council of international fellowship in finland kiljava 4 august 2009 disability, rehabilitation, and...
TRANSCRIPT
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Council of International Fellowship in FinlandKiljava 4 August 2009
Disability, Rehabilitation, and Dialogue
A Finnish Perspective
Mr Ilpo VilkkumaaCentre of Expertise
Verve, Helsinki
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Contents of my presentation
• Little bit of history (of Finnish rehabilitation system)
• Multiprofessional/multidisciplinary nature of rehabilitation
• Some observations on social rehabilitation and counseling
• Future perspectives?
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Rehabilitation (according to UN programme)
Rehabilitation means a goal-oriented and time-limited process aimed at enabling an impaired person to reach an optimum mental, physical and/or social functional level, thus providing her or him with the tools to change her or his own life. It can involve measures intended to compensate for a loss of function or a functional limitation (for example by technical aids) and other measures intended to facilitate social adjustment or readjustment.
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Some landmarks in multidisciplinary rehabilitation
• Vocational rehabilitation of war invalids (1942)[Rogers: Counseling and Psychotherapy, 1942]
• The first multiprofessional rehabilitation team (doctor, psychologist, social worker) in 1953
• Comprehensive rehabilitation service system, from mid 1960’s; the same structure still remains
[Rehabilitation Counselor Preparation. National Rehabilitation Association, National Vocational Guidance Association, Washington D.C.: 1956]
• Coordination of the rehabilitation legislation in 1991; service provider structure as before
• Minor systemic changes 2004/2005 in line with EU ”open coordination” of social and employment policy
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Towards independent living policy
• International year of disabled persons 1981
• UN Decade of Disabled Persons (1983-1992)
• Convention on the Rights of Persons with Disabilities
• Government Report on Disability Policy (2006)
• National Programme of Disability Policy (2010?)
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Disability models
ICF impairment activity limitation – participation restriction
ICIDH impairment disability handicap
Nagi pathology, impairment
functional limitation
disability
Quebec impairment disability handicap situations
body person society
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ICF – International Classification of Functioning, Disability, and Health (2001,
2004)
• Functioning is an umbrella term for body functions, body structures, activities and participation. It denotes the positive aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environment and personal factors)
• Participation is a person’s involvement in a life situation. It represents the societal perspective of functioning
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Finnish style of disability and rehabilitation policy
• Bio-psycho-social approach (ICIDH, 1985; ICF, 2004)
• Three-tier system– Work and traffic accidents (first priority)– Social insurance (responsibility according to
risk/threat of disability: social insurance incl. earnings-related pensions)
– Mainstreaming in health and social services, special education, employment, career planning
• Disability and non-govenrmental organizations as service providers; partly through Slot Machine Association funding
• EU structural funding
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Trends in social rehabilitation
• Rehabilitation counselors; professionals in medical rehabilitation (hospital districts)
• Career guidance and vocational assessment in job centres since 1960
• Counselors in disability organisations • Adaptation/adjustment training courses • Peer support groups
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Rehabilitation triad
clientprofessio
nal
peer
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Triangulation = an attempt to map out, or explain fully, the richness and complexity of human behavior by studying it from more than one standpoint.
[Originally, a trigonometric method used in surveying, navigation, astronomy etc.]
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A – client/professional dialogue
• Medical vs. social model• Patient rights, right to
rehabilitation, participation• Knowledge management – ICT
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B – peer/professional dialogue
• Carers• Personal assistance• Family therapy• Networking
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C – client/peer dialogue
• Social support• Disability organisations ->
facebook, twitter etc.
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OECD observations and policy recommendations for Finland (2008)
• The fragmentation of the system of vocational rehabilitation
• The limited focus of the mainstreamed Public Employment Service on the participation and integration of people with long-term health problems or disability
• Thw widespread use of disability benefits as an early retirement tool
• The potential, and the remaining challenges, of the strong employer responsibilities
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Evidence-based effectiveness?Some common arguments
• ”Train and Place” principle ought be replaced by ”Place and Train” principle
• Team work is an inefficient method and waste of time?
• Rehabilitation assessment leads to pension application in too many cases?
• Rehabilitation should take place at person’s everyday environment and not in an institution
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Disappearance of disability and rehabilitation?
[At least in principle]
• Employability vs. rehabilitation• Inclusion, accessibility, barrier-free
society, design-for-all vs. disability • Guidance, case/care management etc.
vs. individual services• Mainstreaming and human rights makes
rehabilitation (as we know it) old-fashioned or unnecessary?