin the field of health at all levels - ministry, provincial, district, sub-district andvillage - especially in reaching down to the family level in order to develop


17/93

7

competencies in taking care of oneself and one's family members. This isthe main objective of health administration.

b) EOUITY: To manage the health service system to ensure equity ofhealth services to the people,c) HEALTH CARE REFORM: To reform the health care system by

introducing new models in health services. For example, the "Family Doctor"which will link the hospital to the community, etc.

d) HEALTH INSURANCE: To emphasis health insurance service forpeople, to ensure the establishment of a public system so that people willhave assurance of medical care whenever they become sick.

4. The present conditions of people with disabilities (Statistic survey)

A study from the National Statistics Office found that in 1995 therewere approximately 1,024,120 disabled person of all ages. Most of disabledpersons were scattered in rural areas (in both municipal areas and non-municipal areas). The majority of disabled person were in the Northeast,followed by the North and Central respectively, and that the South had theleast compared to all the regions. The figures for people with disabilitieswill be presented by using the most recent survey data (1996). The detaileddata is shown in the following tables.(Table 4,5,6 respectively)


18/93

GE(E

.g.9tr5=co=

g(uEolrq(oo)


19/93

Fgfigfq$dqS3FggggZ' tf,ggE9'BTFF$$gd=EEv 3 s=EEEEa n 6'$ I frfl3333,. fr _+ v,v dFdl

{Itooc,oog

dNds*d*F$s$NssFno (.) iJ s - .A b N iJ O, @ (rt O O, O, S {oF}Eiie:'It, Iii|Ii'Pl$**(o@:EsNoooro@o)(,{

o6t

ctooIoctooio

Jrrts'@NNOa()TJNOOb, b Ltt * iD r' :, b, io'


20/93

!o3(,(,otroE.!Ge.Eotco'oED

tocJcf 3,3*;:,':,r:::3EFbE6 ::3E:3ff:$.;'sBigtuld||? rqqlu?ctFNoq:-(lq,!?q


21/93

44ll

Summary of the Latest Survey Regarding the Disabled' s CircumstancesIn the most recent survey (1996), Thailand had a disabled population

totaling al 1 ,024,120 or 1 .7% of the total population (report form the NationalStatistics Office). The National Health Foundation reported 4,825,682persons or 8.08% of the total population as being disabled.

The disabled who are eligible to register as disabled personsaccording to the Rehabilitation Act totals 716,884 - 3,377,g78 persons(70o/o), but the actual total registration is only 117,728 persons or 3.49 -16.40 %o of all the disabled (Table 7)

Table 7 : Total of Disabled Persons and Ratio of Registration (1996)

Characteristicsof disabilig

TotalRegistration

From NSO Survey From NHF SurveyTotalNumber

Total ofdisabledwho areeligibletoregister(70%)

% of thedisabledwho haveregistered

Totalnumber

Totalofdisabledwho areeligible toregister(70o/o)

% of thedisabledwho haveregistered

Mobilitylmpairment

14,994 1 10,300 77,210 tv.lz 955,344 668,741 z.z1Hearing andCommunicationlmpairment

14,864 208,033 145,623 10.21 298,545 208,982 '7 44

Physical andMobilitylmpairment

59,122 431,991 302,394 19.55 2,746,614 1,922,630 3.08

Psychosis 2,322 58,1 96 40,737 5.70 229,283 160,498 1.45MentallyRetardation 16,290 149,445 104,612 15.57 476,478 333,534 4.88Others 10,136 66,1 55 46,308 21.88 119,418 83,593 12.12

Source : lnstitute of Health System Research


22/93

12

Characteristics and causes of disabilities:

From the thesis on "Employment Opportunity for HandicappedPersons " done by Wasana Tapaopong from Thammasart University (1994),( sample size is 60 persons), it was found that the causes of disability aremostly from sickness (63.40%) and from accidents (18.30%) as shown in thefollowing table:

Table 8: Causes of disability (data from thesis)

From statistic suryey of National Statistic Office, latest survey in 1996,it was found that the causes of disability are mostly from congenital anomaly( 358.6) , secondly from accidents (264) as details in table 9:

Causes Blind Deaf Physic. Disabi. TotalAccident

(25.0)4(20.0)

2(10.0)

11(18.3)

Result fromSickness

10(50.0)

13(65.0)

15(75.0)

38(63.4)

unknown 5(25.0)

3(15.0)

3(15.0)

11(18.3)

Total 20(100.0)

20(100.0)

20(100.0)

60(100.0)


23/93

{oEoCOolfcooottCL{ttoogo!lg6'loottoIoCLI=totrool3CL

(/,)

{ootfi * g E g g * 1$ 5 I I E g E E2 s s E F g $: s r g F F ggci' SFtH3 SFxEEEB -8 6$ q efraaaich. 6. . u oF,A,g3

oEe$'8cr{=lt o\lIC'I dsAs.idFF$sFNFsFno o) i\, s J s b N i9 o) o qr 6 d) cD s {o!l{1io!tgr(,JAio

N(obt

o,ir>

t9i\J

@le(o

(,i.J

o)b)

"9oP$i@ioN99iS'NJO('j9!t:il.r9oorobo(o

5@

. r.3

55o)'.lNrbi.nbbrbo

9:'9(oN(,l

J J J O :, orooNrNo)io

oC|)o)

g:":'grjUisrglNCnNaJOON)

dsrl,oftr@Joiji,',bb['irirsN)

os i.J

9i.iiNO)('tGt*it*l

*t*+Lt

it

9P!5

J

N(,r

P-ll*olP> \,^ii q* I =.6'6

8tra!grPrrF$agEE@(rlin S9lBEdeteoEt$etoeL I bo irr i$ (o i.., cD i\t sl \| (r) ctdo:oaNN's fisissiiu$3i335si -ot-otaora


24/93

14

5. Networking among administrative organizations in the rehabilitationservices

To resolve and alleviate the problems of disabled persons, thepooling of various resources from different fields are needed.

Presently, no one organization provides the full range of rehabilitationservice for disabled people, covering all aspect of rehabilitation, ie, medical,education, vocational and social issues. Doing so is a huge investment withtoo many specialties and detailed functions; it is too big a job for anyindividual organization to handle.

Therefore, in coping with the problem, and in orderdisabled most effectively and efficiently, a network amongorganizations was developed to coordinate the variousresources from the different agencies so that the servicesserve the disabled persons according to their needs.

to serve theadministrativeservices andappropriately

6. Specialists in the rehabilitation field (medical,education,vocation,social)In Thailand, there are 16 different kinds of specialists working in the

rehabilitation field listed as follows:1. Physician ( physicatrist, surgeon )2. Nurse3. Physiotherapist4. Occupational therapist5. Speech theraphist6. Social working expert7. Psychiatrist8. Psychologist9. Nutritionist1 0. Vocational training officer


25/93

15

11. Interpreter12. Note taker (for deaf student)13. Tutor (for deaf student)14. Vocational guidance officer15. Low vision specialist16. OptometristAll of the above mentioned specialists have a significant role in

helping to rehabilitate disabled persons and assist their families as well. Inaddition, together they plan to help disabled people to return to their highestlevel of normal functioning as well as to strengthen them to be able to helpthemselves as much as possible.

7. Main Organizations of CBR- Ministry of Labour and Social Welfare

(Department of Social and Welfare)- Ministry of Health

(Department of Medical Services)- Ministry of Education

(Department of General Education & Non-Formal Education)

5.2 C.B.R. Services

1. The policies for people with disabilitiesAt present, the government has issued six decrees in TheRehabilitation of Disabled Person Act (1991), which consists of policies toprovide equity between disabled persons and non-disabled persons insociety, For example, it allows disabled persons to become senators, to


26/93

16

work in government positions, and to have the right to be employed in theprivate sector.

Furthermore, the law entitles and encourages disabled people whohave registered under the "Rehabilitation of Disabled Person Act" to receivethe following rehabilitation services:

(a) Medical rehabilitation service, medical treatment costs, aids andequipment for rehabilitating physical, mental or psychological conditions orfor improving capacities as follows:

- Diagnostic service, laboratory inspection and other type of specialexamination.

- Counseling- Medicine- Surgery- Medical rehabilitation and nursing care- Physicaltherapy- Occupational therapy- Behavioral therapy- Physiotherapy- Social service and therapy- Speech therapy- Audio therapy, hearing and therapy- Use of equipment or supporting machine for disabled persons(b) Providing all levels of education as considered appropriate, ie,

primary, secondary, high school and vocational school, including collegelevel under the National Education Plan. Such education can be provided inspecial schools for disabled persons or by ordinary schools as a dualprogram.


27/93

17

(c) Giving advice and consultation regarding occupation andproviding, free of charge, vocational training appropriate to their physicalcondition and their potential to work.(d) They are entitled to participation in social activities and access tovarious facilities and services essential to them ie, toilets, telephone booths,lifts, ramps, water coolers, etc.

(e) Government lawsuit services and contact with governmentalorganizations.

The policies of communitfbased rehabilitationThe main policy of community-based rehabilitation is to promote

community members, including state and private agencies both in the cityand rural areas, family members of disabled persons, local organizations atevery level nationwide - province, district, sub-district, and village, to worktogether in using community resources and local knowledge to contribute tothe rehabilitation of disabled persons to their highest potential. Thus, thefamily and community will participate in the caring for and the providing ofrehabilitation efforts for the disabled in the community. This will result inmaintaining a happy life for the disabled.

Areas of insufficiency: material aspect. personal aspectMaterial Aspects (facilities & equipment)

a) Disabled persons feel transportation is inconvenient (ie, getting on& off the public bus)

b) Ramp ways for disabled persons are inadequate.c) Public services for the disabled are very scarce (ie, public

telephones, public toilets, clubs, sport centers, recreation facilities)


28/93

18

d) Street footpaths are a problem for the disabled (ie, no covers ondrainage holes on the footpath)

e) Inadequacies of tools, equipment and educational materials fordisables persons.

0 Prosthesis and orthosis are not enough and often not suitable totheir particular needs.Personal aspects:

a) Lack of skilled training personnel who have knowledge andunderstand the problems of disabled persons.

b) The deaf lack language interpreters.c) There is a great need for interpreters, note takers and tutors for the

deaf student.d) Lack of professional personnel in rehabilitation :- Lack of physicatrists to assess physical capacities.- Lack of physical therapists for body conditioning and instructing

and orienting disabled people with adaptive tools.- Lack of vocational guidance counselors to consel as appropriate to

the disabled's needs.- Lack of social workers to help solving personal problem, including

general referrals and coordination of services.- Lack of vocational trainers to provide knowledge and strengthen theskills in various occupations.

e) Training centers for the disabled are still not well-equiped, ie,buildings, facilities. They are inadequate in updated technology, still havingoutdated training equipment which is not competitive to the real world of thelabour market demands.


29/93

19

Networking between the central organization and the peripheral branchesEach social welfare and health organization has their headquarters in

Bangkok and a branch offices in allthe provinces.The nature of collaboration partly follows the line of command andpartly is dependent on the individual who coordinates with the variousrelated agencies. Sometime coordinating on the personal level works wellfor conducting business in the health development field.

At village level, the two small organizations at local level in the villagethat the help coordinate services are the Community Welfare Center andCommunity Primary Health Care Center.

Policies and networking between public and private sectorsThe networking between public and private sectors has shown a

good collaboration in which each organization knows well the role of theother. Thus, once a particular cases is presented, they can refer cases tospecific responsible agency accordingly.

Government and private agencies work in collaboration to study theoperational conditions, to research and develop models for services, todevelop information systems, and to give clear direction to rehabilitationservices in certain areas. The principle coordinating organization is theOffice of the Committee on Rehabilitation (OCR).

A good example of collaboration was the effort in preparing the"master plan" - Rehabilitation for disabled persons (1997-2001). There wasjoint seminar which included various government agencies, NGO's andorganizations of disabled persons. The objective was to brainstorm ideasand service needs. After the seminar, OCR incorporated the information inthe responsible agencies: in the Ministry of Public Health for planning


30/93

20

purposes on medical rehabilitation, the Ministry of Education for planningpurposes on educational rehabilitation, and the Social Welfare Departmentfor planning purposes on vocational & social issues.After that, a workshop revised the master plan one more time, beforesubmitting it to the cabinet to be approved and inclusives within the BthNational Economics and Social Development Plan.

Registration systems for people with disabilitiesDisabled persons are able to apply for registration with the central

registrar at head office of rehabilitation for disabled persons in Bangkok orsubmit an application form to the provincial registrar at the provincial Officeof Labour and Social Welfare in the particular province where the disabledpersons have residency. The procedure of registration is outlined as follows:

a) Submit Form: to register and classify the disabilities by type, classand characteristics of disabi lity.

b) Interviewing: disabled persons will be asked about their historyand their needs will be assessed relating to their families, education, and inother relevant aspects.

c) Assistance Plan: to bring relief to the immediate or urgentproblems which are followed with long-term assistance,d) Follow-Up: to check the outcomes following referrals to the variousservice agencies.

The future scheme for rehabilitation systema) Future Scheme for Medical Rehabilitation

- lmproving the structure and service system by having a clearresponsible unit- Developing service standards


31/93

21

- Promote research and development of technology appropriate tothe disabled

- lncrease training for personnel in fields where their are laborshortages- Set up information systems for information exchange concerning

operations- Developing the efficiency of personnel on a continuous basis- Educating people in preventing disability- Establish a priority in assessing the development of 0-6 years old

children in the hope of preventing disability- Establish a priority to deal with dangerous toxins and harmfulenvironmental factors- Promote medical rehabilitation from the beginning as soon asdisability symptoms are identified

b) Future Scheme for Educational Rehabilitation- Develop a survey form and methodology in cooperation with the

Statistical Office and the Ministry of Education to collect data to moreaccurately estimate of the number of special education eligible children inregards to disability and their region of residency. The survey needs toparticularly target areas in which no information is available or appears to bevery unreliable.- Develop a "standard" measure of minimal competencies, such asthe national exams that are given to all students in regular education inThailand. These exams can be designed to measure academicacheivement, without emphasizing disabilities, if done thoughtfully. (Forexample, written exam material for the exams can be made available in


32/93

22

Braille for the blind. However, the content of the material would remain at thesame level as expected of regular students)

- Increase cooperation between the NGOs and the government byclearly defining needs and budget requirements that would allow thegovernment to more effectively make financial contributions to the variousprogram.- Develop (and fund) a liaison position at each institution that wouldbe able to make recommendations on needs which can be given to all thevarious organizations, either public or private, that provide assistance to theschool.

- Increase government efficiency by eliminating unnecessary paperwork. Allow more autonomv at the local or individual site level for mosttasks. - Increase the availability of teacher training and upgrading of skillsof inadequately trained teachers who are now working. Provide morespecial education teacher training programs at Teacher Colleges throughoutthe country. Require all teachers to complete a specific number of hours of"up-graded skills training" each year with reports to be made on this trainingand to be tied to their salary increases.

- Establish a National Committee to develop an appropriatecurriculum for the disabled. Include special education professors as well asoutstanding staff that are working in the institutions at this time. Attempt todevelop a curriculum that is feasible and effective and maintains highstandard of accomplishment for the students and teachers.- Provide regular workshops for staff to learn about the adaptivetechnology available for teaching the disabled. ln addition, encourage thevarious institutions to work with the Ministry of Public Health in using funding


33/93

23

available through the Rehabilitation Act thatof students.

could buy equipment for the use

Tabfe 10 : Government Budget Plan for Special Education(1995 - 2001)

C) Future Scheme for Vocational Rehabilitation- Building a good sense of understanding about disabled persons.- Adjust tools, equipments and training facilities to be more

appropriate to each type of disabled persons.- Eliminate those law which limit the right of disabled persons to work.

- Government agencies provide more appropriate positions todisabled government officers who return to work instead of dismissing them.- Set up a research unit focusing on adaptive tools so to keep

disabled persons working as normal people.- Promote special facilities for disabled persons within theworkplace.

- Speed up to the obtaining of more adaptive equipment for thedisabled on commuting or traveling services.

Planning Urgent or lmmediate1995 - 1996

I th National Plan1997 - 2001

Expanding ServicesAdministrationDevelopmentAcademic Development

487.870260.97068.630

1,083.0001,248.640

78.940

Total Budget 886.100 2,410.580*Number reoorted in million Baht


34/93

24

- Promote more training of "guidance counselors on employment" fordisabled persons.

- Promote "business management" training to disabled persons inorder to help them learn more skills in doing business.- Provide a source of funds for them to be entrepreneurs in addition to

making loans.- Support private institutions relating to vocational training andemployment placement for disabled persons by providing funding,personnel and instruments.

- Cooperate taxes should be exempted for those companies thatemploy 50-80% of disabled persons in the work force.

- Speed up support for competent networking, especially in ruralareas, in regards to provide information about vocational training andemployment prospects.

- Government needs to stress vocational training for the disabled,especially those disabled persons in rural areas.

d) Future Scheme for Social Rehabilitation- Extension of social welfare to those disabled according to the needs

of the specific type of disability. Thus, by providing the disabled withassistance, welfare service protection, re-conditioning, rehabilitation,guidance, the development of problem-solving skills, self-reliance, thedevelopment of quality of life (QOL), and the ability to participate in socialactivities.

- The promotion of knowledge, understanding and good attitude inregards to the disabled to society, the communities, the rural area and to


35/93

25

individuals through public relations and cooperation from all concernedsector, ie, government, NGO and private individuals.

- Developing a system of information and personal in the universitiesto assist in the operation of social rehabilitation.- Laws, regulations, and rules, including the process of itsimplementation, have to be clearer in order to help protect the human rightof the disabled.

- The promotion in all levels of organizations, government and private,of participating in social rehabilitation more than before. Furthermore, toestablish more effective networks within the system.

- The development of models for community-based rehabilitation forthe disabled more appropriate to the problem situation and the needs ofeach type of disability.

e)Future Guideline for mass media implementation- Publicize an emphasis on prevention and causes of the total range

of disabilities to all group, especially the less privileged - people in ruralcommunities and in slum areas.

- Correcting negative social attitudes toward the disabled, so thatsociety understands, accepts, and gives opportunities to the disabled asthey are also members of society,

- Having an intensive campaign through all forms of mass media thatis in close collaboration with organization for the disabled focusing onreducing the numbers of disabled persons in the future and promoting QOLof the disabled so that they may have more opportunities to enjoy a happy,successful life, just as other people do.


36/93

26

- Having a central role in encouraging the various governmentalagencies to quickly assume responsibility in improving the extension ofservices to the disabled as well as pressing for the reform of laws and ruleswhich constrain and abuse the rights of disabled persons.

fl Future Roles of Religions lnstitutions in Helping theDisabled- Taking on the role as a development center to provide special

education as well as a rehabilitation center for both disabled children andadults, under the supervision of specialists and involving village volunteers.This will enable them to participate more fully in activities such ascommunity - based rehabilitation. The temple area is to be a venue foractivities ie, vocational training.

- For the monks, when preaching to the people, should includesupplementary information, ie, an example of an outstanding disabledperson, as well as educating the community in order to mould positiveattitudes toward the disabled so that they will earn acceptance andopportunities within society like other people.

- Providing opportunities to the disabled to participate in making meritor religious charity according to their economic status.

g) Future Guidelines for Peoole and Communities to Assist the Disabled- People should have more understanding of the disabled and treat

them as fellow human beings who have feeling and needs like other people.No insults or discrimination.

- Encourage the disabled to show their potential and ability and givethem opportunities to take on self-assistance and self-reliance as much aspossible.


37/93

27

- More knowledge to prevent people from becoming disabled andthus reduces the number of disabled.

- Those in the working place, ie, factories, should provide workopportunities to the disabled according to their abilities. ln particular, privateenterprises should seriously follow the "Ministerial Regulations" regardingthe hiring of the disabled to work in their factories like other people so thatthey are able maintain a livelihood.

h) Future Guideline for Operational Functions of Disabled Organizations andSelf-helo Groups.

- To be a resource center responsible for maintaining, coordinatingand disseminating information to organizations of disabled persons.- Promoting self-help groups among the disabled and buildingnetworks from central to rural areas, ie, from Bangkok to province - district -community - village. Thus, members will be able to get information about therights and opportunities to access services.- Promoting effective self-development among members in theorganizations through exchanging experiences, shared problem-solving andsuggesting ideas which will guide them toward a quality life'

- Protect the right of the disabled and spread information to promoteunderstanding thus creating a more positive attitude toward the disabled. Inaddition, advisers should be available to members who have problems, etc.

- Coordinating with state & private agencies which work with disabledpersons to build mutual understanding so as to have a cooperative effortand constructive way to problem-solve.


38/93

The Referral System

Chart 1: Referral System for Disabled Persons to Receive the Services.

The Follow - up SystemWhen the disabled person had been referred to particular agency,

the sending agency will send a follow-up letter or inquire by telephone tofind out how the case transpired. Also, a separate follow-up letter will besent to the disabled person directly. From time to time, the follow - up letterwill be sent along with a newsletter or PR publication to keep informed of

Interviewfor history and problem

Checking information onagencies which provide services& assistance

Assisting operation

Givingguidanceto thedisabledand fam


39/93

29

various issues concerning rehabilitation development. This usefulinformation will also be stored in a computer at the central office in Bangkok.The follow - up system will go together with the referral system in order tohave the organization become more concerned with effective coordination.

2. The actual condition of medical rehabilitationAt present, all institutions concerning CBR have served wide range of

problems but problems still exist in some areas:a) Inadequate services in medical rehabilitation, especially the lack of

coverage to all rural communities.b) People in rural areas are lacking knowledge concerning

disabilities; therefore, they are not interested in bringing disabled personsfor treatment and rehabilitation services.

c) Personnel with skill and expertise in rehabilitation are too few tocover all the areas.

d) Coordination and transferring systems for patients are inefficient.

3. The education for handicapped (Pre school - university)The Thai government and Thai non-profit groups work together in

many special education programs that have received funding. ln the past,the funding has been assigned to specific local programs, such asproviding funds for a school building, or providing food for boardingstudents in a special education facility. However, it is mostly small localinfrastructure projects that are funded, rather than educational program.

The following is the information excerpted from a sectoral survey onspecial education for the disabled (3-24 years old) investigated by Dr.Poolpit Amattayakul and his team:


40/93

30

Table 11 :Government Sponsored School of Special EducationYear Province Region SP/Ed.Pop Remark

1992 Nakorn Sawan North Central Qssf+M.R. Dual Program1993 Pitsanulok

Nakon RatchasimaUbon RachathaniSurinMookdaharnPrachuab KirikhanChumpornSongkla

NorthN.E.N.EN.E.N.E,SouthSouthSouth

Deaf+M.R,pssf+M,R.Blind+Deaf+M.RDeaf+M.R.Deaf+M.R.DeafM,R,M.R.

Dual ProgramDual ProgramMixecl ProgramDual ProgramDual Program

1994 LopburiRayongPhuket

CentralEastSouth

M.R,M.R.M.R.

1995 Nakorn PathomSuphanburiKarllasinRoi-Et

CentralCentralN,E.N.E.

DeafM.R.M.R.Blind

1996 Chaing RaiPraePichitNanPetchaboonChachaengsaoPrajeenburiKanchanaburiPetch-buriChaiyapoomKhon Kaen

NorthNorthNorthNorthNorthCentralCentralCentralCentralN.E.N.E.

M.RM.RM.RM.RDeafM.R.DeafDeafM.R.DeafPhysically Disabled

7h Natioanl Plan

Source: lnformation from Division of Special Education


41/93

31

Overview of schools and teachers in special education

An overview of the number of schools and their current staffing ratio isgiven in Table 12 below. These programs are grouped by both disability andgeographic location. Both the estimated need and the number of programsavailable can be determined by comparing the figures in this table withthose of the Government Census figures to get an estimate of under-servedstudents in each region of the country.

Table 12: Teachers is Special Education Program

Program & School Site of SchoolProvince Region

Number of Teacher in Sp.Ed.Program.Total I tn.o. lu".t", leacnetorlcertiticate

School for the DeafSetsatianThong MahamekSote NontaburiSote CholburiSote Theparat

Sote Nakon PathomSote PattanaPratamnakSote TakAnusarn SunthornSote Khon KeanSote SongklaSote Thungsong

BangkokBangkokNontaburiCholburiPrachuabKirikhanNakon PathomCholburiBangkokTakKhon KaenKhon KaenSongklaNakonSritammarat

CentralCentralCentralCentralCentral

CentralCentralCentralNorthNorthN.E.SouthSouth

4945363810

I

8745?1513917

1 241

3I

2

4I

14I

2

45413535I1

454528473514

1

4

2331


42/93

32

Table 12 (Continued)

Program & School Site of SchoolProvince Region

Number of Teacher in Sp.Ed.Program.Totat I en.o. luaster laacnetorlcertincat"

School for BlindBangkok SchoolSchool of the BlindEd.Ctr.of BlindRedemptis Sch BlindSouth sch. of BlindEd.Ctr,of BlindEd.Ctr.of Blind

BangkokChaing MaiKhon KaenChonburiSuratthaniKoratRoiet

CentralNorthN.E.CentralSouthN.E.N.E.

41224181787

3z

1

3119367I7

71

1

11

School for the Physically DisabledSriSangwanRedemptoristSch.of Physical Dis.

Nonthaburi

Cholburi

Central

Central

33

17

1 24

7

8

10School for Mentally RetardationPanya WootthikornRachanukulSuksapiset LopburiSuksapiset SuphanKawila AnukulSuksapiset UdonSuksapiset PhuketChumporn PanyanukulSongkla Patana Panya

BangkokBangkokLopburiSuphanburiChaing MaiUdon ThaniPhuketChumpornsSongkla

CentralCentralCentralCentralNorthN.E.SouthSouthSouth

142484443B1214

221

2

7z4I

1021744134I

I10

2II

1

1

3Classroom for Mentally RetardationPrapakarn Panya Bangkok Central 13 I 7 5


43/93

33


Program & School Site of SchoolProvince RegionNumber of Teacher in Sp.Ed.Program.

Totat I en.o. lMaster leacnetorlcertincateSchool for Dual Prog.fams (Deaf+M.R.)SuksapisetSuksapisetSuksapisetSuksapisetSuksapisetSuksapiset

Nakorn SawanRayongPitsanulokRatchasimaMookdaharnSurin

CentralCentralNorthN.E,N.E.N.E.

116612611

4I

1

10

612

11(Blind+M.R.+Deaf)Suksapiet Ubol Ubol Ratchathani N,E. 24 1 23Classrooms for Children with Brain Damage & Behavioral DisordersSaeng Sawang Inst.Yuwaprasart Hosp.

Samut PrakarnSamut Prakarn

CentralCentral

55 I lz 1,. lootospital ClassroomClassrooms for Children with Multiple disorders (not registered as school)PrachabodeeHome of Children withMultipleDisordersTotal

NonthaburiBangkok

CentralCentral

10to

844 1

1

49

I6

678

10

116


44/93


45/93

35


Type & School AreaProvince Regions

Stu.ffeacherRatio

Class R Remarks

Suksapiset PhuketChumporn PanyanukulSongkla Patana PanyaUdon Panyanukul

PhuketChumpornSongklaUdon

SouthSouthSouthN.E.

6418120t1517211410017 No

5l1215

report M

Ministry of EducationMinistry of EducationMinistry of Education

inistry of EducationClassroom for Mentally RetardationPrapakan Panya Bangkok Central 70t13 10 Private FoundationSchool of Dual Programs(Deaf+M.R.)Suksapiset NakornSawanSuksapiset RayongSuksapiset PitsanulokSuksapiset RatchasimaSuksapiset MookdaharnSuksapiset Surin

Central (DeafCentralNorthN.E.N.E,N.E.

0/ M.R.40)

Deaf

80/928t440t3154t1240t3109/81211

I3494o1

Ministry of EducationMinistry of EducationMinistry of EducationMinistry of EducationMinistry of EducationMinistry of EducationMinistry of Education

School of Mixed Program (Blind+Deaf+M.R.)Ubon Panya Nukul N.E. Blind

DeafM.R.

35t422t4237t15

4J15

Ministry of EducationMinistry of EducationMinistry of Education

School of Physically DisabledSriSangwarn,Redem ptorist VocationalSchoolfor the Disabled

NonthaburiPattayaEast of Central

CentralCholburi

257133145t17

2211

NGO+GovernmentNGO-Church

Classroorns for Children with Multiple Disorders (not registered as a school)Sathabun Saeng SawangYuwaprasart Hospital

Samut PrakarnSamut Prakarn

Central I roorss250tentral

Nurses

1511

NGO FoundationMinistry of Health


46/93

36


Integration-Mainstreaming Program of Special Education Childrenlnformal integration has occurred with small numbers of children for

a number of years. In 1957 a formal program was established with the slow-learning children in the Bangkok area; in the last 10 years there has beenmore formal approach to developing quality integration program.

The Christian Foundation of the Blind in the Northeast of Thailand hasdeveloped outstanding integration programs for the blind. The programconsists of a preparatory segment which can run for one to two years inwhich the child lives in a residential setting. This program trains the blindchild in daily living skills, effective learning skills and the use of variousadaptive equipment needed by the blind to function competitively in theregular school environment.

Type & School Area StudenUTeacherRatio

Class F Remarks

Classrooms for Children with Multiple Disorders (not registered as a school)Pak Kred Nonthaburi Province:--Prachabodi School of Multiole Disorders Mixed-Ban Nonthapoom,Home of Multiple DisorderMixed-Ban Fuang Fa,Home of Disabled Children-Ban Rachawadi,Home of Brain Damage & M.R.

92t16593

467935

Schoolfor 3 Homes BelowDept. of Public Welfare

Prathumthani Province:--Ban Kung ViTee Children (Mental)-Ban Kung ViTee Children (Mental)

304304

Home for boys with mental disoHome for girls with mental diso


47/93

37

The foundation also open Educational Centers in additional areasthe North and Northeast and train various officials in the techniquessuccessful integration.

The integration of the deaf is part of a longterm project started at theSuan Dusit College of Teacher in Bangkok, This first group of integrateddeaf children were of preschool age and consisted of a mix of half non-deafand half deaf children in the classroom. Some of the teachers were trainedin early intervention programs abroad, at the John Tracy Clinic in LosAngeles and in a deaf program at Tel Aviv. Later, some of the children fromSuan Dusit were integrated at the Phayathai School (grade 1-6, started in1973) in Bangkok.

The Prathamnak Suan Kulurb School was established in 1981 byHRH Princess Sirindhorn who has a long-term interest in the disabled. Thisschool started with 16 children in two classrooms and 2 teachers who had aB.A. degree in special education (deaf program). Today, there are 7 roomswith 62 children andT trained teachers, 5 with B.A. in Special Education and2 with MA in Special Education all with majors in deaf education. Studentsfrom this school continue their studies in two main systems, the oral systemat other primary school such as the Payathai school or the Bangkok Schoolfor the Deaf which used sign language.

Ratcha-vinit Primary School was the next integration site with a similarprogram to the one at Phayathai school, followed by Pibul-prachasan whichis a secondary school of mixed programs where young deaf, blind,physically disabled can attend at the secondary level. The government ismaking an attempt to start programs of integration of the deaf in areas whichalready have a school for the deaf and to offer support services to localschools interested in integrating deaf students into their regular classes.

ofof


48/93

38

Table 14 :School with Integration (Mainstreaming) Programs ofBangkok Area (Up date December 1995)

Area & School Program Student Teacher RemarkBangkok AreaSchool Under supervision of Ministry of EducationRachapat Suan DusitPra Tamnak Suan KularbPhayathaiSamsenRatchavinitWat ChawmonPiboon PrachacsanChinorosThep Lee LaSantirat WittayalaiBan Bang KapiWichutitWat Way TawanWat Chana SongkramWat HnangDarakamPiboon Prachasan

Deaf- Blind - M.R.DeafDeafDeafDeafDeafDeafBlindBlindBlindM.R.M.R.Slow LearnerSlow LearnerSlow LearnerSlow LearnerSlow Learner

9916256

1271337

No ReportNo Report

70206527103

9862

177I21

1321

1

1

1

5.1I

2211

Pre SchoolPre SchoolPrimaryPrimaryPrimaryPrimarySecondarySecondarySecondarySecondaryPrimaryPrimaryPrimaryPrimaryPrimaryPrimarySecondary

School Under Supervision of the Bangkok Metropolitan Area (Local Government)Wat Tasanaroon SuntariPrathom Bang KaeWay Hongj RatanaRamPrathom Non ZeeWat Maha BootWat Don YannawaWat Suwannaram

Slow LearnerSlow LearnerSlow LearnerSlow LearnerSlow LearnerSlow LearnerSlow Learner

436019B134812

262324I

1

PrimaryPrimaryPrimaryPrimaryPrimaryPrimaryPrimary


49/93

39


Table 15 :School with Integration (Mainstreaming ) Programs OutsideBangkok Area (1995)

Area & School Programme Student Teacher RemarkSoon Puam Nam JaiSamsen NokWat Lard PraoRitthiWittayaWat Nimman NoradeeWat Jang Ron

Slow LearnerSlow LearnerSlow LearnerSlow LearnerSlow LearnerSlow Learner

B4115722166

1

1

1I

II

2

PrimaryPrimaryPrimaryPrimaryPrimaryPrimary

Private SchoolJantayanond KindergartenSupawan Primary School

AutisticsAutistics

303

122

PrimaryPrimary

Area & School Program Student Teacher RemarkNorth ThailandChit Aree, LampangHo Pra, Chaing MaiWattano Thai PayapNan Welfare School

DeafBlindBlindM.R.

343o1B

33

I

PrimaryPrimarySecondaryPrimary

North East ThailandSakol Nakorn WelfareSanam BinKhon Kean KindergartenThesaban Suam SanookBan Kham HiThesaban Sri Than

DeafBlindBlindBlindBlindBlind

11oI699

2

1

1

PrimaryPrimaryPre SchoolPrimaryPrimary


50/93

40

Area & School Program Student Teacher NoteRatchasima WittaualaiKaen Nakorn WittayalaiKalayanawatLeoiWelfare SchoolPanom Tuan WelfareNon Somboon Welfare

BlindBlindBlindM,R.M.R.M.R,

623504880

35I

SecondarySecondarySecondaryPrimaryPrimaryPrimary

Central ThailandPanom Tuan, KanchanaburiPrachabodi, Nonthaburi

M.R.Mult. Handi

48No Report

5No Report

PrimaryPrimary

South ThailandWat Thalay Sorn I BlindSuratthaniWelfare I t *Integrated Program for Chronically and HospitalizedChildren 6 Hospitals in Bangkok and 5 out of BangkokArea

8

391

II

25

SecondaryPrimaryPrimary+Secondary

Physically disabled children who are more severely impaired areoften given bed-side instruction until they are capable of living in a lessrestrictive setting. After these children are released from the hospital theyoften are given training in a residential setting where there are fewopportunities for full integration, The few children who are able to beintegrated are these who are not wheel-chair bound, but can ambulateindependently. There is no school for the physically disabled in Bangkok.The only school available for this group of children is named "Sri Sangwan"and is located outside of Bangkok. This is a boarding school with relativelygood access for wheel chair students, however it only provides instruction toGrade 9 at this time.


51/93

41

The mentally impaired enrolled in the Rachanukul program have beenintegrated into some of the regular education programs in the area (see thenext table). They are usually integrated until they are of secondary schoolage and then they are transferred into vocational programs. At this pointthere are two programs for the integration of the mentally impaired, inChiang Mai in the North of Thailand.

Brain-damaged and autistic children usually are not able to beintegrated because of the severity of their disability, Some of them are ableto be controlled with medication, but the most successful program forautistic children is at the Satit Kaset School run by the Faculty of Educationof the Kasetsart University in the Bangkok arca. This has been a successfulprogramme, but is considered as a rather expensive alternative as the staffused in this setting are all Masters Degree teachers.

Post-secondary mainstream programmes for students with disabilitiesin Thailand are still in their infancy. Today only a few of the btind studentstaking the National Exams (1-3 students per year) were able to pass theNational College Entrance examination to public universities, In the past 2years there were 2 or 3 blind students who finished a B.A. degree in Law,Education and Computer Technology, while only one deaf students got hisB.A. in Applied Arts. Another two deaf students received degrees HomeEconomics. At the open universities, the Ramkhamhaeng and the SukhothaiThammatirat as well as in the Teacher Colleges, some physically disabled(wheel-chair user) students were reported to have finished their B.A.degrees in Education, Social Sciences and Humanities.

Srinakarin Wirote Prasanmitr in Bangkok is the only University inThailand that grants a Master's degree in Special Education (Deaf, MentalRetardation and Gifted Child Programs) and also a Master's Degree in


52/93

42

Related Programs in which teachers can study and return to work in schoolsas specialists in various fields of intervention.

There are programs in special education in Speech Pathology,Speech Therapy and Audiology through Mahidol University at the Faculty ofMedicine and Ramathobodi Hospital in Bangkok.

In 1996 Ratchasuda College (Disabled Program) of MahidolUniversity started a masters degree programme in rehabilitation servicedevelopment for people with disabilities. This masters degree programmewill meet the nation's need for training special education teachers in suchfields as in Access Technology, Rahabilitation Counseling Services, andRahabilitation Service Administration. In addition, it will sponsor short andlong-term courses for teachers wishing to improve their skills in adaptivetechnology for the disabled. lt plans to offer another in Research and finallya Masters in Media Production for Special Education.

There are 6 out of 53 Teacher Colleges that offer training in specialEducation courses. The following Teacher Colleges offer Bachelor Degreesin areas of Special Education:


53/93

43

Table 16 : Teacher Colleges with Special Education Programs

In addition, a separate university in Bangkok, Srinakarin Wirot, offersspecial day and evening programs in Special Education. Through thisprogram, graduate students can earn a Masters Degree in Education of theDeaf and Education of the Mentally lmpaired. This University has offeredprograms for teachers of the deaf for almost 10 years and majors foreducation of those with mental disabilities for the last 3-5 years. Thisprograms usually serves 74 graduate students, with 169 completing theirMasters Degree since its inception 10 years ago. In addition, the universityprovides short-course training for bachelor level teachers who need moreinformation about the education of the special needs child. lt has trained210 teachers in this short-course summer program since its inception.

Area of the Kingdom andSchool (Programme Major)

Age of ProgramYear

Areas of Specialty

Bangkok-Ratchapat Suan Dusit 26426?

Special EducationBlind MajorDeaf MajorM.R, Major

South-Rachapat Songkla z1

GeneralSpecial Ed.M.R. Major

North-Rachapat-Chiang Mai 22

Planning Blind Major in '1996

GeneralSpecial Ed.Deaf MajorM.R. Major

North-Phiboonson gkram Col legeof Teacher, Pitsanaulok

21

GeneralSpecial Ed.M.R. Major

Northeast-Ratchapat-Korat z1

General Special Ed.Bling Major

Northeast-Ratchaoat Mahasaraka m 4

Planning M.R.and Deaf in 1997

Generalspecial Ed.Blind Major


54/93

44

Short Course Teacher Training in Special EducationShort course training in special education for teachers has been done

in Thailand for several decades by individual schools of special education.It started even before the government had established the Teacher'sCollege programs in Special Education over 30 years ago. Back in thosedays all teachers in schools of special education were graduated first fromthe regular education programs of the Teacher Colleges (since there wereno formal training programs in special education.) Later, short coursetraining was offered in this specialty area which might consist of 2 weeks oflectures and demonstration. As an incentive to special education teachers,about 30 years ago the Ministry of Education provided teachers who hadpassed this training an extra 300 Baht per month.

Today this kind of short course training is still being done, but inlarger groups with targeted teachers who are willing to work with thedisabled students in both schools of special education programs and withintegrated programs. Training is being sponsored officially by the Ministry ofEducation (Department of General Education and /or the department of theNational Primary Education Commission) and by the Srinakarin WiroteUniversity (which also offers a masters degree program in SpecialEducation). After the training (which consists of a 200 hour training oftengiven during 4-6 weeks during summer) all teachers would receive theaddition of 1,200-2,000 Baht per month to their regular salary (depending ontheir current rank). Table 17 shows the number of teachers completing short .course training in the past 9 years.


55/93

45

Table 17 :Short Course Teacher Training in Special Education1986-1995

4. The condition of employment and vocational training for handicapped

Vocational Training for handicappedThe handicapped receive vocational training from governmental or

private organizations with no charge. A variety of vocational trainingservices are listed as follows :

For vocational training with non-handicapped people, twoorganization offer training :

O Multiple skills Training School (Under the Vocational EducationDepartment, Ministry of Education)

Training Venue Year Number of Teachers TrainedSrinakarin Wirote UniversitySrinakarin Wi rote U niversityN.P.E.C. Min. of Education*Sdnakarin Wirote U niversityDept. of Gen. Ed., Min. of EducationSrinakari n Wi rote U niversityN.P.E.C. Min. of Education*Srinakarin Wirote UniversityDept. of Gen. Ed., Min. of Education

1 9861 990199219921 99319941 9941 9951 995

682725251663939rtcl84

Total Teachers 9 Years 578N.P.E.D,= National Primary Education Commission Department


56/93

46

Skills training on the following topics :-Automation mechanics-Metallic lathing-Electric wiring-Electric fan repair-Radio - TV repair-Women's dress making-Beauty services-Advertising design-Photography-Computer prog ram m ing.

O Institute for Skills Development (under the Ministry of Labor andSocialWelfare)

This institute focuses on upgrading skills in 8 different fields andprovide training nationwide :

Training Topics:- Electronics- Computer education- Automobile - electric wiring- Industrial sewing machine- Building painting- Material-ware painting- Construction carpentry- Air & cooling conditioner machanics- Industrial - tooling machanics- Motor - bike repair


57/93

47

- Radio - TV. repair- Telecommunication machanics- Automobile machanics- Metallic lathering- Aluminium structure setting- Agreecultural machine machanics- Auto - engine repair

OTwelve NGO's Provide Vocational Training (Throughout Thailand).Training Topics- Radio & TV repair- Leather cutery- Glass sculpturing & cutting- Program design- Office computer course (6 months)- Traditional massage- Weaving- Artificial flower making- Cooking- Astrology- Carpentry- Painting- Drawing- Telephone operator- Lottery selling- Musical performance- Dessert - baking


58/93

48

- Waste - materials handicraftingFor vocational training in clothing and hair styling that require a

higher level of skill, after completing the course, the disabled will havefurther training and practice at the Vocational Development Center beforework placement.

Emoloyment for the handicaopedln accordance with employment and occupational placement for thehandicapped, the Social Welfare Department has set guidelines as per B.E

2537(1994) Ministerial Regulations providing a description of the work inwhich the handicapped are capable of engaging in. These guidelines listthe criteria for employment appropriate to the knowledge, capability andphysical condition of disabilities to the job.

Consequently, according to Ministerial Regulations, it's required thatprivate establishments, ie, factories, companies, or enterprises with aworkforce of at least 200 employees must to employ at least one (1)handicapped person, lf any particular workplace does not have a suitableposition for the handicapped, then it is required to remit money annually tothe Rehabilitation Fund for the handicapped, at a rate of remittance of half ofthe annual minimum wage multiplied by 365 and matching the ratio of thenumber of handicapped persons that would have been in the workforce.

Employers who employ the handicapped will have the right to claimtwice the amount of salary paid to the handicapped as company expensesin regards to revenue tax. In addition, facilities expenses (ramps ,toilets,etc.) allocated for handicap accommodation can be included as a taxdeduction.


59/93

In reality, according to the research on Employment Opportunity ofHandicapped Persons (1994) by Wasana Tapaopong of ThammasatUniversity, most employers do not want to employ the handicapped, whichproves that even though the employer may have very good attitude towardsthe handicapped and the Rehabilitation for Disabled Act is in place, inpracticality this Act has not worked and it seems difficult to employers toemploy the handicapped.

From the OCRDP survey, it had found that there are 5,000 workplaces(employing more than 200 persons) which are required to hire the disabled.However, only 2,000 workplaces have complied with the "RehabilitationAct"; 1,200 workplaces have hired the disabled and another 600 workplaceshave chosen to submit funding into the "Rehabilitation Fund". The rest of the3,000 workplaces have not followed the Act.

However, the "Rehabilitation Act" has no penalty for wrongdoers.Therefore, no enforcement can be done, In practical terms, the Ministry ofLabour Protection and Social Welfare tries to use positive reinforcementperks of various types, ie, tax deductions as previously mentioned, giving"recognition awards" for those workplaces which hire disabled persons, andby constantly publicizing the performance of the disabled in the workplace.

Presently, employers' attitudes have begun to change. This is due tothe good performance of the disabled, In the future, it appears thatoccupational placement will improve.

On August 21, 1998, principledisabled will have a forum to considerdisabled in entering the labour market.Parliament Assembly.

organizations working with thethe various problems facing the

The forum will be held at the


60/93

50

Employment Problems after Vocational TrainingIn addition to the previously cited data, results of the research

conducted by Orapin Phitakmahaket from the Institute of Population andSocial Research, Mahidol University on the topic "Problems Facing theDisabled who were Trained in Rehabilitation Centers", found the followingnoteworthy i nformation :

1. More than half of the disabled did not have employment matchingtheir training,

2. Radio and television repair employment did match their previoustraining and resulted in a secured job, while those in leather cutting andcloth-making had a significant problem to do the same.

3. Among the problems facing the disabled in entering the labourforce that were reported in the research were: the job being too hard, the jobnot being suitable to physical needs, the majority earning income less thanminimum wage, and insufficiency of housing and/or facilities, ie, ramp andtoilets to accommodate the disabled. (Note from researchm Concerning thefacilities to accommodate the disabled in the workplace, they are nowbecoming supported and enforced by the latest Act declared on March 10,1ee8.)

4. The principle factor impacting on the disabled' s enterance into theworkforce was "earned little income"

5. The present condition of the supply of prosthesis and orthosis

Upon interviewing the Director of Sirindthron National MedicalRehabilitation Centre (Dr, Phatriya Jaruthat) and Deputy Director, Dr.Praphan Phongkhanitanont (also a Division Chief of Medical Treatment &Rehabilitation), information was given which is summarized below:


61/93

51

1) In Thailand, after the law (Rehabilitation Act.) related to artificialbody-parts had come into effect in 1995, good budgetary support from thegovernment resulted in obtaining enough of the required artificial units.

2) Currently, Thailand is unable to produce those artificial body-partlocally. They need to be imported from the USA, England and Germany.The only item that can be produced locally is the artificial foot-sole, but it isnot of a good enough quality compared to imported items due to the lowproduction technique.3) There are no prosthetists nor orthotists. Thailand only has P&OTechnicians. This results in low production standards, ie, artificial foot-solesdo not correctly fit the foot of the disabled person.

4) There is an inadequate supply of P&O Technicians on duty atprovincial hospitals in the country. There is only one P & O Technician perprovincial hospital on average and about 10 % out of 96 hospitals have noP&O Technicians at all.

5) Currently, the Artificial Leg Foundation (private agency) and theKing MongKut Institute of Technology have jointly undertaken research inorder to build artificial knee - joints.

6) Sirindthron Centre has the responsibility to act as the P&O Centerand distribute artificial body - parts to provincial hospitals nationwideaccording to their individual requests.


62/93

52

Procurement for Prosthesis, Orthosis, Gait Aids, etc.

National Budgetary BureaultIllllSirind hron Rehabilitation CentretllltlHealth Service Unit

Note : - lf the provincial hospital or regional hospital wants to have their ownbudget for purchasing their own needs, those hospitals are able to do sothrough the Sirindthorn Centre, The Sirindthorn Centre will aggregate thebudget then allot to individual hospital their share respectively.

5.3 The Needs of CB

ln the past, it has been the traditional understanding that real successin rehabilitating the disabled meant to bring them to receive treatment at aresidential compound, ie, hospital, school, etc.

At present, it is realized that the disabled who are capable of makinga living have no real need to stay in a treatment compound but should staywith their family. The CBR concept is accepted and deemed essentialbecause its help sustaining the development on rehabilitation of thedisabled. lt uses resources from community services and agencies as well


63/93

as cooperating with members of the community to provide support to thedisabled, according to their specific disability and according to thesuitability of the particular community, so that the disabled can be self-reliantliving in their own community.

CBR in Thailand were established by the Public Welfare Departmentin 1994 by selecting 10 provincial pilot projects, which succeeded in only 2provinces, on education in Kanchanaburi Province and on occupationalaspects in Chiang-Mai Province. The plan will be expanded to an additional5 provinces in the year 1999.

CBR activities by the Medical Service Department, MOPH have beendone before Public Welfare Department, has begun with the translation ofrehabilitation manual for people who work with the disabled. Now theMedical Service Department's are in the process of pilot testing the model ofthe " Independent Living Unit" that is modified from the Japanese model inorder to be more appropriate to Thais.

l.Training for Staff and SpecialistsSpecial courses in the rehabilitation field in higher education

At present, Ratchasuda College is a newly opened school thatprovides graduate study in the field of rehabilitation services for personswith disability. However, there is only one course in the graduate curriculumthat deals with community - based rehabilitation. This master degreeprogram will be started in 1999.

Ratchsuda College is under the umbrella of Mahidol University andunder patronage of H.R.H Princess Sirindhron. Prior to starting this masterdegree program, an orientation session will be conducted for faculty andstaff by experts from Australia and the USA in order to become wellprepared before launching the program.


64/93

54

In addition, Ratchasuda College is now providing :-Teacher training in special education techniques, counseling,

research, and educational media production.-Training of teacher skills in Orientation & Mobility, adaptive

technology, and teaching of sign language/Braille.

Methods of providino information services for patients after discharge.

Personnel from Sub-District Health Center, ie Health TechnicalOfficers, Health Community Officers or Nursing Officers, work as the pointperson in providing information services on the village level. The centralagency provides manuals (4 manuals) to the Health Center dealing with thecare of the disabled persons' rehabilitation, ie, blind, deaf, physical disabilityand mentally retarded.

These 4 manuals will be used in educating and helping the disabledand their family. The Health Officers provide information not only at theHealth Office but also through home visits and advise them on useful topics,ie, ways of sitting so as to avoid further injuries or educating the family ofbrain-damaged or mentally retardation about their nutrition needs, so thatthey are able to help themselves In some villages, the Village HealthVolunteer will be of help in this manner depending on their capability.

Activities of Village Health Volunteers.In the past, there were two kinds of volunteers working in the village,

Village Health Communicators (VHC) and Village Health Volunteers (VHV).Presently, VHC's have merged with VHV's.


65/93

55

The number of VHV's are based on the density of households in thearea; usually one VHV will serve 15 - 20 households. VHV;s receive no salarybut receive incentives, such as free medical treatment, covering their entirefamily. VHV's also earn the "respect of cognition" from their community.

Roles and Activities of VHV's are as follows :1. ln charge of running the Community Primary Health Care Center

which have been set up to deal with the community's primary health careproblems in village. For example, if villagers became sick, the VHV woulddo simple treatment or if villagers have some other problems, they wouldconsult the VHV as well.

2. VHV's are responsible for the early detection of disease, iediabetes, high blood pressure, etc. as well as assisting the Health Center inconducting surveys to gather information as needed.

3. Providing necessary heath information (14 elements of PHC) tovillagers in their respective areas.

4. Weighing pre-school children and distribution of supplementaryfood for malnourished children.

2. Distribution of primary health care in the districtPrimary health care centers are spread throughout the provincesnationwide and are under the responsibility of the Provincial Health Office(The Department of Personal Development and Primary Health Care) whichis directed by the Provincial Chief Medical Officer who has authority withintheir province under the same central policy guideline.

At district level, Health District Offices oversee primary health careservice within their district. For sub-districts, the Health Center is responsiblefor PHC services at the sub-district level.


66/93

56

From the Sub-District level down to the village level, there are smallunits of primary health care services called "Community Primary Health CareCenters".3.Vocational training for economical independence (independent living inthe community)

From research conducted by Wasana Taphophong regardingvocational training for handicapped persons, it was found that the majority ofthe disabled are satisfied with their training, especially regarding the trainingevaluation, the venue and the trainer.

Table 18 : Opinions of the handicapped on the learning system duringvocational training

Opinions Blind Deaf Physical Disabilitysatisfy unsatisfactory satisfy Unsatisfactory satisfu unsatisfactory

Curriculum & learning- teaching process

16(80.0)

4(20.0)

'18(eo.o)

2(10.0)

16(80.0)

4(20,0)

Teacher, trainer(e5.0)

1

(5.0)16

(80.0)4

(20.0)20

(100.0)Teaching & Trainingmaterials

13(65.0)

7(35.0)

'19(e5,0)

I

(5.0)16

(80.0)4

(20.0)Training venue 20

(100.0)20

(100.0)'t8

(eo.o)2

(10.0)Training evaluation 20

(100.0)zu

(100.0)20

(100.0)Rules and regulations 18

(eo.o)2

(10.0)to

(80.0)4

(20.0)17

(85.0)3

(15.0)

research on the needs of community based rehabilitation (cbr) for disabled persons in thailand

Documents