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'''Original Editor '''- Pasala Maneewong and Patrick Le Folcalvez 


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== Introduction ==
== Introduction ==
There is no single treatment and rehabilitation programme that could be managed only by one single professional to assist the needs of patient’s conditions in health services atmospheres.  Depending on the individual needs of the individual patient who visit the hospital or rehabilitation centres will determine the various inputs required throughout their treatment and rehabilitation e.g. Assessment by Doctors, Radiologists, Specialised DoctorsPhysiotherapists (PT), Occupational Therapists (OT), Psychologists, Dieticians, and Social Workers etc. Additionally, other professionals outside of the healthcare team when we are thinking holistically as one human need to survive such as vocational training professional, education professional, etc. Therefore, as a physiotherapist, we need to be creative and open minded to work with different professional to contribute and fullfill the needs of the patients. In the certain context as refugee camps we need to work collaboratively with other professionals who are not only health professionals as the situation for them seem very complexes and many things surround them are just interfere you rehabilitation process if you are not plan and work thoroughly.
There is no single treatment or rehabilitation programme within a health service that can be managed in isolation by a single professional to assist with needs of the person's specific condition. The specific needs of a person who visits a health service will determine the various inputs that would be required throughout their treatment and rehabilitation e.g. assessment by doctors, radiologists, specialised doctorsphysiotherapists (PT), occupational therapists (OT), psychologists, dieticians, and social workers. Additionally, other professionals outside of the healthcare team also play a role in meeting this person's needs to survive and thrive, including vocational training professionals and education professionals.  


Therefore, if you may ended up with poor progression of your patients according to they have less motivation and collaboration in your rehabilitation session because there are many issues such as no food for family members, domestic violence issues which needed to be solved. Thus, working with inter-professionals will help us to see the holistic situations of patient then see how each of profession could contribute and most importantly how much resources do we have in this camps context and who should to do what.
As rehabilitation professionals, we need to be creative and open-minded to work with other specialists to contribute and fulfil the needs of the individual person seeking support. In specific contexts, like camps for displaced persons, it is vital that we work collaboratively with other professionals. The needs of displaced person are often complex with many factors  which, if not addressed, can negatively impact the rehabilitation process.  They may include limited access to food for family members, inadequate shelter, sanitation or potable water.  


To summarise, a person-centered approach is necessary, combining multidisciplinary skills in one common goal. The physiotherapist often plays a central role, linking medical and social stakeholders.
Working with inter-professionals will help to built a holistic approach to meet the patient's needs, where each profession contribute and where all available resources are well utilised. To summarise, a person-centred approach is necessary, combining multidisciplinary skills with one common goal. The rehabilitation professional plays a central role, in linking medical and social stakeholders.


== Understanding the Refugee Camp Management Structure ==
== Understanding Camp Management Structure ==
In the complexity of the Refugee’ Camp context, there are different structures that you should aware of. Although it seem that working as physiotherapist, we are very much focused on health services, but in fact it is very helpful for you to aware of the social structure in camps so you understand who you should collaborate and who you should be aware of according to community norms, which may help you to discuss and get some advice to improve your rehabilitation session for your patients. It is also important to have an understanding of who the main authorities are to advise in relation to rules and regulations in the camps and what you should or should not do in their communities. Furthermore, in refugee camp contexts you will see many humanitarians organisations who are implementing a wide range programs with various contents e.g. health, food distribution, shelter establishment, water and sanitation, education, vocational training, protection, social services, and resettlement.
In the complexity of the camp context for displaced persons, there are many different structures that you should be aware of. It seems that working as rehabilitation professionals, we are very much focused on health services. In fact, it is very helpful to be aware of the social structure within camps to understand who you should collaborate with and what role they play, which may help you to improve the rehabilitation services uptake. It is also important to have an understanding of who is the main authority within the camp to ask for advise about rules and regulations in the camps and what you should or should not do in its communities. Furthermore, in most camp contexts you will have many humanitarian organisations that are implementing a wide range of programs with various contents e.g. health, food distribution, shelter establishment, water and sanitation, education, vocational training, protection, social services, and resettlement.


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   <div class="col-md-6"> {{#ev:youtube|SSDK2Dyqi9E|250}} <div class="text-right"><ref>Elena Taber. Visiting A Syrian Refugee Camp. Available from: http://www.youtube.com/watch?v=SSDK2Dyqi9E[last accessed 30/07/2020]</ref></div></div>
   <div class="col-md-6"> {{#ev:youtube|iMm9NxKgU6c|250}} <div class="text-right"><ref>IOM - UN Migration
. Nepal: Camp Coordination and Camp Management (CCCM) in Disaster Response. Available from: https://youtu.be/iMm9NxKgU6c[last accessed 30/07/2020]</ref></div></div>
   <div class="col-md-6">{{#ev:youtube|O7fF0eFHn7o|250}} <div class="text-right"><ref>Human Rights Watch. Greece: Refugees with Disabilities Overlooked, Underserved. Available from: http://www.youtube.com/watch?v=O7fF0eFHn7o[last accessed 30/07/2020]</ref></div></div>
   <div class="col-md-6">{{#ev:youtube|O7fF0eFHn7o|250}} <div class="text-right"><ref>Human Rights Watch. Greece: Refugees with Disabilities Overlooked, Underserved. Available from: http://www.youtube.com/watch?v=O7fF0eFHn7o[last accessed 30/07/2020]</ref></div></div>
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The purposes of camp management is to make sure that services and protection provided are in line with national and international laws, guidelines and agreed standards. The International Guideline Standard such as SPHER standard, which is a set of guidelines that formulate the minimum humanitarian standards in four technical areas: Water Supply, Sanitation and Hygiene Promotion, Food Security and Nutrition. Another example is the Inter-Agency Network for Education in Emergencies (INEE), which is the standard for humanitarian actors to coordinate the quality educations prior to, during and after agencies. These guidelines have set the standards of its relevant issues. They also consist of the ethical points of views, and how to work with refugee community in practice since situation analyses until outcome assessment. Therefore, as a physiotherapist you can study some specific guideline that you may see that it’s relevant to your patients’ needs, then you can assist them by referral or consultation to the relevant actors or at least give information to your patient or their families to seek for further support channels in the correct way. You may need to keep in mind that in practice, what is available in your context and what do other organisations able to give service or what process to let the population to consult further in this camp.
The purpose of camp management is to make sure that services and protection provided are in line with national and international laws, guidelines and agreed standards.<ref>International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR), Global Camp Coordination and Camp Management (CCCM) Cluster. Chapter 1 About Camp Management Introduction. 2015. Available from: http://cmtoolkit.org/media/transfer/doc/chapter_1.pdf (accessed 16 June 2020)
</ref> International Guidelines and Standards, such as the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response, <ref>Sphere Project. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Edition 2018.  Available from: https://handbook.spherestandards.org/en/sphere/#ch001 [Accessed 16 June 2020]</ref>outline the minimum humanitarian standards in four technical areas: Water Supply, Sanitation and Hygiene Promotion, Food Security and Nutrition. Another example is the Inter-Agency Network for Education in Emergencies (INEE)<ref>Inter-agency Network for Education in Emergencies (INEE). INEE Minimum Standards for Education: Preparedness, Response, Recovery. 2020. Available from: https://inee.org/resources/inee-minimum-standards [Accessed 16 June 2020]</ref>, which is the standard for humanitarian actors to coordinate the quality of education prior to, during and after agencies. They also include ethical considerations for working with displaced persons.  


=== Camp Management in Thailand Myanmar Refugees’ Camps ===
=== Example of Camp Management in Thailand Myanmar Displaced Persons Camps ===
There is the form of committee that created by the humanitarian agencies which are working in 9 refugees camps along Thailand/ Myanmar border. It is called ‘The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT). It was formed and aimed to be a forum for the members to communicate and coordinate between them to ensure the quality of services for refugees in camps as well as being the representing of membership’s interest to the Royal Thai Government, international organizations and embassies.
The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT)<ref>The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT). 2020. Available from:  http://www.ccsdpt.org/theborderconsortium [Accessed 16 June 2020]</ref> was developed by the humanitarian agencies working within 9 Displaced Persons Camps along the Thailand / Myanmar border. It was formed and aims to be a forum for members to communicate and coordinate between them to ensure the quality of services for displaced persons in the camps and to represent the membership’s interest to the Royal Thai Government, International Organisations and Embassies.


The camp management is one sector of CCSDPT which function to facilitate the refugee communities experience in their camp management as an accountable, inclusive and capacitated self-governance system that adheres to humanitarian principles ensures access to justice and involves them in planning for solutions. One of their strategies is to promote the rights of persons with specific needs and under-represented groups, ensuring their equitable access to services, including justice. The mapping services mapping document is always available and facilitate to develop by agencies group so you should look for this document to assist you to work. Therefore, here you can see the link that your patients may need to access the services from camp management like other. Moreover, this is the great opportunity that the system is already open for them to access so if in practice you patient have some challenges then they are eligible to raise their voice or contact relevant actors.
The camp management is one sector of the CCSDPT, which functions to facilitate the displaced communities' experience in their camp management as an accountable, inclusive and capacitated self-governance system that adheres to humanitarian principles. It ensures access to justice and involves them in planning for solutions. One of the strategies is to promote the rights of persons with specific needs and under-represented groups, ensuring their equitable access to services, including justice. The mapping services document outlines what is always available and facilitates links to agencies that support specific roles. Being aware of this document is important so that rehabilitation professionals understand the links that allow the patients to access services from camp management. Moreover, there is a great opportunity for the rehabilitation professionals to use the system if they need to raise their concerns about patients or contact relevant actors.[[File:CCSDPT.png|center|frame|Fig 1. CCSDPT Coordination Structure]]
There are different sectors that the CCSDPT members are divided into, to support specialised or responsive approaches to the needs of the displaced communities. You may see the overall services for the camps, which are available in greater detail in the handbook. The graph provides guideline of the camp structure on which organisations are implementing what activities and providing what services so that you can either contact them or advise your patient to access further support. The Rehabilitation Project is under the Health Sub-committee according to this structure and the Disabilities Inclusion project is a cross-cutting project that includes involvement across a number of sectors. This coordination structure is similar in other Displaced Person Camps settings all around the world so you can explore further in other contexts in the references resources on this page. <ref>International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR), Global Camp Coordination and Camp Management (CCCM) Cluster. Camp management toolkit. Edition June, 2015. P 60. Available from:  https://www.humanitarianlibrary.org/sites/default/files/2015/08/CMT_2015_Chapter_00-18_print%20%282%29.compressed.pdf [Accessed 16 June 2020]</ref><ref>World Health Organisation (WHO). 2012. Available from: https://www.unicef.org/disabilities/files/ECD-and-Disability-WHO-2012%281%29.pdf [Accessed 16 June 2020]</ref>


The structure of CCSDPT
== Roles of Rehabilitation Professionals with Camps Setting ==
There are different sectors that CCSDPT members divided to work as per their specialized or responsive approaches to the needs of the refugees’ communities.
Rehabilitation professionals have various roles within the health services system, including promotion, prevention, treatment, and rehabilitation. Therefore, you should analyse the needs of the camp context that you are going to work in, the local and available resources and your organization's capacity to contribute to filling the gaps.  


Figure1. CCSDPT coordination structure
The role of rehabilitation professionals in camps settings include:
 
According to figure 1, you may see the overall services for the refugees in camps which you can see in the details further in the handbook or the guideline of this structure in term of which organization implementing what activities and providing what services so that you can either contact them or advice your patient to seek for further assistants. Rehabilitation project is under health sub-committee according to this structure and disabilities Inclusion project is cross cutting project so there are involve in all other sectors.
 
This coordination structure is similar in other refugee’s camps setting all around the world so you can explore further in other context in the references resources of this page.
 
== Roles of Physiotherapy in Health and Rehabilitation in Camps Setting ==
As physiotherapy have various roles in health services system since promotion, prevention, treatment, and rehabilitation. Therefore, you should analyse the needs of the camp context that you are going to work, the local and available resources and your organization capacity to contribute to fill the gaps. If following each part of health system we can see the role of PT in camps setting as:


=== Health Promotion ===
=== Health Promotion ===
* The give education of physical activities to improve the strength, cardiovascular could be possible, although several times these activities seem not priority of the refugees as they tend to focus on their basic needs such as food, safety and security of family members according to the context.
* Provide education on physical activities to improve strength, cardiovascular health, psychological health and well-being. Although often these activities are not seen as a priority within the context of camps for many displaced persons as the focus tends to be on their basic needs such as food, safety and security of family members according to the context.
* Recreation activities such as relaxation exercises could be possible to give advices for refugees but to apply based on cultural acceptance is need to be determined.


=== Prevention ===
=== Prevention ===
* Health education
* Health Education
* Awareness rising for particular health conditions such as nutrition programs.
* Awareness rising for particular health conditions such as nutrition programs.


=== Early Identification Activities ===
=== Early Identification Activities ===
As we all know that early detection of all health issues is best for further treatment to see good outcomes and prognosis.  Some activities that have been conduct in camp context such as.
As we all know that early detection of all health issues is important for effective management and to access further treatment to ensure good outcomes and prognosis.  Some activities that have been conducted in camp contexts include;
* Early childhood development program -> detection of any sign of impairments in early childhood age and referral to proper services. You can find some resource in the references.
* Early childhood development programs - detection of any sign of impairments in early childhood age and referral to proper services. <ref>Buxton S. Physiopedia. New Ways to Act F.A.S.T. Initiatives to Speed up Diagnosis of Stroke. 2017. Available from:  https://www.physiospot.com/2017/11/20/new-ways-to-act-f-a-s-t-initiatives-to-speed-up-diagnosis-of-stroke/[Accessed 16 June 2020]</ref>
* FAST, facial droop, arm drop, speech disturbance and time, the way to identify the signs of stroke.
* FAST, facial droop, arm drop, speech disturbance and time, the way to identify the signs of stroke.<ref>World Health Organisation (WHO). 2012. Available from: https://www.unicef.org/disabilities/files/ECD-and-Disability-WHO-2012%281%29.pdf [Accessed 16 June 2020]</ref>
* Early detection for all impairment of people in the community
* Early detection of impairment of people in the community.<ref>Physiopedia. International Classification of Functioning, Disability and Health (ICF) 1 April 2020. Available from:  [[International Classification of Functioning, Disability and Health (ICF)|https://www.physio-pedia.com/International_Classification_of_Functioning,_Disability_and_Health_(ICF)]] [Accessed 16 June 2020]</ref>


=== Treatment and Rehabilitation ===
=== Treatment and Rehabilitation ===
This domain is the clinical part that you really need to work closely with inter-professional team and identify the needs with the team based when and what you should intervene the treatment or rehabilitation process. The international classification of health and disabilities framework (ICF) is effective tools for us to work together with inter-professional team though tout all cycle of rehabilitation since assessment until follow up.
In this clinical role, rehabilitation professionals need to work closely with the inter-professional team. The entire team will identify the patient's needs that will determine the treatment or rehabilitation process. The International Classification of Health and Disabilities Framework (ICF) <ref name=":0">Béguin R., Humanity & Inclusion, 2019. Early Childhood Stimulation Therapy for Severe Acute Malnourished children 0-5 years: Training Manual.</ref> is an effective tool for teams to work together throughout the rehabilitation process.


You can consider give your Physiotherapy technique services in various stage for example:
You can consider offering your physiotherapy services in various stages, including:


==== Early Stage ====
==== Early Stage ====
* Positioning
* Positioning
* Passive Mobilisation
* Mobility
* Gentle Active Exercise
* Gentle Active Exercise
* Breathing Exercise
* Breathing exercises
* Early TransferS with or without assistant
* Early transfers with or without an assistant
* Development Stimulation for children at simple level, based on their condition
* Developmental activities for for children <ref name=":0" /><ref>UNICEF. Guidance note for integrating ECD activities into nutrition programmes in emergencies. June 2012. Available from: https://www.unicef.org/earlychildhood/files/Integrating_ECD_into_Nurtition_in_Emergencies_-_Final_June_2012.pdf [Accessed 16 June 2020]</ref>
* Bed Mobility Training
* Provision of assistive technology
* Consider providing assistive devices


==== Recovery Stage ====
==== Recovery Stage ====
Techniques of early stage with more advance techniques
Techniques of the early stage with more advanced techniques
* Active resisted exercises or strengthening programs
* Active resisted exercises or strengthening programs
* Independent Transfers
* Independent Transfers
* Development Stimulation (for children) at more dynamic and advance levels
* Independent Mobility
* Independent Mobility
* Self-Stretching
* Self-Stretching
* Consider providing assistive devices
* Provision of assistive technology


==== Prepare for Discharge Stage ====
==== Prepare for Discharge Stage ====
* Take time for patients or their care givers to learn to do thing by themselves and the therapists step back to be the coacher rather the direct services provider
* Take time for patients or their caregivers to learn to do things by themselves and the therapists step back to be the coacher rather than the direct services provider
* Cross check all understanding and handling technique of patients and care givers are correct and safety
* Cross check all understanding and handling techniques of patients and caregivers are correct and that safety
* Prepare all education tools, such as poster, handbook, and card for patient to follow at home
* Prepare all education tools, such as poster, handbook, and card for patient to follow at home
* Discussing with all relevant care givers and stakeholder according to the patients future plan e.g. continue education, willing to attend vocational training, etc.
* Discuss with all relevant caregivers and stakeholders according to the patients' future plan e.g. continue education, willing to attend vocational training, etc.
* If possible, visit the patient’s home and environment to identify potential obstacles that request specific adaptations.
* If possible, visit the patient’s home and environment to identify potential obstacles that request specific adaptations. <ref>Skelton P. and Harvey A.. Rehabilitation in Sudden Onset Disasters. 2015. Available from: https://donate.handicap-international.org.uk/wp-content/uploads/2017/06/rehabilitation-in-sudden-onset-disasters-complete-manual-web.pdf?_ga=2.208021717.696820625.1592021360-356917845.1592021360 [Accessed 16 June 2020]</ref>
For more information of PT techniques and intervention you can explore from “Clinical Manual: Rehabilitation in Sudden Onset Disaster”
{{#ev:youtube|v=s_La3I_TS14|250}} <div class="row"><div class="col-md-6 col-md-offset-3"><div class="text-right"><ref>Doctors Without Borders / MSF-USA. Physiotherapy in Emergency Settings. Available from: http://www.youtube.com/watch?v=v=s_La3I_TS14[last accessed 30/10/17]</ref></div></div></div>


{{#ev:youtube|v=s_La3I_TS14|250}} <div class="row"><div class="col-md-6 col-md-offset-3"><div class="text-right"><ref>Doctors Without Borders / MSF-USA. Physiotherapy in Emergency Settings. Available from: http://www.youtube.com/watch?v=v=s_La3I_TS14[last accessed 30/10/17]</ref></div></div></div>
=== Value of Rehabilitation ===
Rehabilitation services require collaboration amongst all team members and the commitment of the patient and their support structures to improve their health conditions. As we know rehabilitation is often a long process towards the improvement, and more complex conditions might take months or years to show any progress. Moreover, rehabilitation and its role are not always well understood or valued in many countries so advocacy for rehabilitation services is often a huge part of the role. This lack of understanding of rehabilitation comes not only from the population but can be present within the health service itself. Therefore, having strategies to show the contribution of rehabilitation professionals is vital to increase awareness of what rehabilitation can achieve and the benefits of our interventions toward population health.


=== Challenging of making people understand and aware your value ===
== Facilitation of Inter-professional Working in the Community Setting ==
As physical therapy services are needed a lot of collaboration and commit of the patients to collaborate to improve their health conditions. As we know rehabilitation is long time process for patient to see their improvement which some condition might take months or years to see the big progression. Moreover, physical therapy is not well known therapeutic in many countries so to start all physical therapy services or rehabilitation we really need to explain demonstration, advocate and make understand to people in target locations. This lack of understanding is not only from the population, but also from the doctors or nurses in the front line. Therefore, we would like to be prepare of develop strategies to make all relevant people aware what we can contribute and support and what are benefits of our interventions to the population health’s.
There are different approaches and levels that community providers and the agencies agree on regarding who will lead or facilitate the health services in this setting. One example is the case manager as a team leader. In the community’s hospital, the focal person is most likely a nurse.  At the community level, such as Community Based Rehabilitation (CBR) Projects, <ref>World Health Organisation (WHO). Community-based rehabilitation: CBR guidelines. 12 May 2010. Available from: https://www.who.int/publications/i/item/community-based-rehabilitation-cbr-guidelines [Accessed 16 June 2020]</ref> the case manager is the social worker. In addition, a physiotherapist is one member of the inter-professional team so he or she may also be the focal person. In either role as a member of the team or the main facilitator of the team, you need to be prepared and proactive to provide information about your assessment and what contribution you should offer to this person and the team. Think holistically and prepare yourself before the team updates session start, so that all of the patient, caregivers and your own concerns can be asked and put in place to find the solution for the next step. [[Effective Communication Techniques]] are needed in this role.


Which levels should you priorities to involve in improving situation of people in refugees camps?
Keep in mind that as a rehabilitation professional, you spend a long time with patients during their rehabilitation sessions so you tend to form a closer relationships with patients and caregivers than other inter-professional team members. Therefore, it is a good idea to gather and catalyse important information to discuss them with the team for the best outcomes for the patients.
As mentioned in the roles of physical therapy in health and rehabilitation in camps setting section, you can assess the community situation together with local health committees and stakeholders in targets are and see how and where should develop the interventions or project to fill the gap. To discussion with all stakeholders, you will be able to explore and understand the holistic needs of the patients and how one project may impact to others.


== Facilitation of inter-professional working in the community setting ==
=== Information and Communication Tools ===
There are different approaches and level that the community’s providers and the agencies will agree who will lead or facilitate the health services in this setting. The obvious example that we can focus on this is the case management team leader. This is the role of the focal person to facilitate the discussion among that relevant team who involve contributing support this person (case). Most of the time if it is in the community’s hospital the focal person is nurse and many times in the community level such as community based rehabilitation projects, the social worker is case manager. In addition, physiotherapist is one member of inter-professional team so you may also be the focal person too. In either your roles as member of the team or the main facilitator of the team, you need to be prepare and proactive to provide information about your assessment and what contribution you should give to this person and the team. Think holistically and prepare yourself before the team updates session start so that all of patient, care givers and your concerns can be asked and put in place to find solution for next step. The effective communication techniques are needed in this role so you can practice and learn more in the topic of ‘effective communication techniques’ webpage of physiopedia.
Information and Communication Tools (ICT) play a very important role in the context of camps for displaced persons because the rehabilitation services need a lot of application to ensure the patients and caregivers are less dependent on the health centre. The ICT are needed due to:


Keep in mind that as rehabilitation profession, you have a great and long time with patient during rehabilitation session so you tend to gain relationship with patient and care giver more than other inter-professional team members. Therefore, it is good if you can gather and catalyze important information to discuss with the team for the best beneficial rehabilitation outcomes for the patients.
* limited resources of rehabilitation centres
* cases overload
* long distance for patients to come to the centre
* caregivers are not able to assist them to come to the centre too often too.  


=== ICT Tool for you to facilitate Inter-professional Working in the Community Setting ===
To develop simple tools for rehabilitation homework or home exercise is crucial to support them. This is also a good tool for other professionals to see what you have advised the patient to take care of themselves so the inter-professional members can either remind them of you or avoid any duplication plan which may make them confused.
The information and Communication Tools (ICT) play a very important role in refugees camp context as the rehabilitation services are need a lot of application to ensure the patients and care giver are less dependent to health center. The reasons are that the limited resources of rehabilitation centers, over case load, long distance for patient to come to the center and care giver are not able to assist to them to come to center too often too. Therefore to develop simple tools for rehabilitation homework or home exercise is crucial to support them. This is also is a good tool for other professionals to see what you have advice the patient to take care of themselves so the inter-professional members can either remind them for you or avoid any duplication plan which may make them confuse.


In addition, the way to use the tools to make sure patient and care giver understand correctly is very important. Giving demonstration and ask them you demonstrate back to you as two way communication is one of effective way of home exercise education. Besides, pictures are more effective tools that the text as it is visible clear demonstration. Adding some text is suggested, but too much text is less interesting and many refugees are not able to read and write. Follow up process and monitoring the outcomes
In addition, the way to use the tools to make sure patient and caregiver understand correctly is very important. Giving a demonstration and asking them to demonstrate back to you as two-way communication is one effective way of home exercise education. Besides, pictures are more effective tools than text as it is a visible clear demonstration. Adding some text is suggested, but too much text is less interesting and many refugees are not able to read and write. Follow-up process and monitoring of the outcomes


=== Follow Up Process and Monitoring the Outcomes ===
=== Follow Up Process and Monitoring the Outcomes ===
The follow up process and monitoring the rehabilitation outcomes is important process which is to see the progression of the patient, quality or your services and feedback tools to your stakeholders about patient situation. It is one challenge of working in the refugee context regarding to people movement and situation changes. However, it is always possible for the inter-professional team to find the simple way to measure the outcomes of you treatment and rehabilitation. To modify the standard tools such as Functional Independence Outcomes (FIM), Barthel index and other tools are encouraged all PT in refugees’ context to put your effort to work with inter-professional team to select the most suitable tools to apply in each context. Besides, to monitor to holistic approaches and long term rehabilitation such as community based rehabilitation approaches you may apply more tools to evaluate the person’s quality of life as well as community support level. All of this could be discuss with the communities and stakeholder to find out the proper tools or questionnaire. The good example of international tool such as Disability Measurement and Monitoring of the Washington Group Disability Questions, which available in short and long questionnaire to apply to your work context to assess the situation of people with impairments in the communities that you have involved.
The follow-up process and monitoring of the rehabilitation outcomes are important, because they allow to:


== Resources  ==
* see the progression of the patient
* assess the quality of your services
* provide feedback tools to your stakeholders about the patient situation.
<br>
These processes are challenging to apply in the refugee context because of people's movement and changes in their social or housing situation. However, it is always possible for the inter-professional team to find a simple way to measure the outcomes of your treatment and rehabilitation. [[Functional Independence Measure (FIM)|Functional Independence Measure]] (FIM), [[Barthel Index]] and other [[Outcome Measures]] are encouraged in the Refugee context to monitor the impact of your programs. Holistic approaches and long-term rehabilitation including Community Based Rehabilitation approaches use a wide range of tools to evaluate the person’s quality of life as well as a community support level. All of this could be discussed with the communities and stakeholders to find out the proper tools or questionnaire. Good examples of international tools include the Disability Measurement and Monitoring of the Washington Group Disability Questions <ref>Washington Group on Disability Statistic. 2020. Available from:  http://www.washingtongroup-disability.com/about/history/ [Accessed 16 June 2020]</ref>, which is available in short and long questionnaires. It is used to assess the situation of people with impairments in the communities that you were involved.


== References  ==
== References  ==
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[[Category:PREP Content Development Project]]
[[Category:PREP Content Development Project]]
[[Category:Course Pages]]
[[Category:ReLAB-HS Course Page]]
[[Category:Displaced Persons]]

Latest revision as of 18:13, 23 November 2022

Original Editor - Pasala Maneewong and Patrick Le Folcalvez

Top Contributors - Naomi O'Reilly, Kim Jackson, Ewa Jaraczewska and Rishika Babburu  

Introduction[edit | edit source]

There is no single treatment or rehabilitation programme within a health service that can be managed in isolation by a single professional to assist with needs of the person's specific condition. The specific needs of a person who visits a health service will determine the various inputs that would be required throughout their treatment and rehabilitation e.g. assessment by doctors, radiologists, specialised doctors, physiotherapists (PT), occupational therapists (OT), psychologists, dieticians, and social workers. Additionally, other professionals outside of the healthcare team also play a role in meeting this person's needs to survive and thrive, including vocational training professionals and education professionals.

As rehabilitation professionals, we need to be creative and open-minded to work with other specialists to contribute and fulfil the needs of the individual person seeking support. In specific contexts, like camps for displaced persons, it is vital that we work collaboratively with other professionals. The needs of displaced person are often complex with many factors which, if not addressed, can negatively impact the rehabilitation process. They may include limited access to food for family members, inadequate shelter, sanitation or potable water.

Working with inter-professionals will help to built a holistic approach to meet the patient's needs, where each profession contribute and where all available resources are well utilised. To summarise, a person-centred approach is necessary, combining multidisciplinary skills with one common goal. The rehabilitation professional plays a central role, in linking medical and social stakeholders.

Understanding Camp Management Structure[edit | edit source]

In the complexity of the camp context for displaced persons, there are many different structures that you should be aware of. It seems that working as rehabilitation professionals, we are very much focused on health services. In fact, it is very helpful to be aware of the social structure within camps to understand who you should collaborate with and what role they play, which may help you to improve the rehabilitation services uptake. It is also important to have an understanding of who is the main authority within the camp to ask for advise about rules and regulations in the camps and what you should or should not do in its communities. Furthermore, in most camp contexts you will have many humanitarian organisations that are implementing a wide range of programs with various contents e.g. health, food distribution, shelter establishment, water and sanitation, education, vocational training, protection, social services, and resettlement.

The purpose of camp management is to make sure that services and protection provided are in line with national and international laws, guidelines and agreed standards.[3] International Guidelines and Standards, such as the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response, [4]outline the minimum humanitarian standards in four technical areas: Water Supply, Sanitation and Hygiene Promotion, Food Security and Nutrition. Another example is the Inter-Agency Network for Education in Emergencies (INEE)[5], which is the standard for humanitarian actors to coordinate the quality of education prior to, during and after agencies. They also include ethical considerations for working with displaced persons.

Example of Camp Management in Thailand Myanmar Displaced Persons Camps[edit | edit source]

The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT)[6] was developed by the humanitarian agencies working within 9 Displaced Persons Camps along the Thailand / Myanmar border. It was formed and aims to be a forum for members to communicate and coordinate between them to ensure the quality of services for displaced persons in the camps and to represent the membership’s interest to the Royal Thai Government, International Organisations and Embassies.

The camp management is one sector of the CCSDPT, which functions to facilitate the displaced communities' experience in their camp management as an accountable, inclusive and capacitated self-governance system that adheres to humanitarian principles. It ensures access to justice and involves them in planning for solutions. One of the strategies is to promote the rights of persons with specific needs and under-represented groups, ensuring their equitable access to services, including justice. The mapping services document outlines what is always available and facilitates links to agencies that support specific roles. Being aware of this document is important so that rehabilitation professionals understand the links that allow the patients to access services from camp management. Moreover, there is a great opportunity for the rehabilitation professionals to use the system if they need to raise their concerns about patients or contact relevant actors.

Fig 1. CCSDPT Coordination Structure

There are different sectors that the CCSDPT members are divided into, to support specialised or responsive approaches to the needs of the displaced communities. You may see the overall services for the camps, which are available in greater detail in the handbook. The graph provides guideline of the camp structure on which organisations are implementing what activities and providing what services so that you can either contact them or advise your patient to access further support. The Rehabilitation Project is under the Health Sub-committee according to this structure and the Disabilities Inclusion project is a cross-cutting project that includes involvement across a number of sectors. This coordination structure is similar in other Displaced Person Camps settings all around the world so you can explore further in other contexts in the references resources on this page. [7][8]

Roles of Rehabilitation Professionals with Camps Setting[edit | edit source]

Rehabilitation professionals have various roles within the health services system, including promotion, prevention, treatment, and rehabilitation. Therefore, you should analyse the needs of the camp context that you are going to work in, the local and available resources and your organization's capacity to contribute to filling the gaps.

The role of rehabilitation professionals in camps settings include:

Health Promotion[edit | edit source]

  • Provide education on physical activities to improve strength, cardiovascular health, psychological health and well-being. Although often these activities are not seen as a priority within the context of camps for many displaced persons as the focus tends to be on their basic needs such as food, safety and security of family members according to the context.

Prevention[edit | edit source]

  • Health Education
  • Awareness rising for particular health conditions such as nutrition programs.

Early Identification Activities[edit | edit source]

As we all know that early detection of all health issues is important for effective management and to access further treatment to ensure good outcomes and prognosis.  Some activities that have been conducted in camp contexts include;

  • Early childhood development programs - detection of any sign of impairments in early childhood age and referral to proper services. [9]
  • FAST, facial droop, arm drop, speech disturbance and time, the way to identify the signs of stroke.[10]
  • Early detection of impairment of people in the community.[11]

Treatment and Rehabilitation[edit | edit source]

In this clinical role, rehabilitation professionals need to work closely with the inter-professional team. The entire team will identify the patient's needs that will determine the treatment or rehabilitation process. The International Classification of Health and Disabilities Framework (ICF) [12] is an effective tool for teams to work together throughout the rehabilitation process.

You can consider offering your physiotherapy services in various stages, including:

Early Stage[edit | edit source]

  • Positioning
  • Mobility
  • Gentle Active Exercise
  • Breathing exercises
  • Early transfers with or without an assistant
  • Developmental activities for for children [12][13]
  • Provision of assistive technology

Recovery Stage[edit | edit source]

Techniques of the early stage with more advanced techniques

  • Active resisted exercises or strengthening programs
  • Independent Transfers
  • Independent Mobility
  • Self-Stretching
  • Provision of assistive technology

Prepare for Discharge Stage[edit | edit source]

  • Take time for patients or their caregivers to learn to do things by themselves and the therapists step back to be the coacher rather than the direct services provider
  • Cross check all understanding and handling techniques of patients and caregivers are correct and that safety
  • Prepare all education tools, such as poster, handbook, and card for patient to follow at home
  • Discuss with all relevant caregivers and stakeholders according to the patients' future plan e.g. continue education, willing to attend vocational training, etc.
  • If possible, visit the patient’s home and environment to identify potential obstacles that request specific adaptations. [14]

Value of Rehabilitation[edit | edit source]

Rehabilitation services require collaboration amongst all team members and the commitment of the patient and their support structures to improve their health conditions. As we know rehabilitation is often a long process towards the improvement, and more complex conditions might take months or years to show any progress. Moreover, rehabilitation and its role are not always well understood or valued in many countries so advocacy for rehabilitation services is often a huge part of the role. This lack of understanding of rehabilitation comes not only from the population but can be present within the health service itself. Therefore, having strategies to show the contribution of rehabilitation professionals is vital to increase awareness of what rehabilitation can achieve and the benefits of our interventions toward population health.

Facilitation of Inter-professional Working in the Community Setting[edit | edit source]

There are different approaches and levels that community providers and the agencies agree on regarding who will lead or facilitate the health services in this setting. One example is the case manager as a team leader. In the community’s hospital, the focal person is most likely a nurse. At the community level, such as Community Based Rehabilitation (CBR) Projects, [16] the case manager is the social worker. In addition, a physiotherapist is one member of the inter-professional team so he or she may also be the focal person. In either role as a member of the team or the main facilitator of the team, you need to be prepared and proactive to provide information about your assessment and what contribution you should offer to this person and the team. Think holistically and prepare yourself before the team updates session start, so that all of the patient, caregivers and your own concerns can be asked and put in place to find the solution for the next step. Effective Communication Techniques are needed in this role.

Keep in mind that as a rehabilitation professional, you spend a long time with patients during their rehabilitation sessions so you tend to form a closer relationships with patients and caregivers than other inter-professional team members. Therefore, it is a good idea to gather and catalyse important information to discuss them with the team for the best outcomes for the patients.

Information and Communication Tools[edit | edit source]

Information and Communication Tools (ICT) play a very important role in the context of camps for displaced persons because the rehabilitation services need a lot of application to ensure the patients and caregivers are less dependent on the health centre. The ICT are needed due to:

  • limited resources of rehabilitation centres
  • cases overload
  • long distance for patients to come to the centre
  • caregivers are not able to assist them to come to the centre too often too.

To develop simple tools for rehabilitation homework or home exercise is crucial to support them. This is also a good tool for other professionals to see what you have advised the patient to take care of themselves so the inter-professional members can either remind them of you or avoid any duplication plan which may make them confused.

In addition, the way to use the tools to make sure patient and caregiver understand correctly is very important. Giving a demonstration and asking them to demonstrate back to you as two-way communication is one effective way of home exercise education. Besides, pictures are more effective tools than text as it is a visible clear demonstration. Adding some text is suggested, but too much text is less interesting and many refugees are not able to read and write. Follow-up process and monitoring of the outcomes

Follow Up Process and Monitoring the Outcomes[edit | edit source]

The follow-up process and monitoring of the rehabilitation outcomes are important, because they allow to:

  • see the progression of the patient
  • assess the quality of your services
  • provide feedback tools to your stakeholders about the patient situation.


These processes are challenging to apply in the refugee context because of people's movement and changes in their social or housing situation. However, it is always possible for the inter-professional team to find a simple way to measure the outcomes of your treatment and rehabilitation. Functional Independence Measure (FIM), Barthel Index and other Outcome Measures are encouraged in the Refugee context to monitor the impact of your programs. Holistic approaches and long-term rehabilitation including Community Based Rehabilitation approaches use a wide range of tools to evaluate the person’s quality of life as well as a community support level. All of this could be discussed with the communities and stakeholders to find out the proper tools or questionnaire. Good examples of international tools include the Disability Measurement and Monitoring of the Washington Group Disability Questions [17], which is available in short and long questionnaires. It is used to assess the situation of people with impairments in the communities that you were involved.

References[edit | edit source]

  1. IOM - UN Migration . Nepal: Camp Coordination and Camp Management (CCCM) in Disaster Response. Available from: https://youtu.be/iMm9NxKgU6c[last accessed 30/07/2020]
  2. Human Rights Watch. Greece: Refugees with Disabilities Overlooked, Underserved. Available from: http://www.youtube.com/watch?v=O7fF0eFHn7o[last accessed 30/07/2020]
  3. International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR), Global Camp Coordination and Camp Management (CCCM) Cluster. Chapter 1 About Camp Management Introduction. 2015. Available from: http://cmtoolkit.org/media/transfer/doc/chapter_1.pdf (accessed 16 June 2020)
  4. Sphere Project. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Edition 2018.  Available from: https://handbook.spherestandards.org/en/sphere/#ch001 [Accessed 16 June 2020]
  5. Inter-agency Network for Education in Emergencies (INEE). INEE Minimum Standards for Education: Preparedness, Response, Recovery. 2020. Available from: https://inee.org/resources/inee-minimum-standards [Accessed 16 June 2020]
  6. The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT). 2020. Available from:  http://www.ccsdpt.org/theborderconsortium [Accessed 16 June 2020]
  7. International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR), Global Camp Coordination and Camp Management (CCCM) Cluster. Camp management toolkit. Edition June, 2015. P 60. Available from:  https://www.humanitarianlibrary.org/sites/default/files/2015/08/CMT_2015_Chapter_00-18_print%20%282%29.compressed.pdf [Accessed 16 June 2020]
  8. World Health Organisation (WHO). 2012. Available from: https://www.unicef.org/disabilities/files/ECD-and-Disability-WHO-2012%281%29.pdf [Accessed 16 June 2020]
  9. Buxton S. Physiopedia. New Ways to Act F.A.S.T. Initiatives to Speed up Diagnosis of Stroke. 2017. Available from:  https://www.physiospot.com/2017/11/20/new-ways-to-act-f-a-s-t-initiatives-to-speed-up-diagnosis-of-stroke/[Accessed 16 June 2020]
  10. World Health Organisation (WHO). 2012. Available from: https://www.unicef.org/disabilities/files/ECD-and-Disability-WHO-2012%281%29.pdf [Accessed 16 June 2020]
  11. Physiopedia. International Classification of Functioning, Disability and Health (ICF) 1 April 2020. Available from:  https://www.physio-pedia.com/International_Classification_of_Functioning,_Disability_and_Health_(ICF) [Accessed 16 June 2020]
  12. 12.0 12.1 Béguin R., Humanity & Inclusion, 2019. Early Childhood Stimulation Therapy for Severe Acute Malnourished children 0-5 years: Training Manual.
  13. UNICEF. Guidance note for integrating ECD activities into nutrition programmes in emergencies. June 2012. Available from: https://www.unicef.org/earlychildhood/files/Integrating_ECD_into_Nurtition_in_Emergencies_-_Final_June_2012.pdf [Accessed 16 June 2020]
  14. Skelton P. and Harvey A.. Rehabilitation in Sudden Onset Disasters. 2015. Available from: https://donate.handicap-international.org.uk/wp-content/uploads/2017/06/rehabilitation-in-sudden-onset-disasters-complete-manual-web.pdf?_ga=2.208021717.696820625.1592021360-356917845.1592021360 [Accessed 16 June 2020]
  15. Doctors Without Borders / MSF-USA. Physiotherapy in Emergency Settings. Available from: http://www.youtube.com/watch?v=v=s_La3I_TS14[last accessed 30/10/17]
  16. World Health Organisation (WHO). Community-based rehabilitation: CBR guidelines. 12 May 2010. Available from: https://www.who.int/publications/i/item/community-based-rehabilitation-cbr-guidelines [Accessed 16 June 2020]
  17. Washington Group on Disability Statistic. 2020. Available from:  http://www.washingtongroup-disability.com/about/history/ [Accessed 16 June 2020]