ساختار توانبخشی در ايران و جهان

1. ساختار توانبخشی در ايران و جهان دکتر محمد کمالی استاديار دانشکده علوم توانبخشی ، دانشگاه علوم پزشکی ايران اسفند 82

2. “Would you tell me, please, which way I ought to go from here?”“That depends a good deal on where you want to go,” said the Cheshire cat.“I don’t much care where,” said Alice.“Then it doesn’t much matter which way you go,” said the cat.Lewis Carroll's Alice in Wonderland

3. Rehabilitation • Rehabilitate …to restore not to create • “reinstatement” “return to normal” “redevelopment” “ restoration”

4. Rehabilitation • Rehabilitation has three overlapping phases • The pioneering phase- characterized by flexibility • The status phase - characterized by rigidity and adherence to rules and regulations • The expansion phase- characterized by tolerance(peat,1981)

5. Rehabilitation • Rehabilitation is a progressive, dynamic, goal oriented and often time-limited processes which enables an individual with an impairment to identify and reach his or her optimal mental, physical, cognitive, and/or, social functional level. Rehabilitation provides opportunities for the individual, the family and the community to accommodate a limitation or loss of function and aims to facilitate social integration an independende.OMH,1995)

6. How individuals view Rehabilitation • Consumers and their family and advocates • Health and Social Professionals and other service provider • Founders of Rehabilitation Services • Designers and Planners of Rehabilitation Services • Regulators of Services

7. 5 Reactions to Persons with Disabilities • Elimination- removing the disabled from the community • The “poor house”-removing from view • Institutional care - the process leading to the full involvement of disabled persons in the life of their families, communities and society. • Self-actualization-the ability of the disabled person to fulfill his or her need for living a life in dignified independence with self-esteem

8. Pre-Historic Times • People with Disabilities • Seen as unworthy • Extra mouth to feed • Killed or abandoned

9. Historical Perceptions • Christianity Spreads • Parents blamed • Slaves • 1700’s • Poor or alms houses • Subhuman organisms

10. History & Perceptions • Early 1800’s • Menace to society • Institutionalized & Sterilized • Schools developed • 1817/1819 American School for the Deaf or Connecticut Asylum for the Deaf and Dumb • 1826 Asylum for the Deaf and Dumb in Kentucky • 1832 Perkins School for the Blind in Boston • 1841 Dorothea Dix • 1841 American School for the Deaf publishes American Annals • 1848 Perkins Institution

11. History & Perceptions • 1850’s • Object of Pity • Reform and Social Awakening • 1854 New England Gallaudet Association of the Deaf • 1860 Braille Demonstration • 1864 Columbia Institution for the Deaf and Dumb and Blind confers college degrees • 1883 Eugenics by Sir Francis Galton • US laws passed to discriminate against people with disabilities • Jim Crow Laws passed in the South

12. History & Perceptions • Early 1900’s • Medical Model - Diseased Organisms • 1901 National Fraternal Society of Deaf • 1902 Helen Keller graduates • 1912 The Threat of the Feebleminded is published • 1927 US Supreme Court rules forced sterilization is violation of civil rights • 1930’s WW 1- Eugenics • 1933 President Franklin Delano Roosevelt • 1935 Social Security Act • 1936 Randolph Sheppard Act

13. History & Perceptions • 1940’s • Medical Model - Diseased Organisms • 1943 Congress passes Vocational Rehabilitation Amendments • 1945 President Truman signs Public Law 176 • 1946 Hospital Survey and Construction Act • 1946 The Cerebral Palsy Society • 1947 President’s Committee on Employ the Physically Handicapped Week

14. History & Perceptions • 1950’s • Fund raising based on stereotype of eternal child • Still have medical model of support • Still lots of shame and blame for parents • 1950 Social Security Act Amendments • 1950 The Association for Retarded Children in Minneapolis • 1954 Brown vs the Board of Education of Topeka • 1956 Social Security Act Amended to create SSDI • 1958 SSDI amended to extend benefits to dependents of disabled workers

15. History & Perceptions • 1960’s • Fund raising based on stereotype of eternal child • Still have medical model of support • Parent Movement Continues • 1961 President Kennedy appoints President’s Panel on Mental Retardation • 1962 Ed Roberts at University of CA at Berkeley

16. History & Perceptions • 1960’s • 1963 President Kennedy and institutions • 1964 Civil Rights Act • 1965 Medicaid and Medicare in the SS Act Amendments • 1965 Vocational Rehabilitation Act Amendments • 1965 Autism Society of America founded • 1966 President’s Committee on Mental Retardation • 1966 Christmas in Purgatory published • 1968 Architectural Barriers Act passed

17. History & Perceptions • 1970’s • Self Advocacy Movement begins • 1970 Developmental Disabilities and Facilities Construction Amendments are passed • 1970 Urban Mass Transportation Assistance Act • 1971 Wayne vs. Stickney • 1971 Fair Labor Standard Act of 1938 Amended • 1972 Center for Independent Living at UC Berkeley • 1972 SS Act Amended to establish SSI • 1972 Principle of Normalization

18. Rehabilitation Act of 1973 • Greatest Achievement of Disability Rights Movement • Title V Section 504 • Prohibits discrimination against otherwise qualified people with disabilities by programs & facilities receiving federal funding & the postal services • Litigation from this act leads to defining • Reasonable modification • Reasonable accommodation • Undue burden

19. History & Perceptions • 1975 • Education of All Children Act (PL 94-142) • The Developmental Disabilities Assistance and Bill of Rights Act • The Association of Persons with Severe Handicaps (TASH) • Ed Roberts hired as Director of CA Dept of Rehabilitation

20. History & Perceptions • Late 1970’s • 1978 ADAPT demonstrations begin • 1978 The Rehabilitation and Developmental Disabilities Amendments • 1979 The Disability Rights Education and Defense Fund at Berkeley

21. History & Perceptions • 1980’s • 1980 Civil Rights of Institutionalized Persons Act • 1980 SS Amendments establishing status 1619 • 1981 Baby Doe in Bloomington, IL dies • 1984 Voting Accessibility for the Elderly and Handicapped Act • 1986 The Education of the Handicapped Act Amendments • 1986 Air Carrier Access Act • 1988 Fair Housing Act Amendments • 1988 Gallaudet University student demonstrations • 1988 Technology Related Assistance Act

22. ADA • 1990 • Greatest Victory of Disability Rights Movement • Comprehensive anti-discrimination legislation • Americans with Disabilities Act prevents discrimination against people with disabilities in: • Employment • Access to public services • Transportation • Public accommodations • Telecommunications

23. IDEA Amendments 1992 • Individuals with Disabilities Education Act • Transition is a coordinated set of activities for a student with a disability that: • Is outcome oriented promoting post school options: post-secondary education, vocational training, employment, adult education, adult services, independent living, or community participation • Is based upon individuals needs and preferences • Includes instruction and community experiences leading to employment or other adult living objectives • Beginning at age 14 and updated annually, a statement of transition service needs that focuses on course of study • Beginning at age 16 a statement of needed transition services and interagency responsibility

24. History & Perceptions • 1990’s • 1992 Rehabilitation Act Amendments • 1993 Facilitated Communication • 1993 Robert Williams becomes Commissioner of Administration on Developmental Disabilities • 1994 Tech Act reauthorized • 1995 Helen L. vs. Snider • 1995 Sandra Jenson • 1996 The Developmental Disabilities Assistance and Bill of Rights Act Amendments

25. Policy history: pre-20th century • Developments in disability policy in UK during 20th century • Industrial revolution - disabled people became a ‘problem’ • Poor Law Amendment Act - workhouses • administrative model of disability

26. Growth of institutions • institutions: from philanthropic to controlling • Mental Deficiency Act 1913 • Eugenics movement

27. Welfare state • 1948:Creation of NHS -- medicalised learning disability • conditions in hospitals declined • people suffered physical and emotional abuse • pressure to move people into community

28. Welfare policy 1970s & ‘80s • 1970 Chronically Sick and Disabled Persons’ Act (1972 Scotland) • 1986 Disabled Persons (Services, Consultation and Representation) Act

29. NHS and Community Care Act 1990 • 1990 NHS and Community Care Act • growth in ‘community’ services • Community Care (Direct Payments) Act 1995

30. Employment Policy1944-1990s • 1944: Disabled Persons (Employment) Act • Disablement Resettlement Service • Sheltered workshops • Disability Service Teams • Supported Employment Programme • Access to Work • New Deal

31. Disability Discrimination Act 1995 The right to challenge unjustified discrimination • at work • in provision of goods and services • in buying/renting land & property • Now also - in education • transport Disability Rights Commission

32. Models of disability - M. Oliver • Individual model of disability - ‘personal tragedy’ • (medical model ?) • Social model of disability - created by disabled themselves

33. Models of disability • Moral Model • Medical Model • Environmental Model • Civil Rights/Minority Model • Legal Foundations

34. FACTORS • Population changes • Changes in disease patterns • Environmental factors • Economic outlook

35. Medical model of disability • Focuses on impairment • pathologies individual • professionals seen as experts • looks for cure / treatment

36. Social model • “The disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from the mainstream of social activities” - UPIAS 1976

37. Concepts of Disability • Social model vs medical model • Disabling environment or personal deficit • “Disability is not something individuals have. What individuals have are impairments” • –New Zealand Disability Strategy (2001)

38. Concepts of Disability • “We must create a world in which disability is:” • understood & accepted as a normal part of the human experience • not a lifelong experience of loss & sadness • life that is interesting, exciting, challenging ,joyous • in a society that is inclusive • able to avoid unnecessary & unwanted economic dependence (NIDRR, 1993)

39. Needs or rights-based policies? Needs-led policies since ‘40s • medical model • classification and assessment • help at individual level Some shift to rights-based recently • institutional discrimination = ‘the problem’ • equal rights and citizenship • changing environments (not the person)

40. VISION • Human and civil rights fully protected • Public services to meet personal needs • Access to the same opportunities as non-disabled people have • Full participation in family and community life • Income to ensure a life in dignity

41. Institutional Based Rehabilitation • Designed and controlled by professional groups • Delivered by professionals • Centralized • Referral based • Specialized • Resources and technology intensive

42. General principles of CBR • Community and client centered • Focused on prevention and early intervention • Collaborators with institutional facilities • Promoters of consumer participation and control • Consistent and flexible • Coordinate by referral system

43. General principles of CBR • Interdisciplinary and multisectoral • Focused on information sharing • Providers of appropriate knowledge to the community • Agents for selecting appropriate technology to fit community need • Providers of full- or part- time professional or non-professional teams

44. Acute care and specialist facility IBR Outreach Services Home care program Social services Community workers Volunteers Family/caregiver Person with disability CBR