# Situation: The public health nurse coordinates a community-based rehabilitation (CBR) program for persons with disabilities (PWDs) in an upland municipality. The nurse explains the program to the municipal council. Which statement describes community-based rehabilitation?

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> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse coordinates a community-based rehabilitation (CBR) program for persons with disabilities (PWDs) in an upland municipality.

The nurse explains the program to the municipal council. Which statement describes community-based rehabilitation?

## 보기

1. Rehabilitation given in specialized centers by a full team of therapists
2. Rehabilitation and inclusion where the person lives, using local resources **✔ 정답**
3. Long-term residential care for persons who cannot live with their families
4. Home therapy visits by a hospital team, with the family as observers only

**정답: 2**

## 해설

Community-based rehabilitation, now framed by WHO as community-based inclusive development, delivers rehabilitation, equal opportunity, and social inclusion in the community where the person lives. It uses local resources and involves the person, family, and community. Its goal is an independent, satisfying life in the community rather than care centered on hospitals or institutions.

## 심화 해설

Core concept: What CBR actually is

Community-based rehabilitation is best understood by what it is *not*. It is not a downsized hospital service delivered in a village, and it is not a program where professionals do things *to* or *for* passive recipients. The defining feature is that rehabilitation, equal opportunity, and social inclusion are delivered in the community where the person lives, using local resources, with the person, family, and community as active participants. This is why option 2 is correct.

The World Health Organization has reframed CBR as community-based inclusive development, which signals a shift from a purely medical or therapy-focused model toward a rights-based approach. In this framework, the goal is not simply improved physical function but an independent, satisfying life within one’s own community [2]. The program the public health nurse coordinates in an upland municipality fits this model precisely because it emphasizes local resources rather than referral to distant specialized centers.

Watch out! Option 1 describes institution-based rehabilitation—specialized centers staffed by a full team of therapists. This is the opposite of CBR. Option 3 describes long-term residential care, which is a custodial or institutional arrangement, not rehabilitation. Option 4 describes home-based therapy delivered by a hospital team, but the family is positioned as observers only. This violates a core CBR principle: the family and community are not passive observers; they are partners and primary resources in the rehabilitation process.

| Model | Setting | Who delivers care | Role of family/community |
| --- | --- | --- | --- |
| Community-based rehabilitation | Where the person lives | Local resources, trained community workers, family | Active participants and decision-makers |
| Institution-based rehabilitation | Specialized centers or hospitals | Full team of therapists | Minimal or visiting role |
| Home-based therapy | Person’s home | Hospital outreach team | Observers or assistants only |
| Residential care | Long-term facility | Institutional staff | Separated from daily care |

The evidence base for CBR consistently emphasizes empowerment and participation as central outcomes. A systematic review of CBR programs found that the strategy is widely adopted to promote participation, empowerment, and well-being of persons with disabilities, particularly in low- and middle-income contexts . This is not incidental—it reflects the core logic of CBR. When rehabilitation is embedded in the person’s own environment, the skills learned are immediately applicable to daily life, and the social barriers that produce disability are addressed alongside physical or functional limitations.

The rights-based framing is also clinically relevant. CBR holds local authorities accountable for service delivery, which means the municipal council the nurse is addressing has a direct responsibility to support the program [2]. This is a shift from older charity-based or purely medical models. The nurse’s explanation to the council should therefore emphasize shared ownership and sustainability through local capacity, not dependence on outside specialists.

Two recent studies illustrate how CBR operates in practice, even for conditions not traditionally associated with community rehabilitation. A cluster randomized trial in China evaluated a group-based CBR intervention for adults with schizophrenia and found it cost-effective when added to facility-based care . A mixed-methods study in Malawi examined CBR for people with psychosis and their caregivers, documenting changes in quality of life through functional support, empowerment, and social reintegration . In both cases, the intervention was delivered in community settings, involved caregivers as active participants, and targeted social inclusion—not just symptom reduction. These examples reinforce that CBR is a delivery strategy and philosophy, not a specific therapy technique.

Key point! For licensure exams, the discriminator is almost always *where* and *with whom* rehabilitation happens. If the setting is the person’s own community and the family/community are active partners using local resources, it is CBR. If the setting is a specialized center or the family is passive, it is not.References (research sources)

- [2]Concept Changes and Standardizing Tools in Community-Based Rehabilitation.Research articleDe Groote W (2019) · DOI: 10.1016/j.pmr.2019.07.013

## 임상 시나리오

CBR Program CoordinationWhat to emphasize when explaining to local government
When presenting to the municipal council, frame CBR as rehabilitation and inclusion delivered where the person lives, not a referral system to distant centers. Emphasize the use of local resources and the active role of the person, family, and community.

Use the WHO's current framing of community-based inclusive development to shift the discussion from a purely medical model to a rights-based approach. The goal is an independent, satisfying life in the community, not just improved physical function.

CautionDo not describe CBR as a downsized hospital service or a program where professionals act on passive recipients. Avoid positioning family members as observers only; their active participation is a core principle.

## 핵심 개념

- **Community-Based Rehabilitation (CBR)** — A strategy that delivers rehabilitation, equal opportunity, and social inclusion in the community where the person lives, using local resources and involving the person, family, and community as active participants.
- **Community-Based Inclusive Development** — The WHO's reframed term for CBR, signaling a shift from a purely medical model toward a rights-based approach focused on independent, satisfying community life.
- **Institution-Based Rehabilitation** — Rehabilitation provided in specialized centers or hospitals by a full team of therapists, which is the opposite of the community-based approach.
- **Social Inclusion** — The process of improving the terms of participation in society for persons with disabilities, ensuring equal opportunity and access to community life.

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