Theoretical foundations of social rehabilitation of disabled children. Theoretical foundations of socio-technological rehabilitation of children with disabilities in Russia

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Lecture 1. Introduction to the specialty. history of the development and establishment of the rehabilitation service 2

LECTURE 2 theoretical foundations of rehabilitation.. 19

LECTURE 3 MODERN APPROACHES TO REHABILITATION OF SICK AND DISABLED PEOPLE... 33

LECTURE 4 MEDICAL REHABILITATION.. 41

LECTURE 5 PHASES OF REHABILITATION... 57

LECTURE 6 ORGANIZATION OF REHABILITATION SERVICES AND PERSONNEL TRAINING... 68

LECTURE 7 ASSESSMENT OF THE EFFECTIVENESS OF REHABILITATION... 76

LECTURE 8 MEDICAL AND PROFESSIONAL REHABILITATION.. 81

LECTURE 9 PROFESSIONAL REHABILITATION OF SICK AND DISABLED PEOPLE... 93

LECTURE 10 SOCIAL STAGE OF REHABILITATION.. 109

LECTURE 11 INDIVIDUAL PROGRAM FOR REHABILITATION OF THE SICK AND DISABLED.. 117

APPENDIX 1. 132

APPENDIX 2. 145

APPENDIX 3. 161

LITERATURE.. 173

lecture 1. introduction to the specialty. history of the development and establishment of the rehabilitation service

Rehabilitation - is the restoration of health, functional state and ability to work, impaired by diseases, injuries or physical, chemical and social factors. The goal of rehabilitation is the effective and early return of sick and disabled people to everyday and work processes and to society; restoration of a person’s personal properties.

The World Health Organization (WHO) gives a very similar definition of rehabilitation: “Rehabilitation is a set of activities designed to ensure that persons with disabilities as a result of disease, injury and birth defects adapt to new living conditions in the society in which they live.” The term rehabilitation comes from the Latin word habilis - “ability”, rehabilitation - “restoration of ability.”

According to WHO, rehabilitation is a process aimed at comprehensive assistance to sick and disabled people so that they achieve the maximum possible physical, mental, professional, social and economic usefulness for a given disease.

Thus, rehabilitation should be considered as a complex socio-medical problem, which can be divided into several types or aspects: medical, physical, psychological, professional (labor) and socio-economic.

The main task of medical rehabilitation is the full restoration of functional capabilities various systems body and musculoskeletal system (MSA), as well as the development of compensatory adaptations to the conditions Everyday life and labor.

Particular tasks of rehabilitation include:

Restoring the patient’s everyday capabilities, i.e., the ability to move, self-care and perform simple housework;

Restoration of working capacity, i.e. professional skills lost by a disabled person through the use and development of the functional capabilities of the musculoskeletal system;

Prevention of the development of pathological processes leading to temporary or permanent loss of ability to work, i.e. implementation of secondary prevention measures.

The goal of rehabilitation is the most complete restoration of the body's lost capabilities, but if this is not achievable, the goal is to partially restore or compensate for impaired or lost function and, in any case, to slow down the progression of the disease. To achieve them, a complex of therapeutic and restorative means is used, among which the greatest rehabilitative effect has: physical exercise, natural factors (both natural and preformed), various types of massage, exercises on simulators, as well as orthopedic devices, occupational therapy, psychotherapy and auto-training. Even from this list it is clear that the leading role in rehabilitation belongs to the methods of physical influence and the further from stage to stage it moves, the more important they are, eventually forming a branch or type called “physical rehabilitation”.

The problem of under-functioning citizens of society has been known since ancient times and its solution has always depended on the economic, political, cultural level of a particular country and on the stage of development of society as a whole. Having moved on from the ideas of hostility and physical destruction of people with disabilities, society has come to understand the need for integration and reintegration into society of persons with various physical defects and psychosocial disorders. Indeed, from the perspective of today, disability should be considered as a problem not of one specific person, but of the entire society as a whole. Its integration into the social environment requires significant efforts from many specialists: doctors, psychologists, teachers, lawyers, etc.

Rehabilitation is a science that studies the patterns, methods and means of restoring the morphological structures and functional capabilities of a person lost as a result of a particular disease, injury or birth defects in the formation and development of the body, as well as the social consequences associated with this restoration.

Rehabilitation as a way to restore impaired body functions has been known since ancient times. Even ancient Egyptian doctors used some occupational therapy techniques to speed up the recovery of their patients. Doctors Ancient Greece and Rome also used physical activation of patients and occupational therapy in treatment complexes. In these same countries, massage was widely used as a hygienic and therapeutic remedy, as well as to improve performance. At the same time, attention began to be paid to disabled citizens who were injured while defending the fatherland. Thus, in the Roman Empire, legionnaires who were injured during military campaigns were provided with land plots with slaves and a one-time material reward.

During the Middle Ages, attitudes towards under-functioning citizens worsened, resulting in developmental delays organizational forms provision of assistance and only the introduction of Christianity contributed to the establishment of a higher than previously level of attitude towards people with disabilities in the form of public and partial charity. Shelters and almshouses began to open at the monasteries, in which those in need had to work off the shelter and food provided to them.

At this time, the concept of “disabled” was applied only to former military personnel who, due to injury or illness, could not support themselves and were therefore sent to a shelter. This was widespread in many European countries. However, not all those in need had the opportunity to live in shelters, despite the fact that the living conditions in them were extremely modest, the food was very poor, and medical care was practically absent. Of course, in those days, no country raised the question of restoring detainees to the level of full-fledged members of society, although it should be noted that certain progress had already been made in the field of restorative treatment and material compensation.

In Rus', after the introduction of Christianity, the attitude of society towards persons with disabilities was reduced to feeding the poor; during the reign of Prince St. Vladimir, the first hospitals appeared in Rus' in which medical care was provided. At many monasteries, special premises were set up for the poor and wretched in accordance with the Church Charter of 996, which included supervision and care as the responsibilities of the clergy.

In subsequent centuries, beggary developed on a grandiose scale in Rus', a Decree was issued on the registration of all “lepers and the elderly” and on the introduction of a differentiated approach to those in need. In this case, it is recommended either charity in almshouses, or “food in the courtyards,” or involvement in work on a voluntary or compulsory basis. At the same time, the sprouts of medical and social expertise began to form, as a result of which in 1663 a Decree was issued on the assignment of monetary and food allowances to the disabled, wounded and those who came from captivity. According to this decree, disabled people were divided into two categories - seriously and lightly wounded, and from 1678. disabled people were already divided into three categories: seriously, moderately and lightly wounded.

Systematization of activities in the field of public charity occurs under Emperor Peter I - differentiation of those in need appears according to their potential (able-bodied, professional beggars, temporarily disabled, etc.). In 1700 The emperor writes about the creation in all provinces of almshouses for the old and crippled, as well as hospitals for illegitimate (“shameful”) children and orphanages.

In 1775 Catherine II ordered the creation in 40 provinces of a whole network of special institutions called “Orders of Public Charity”, which were charged with the care of public schools, orphanages, hospitals and clinics, insane asylums, etc.

IN late XIX- the beginning of the 20th century, the concepts of “full and partial ability to work” appeared, and in 1903. “Rules for determining disability from bodily injury due to accidents” are published, in which the degree of disability is expressed as a percentage. It was stated that the owners of the enterprises were obliged to treat the victim and pay him a cash benefit during treatment and a pension in the event of disability. However, compensation under this law could only be received by those persons whose accidents were not caused by the gross negligence of the victim. The victims had to present evidence in court that the accident was the fault of the employer and not the worker.

Since 1908 In Russia, medical consultation bureaus began to be organized, which were the prototype of expert institutions, the main task of which was to assess the ability to work of patients, taking into account the nature of the disease or injury. The consultation bureaus consisted of three to five doctors and were located in city hospitals.

Medical and social expertise received further development after the October Revolution. So December 22, 1917 the “decree “On sickness insurance” was issued, and on October 31, 1918. “Regulations on social security of workers”, according to which “the presence of disability and its degree are established by a medical examination established at the insurance fund.” In accordance with this Regulation in the Labor Code of 1918. it was written that the fact of permanent or temporary disability is certified by a medical examination conducted by the medical examination bureau at city-wide, district and regional insurance offices.

In the 1920s, the first societies for people with disabilities began to appear. In 1925 The All-Russian Society of the Blind (VOS) was organized, and in 1926. – All-Russian Society of the Deaf (VOG), which took care and responsibility for the employment of this contingent of disabled people.

In 1933 Medical and labor expert commissions (MTEK) were organized.

The main objectives of VTEK were determined:

§ expert study (assessment) of the health status, character and working conditions of the patient, on the basis of which a decision is made on the degree of disability;

§ establishing the time of onset of disability of its group and the socio-biological cause (general or occupational disease, work injury, disability since childhood; wound, concussion, injuries received while defending the USSR or while performing military service duties, etc.);

§ determination of the percentage of disability resulting from injury or disease associated with production;

§ determination of conditions and types of work, accessible to people with disabilities for health reasons (work recommendations), as well as recommendations for measures to help restore their ability to work;

§ re-examination of disabled people within regulated periods; study of the dynamics and causes of disability.

The most important task for medical experts is to study the possibilities of rational employment. Therefore, in 1930 The Institute for the Examination of Working Capacity of the Moscow State University is being created in Moscow regional department health care, in 1932 - Central Research Institute for Employment of Disabled Persons, who in 1937. united into the Central Research Institute for the Examination of Working Capacity and Labor Organization of Disabled Persons. Similar institutions were created in 1932 - 1934. in other cities: Kharkov, Rostov, Gorky, Leningrad, and later - in Dnepropetrovsk, Vinnitsa, Minsk.

The organization of these research institutions contributed to the development of scientific, theoretical and practical issues of medical-labor (and now medical-social) examination, personnel training, the beginning of the study and analysis of morbidity, and the development of measures to reduce it.

The Great Patriotic War caused huge losses of labor resources. A new category of disabled people has appeared - disabled people of the Great Patriotic War. The peculiarity of this category was that they were mainly young and middle-aged people who, despite the severe consequences of wounds and injuries, sought to continue their working activities.

Since the 50s, the concept of integrating sick and disabled people into society has been developing in the Soviet Union. At the same time, the emphasis is on their training and obtaining technical equipment.

In the 70s, multidisciplinary rehabilitation centers for patients with chronic nonspecific lung diseases, consequences of injuries to the musculoskeletal system, brain, spinal cord, diseases of cardio-vascular system, kidneys, using rehabilitation treatment complexes in hospitals - clinics, resort establishments. For the first time in the country, an industrial rehabilitation system was created on the basis of the Gorky Automobile Plant, which was approved by the board of the Ministry of Health. Rehabilitation institutions created at industrial enterprises have their own technical base, which makes it possible to create ergonomic adaptations to equipment for people with disabilities in order for them to maintain their previous profession, adapt to professional work, rational employment and acquire a new profession. This kind of institution can be used for rehabilitation treatment of workers of different professions, since the targeted impact of specially designed industrial equipment can be equally effective for patients of different professional groups.

Rehabilitation systems in different countries differ significantly and therefore questions are raised about the need for international cooperation in developing a coordinated program for the rehabilitation of physically disabled persons. In 1993 The UN General Assembly adopted the “Standard Rules for the Equalization of Opportunities for Persons with Disabilities, the political and moral basis of which was the International Bill of Human Rights, including the Universal Declaration of Human Rights, the International Package of Economic, Social and Cultural Rights, the International Package of Civil and Political Rights, the Convention on Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women, and the World Program of Action for Persons with Disabilities.

As for the stages of development of medical and social expertise and rehabilitation in the world, since the 18th century, medical rehabilitation in Europe has been combined with elements of psychological support for patients. At the same time, Spanish doctors noticed that those patients who cared for other patients during their treatment recovered faster than those who were passive in their treatment. In the 19th century, the center of rehabilitation therapy moved to the USA. Since the beginning of the 20th century, there has been a growing number of institutions that use various types of physical activation of patients to solve various socio-psychological problems. In 1917 The Association for Rehabilitation Therapy was founded in the United States.

The impetus for the development of rehabilitation of patients in the first half of the last century was the first World War, which crippled the health and lives of thousands of people. Scientific and practical disciplines such as orthopedics, physiotherapy, occupational therapy and therapeutic physical culture began to develop rapidly. At first the term " rehabilitation treatment“, and this concept included the use of medical treatment methods, but subsequently, especially after the Second World War, the problem of social and labor rehabilitation of disabled people became widespread. In addition to medical ones, its solution included a whole range of psychological, social and other issues that went beyond the narrow treatment, and then the term “rehabilitation treatment” was replaced by the term “rehabilitation”. The concept of rehabilitation of sick and disabled people in the modern sense appeared during the Second World War in England and the USA. Over time, an understanding has come that with the increase in cases of chronic diseases leading to disability, certain areas of medicine are not able to resist it and only the entire healthcare system as a whole can solve this problem.

Even 20 - 30 years ago, the majority of medical workers in various specialties considered rehabilitation as a side activity that went beyond the usual framework of healthcare, more related to social security. In subsequent years everything larger number medical institutions, recognizing the feasibility of the rehabilitation service, began to allocate separate hospital beds for rehabilitation, and then special wards and departments. Today, the rehabilitation service has organizationally developed into the structure of rehabilitation centers specialized in the profile of diseases (cardiological, neurological, orthopedic, etc.). Depending on the institution at which they are organized, these can be inpatient, sanatorium or outpatient rehabilitation centers. The expansion of the network of such institutions is also due to economic considerations. Economists have come to the conclusion that ignoring the problem of restoring the ability of patients to work - in monetary terms - is much more expensive than carrying out active rehabilitation at an early stage of the disease, when it is still possible to restore the patient’s health to the maximum possible level of his physical, psychological and socio-economic usefulness.

Indeed, only very rich country can afford to increase the number of disabled and socially dependent people, and therefore rehabilitation is not a luxury or excess, but an important practical task of healthcare. The “Report of the WHO meeting” (Geneva, 1973) emphasizes that the goal of treating a patient is not only to preserve his life, but also the ability to live independently. This implies the purposeful nature of the entire rehabilitation system in the interests, first of all, of the patient himself, his loved ones and the entire society. Currently, rehabilitation has taken a strong place among the leading medical and social areas, being developed all over the world. Scientific studies of the effects of rehabilitation means have clearly shown that with a properly developed program, 50% of seriously ill patients can be returned to active life.

In the 70s, the United Nations paid great attention to rehabilitation issues. So, in 1975 At the UN General Assembly, a resolution was adopted calling on UN member states to strengthen the faith of people with disabilities in human rights, in fundamental freedoms and principles of peace, human dignity and values, and in the principles of social justice. The UN General Assembly proclaimed the “Declaration on the Rights of Persons with Physical or Mental Disabilities” and called on all countries to comply with its provisions, which are the standard in protecting the rights of the disabled.

1. People with physical or mental disabilities are all those persons who, due to congenital or acquired impairment (physical or mental), are not able to secure for themselves, fully or partially, with their own efforts, as people without physical or mental disabilities, an appropriate position at work , V professional activity and in society.

2. Persons with physical or mental disabilities shall enjoy all the rights contained in this declaration. These rights must be granted to all persons with physical or mental disabilities, without any exception, regardless of race, color, skin, sex, language, religion, political or other opinion, national or social origin, property, birth or other circumstances as in relation to the person with physical or mental disabilities, and in relation to his family.

3. Persons with physical or mental disabilities have the inalienable right to respect for their human dignity, have the same fundamental rights as their fellow citizens, and above all the right to a life that is as normal and meaningful as possible .

4. Persons with physical or mental disabilities have the same civil and political rights as all other people. Article 7 of this declaration prohibits any possible limitation or suppression of these rights of persons with mental disabilities.

5. People with physical or mental disabilities have the right to activities that will help them achieve maximum independence.

6. People with physical or mental disabilities have the right to medical, psychological and functional treatment including the provision of prosthetics and orthotics, medical and social rehabilitation, vocational training, rehabilitation activities promoting vocational training, assistance, advice to employment services and other services that promote the maximum development of abilities and skills in persons with physical or mental disabilities. mental disabilities and speed up the process of their social inclusion or recovery.

7. People with physical or mental disabilities have the right to economic and social guarantees and an adequate standard of living. They have the right to find themselves workplace, appropriate to their skills, and keep it or resume work and become a union member.

8. People with physical or mental disabilities have the right to have their special needs taken into account in all phases of economic and social planning.

9. Persons with physical or mental disabilities have the right to live with their family or adoptive parents and to participate in all areas of social and creative life. No physically or mentally handicapped person should be subjected to any treatment other than that required by his condition or necessary to improve his health. If it is necessary for a person with physical or mental disabilities to stay in a special institution, then the environment and living conditions there must be highly consistent with the environment and conditions in which a person of his age who does not have physical or mental disabilities would live.

10. People with physical or mental disabilities must be protected from any use of them for personal gain, from definitions and treatment of a discriminatory, offensive and defamatory nature.

11. People with physical or mental disabilities should have access to qualified legal assistance, if such assistance turns out to be necessary to protect their persons or their property. If proceedings are directed against them, their physical and mental condition must be taken into full consideration during the trial.

12. For all questions concerning the rights of people with physical or mental disabilities, they can contact organizations of people with physical or mental disabilities.

13. Persons with physical or mental disabilities, their families and the communities in which they live should be informed by all available means of the rights contained in this Declaration.

At the 31st meeting of the UN General Assembly, it was decided to declare 1981 the “International Year of Persons with Disabilities”, and later the 80s the “Decade of Persons with Disabilities”.

In various countries historical experience the formation of legal and organizational aspects of medical and social examination and rehabilitation has its own specifics, although in most countries a distinction is made between physical, general and professional disability associated with both the loss of an organ or mental function, regardless of economic or professional consequences, and with the loss of the ability to perform any activity at all. -either a job or work in a previous profession.

In Germany, the words were added to the Constitution: “No one can be disadvantaged because of his disability.” It provides all citizens with “the right to rehabilitation and integration into normal life.” It obliges the legislative, executive and judicial authorities at the federal, state and community levels, as well as other institutions and organizations of public power to use all opportunities to introduce disabled people of all groups “as far as possible into normal life.” There is a set of norms and rules, the purpose of which is the integration into society of people with disabilities and people at risk of disability. It emphasizes that the concept of highlighting disability should not contribute to ideological or social discrimination against people with disabilities; it is only intended to emphasize the individuality of their problems and chances. The legislation on disabled people is based on the idea that rehabilitation and subsequent employment of disabled people is more economically profitable than constantly providing them with pensions and benefits. There are laws “On the equalization of rehabilitation services”, “On social assistance”, the norms of which are aimed at the rehabilitation of disabled people using insurance mechanisms. According to these laws, funding for the process of integrating a disabled person into working life has priority over pension funding. The principle of “rehabilitation before retirement” applies here. Measures to encourage the professional rehabilitation of people with disabilities have been established by law. Working disabled people are provided with special compensation for travel expenses to get to work and back. However, in accordance with the law, social protection of disabled people in Germany applies only to persons whose degree of disability is at least 50%. Disabled people with severe disabilities receive compensation for damages and have many benefits (tax reduction, protection from layoffs, etc.). The disability examination itself is a three-step process. The conclusion of the attending physician is submitted to the authorized doctor of the strass society. This doctor checks the attending physician's report and assesses the patient's remaining work potential. After this, the assessment goes to the approving doctor, who supplements, interprets and approves this assessment.

France has adopted 7 laws aimed at protecting and employing people with disabilities. The organization of activities to protect people with disabilities is entrusted to the Ministry of Health and Social Welfare. Disability pensions are assigned by local temporary disability insurance funds based on an assessment by a specialist doctor from the said fund.

In Finland, the integration of rehabilitation activities into the sphere of social protection of the population, healthcare, employment, social insurance, education is enshrined at the legislative level, and mechanisms for their cooperation and cooperation have been formed. Particular attention is paid to the professional rehabilitation of people with disabilities, which is provided by a three-level system with the integration of training, vocational education, as well as vocational guidance and employment, professional development and assessment of rehabilitation results. Issues of social services, rehabilitation of people with disabilities and provision of medical care are within the competence of local authorities, but the state compensates them for a significant part of the costs. For people with disabilities, many services are free or paid on preferential terms. A legal framework has also been created for the development of private rehabilitation structures, which are often used to place government orders. During the period of rehabilitation, disabled people are paid a special rehabilitation allowance from social insurance funds.

Canada has extensive legislation aimed at protecting the rights and interests of people with disabilities. In particular, these are the Blind Persons Act, the Persons with Disabilities Act, the Vocational Rehabilitation of Persons with Disabilities Act, the Canadian Human Rights Act, the Labor Act, the Workers' Compensation Act and a number of others. The education system in Canada legally provides for the possibility of education for people with disabilities at all levels from school to university. The form of integration education predominates; special technical means and individual programs are used. Among Canadian university students, at least 1% are disabled. In the process of rehabilitation of disabled people, special types of specialists are provided - occupational therapists and nurse managers, whose activities are aimed at determining the individual needs of disabled people and compensating for life limitations.

In Denmark, the issue of the degree of disability and pension is decided on the basis of the opinion of the attending physician by the so-called disability insurance tribunals. There is a network of state rehabilitation centers, each of which serves a specific area. The integration of disabled children into the general educational process in regular schools is recognized as a priority area.

In Italy, medical and social examination to determine disability is carried out by specialist doctors from the bureaus (offices) of the Regional Bureaus National Institute social insurance. These doctors are united in diagnostic rooms, and the conclusion is approved by the head of the bureau.

In Austria, there are many legislative documents aimed at the social protection and rehabilitation of disabled people: the Act on the Integration of Disabled Persons, the Act on the Care of Disabled Persons, the Act on Medical Care for War Victims, the Tuberculosis Act, the General Social Security Act, the General Social Insurance Act, the providing assistance with employment. As for the disability pension, it is assigned by the Pension Commission of the insurance company, and the examination is carried out by the doctors of the insurance company, who are united in diagnostic centers.

In the UK, the issue of incapacity for work is decided by a doctor in the public health department. However, this decision can be appealed by the insurance employee of local offices (offices), after which an examination must be carried out by another doctor. Serious importance is attached to the organization of professional rehabilitation of disabled people in specialized centers. The effectiveness of professional rehabilitation and the percentage of disabled people returning to professional activity is quite high. It is planned to organize enterprises with gentle work conditions for disabled people, where they learn new professions and then move on to ordinary enterprises. For severely disabled people, conditions for training and employment at home can be created. Quotas and reservation of jobs for people with disabilities are indicated.

In Sweden, medical and social examination is carried out by a commission consisting of seven people. At the same time, the commission includes representatives pension fund(chairman), doctors, representatives of the State Insurance Institute and representatives of local government. The government stimulates employers not by providing tax benefits to enterprises, but by paying individual subsidies for each disabled person employed. The disabled person himself receives disability benefits and wages, but the amount of payments does not exceed a certain limit. The legislation provides for the provision of disabled people with technical means for prosthetics, movement, sports, etc. In addition, provision is made for equipping apartments for disabled people with special adaptation devices.

In Belgium, legislation has approved the creation of an extensive social insurance system, within the framework of which medical and social rehabilitation of disabled people is carried out. Institutions providing different types medical rehabilitation services belong mainly to the private sector. Payment for services is partially (about 10-15%) carried out by disabled people, the rest of the amount is paid from insurance funds. Disability pensions are assigned by the State Office of Sickness and Disability Insurance on the basis of assessments developed by the regional medical council for disability of the State Office and which, in some cases, are approved by the Central Medical Council.

In Norway, medical and social examination is carried out by a regional committee of commissions consisting of an employment specialist, doctors and other necessary specialists who make an expert decision.

In Japan, the Ministry of Health and Welfare is responsible for organizing social protection for people with disabilities. At the same time, medical rehabilitation of disabled people is carried out within the framework of national health insurance programs.

In Australia, legislation pays special attention to people with complex functional impairments. It is planned to implement measures to return them to normal, everyday life. All disabled people undergoing rehabilitation are entitled to be provided with prosthetics and other types of auxiliary aids. If necessary, houses are equipped for disabled people where they can work on provided machines and machines.

In the United States, the Americans with Disabilities Act states that employers cannot discriminate against employees solely because of a disability. As for conducting a medical and social examination and recognizing a citizen as disabled, in the United States all that is required is a doctor’s conclusion that the patient’s existing inability to perform full-fledged activities due to any physical or mental disorder will last for at least 12 months. Vocational training for people with disabilities is provided both in enterprises with favorable working conditions and in large enterprises. The Architectural Barriers Removal Act legitimized the need to make public buildings accessible for people with disabilities. The Rehabilitation Act created a special body that is responsible for monitoring the creation of a barrier-free environment for people with disabilities. Special acts also provide for the provision of disabled people with the opportunity to fulfill their needs (shopping in a store, visiting a library) with the help of adaptive technical devices provided to them in a regulatory manner.

Thus, in different countries of the world, various examination and rehabilitation services have developed, tied to the peculiarities of the state structure, pension system, territorial characteristics, etc. Common to the vast majority of countries is the commission's resolution of expert issues, the existence of relatively independent expert services and the presence of a legislative framework aimed at social protection and the implementation of medical, professional and social rehabilitation.

In the Republic of Belarus in 1991. The “Law on the social protection of disabled people in the Republic of Belarus” was adopted, which determined the state policy in the field of social protection of disabled people and introduced a new definition of disability. According to Article 2 of this Law, “a disabled person is a person who, due to limited life activity due to physical or mental disabilities, needs social assistance and protection.” It should be noted that a similar law protecting the rights of people with disabilities was adopted in the Republic of Belarus several years earlier than in Russia. The law is aimed at protecting the rights of people with disabilities, it expanded the opportunities for people with disabilities to engage in work and introduced rehabilitation of the disabled as a type of social assistance for people with disabilities and the obligation of medical and other institutions to provide services in the field of rehabilitation.

According to the law (Article 13), the concept of “individual rehabilitation program for disabled people” was introduced. In accordance with this article, “medical, professional and social rehabilitation of disabled people is carried out in accordance with an individual rehabilitation program, determined on the basis of the conclusion of a medical and social examination by state bodies with the participation of representatives public organizations disabled people." An individual rehabilitation program determines the specific volumes, types and timing of rehabilitation measures, types of social assistance and is “a document mandatory for execution by the relevant government bodies, as well as enterprises, institutions and organizations, regardless of their form of ownership and economy.”

After the adoption of the “Law on Social Protection of Persons with Disabilities”, a significant reorganization of medical and labor examination and rehabilitation services was carried out in Belarus. VTE was renamed into medical and social examination, giving it new tasks. The MSA and rehabilitation services were merged. The position of deputy chief physician for examination of temporary disability was renamed into “deputy chief physician for medical rehabilitation and examination” with an expansion of their functional responsibilities. Medical and labor expert commissions (VTEK) were transferred to the healthcare system with subsequent reorganization into medical and rehabilitation commissions (MREC), giving this service new, broader tasks. The new “Regulations on medical and rehabilitation expert commissions” was approved by Resolution of the Council of Ministers of the Republic of Belarus No. 801 of December 31, 1992. To staff the reorganized MTU and rehabilitation service, the nomenclature medical specialties new specialties “doctor-expert-rehabilitologist” and “doctor-rehabilitologist” were introduced and under the republican certification commission a subcommittee has been created to certify doctors in these specialties.

However, the release of the “Law on Social Protection in the Republic of Belarus” contributed to a sharp increase in the rates of primary disability, since it was aimed at protecting only the disabled, but not the sick. Therefore, a large influx of patients turned to MREC to receive social benefits and guarantees that disabled people could receive.

The consequence of this increase in primary disability was the release of a new Law “On the Prevention of Disability and Rehabilitation of Disabled Persons” approved by the Resolution of the Supreme Council of the Republic of Belarus dated October 17, 1994.

This law defines the state policy of the Republic of Belarus in the field of prevention of disability and rehabilitation of disabled people as an integral part of the protection public health in order to guarantee and provide conditions for its preservation, restoration and compensation, impaired or lost abilities of disabled people for social, professional and everyday activities in accordance with their interests and potential capabilities.

According to Article 19 of the Law, “if a patient develops a health defect as a result of a disease or injury, including when the disease enters the chronic stage, rehabilitation institutions draw up an individual program of medical rehabilitation.” Thus, the republic received its further development unified service for rehabilitation and medical and social examination.

The adoption of the Law of the Republic of Belarus “On the Prevention of Disability and Rehabilitation of Disabled Persons” (1994) marked the beginning of a new stage in solving problems related to disability. The law is aimed at preventing disability, at developing government measures for active rehabilitation, and at integrating disabled people into society through the guaranteed implementation of an individual rehabilitation program.

To implement the above Laws and based on the results of implementation of RSTP 69.04r “Rehabilitation”, a structural and functional diagram of the rehabilitation service in the Republic of Belarus was developed. The main goal of creating this service was the return of disabled people to work and to society. All these proposals were actually reflected in the order of the Ministry of Health of the Republic of Belarus dated January 25, 1993 No. 13 “On the creation of a system for the rehabilitation of sick and disabled people in the Republic of Belarus.” In accordance with it, regulations on a specialized and specialized medical rehabilitation center were approved; medical rehabilitation departments of clinics and hospitals; Head of the Department of Medical Rehabilitation and Rehabilitation Doctor; department, and sector of medical and social rehabilitation and examination of the health department of the regional executive committees; medical and professional rehabilitation center regional hospital; Council for Medical and Medical-Professional Rehabilitation of the Sick and Disabled; organization of rehabilitation in medical institutions. The formation began unified system medical rehabilitation in the republic.

The further development and improvement of medical rehabilitation services remains very relevant in the republic. The government of the country and the Ministry of Health have formulated tasks for the development of medical rehabilitation and rehabilitation services, which provide for the creation of a modern concept for the development of medical rehabilitation, the development of measures to improve the situation in regions with the highest morbidity rates, the development of methodological approaches regulating the inpatient stage of medical rehabilitation, standardized approaches to volumes medical and rehabilitation care, further improvement of the system of sanatorium and resort care and recreational services based on scientifically based and socio-economic approaches. Modern trends in the development of expert rehabilitation are reflected in the State Program for the Prevention of Disability and Rehabilitation of Disabled Persons for 2001-2005 (approved by Resolution of the Council of Ministers of the Republic of Belarus dated January 19, 2001 No. 68).

This state program provides for solving the following tasks:

implementation of measures to prevent disability;

development and improvement of the structures of medical, professional, labor and social rehabilitation services in the relevant ministries and other republican government bodies;

expansion and strengthening of the material and technical base of healthcare institutions, social protection, education, employment services and other organizations dealing with the problems of disability prevention and rehabilitation of disabled people;

development of a system for training and retraining of rehabilitation specialists;

provision for disabled people technical means rehabilitation;

“pension after rehabilitation”;

improvement of the rehabilitation service management system.

The theoretical basis of rehabilitation is the three-dimensional concept of the disease, developed by WHO experts and presented as an addition to the International Statistical Classification of Diseases (ICD IX and X revisions) in the form of the “International Classification...” and “Nomenclature of Impairments, Disability and Social Disability”. The prerequisite for the development of this concept was the need to study and reflect the impact of the disease on humans, because clinical classifications ICDs, based on the nosological principle, reflect primarily the characteristics of the disease.

According to the three-dimensional concept of a disease, its impact on the human body is considered at three levels:

Level I - consequences of the disease at the organ level - morphofunctional changes on the part of individual organs or systems (“defect” of dysfunction), reflected in the classification as “disorders”;

Level II - consequences at the organismal level (in the classification - “limitation of life activity”) - a violation of the integrative functions of the whole organism or its abilities (for movement, self-care, orientation, communication, control of one’s behavior, learning, work), allowing the individual to adapt to the environment and not depend on the help of outsiders;

Level III - consequences at the social level (in the classification “social failure”) - social maladjustment (impossibility of fulfilling a social role determined by age, upbringing, education, profession and specific environmental conditions).

Introduction

Chapter I. Theoretical foundations of the course work topic

§ 1.1. Concept of social rehabilitation

§ 1.2. Social rehabilitation of disabled people and combatants

Chapter II. Practical research part

§ 2.1. Implementation of social rehabilitation in practice

Conclusion

Bibliography

Introduction

The implementation of radical reforms in economics and political life, social and cultural practice throughout the world shows that no state today can do without specialists in the field of social work.

Social work is a specific type of professional activity, providing state and non-state assistance to a person in order to ensure the cultural, social and material standard of his life, providing individual assistance to a person, family or group of people.

The main goals of social work are: 1) creating conditions in which clients can demonstrate their capabilities to the maximum extent and receive everything that is due to them by law; 2) creating conditions under which a person, despite physical injury, mental breakdown or life crisis, can live, maintaining a sense of self-esteem and self-respect from others.

Social rehabilitation and support is one of the most relevant and sought-after areas of social practice. A high humanitarian orientation, social spiritual support for vulnerable segments of the population, concern for the social welfare of orphans, disabled people, elderly citizens, and amateur creativity have always been characteristic of the advanced strata of Russian society.

The main objects of social rehabilitation and support are socially weakened and socially unprotected groups of the population, primarily children and disabled adults, elderly people and single pensioners, orphans and children in orphanages, single-parent and large families and others.

A significant part of these people are united by the concept of social disability, adopted at the initiative of the International Health Organization (WHO), associated with impairments or limitations in life. The term “social failure” or “maladaptation” means a violation or significant limitation in a person of his usual life activities due to old age, congenital or acquired disability, illness, injury or disorder, as a result of which the usual contacts with the environment are lost, corresponding age, life functions and roles.

Today, a significant part of the population (both adults, children and adolescents) experiences various kinds of social and physical difficulties - economic problems, mental and physical development delays, communication problems, chronic diseases, and disabilities.

In a broad sense, social rehabilitation is a system of legal and socio-cultural measures aimed at overcoming a person’s social insufficiency, creating and providing conditions for social integration or reintegration of a person who, for various reasons, has permanent or temporary functional limitations in various areas of his or her life.

The goal of social rehabilitation is social integration - a process that characterizes the extent to which a person achieves an optimal level of life and realizes his potential abilities and capabilities as a result of interpersonal interaction and in a specific socio-cultural space and social time. Accordingly, reintegration should be understood as the process and characteristic of a measure of restoration previously inherent in a disabled person, but due to any reasons, weakened or lost social and role functions in a socio-cultural space adequate for him.

The process of social rehabilitation and promotion of integration is ensured by a system of social protection measures aimed at creating the individual conditions for his full or partial legal, political, economic, social, cultural independence and equal opportunities with other citizens to participate in public life and the development of society. Thus, social rehabilitation of disabled people is a system and process of restoring a person’s abilities for independent activity in all spheres of public life.

Main goal course work is to study the process of rehabilitation of vulnerable segments of the population and people with disabilities.

The objective of the study is to identify and ways to solve the problems that currently exist in the rehabilitation of vulnerable groups of the population.

ChapterI. Theoretical foundations of the course work topic

§ 1.1. Concept of social rehabilitation

Social rehabilitation has received widespread recognition in recent years. This was facilitated by the developing theoretical and methodological base, on the one hand, and the training of highly professional social work specialists who implement scientific principles in practice, on the other.

In modern science, there are a significant number of approaches to theoretical understanding of the problems of social rehabilitation of people with disabilities.

Social rehabilitation of disabled people is important not only in itself. It is important as a means of integrating persons with disabilities into society, as a mechanism for creating equal opportunities for people with disabilities in order to be socially in demand. The analysis of social problems of disability in general and social rehabilitation of disabled people in particular is carried out in the plane of sociological concepts of a more general level of generalization of the essence of this social phenomenon - the concept of socialization, to which E. Durkheim, M. Weber, N. Vasilyeva, V. Skvortsova, E. devoted their works. Yarskaya-Smirnova.

Important in the development of the theory of social rehabilitation are the approaches to the concept of disability proposed by N. Vasilyeva, who examined the problems of disability within the framework of basic sociological concepts: the structural-functional approach, the socio-anthropological approach, symbolic interactionism, the theory of societal reaction, the theory of stigmatization.

An integrative document covering all aspects of the life of people with disabilities is the Standard Rules for the Equalization of Opportunities for Persons with Disabilities, approved by the UN in 1994. The ideology of the Rules is based on the principle of equal opportunity, which assumes that people with disabilities are members of society and have the right to remain living in their communities. They should receive the support they need through regular health, education, employment and social services systems.

T. Parsons is responsible for the development of the social concept of the “sick role”, introduced in 1935 by Henderson. Considering illness as a form of social deviation in which the individual plays a specific social role, the scientist developed a model of this role of the patient. The model is described by four characteristics: the patient is relieved of normal social responsibilities; a sick individual is not considered guilty of being sick; since the disease is socially undesirable, the patient strives to recover quickly and seeks competent professional help; As part of this social role, the individual is expected to comply with the orders of a competent physician.

Social rehabilitation of disabled people is defined as a set of measures aimed at restoring destroyed or lost social connections and relationships by an individual due to health problems with persistent impairment of body functions (disability), and changes in social status.

The goal of social rehabilitation is to restore the social status of the individual, ensure social adaptation in society, and achieve financial independence.

The understanding of social rehabilitation has undergone significant changes. Initially, a purely medical approach prevailed here. The World Health Organization believed that the essence of rehabilitation is “not only to return the patient to his previous condition, but also to develop his physical and psychological functions to an optimal level.” It is obvious that here the emphasis is placed primarily on the psychosomatic qualities of a person, the restoration of which was sufficient for him to achieve social well-being. True, this contains an indication of the need for development “to an optimal level,” which can be considered as some prerequisite for super-rehabilitation, the development of an individual’s properties beyond the level that he had before the onset of disability.

Gradually, there is a transition from a purely medical approach to a social model, and within the framework of the social model, rehabilitation is considered not only as the restoration of ability to work, but as the restoration of all social abilities of the individual. The WHO Expert Committee gives the following detailed interpretation: “Rehabilitation of disabled people should include all activities designed to reduce the consequences of the resulting disability and allow the disabled person to fully integrate into society. Rehabilitation aims to help the disabled person not only adapt to his environment, but also to have an impact on his immediate environment and on society as a whole, which facilitates his integration into society. Disabled people themselves, their families and local authorities must participate in the planning and implementation of rehabilitation measures.”

Social rehabilitation as a rather complex, multicomponent process includes:

1. social adaptation - the process of mastering relatively stable conditions of the social environment, solving recurring typical problems through the use of accepted methods of social behavior and action;

2. social and everyday adaptation - the process of optimizing the modes of social and family and everyday activities of a person in specific social and environmental conditions and the individual’s adaptation to them;

3. social-environmental orientation - the process of structuring the most developed social, everyday and professional function of an individual with the aim of subsequent selection on this basis of social and family-social activities, as well as, if necessary, adaptation of the social environment to his psychophysiological capabilities;

4. socio-psychological and socio-cultural adaptation - the process of restoring (forming) an individual’s ability to effectively interact with people around him in the system of interpersonal relationships, including restoration of an adequate level of sociability or sociability, that is, the ability for spontaneous communicative activity, as well as possession of communication skills , stable types of reactions during socio-psychological interaction (characterized by role and other functions performed by the individual in small and / or large groups);

5. provision of a complex of various social services: socio-economic, socio-labor, social and domestic. Medical-social, correctional, social-pedagogical, social-cultural and others.

As practice shows, a decent lifestyle for people with physical and mental development cannot be guaranteed by taking only adequate measures of medical or psychological intervention. To reach a level of socio-cultural competence that would allow this part of the population to enter into ordinary social contacts and interactions without much difficulty is a goal that unites both civil institutions and people with disabilities themselves.

It applies to numerous socially weakened and socially unprotected categories of the population, including primarily orphans and children in orphanages, financially disadvantaged and large families, children and adults with disabilities (disabled people), elderly and elderly people and others. their socio-cultural support and rehabilitation

This is an extremely important area of ​​everyday practical activity of state and non-state (public, commercial, private) organizations. In this case, we are talking about a practical solution at the level of each society of many problems associated with the alienation of this part of the population from cultural and spiritual benefits, the creation of a full-fledged environment for their creative self-affirmation and self-development.

Social rehabilitation of children with disabilities is one of the most important and difficult tasks modern systems social assistance and social services. The steady increase in the number of people with disabilities, including children with disabilities on the one hand, increasing attention to each of them - regardless of his physical, mental and intellectual abilities, on the other hand, the idea of ​​​​increasing the value of the individual and the need to protect his rights, characteristic of a democratic, civil society, on the third hand, - all this predetermines the importance of social rehabilitation activities.

Currently there are about 80 thousand in Russia. disabled children. According to the conducted scientific research In the coming decades, Russia expects an increase in the number of children with disabilities.

Children with disabilities are children with physical and (or) mental disabilities who have disabilities caused by congenital, hereditary, acquired diseases or the consequences of injuries, confirmed in the prescribed manner.

Children with disabilities are children with various mental or physical abnormalities that cause general developmental disorders that do not allow children to lead a full life. The following definitions of such children can be synonyms for this concept: “children with problems”, “children with special needs”, “atypical children”, “children with learning difficulties”, “abnormal children”, “exceptional children”. The presence of one or another defect (disadvantage) does not predetermine incorrect, from the point of view of society, development. Hearing loss in one ear or visual impairment in one eye does not necessarily lead to developmental disabilities, since in these cases the ability to perceive sound and visual signals with intact analyzers remains.

Thus, children with disabilities can be considered children with impaired psychophysical development who need special (corrective) training and upbringing. According to the classification proposed by L.I. Akatov and B.P. Puzanov, the main categories of abnormal children include:

• 1. Children with hearing impairment (deaf, hard of hearing, late deaf);
• 2. Children with visual impairments (blind, visually impaired);
• 3. Children with speech impairments (speech pathologists);
• 4. Children with musculoskeletal disorders;
• 5. Children with mental retardation;
• 6. Children with mental retardation;
• 7. Children with behavioral and communication disorders;
• 8. Children with complex violations psychophysical development, with so-called complex defects (deaf-blind, deaf or blind children with mental retardation).

Depending on the nature of the disorder, some defects can be completely overcome in the process of development, education and upbringing of the child, for example, in children of the third and sixth groups), others can only be smoothed out, and some can only be compensated. The complexity and nature of the violation of the normal development of the child determine the characteristics of the formation of the necessary knowledge, skills and abilities, as well as various shapes pedagogical work with him. One child with developmental disabilities can master only basic general educational knowledge (read syllables and write simple sentences), while another is relatively unlimited in his abilities (for example, a child with mental retardation or a hearing impairment). The structure of the defect also affects the practical activities of children. Some atypical children in the future have the opportunity to become highly qualified specialists, while others will spend their entire lives doing low-skilled work.

The sociocultural status of a child is largely determined by both hereditary biological factors and the social environment of the child’s life. The process of personality development is characterized by the unity and interaction of a system of biological and sociocultural factors. Each child has its own unique innate properties nervous system(strength, balance, mobility of nervous processes; speed of formation, strength and dynamism of conditioned connections...). From these individual characteristics higher nervous activity (hereinafter referred to as GNA) depends on the ability to master social experience, to understand reality, that is biological factors create the prerequisites for human mental development.

In the psychological and pedagogical literature, several concepts are used for the category of children that belong to the special education system.

• - children with developmental disorders - children lagging behind in physical and mental development due to organic damage to the central nervous system and due to disruption of the activity of various analyzers (auditory, visual, motor, speech).
• - children with developmental disabilities - children who have the above-mentioned deviations, but the degree of their severity limits their capabilities to a lesser extent than for children with developmental disabilities.
• - children with disabilities - children who have developmental disorders provide them with the opportunity to enjoy social benefits and allowances. Such children have always been called disabled children. Nowadays, the term “problem children” is also often used in psychological and pedagogical literature.

At the core pedagogical classification Such violations depend on the nature of the special educational needs of children with developmental disabilities and the degree of impairment.

Depending on the degree of dysfunction (taking into account their impact on the child’s social adaptation capabilities), the child’s disability is determined by the degree of health impairment. There are four of them (degrees):

• - the first degree of loss of health is determined with mild and moderate impairment of functions, is an indicator for establishing disability in a child, but, as a rule, does not lead to the need for determination in persons over 18 years of age;
• - the second degree of health loss is established in the presence of pronounced dysfunctions of organs and systems, which, despite the treatment provided, limit the child’s possibilities for social adaptation (corresponds to disability group 3 in adults);
• - third degree of health loss corresponds to group 2 disability in an adult;
• - the fourth degree of loss of health is determined in case of pronounced dysfunctions of organs and systems, leading to social disadaptation of the child, provided that the damage is irreversible and treatment and rehabilitation measures are ineffective (corresponds to disability group 1 in an adult).

Each degree of loss of health of a disabled child corresponds to a list of diseases, among which the following main groups can be distinguished:

1. Neuropsychiatric diseases occupy second place (32.8%). Among children with these diseases, 82.9% are children with mental retardation.

The most common diseases of this group are cerebral palsy, tumors of the nervous system, epilepsy, schizophrenia and other endogenous psychoses, mental retardation(mental retardation or dementia of various origins, corresponding to the stage of idiocy or imbecility), Down's disease, autism.

All these diseases are combined into one group, however, it is necessary to distinguish between mental and mental disability. The International League of Societies for the Mentally Retarded and other organizations involved in studying this category of people and/or providing them with assistance insist on this.

The term “mental disability” includes two significant components that “must be considered in accordance with biological age and the relevant cultural background: intellectual disability that is below average and present with early age; a significant weakening of the ability to adapt to the social demands of society.”

Disabled children in this category very often experience gross impairments in all aspects of mental activity: memory, attention, thinking, speech, motor skills, and the emotional sphere. However, after special exercises and classes they can achieve good results. The range of problems of such children requires, mainly, the intervention of specialists in the field of pedagogy and rehabilitation (teachers and social workers, respectively) in close contact with the family.

The term “mental disability” is used to denote numerous changes that affect emotional functions and behavior. It is characterized by imbalance of emotions various types and degrees of complexity, impaired understanding and communication, and misdirected rather than merely inappropriate adaptation. Most often, such diseases occur suddenly and take the form of an acute shift, sometimes the result of biochemical changes or drug use, severe or prolonged stress, psychological conflicts, and also as a result of other reasons.

2. Diseases of internal organs. Currently, they occupy a leading position in the structure of childhood disability, which is caused by the transition of diseases into a chronic form with severe functional impairment. This is often due to late detection of violations and insufficient rehabilitation measures.

This group of diseases includes various diseases, pathological conditions and malformations of the respiratory organs (including chronic pulmonary tuberculosis), kidneys and urinary organs, gastrointestinal tract, liver and biliary tract (liver cirrhosis, chronic aggressive hepatitis, continuously relapsing ulcerative process, etc.), cardiovascular system (including heart defects and large vessels), hematopoietic system, musculoskeletal system (polyarthritis, etc.).

Often, due to their illnesses, such children cannot lead an active lifestyle; peers may avoid communicating with them and including them in their games. A situation of inconsistency arises between the need for the child to carry out normal life activities and the impossibility of its full implementation. Social deprivation deepens due to the child’s long stay in special hospitals and sanatoriums, where social experience is limited and communication is carried out between similar children. The consequence of this is a delay in the development of social and communication skills, and an insufficiently adequate understanding of the world around the sick child is formed.

3. Lesions and diseases of the eyes, accompanied by a persistent decrease in visual acuity to 0.08 in the best seeing eye to 15 from the point of fixation in all directions. Children with this disease make up 20% of the total number of disabled children.

The mental development of children with visual impairments largely depends on the time of onset of the pathology and the time of the start of special treatment. correctional work, and these defects can be compensated for through early and widespread use of the functions of intact analyzers.

• 4. Oncological diseases, which include malignant tumors of stages 2 and 3 of the tumor process after combined or complex treatment, including radical surgery; untreatable malignant neoplasms of the eye, liver and other organs.
• 5. Lesions and diseases of the hearing organ. Based on the degree of hearing loss, a distinction is made between the deaf and the hard of hearing. Among the deaf, two groups can also be distinguished depending on the presence or absence of speech. The number of children with this disease is relatively small, they make up about 2% of all children with disabilities.

The behavioral characteristics of a child with hearing impairment are varied. They usually depend on the causes of the violation. For example, in children with early limited brain damage, hearing impairment is combined with increased mental exhaustion and irritability. Among the deaf there are closed, “strange” children who seem to be “in their own world.” In people who are deaf, on the contrary, there is impulsiveness, motor disinhibition, and sometimes even aggressiveness.

• 6. Surgical diseases and anatomical defects and deformities.
• 7. Endocrine diseases.

Currently, 4.5 percent of children living in Russia are classified as people with disabilities and need special (correctional) education that meets their special educational needs.

In addition, there is a large layer of children who attend mass comprehensive schools and preschool institutions, but under the influence of unfavorable social conditions and, above all, interpersonal relationships, they experience psychological discomfort, which as the child grows up intensifies and turns into a traumatic factor. Such children need special assistance for normal adaptation among peers. This category includes, first of all, pedagogically neglected children. In each school there are at least 10-15 percent of them. Their mental retardation is caused not by pathology, but by a lack of attention on the part of adults at the stages of preschool childhood and early childhood. school age. These children, along with children who have mental development delays due to pathogenic influences at various periods of life, while studying in secondary school, fall into the number of students with behavioral problems and underachieving students.

According to the International Nomenclature of Disabilities, Disabilities and Disabilities (INN), “a disability is defined as any limitation or inability to perform an activity in a manner or within a range considered normal for a person of a given age.” Disability limitations vary in the degree of their manifestation, which is determined using the so-called “severity scale” developed by the INN (in the form of a quantitative indicator).

The majority of children with persistent functional impairments are disabled children. Disability, in accordance with the accepted classification, is interpreted as a social insufficiency that occurs as a result of a health disorder, accompanied by a persistent disorder of body functions and leading to limitation of life activity and the need for social protection.

Based on the adopted legislation, within a month after the child is recognized as disabled by the specialists of the institution who conducted the medical and social examination, an individual program for his comprehensive rehabilitation is developed. This program is a list of activities aimed at restoring the abilities of a disabled child in everyday life, age-environmental and educational activities in accordance with the structure of his needs, range of interests, level of aspirations, etc. It outlines the volumes, timing of their implementation, and performers. When drawing up the program, the predicted level of somatic condition, psychophysiological endurance, social status of the child and real opportunities the family in which he is located.

An individual rehabilitation program for a disabled child is implemented in the form of a sequential chain of rehabilitation cycles, each of which includes the stage of a comprehensive medical and social examination and the stage of their own rehabilitation, i.e. a set of measures to maintain medical, psychological, pedagogical and social rehabilitation, determined by age And personal characteristics the child and the current level of severity of his life activity limitations. The named program is considered completed if complete social adaptation the subject is a former disabled child, having become an adult, created his own family and integrated into society, or specialists from the state medical and social examination service have established that all the child’s existing rehabilitation potential has been completely exhausted.

Comprehensive rehabilitation of a disabled child is thus understood as “a process and system of medical, psychological, pedagogical and socio-economic measures aimed at eliminating or possibly more fully compensating for limitations in life activity caused by health problems with persistent impairment of body functions.” Its goal is defined as “restoration of the social status of a disabled person, his achievement of material independence and his social adaptation.”

In order to analyze the process of social rehabilitation of disabled people, people with disabilities in general, it is necessary to find out what the content of the concept of “disability” is, what social, economic, behavioral, emotional geniuses turn into certain health pathologies and, naturally, what constitutes a process of social rehabilitation, what purpose it pursues, what components or elements are included in it.

Disability, based on Art. 1 of the Federal Law "On the social protection of disabled people in the Russian Federation" is a violation of the health of a person with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, which leads to limitation of life activities and necessitates the social protection of such a subject. Federal Law of November 24, 1995 N 181-FZ (as amended on December 30, 2012) “On social protection of disabled people in the Russian Federation” http://www.pravo.gov.ru

Disability in sociology is interpreted as social failure, i.e. such social consequences of an individual’s health impairment in which he is completely or partially unable to perform the usual role in life for his position (based on gender, age, social and cultural status). Yarskaya-Smirnova E.R., Naberushkina E.K. Social work with disabled people. 2nd ed., St. Petersburg, 2004. P. 9

In essence, based on the definitions of disability, we note that it is always associated with a limitation of life activity, which can be expressed in the complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, study and engage in work.

According to Art. 1 of the Law on Social Protection of Persons with Disabilities - a disabled person is a person who has a health impairment with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a limitation of life activity and necessitating his social protection.

Depending on the degree of disorder of body functions and limitations in life activity, persons recognized as disabled are assigned a disability group, and persons under the age of 18 are assigned the category “disabled child.”

Society has a responsibility to adapt its standards to the special needs of people with disabilities so that they can live independent lives.

Deepening understanding of problems - provides for states to develop and encourage the implementation of programs aimed at deepening the understanding of people with disabilities about their rights and opportunities. Increasing self-reliance and empowerment will enable people with disabilities to take advantage of the opportunities available to them. Deepening understanding of the issues should be an important part educational programs rehabilitation.

Health care - prescribes measures to develop programs for the early detection, assessment and treatment of defects. Disciplinary groups of specialists are involved in the implementation of these programs, which will prevent and reduce the extent of disability or eliminate its consequences. Ensure full participation in such programs of people with disabilities and members of their families on an individual basis, as well as organizations of people with disabilities in the process of the general education system. Parent groups and organizations of people with disabilities should be involved in the education process at all levels.

A special rule is devoted to employment - states have recognized the principle that persons with disabilities should be given the opportunity to exercise their rights, especially in the area of ​​employment. States must actively support disability inclusion and a free labor market. Such active support can be provided through a variety of activities, including vocational training, incentive quotas, reserved or targeted employment, loans or subsidies to small businesses, special contracts and preferential production rights, tax incentives, contract guarantees, or other types of support. technical or financial assistance to businesses that employ disabled workers. States should encourage employers to make reasonable accommodations for persons with disabilities and to take measures to include persons with disabilities in the development of training programs and employment programs in the private and informal sectors.

Under the income maintenance and social security rule, states are responsible for providing social security to persons with disabilities and maintaining their income. When providing assistance, states must take into account the costs that disabled people and their families often bear as a result of disability, and also provide financial support and social protection to persons who have taken on the work of a disabled person. Social security programs should also encourage the efforts of people with disabilities themselves to find work that generates income or restores their income.

Disability is the basis for receiving a monthly cash payment in accordance with Art. 28.1 Federal Law "On social protection of disabled people in the Russian Federation".

The Standard Rules on Family Life and Personal Freedom provide for persons with disabilities to be able to live with their families. States should ensure that family counseling services include appropriate services related to disability and its impact on family life. Families with disabled people should have the opportunity to use patronage services, as well as have additional opportunities to care for disabled people. States must remove all undue barriers to individuals wishing to either adopt a child with a disability or provide care for an adult with a disability.

Special rules are aimed at developing standards to ensure the inclusion and participation of people with disabilities in cultural life on an equal basis. The standards provide for the adoption of measures to ensure equal opportunities for recreation and sports for people with disabilities. In particular, states must take measures to ensure access for people with disabilities to recreational and sports facilities, hotels, beaches, sports arenas, halls, etc. Such measures include providing support to personnel involved in the organization of recreation and sports activities, as well as projects providing for the development of methods for access and participation in these activities for people with disabilities, providing information and developing training programs, encouraging sports organizations to expand opportunities for the inclusion of people with disabilities in participation in sports events . In some cases, such participation requires simply ensuring that people with disabilities have access to these events. In other cases it is necessary to take special measures or organize special games. States should support the participation of persons with disabilities in national and international competitions.

In the field of religion standard rules involve the promotion of measures aimed at ensuring equal participation of persons with disabilities in the religious life of their communities.

In the field of information and research, States are required to regularly collect statistical data on the living conditions of persons with disabilities. The collection of such data could be carried out in parallel with national population censuses and household surveys and, in particular, carried out in close cooperation with universities, research institutes and organizations of disabled people. This data should include questions about programs, services and their use.

Consider the creation of data banks on people with disabilities, which would contain statistical data on available services and programs, as well as on various groups of people with disabilities. At the same time, it is necessary to take into account the need to protect personal life and personal freedom. Develop and support programs to study social and economic issues affecting the lives of persons with disabilities and their families. Such research should include an analysis of the causes, types and extent of disability, the availability and effectiveness of existing programs and the need for the development and evaluation of services and interventions. Develop and improve survey technology and criteria, taking measures to facilitate the participation of people with disabilities themselves in data collection and study. Information and knowledge on issues relating to persons with disabilities should be disseminated among all political and administrative bodies at the national, regional and local levels.

The Standard Rules define the requirements for policy development and planning for persons with disabilities at the national, regional and local levels. Organizations of persons with disabilities should be involved at all stages of decision-making in the development of plans and programs affecting persons with disabilities or affecting their economic and social status, and the needs and interests of persons with disabilities should be included wherever possible in overall development plans rather than considered separately.

In addition, the essence of disability lies in the social barriers that health status erects between the individual and society.

The main goal of the policy towards people with disabilities is recognized not only as the most complete restoration of health and not only as providing them with the means to live, but also as the maximum possible restoration of their abilities for social functioning on an equal basis with other citizens of a given society who do not have health limitations.

In our country, the ideology of disability policy has developed in a similar way - from a medical to a social model.

It is necessary to highlight three main stages in the formation of the domestic legal framework, dedicated to various aspects of social protection of people with disabilities.

• 1st stage: 1990 - 1999 A characteristic feature of this stage is the adoption of the Constitution of the Russian Federation, which formalized the beginning of the formation of an objectively new regulatory framework in all sectors of public relations, legislative codification of health care and education issues. In 1995 with the adoption of the Federal Law “On Social Protection of Persons with Disabilities”, as well as laws on social services, in fact, a legislative framework was formed in the field of social protection of disabled people.
• 2nd stage: 2000-2010 At this stage, pension and labor legislation is being formed, the basic principles of the situation of children (including disabled children) are being legislated.
• 3rd stage: 2012 - 2018 The regulation of relations in the field of social protection of people with disabilities was to the greatest extent determined by the ongoing changes in the organization of public power (centralization of power, local government reform, redistribution of powers, improvement of the structure of federal executive bodies) Simanovich L.N. Legal regulation social protection of disabled people // Social and pension law. 2010. N 1. P. 26 - 28..

In the Russian Federation, the rights of persons with developmental disabilities are recognized by a number of United Nations (UN) documents:

Universal Declaration of Human Rights, Declaration of the Rights of Persons with Disabilities, Declaration of the Rights of Mentally Retarded Persons, Convention on the Rights of the Child. Freedoms, rights and responsibilities of citizens enshrined in norms international law, are regulated by a system of regulations issued by government authorities and other component bodies. N.V. Yalpaeva. Social and psychological work with families of children with disabilities - M. Prosveshcheniya. 2002, p. 1

Recognition of a person as disabled is carried out by the state medical and social examination service.

It is obvious that these definitions place more emphasis on the medical content of the problem than on the social one, reducing the latter to the need for social assistance and the lack of independence of disabled people. The approval of the social aspects of the rehabilitation of disabled people occurs with great difficulties and contradictions.

A situation where children are born with functional impairments that make it impossible for them to normal development and age-appropriate activities. Disability in children is defined as “a significant limitation in life activity, leading to social maladaptation due to impaired development and growth of the child, loss of control over one’s behavior, as well as the ability to self-care, movement, orientation, learning, communication, labor activity in future". N.V. Yalpaeva. Social and psychological work with families of children with disabilities - M. Prosveshcheniya. 2002, p. 68

Determination of disability is carried out by specialized government agencies- Bureau of Medical and Social Expertise.

The procedure for recognizing a person as disabled is regulated by the relevant Rules approved by the Decree of the Government of the Russian Federation of February 20, 2006. N 95, which reveals the content of the conditions under which a citizen can be recognized as disabled, determines the period for establishing disability, the procedure for conducting a medical and social examination (hereinafter referred to as MSE), re-examination, and appealing the decision of the MSE Bureau. Decree of the Government of the Russian Federation of February 20, 2006 N 95 (as amended on December 30, 2009) “On the procedure and conditions for recognizing a person as disabled” // Collection of legislation of the Russian Federation. - 2006. - N9. - St. 1018; Collection of legislation of the Russian Federation. - 2010. - N2. - Article 184.

Of course, the intensive development of technology, transport technologies and urban processes, not accompanied by the humanization of technical impacts, leads to an increase in man-made injuries, which also leads to an increase in disability. The tense state of the environment, the increase in anthropological load on the surrounding landscape, environmental disasters such as an explosion in Chernobyl nuclear power plant, lead to the fact that man-made pollution affects an increase in the frequency of genetic pathologies, a decrease in the body’s defenses, and the emergence of new diseases that were previously unknown.

Paradoxically, the very successes of science, primarily medicine, have their downside in the growth of a number of diseases and the number of disabled people in general. This is due to the fact that in all countries at the stage of industrial development there is a significant increase in life expectancy and diseases of old age become an inevitable companion of a significant part of the population. Many die, however, it is not always possible to achieve full restoration of health, and they continue to live as disabled people.

The increase in disability may also be influenced by situational factors that are short-term compared to long-term trends in socio-demographic processes. The aggravation of the socio-economic crisis in our country is currently increasing the influence of factors that determine the causes of disability. Budgetary difficulties, lack of personnel and modern equipment reduce the ability of the health care system to maintain and restore the health of the population. Labor protection is becoming less consistent and effective, especially in non-state owned enterprises - this leads to an increase in occupational injuries and, accordingly, disability. The deterioration of the environment and unfavorable environmental conditions lead to an increase in health pathologies for both children and adults.