" A SALT-Based Perspective on Children with Severe Disabilities”

[Pooja Rana (Maya)]

Understanding disability and its severity

Disability refers to a person who is suffering from long-term physical, mental, intellectual, or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others. Children with disabilities are those below 18 years of age who experience the above conditions. Disabilities can be classified into broad categories. According to severity, they can be divided into four types: profound, severe, moderate, and mild.

Mild and moderate disabilities have a minimum impact on daily activities and social interaction. However, children with severe and profound disabilities require greater and more extensive support in all aspects of life. This means they need full support from others for daily living activities such as feeding, toileting, communication, and mobility.

Experience of working with children with disabilities in Nepal

My perception of disability completely changed when I started working in this field. I used to think that disability only meant using a wheelchair, walking aids, hearing aids, or vision-related aids. Fortunately, I enrolled in a disability-related program at Child Welfare Scheme Nepal (CWSN), where I had the opportunity to learn more deeply about the issues of disability and the struggles faced by caretakers.

I still remember my first home visit to an 8-year-old boy with cerebral palsy. I couldn’t sleep that night. His condition was severe, and he lived with his parents in a single room. He was unable to move his limbs, had poor head and posture control, and could not eat or sit by himself. Later, I met many more children with disabilities and their parents in Pokhara, which helped me understand the local situation better.

Photo: - 1 First home visit of child with severe disability (Cerebr...

At the same time, I attended several trainings on rehabilitation and intervention practices for children with disabilities, led by experts from Hong Kong. Through this experience, I realized that most children with severe and profound disabilities are not getting enough support from families, communities, the government, or NGOs. The reasons include high costs of assistive materials, challenges in health and wellbeing, the time required for care, and limited improvements. Families also had little knowledge about therapy techniques.

During the past five years, I have worked mainly with children with severe disabilities—those who are non-verbal, have low functioning and cognition, lack mobility, and are fully dependent on caretakers for activities of daily living (ADLs) such as eating, toileting, grooming, and mobility.

How can we implement SALT approach with children with severe disabilities?

The SALT and CLCP approach are a community development framework where SALT (Stimulate, Appreciate, Listen-Learn, Transfer) is a participatory methodology that fosters a positive, community-driven process, and CLCP (Community Life Competence Process) is the learning cycle that guides communities to take ownership of their challenges and implement solutions. SALT provides the appreciative and supportive environment for CLCP's structured steps of dreaming, self-assessment, planning, execution, and transfer of learning, ultimately building community competence and self-driven development (the-constellation.org). 

Applying SALT with community members is easier than with children with severe disabilities. Community people can communicate with facilitator and understands how others are supporting and appreciating them. Usually, SALT approach is implemented through deep conversations. However, with children with severe disabilities, it is not always possible. Many children are non-verbal, have limited gestures, and lower levels of cognition, which restrict their ability to express themselves. For the children with disabilities SALT should be done with proper assessment rather than conversation. Following steps could be helpful while applying SALT with children with disabilities.

1. Stimulate: First, recognized the child capacities in communication, ADL activities, mobility and expression. Assessed with caretaker about child likes and dislikes. Stimulate child by encouraging their capacities and set the goal according to concerned of child & parents.
2. Appreciate: Recognize weakness and valued the strength of child. Prepare the intervention plans by finding local resources to support their weakness. Many cases community people get appreciations verbally. However, for children with disabilities simple signs for example, clapping, tapping overhead, doing high five, high ten and reinforcing with favorite things could be appreciating gesture.
3. Listen-Learn: Spend the more time, modify and adopt the environment for mutual learning. Always prioritize to listen the voice of child and intervene according to child favorite activity. Later shared skills with family members.
4. Transfer: Promote the sharing of insights and solutions within and between communities, nurturing a culture of community-to-community transfer.

Video: - Supporting child participation through modifying sitting posture and appreciating click the link below

https://drive.google.com/file/d/1RlOYRgs7nZp1TgTYvxTpC616oOqRk1NC/v...

Photo: _- Appreciating child through high five cause they cannot un...

[Lipika Das Gupta]

Very inspiring dearest sister 🙏 I am so proud to learn from you

[Rituu B. Nanda]

Thank you Pooja for your reflections. I am learning so much from you!