Positive Approaches Journal, Volume 8, Issue 2

Salzer | 29-35

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Community inclusion² refers to the extent to which individuals have the opportunity to fully participate in their community like everyone else and be welcomed, embraced, and valued for their uniqueness and abilities¹. Community inclusion has been a longstanding concept for policies and service delivery in the broader disability community for more than six decades, starting with the Danish “Normalization Movement” that promoted the notion that individuals with intellectual disabilities should be supported to the extent that they are able “to function in ways considered to be within the acceptable norms of his/her society”². Nirje discussed normalization in terms of ensuring that people with disabilities experience “…patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life of society”³. Expanding on these ideas, Wolfensberger’s^2,4 Social Role Valorization Theory argues that promoting participation in valued social roles, such as work, school, religion, etc., reduces the risk that persons with disabilities are devalued by society.

The Americans with Disabilities Act⁵ was born out of these lines of thinking and established the promotion of “opportunity” for people with disabilities to live in the community in the law. International consensus on this issue was advanced by the United Nations General Assembly that adopted the ‘Convention on the Rights of Persons with Disabilities’⁶, which argues that inclusion of those with disabilities is a human rights issue, and nations must “Promote full and effective participation and inclusion in society, including…competitive employment, and participation in the economic, political, social, cultural, recreational activities of their communities.”

Community inclusion is more than a human rights issue, however. Greater inclusion leads to greater community participation, including work, education, religious and spiritual participation, engagement with family and friends, leisure and recreation, and other domains associated with a meaningful life. All of these are associated with physical, cognitive, and mental health and wellness benefits for anyone, including individuals with disabilities. It is in this sense that community inclusion, and the resulting participation, should be viewed as a medical necessity. This is consistent with the International Classification of Health, Functioning, and Disease (ICF), developed by the World Health Organization⁷. According to this framework, health is viewed as more than problems with “Body function and structure” (e.g., impairments or symptoms). It also includes “Activities,” the execution of specific tasks or actions, and of most relevance here, “participation,” which is defined as involvement in a life situation such as domestic life, interpersonal life, education and employment, and community, civic, and social life (e.g., religion, politics, recreation, leisure, sports, arts and culture, dating). The ICF recognizes community participation as one domain of health by itself, and something that has a positive benefit on body function and structure. Benefits associated with community participation on health, cognition, and mental health apply to everyone. Participation, for example, addresses social determinants of health⁸, such as poverty, social support, and educational attainment, reduces sedentary behavior, especially long, sustained periods of sitting or lying down, that have numerous negative health consequences⁹ and also enhances cognition. Engagement in meaningful activities is also associated with greater levels of happiness ¹⁰.

In the past, there have been doubts about the capacities of people with behavioral, intellectual, and developmental disabilities, including autism, to participate, especially for those with significant impairments, or whether participation would be healthy. The movement away from institutional care, for example, has provided clear examples to the contrary, although doubts may remain about the extent to which participation can occur even for those in residential programs. The case for community inclusion and participation as a medical necessity for people with mental health and other disabilities has been articulated in “Well Together,”¹ where research is offered to indicate that participation is just as beneficial to the health of people with disabilities as it is for the general population. While participation may look different for different people (e.g., different number of hours, modifications in what participation looks like, unique supports), it is clear that inclusion and participation are accessible to all. 

Fundamentals for Promoting Community Inclusion

Salzer and Baron¹ describe eleven fundamentals for promoting community inclusion, supported by key conceptual, theoretical, and research evidence. While the fundamentals presented focus on people with significant behavioral disabilities, they are derived from efforts across all disabilities. They are briefly described here.

Fundamental #1 - Community participation is beneficial. Increasing efforts to promote community inclusion require an appreciation that the resulting participation has significant physical, cognitive, and mental health benefits for people with disabilities.

Fundamental #2 - Community inclusion applies to everyone who experiences a disability. Beliefs that providers/supporters/caregivers are able to predict who is, and who is not, ready to participate, are not well supported by the research. Such beliefs may be used to inadvertently restrict opportunities for full and meaningful participation among those who could otherwise participate to some degree and in ways that are specific to their interests and abilities.

Fundamental #3 - Community inclusion requires seeing ‘the person’, not ‘the patient’. Individuals with disabilities must be viewed as people who have hopes, dreams, desires and capabilities like everyone else that should be supported, rather than solely as “patients” with an emphasis on deficits and impairments.

Fundamental #4 - Self-determination and dignity of risk are central to community inclusion. Self-determination refers to ‘acting as the primary causal agent in one’s life and making choices and decisions regarding one’s quality of life free from undue external influence or interference’¹¹. Dignity of risk is the “right to make choices that affect one’s own life even when these choices could, or do, turn out to be mistakes, allowing individuals to learn from their mistakes along the way like everyone else”¹². The decision about what areas one wants to participate in, and to what degree, is a decision best left up to the person, short of the rare circumstances when such participation might truly be dangerous to them or others. Concerns about potential failure in participation should be weighed against the benefits of pursuing one’s own goals and learning from mistakes.