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Contents of my presentation

Council of International Fellowship in Finland Kiljava 4 August 2009 Disability, Rehabilitation, and Dialogue A Finnish Perspective Mr Ilpo Vilkkumaa Centre of Expertise Verve, Helsinki. Contents of my presentation. Little bit of history ( of Finnish rehabilitation system )

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Contents of my presentation

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  1. Council of International Fellowship in FinlandKiljava 4 August 2009Disability, Rehabilitation, and DialogueA Finnish PerspectiveMr Ilpo VilkkumaaCentre of ExpertiseVerve, Helsinki

  2. 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?

  3. 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.

  4. 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

  5. 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?)

  6. Disability models body person society

  7. 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) • Participationis a person’s involvement in a life situation. It represents the societal perspective of functioning

  8. 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

  9. 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

  10. Rehabilitation triad A client professional C B peer

  11. 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.]

  12. A – client/professional dialogue • Medical vs. social model • Patient rights, right to rehabilitation, participation • Knowledge management – ICT

  13. B – peer/professional dialogue • Carers • Personal assistance • Family therapy • Networking

  14. C – client/peer dialogue • Social support • Disability organisations -> facebook, twitter etc.

  15. 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

  16. 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

  17. 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?

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