Council of International Fellowship in FinlandKiljava 4 August 2009

Disability, Rehabilitation, and Dialogue

A Finnish Perspective

Mr Ilpo VilkkumaaCentre of Expertise

Verve, Helsinki

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?

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.

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

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?)

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

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

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

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

Rehabilitation triad

clientprofessio

nal

peer

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.]

A – client/professional dialogue

• Medical vs. social model• Patient rights, right to

rehabilitation, participation• Knowledge management – ICT

B – peer/professional dialogue

• Carers• Personal assistance• Family therapy• Networking

C – client/peer dialogue

• Social support• Disability organisations ->

facebook, twitter etc.

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

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

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?