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The need for social protection of the population. Theoretical foundations of social work with disabled people and the need for its social

The term “disabled person” goes back to the Latin root (“valid” - effective, full-fledged, powerful) and literally translated can mean “unsuitable”, “inferior”. In Russian usage, starting from the time of Peter I, this name was given to military personnel who, due to illness, injury or injury, were unable to perform military service and who were sent for further service to civilian positions. Peter tried to rationally use the potential of retired military personnel - in the public administration system, city security, etc.

It is characteristic that in Western Europe this word had the same connotation, i.e. applied primarily to crippled warriors. From the second half of the 19th century. the term also applies to civilians who also became victims of war - the development of weapons and the expansion of the scale of wars increasingly exposed the civilian population to all the dangers of military conflicts. Finally, after the Second World War, in line with the general movement to formulate and protect human rights in general and certain categories of the population in particular, the concept of “disabled person” is being rethought, referring to all persons with physical, mental or intellectual disabilities.

Today, according to various estimates, on average, almost every tenth resident in developed countries has some kind of health limitation. The classification of specific types of limitations or impairments as persons with disabilities depends on national legislation; Consequently, the number of disabled people and their share in the population of each specific country may differ significantly, despite the fact that the level of morbidity and loss of certain functions in countries that have reached a certain level of development is quite comparable.

The Federal Law of November 24, 1995 No. 181-FZ “On the social protection of disabled people in the Russian Federation” provides a detailed definition of disability.

Disabled person- this is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limited life activity and necessitating his social protection.

Limitation of life activity is 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 activities.

Thus, according to internationally recognized criteria, disability is defined by abnormalities or impairments in the following areas.

Blind, deaf, dumb, people with limb defects, impaired coordination of movement, completely or partially paralyzed are recognized as disabled due to obvious deviations from the normal physical condition of a person. Disabled persons are also recognized as persons who have no external differences from ordinary people, but suffer from diseases that do not allow them to function in various spheres of life in the same way as healthy people do. For example, a person suffering from coronary heart disease is unable to perform heavy physical work, but he may be quite capable of mental activity. A patient with schizophrenia may be physically healthy, in many cases he is also able to perform work associated with mental stress, but during an exacerbation he is not able to control his behavior and communication with other people.

At the same time, the majority of disabled people do not need isolation, they are able to independently (or with some help) lead an independent life, many of them work in regular or adapted jobs, have families and support them independently.

Social changes that are objectively occurring in modern society and reflected in people’s consciousness are expressed in the desire to expand the content of the terms “disabled person” and “disability”.

Thus, WHO has adopted the following characteristics of the concept of “disability” as standards for the world community:

any loss or impairment of psychological, physiological or anatomical structure or function;
limited or absent (due to the above defects) ability to perform functions in a manner considered normal for the average person;
a difficulty arising from the above-mentioned disadvantages, which completely or partially prevents a person from performing a role (taking into account the influence of age, gender and cultural background).

At the same time, taking into account the complexity and inconsistency of the understanding and definition of such concepts as “health”, “standard of health”, “deviation”, functionalist concepts of the interpretation of disability, based on the assessment of deviations and defects in several scales related to biophysical, mental , social and professional aspects of the life of a disabled person.

At the same time, the importance of developing valid criteria and methods for assessing and regulating the status of a disabled person is determined by the fact that in a society in which the principle of equal rights is fundamental, disability is one of the mechanisms that predetermine inequality and can become a source of marginalization of people with disabilities and families, in which they live.

The World Health Organization has developed the International Classification of Impairments, Disabilities and Handicaps, in which the starting point for defining disability is an impairment, a defect, which is understood as a mental, physiological and (or) anatomical deficiency in the structure of the body. Losses can be global (universal) or partial; the impairment may vary in level and depth, may be permanent or curable, congenital or acquired, stable or progressive (in which the person's condition worsens).

Handicap, which is a consequence of injury (mutilation) and disability, determines less favorable social conditions for a person, since the ability to perform standard functions for a given society and role identification in it is either completely blocked or significantly limited. It also becomes difficult to achieve one’s own life goals that are related to age, gender and cultural traditions.”

The degree of role impairment may manifest itself in difficulties in fulfilling social roles; in the constraints that arise (not all desired roles can be performed at a satisfactory level); in the complete absence of opportunities for adequate role behavior.

The systemic understanding of disability presented by WHO departs from its narrow interpretation, which emphasized occupational limitations and the ability (inability) to work. The presence of disability and the degree of impairment is considered as an indicator of disorders in regulating the relationship of a disabled person with his social environment. At the same time, an analysis of social practice shows that there are people who have disorders of communication and social behavior, maladaptation and social marginalization that are not associated with health problems. Such individuals (deviant behavior) also need social rehabilitation, however, in order to organize specialized assistance, it is necessary to distinguish between marginalized people who have difficulties in the field of social adaptation, based on sociopathy or behavioral disorders, and people with psychosomatic abnormalities.

Multifactor analysis of the social status of disability allows us to conclude that:

from an economic point of view - this is limitation and dependence arising from poor ability to work or from incapacity for work;
medical point of view - a long-term condition of the body that limits or blocks its normal functions;
legal point of view - status giving the right to compensation payments and other social support measures regulated by national or regional legislation;
professional point of view - a state of difficult, limited employment opportunities (or a state of complete disability);
psychological point of view - this is, on the one hand, a behavioral syndrome, and on the other, a state of emotional stress;
sociological point of view - loss of previous social roles, inability to participate in the implementation of a standard set of social roles for a given society, as well as stigmatization, labeling that prescribes a certain, limited social functioning to the disabled person.

If we pay attention to the last two provisions, we can conclude that social restrictions and barriers for persons with disabilities are partly formed not only by physical barriers, but also by subjective social restrictions and self-limitations. Thus, the stigmatization of disabled people in the public consciousness prescribes for them the role of unfortunate people, worthy of pity, in need of constant protection, although many self-sufficient disabled people emphasize their equal subjectivity to all other people. At the same time, some people with disabilities acquire the mentality and behavioral standards of a victim, unable to independently resolve at least part of their own problems, and place responsibility for their fate on others - relatives, employees of medical and social institutions, and the state as a whole.

This approach, reflecting the specifics of the social position of people with disabilities in various spheres, allows us to formulate a new idea: person with disabilities - This is an individual who has all human rights, who is in a position of inequality, formed by barrier restrictions of the environment, which he cannot overcome due to the limited capabilities of his health.

At a conference organized by the UN Secretariat in 2006 and dedicated to the problems of disability, it was noted that the UN Convention on the Rights of Persons with Disabilities recognizes the dynamic development of the concept of disability along with the development of public ideology, which necessitates regular and timely adaptation of instruments for social protection of persons with disabilities. Currently, the following markers of disability are recognized: biological (organismal defects due to diseases, injuries or their consequences, persistent functional impairment); social (violation of interaction between an individual and society, special social needs, limitation of freedom of choice, special social status, need for social protection); psychological (special collective personal attitudes, special behavior in the social environment, special relationships within the population and with other social groups of the population); economic (restriction of freedom of economic behavior, economic dependence); physical (accessibility barriers). All these markers, or factors, form the social specificity of the state of disability, which prevents what is normal for a given environment, i.e. socially recognized set of models of functioning.

All disabled people, but for different reasons, are divided into several groups:

by age - disabled children, disabled adults;
origin of disability - disabled people from childhood, disabled people from war, disabled people from labor, disabled people with general illness;
general condition - disabled people of mobile, low-mobility and immobile groups;
degree of ability to work - disabled people able to work and incapable of work, disabled people of group I (unable to work), disabled people of group II (temporarily disabled or able to work in limited areas), disabled people of group III (able to work in benign working conditions).

Criteria for determining first disability group is a social disability that requires social protection or assistance due to a health disorder with a persistent, significant disorder of body functions caused by diseases, consequences of injuries or defects leading to a pronounced limitation of any category of life activity or a combination thereof.

The criterion for establishing second disability group is a social disability that requires social protection or assistance due to a health disorder with a persistent severe disorder of body functions caused by diseases, consequences of injuries or defects leading to a pronounced limitation of any category of life activity or a combination thereof.

Criteria for determining third disability group is a social disability that requires social protection or assistance due to a health disorder with a persistent, slightly or moderately expressed disorder of body functions, caused by diseases, consequences of injuries or defects leading to a mild or moderately pronounced limitation of any category of life activity or a combination thereof.

self-care ability - the ability to independently satisfy basic physiological needs, perform daily household activities and personal hygiene skills;
ability to move - the ability to independently move in space, overcome obstacles, maintain body balance within the framework of everyday, social, and professional activities;
ability to work - ability to carry out activities in accordance with the requirements for the content, volume and conditions of work;
orientation ability - ability to be determined in time and space;
communication ability - the ability to establish contacts between people by perceiving, processing and transmitting information;
ability to control one's behavior - the ability to self-awareness and adequate behavior taking into account social and legal norms.

Also distinguished ability to learn, the limitation of which may be the basis for establishing a second disability group, when combined with one or more other categories of life activity. The ability to learn is the ability to perceive and reproduce knowledge (general education, professional and others), mastery of skills and abilities (social, cultural and everyday).

When considering childhood disabilities, there are usually 10 categories of children with developmental disabilities. These include children with disorders of one of the analyzers: with complete (total) or partial (partial) loss of hearing or vision; deaf (deaf), hard of hearing or with specific speech disorders; with musculoskeletal disorders (cerebral palsy, consequences of spinal injuries or polio); with mental retardation and with varying degrees of mental retardation (various forms of mental underdevelopment with predominant immaturity of intellectual activity); with complex disabilities (blind, mentally retarded, deaf-blind, deaf-blind with mental retardation, blind with speech impairment); autistic (having a painful communication disorder and avoiding communication with other people).

Despite the increasingly impressive successes of medicine, the number of disabled people not only is not decreasing, but is steadily growing, and in almost all types of societies and all social categories of the population.

There are many different reasons behind the occurrence of disability.

Depending on the cause Three groups can be roughly distinguished:

1) hereditary forms:
2) forms associated with the intrauterine position of the fetus, damage to the fetus during childbirth and in the earliest stages of the child’s life;
3) forms acquired during the development of a disabled person as a result of diseases, injuries, and other events that resulted in a persistent health disorder. Acquired disability is divided into the following forms:
- a) disability due to a general illness;
- b) disability acquired during work - due to a work injury or occupational disease;
- c) disability due to war injury;
- d) disability associated with natural and man-made emergencies - radiation exposure, earthquakes and other disasters.

There are forms of disability, in the origin of which hereditary and other (infectious, traumatic) factors interact. In addition, what often makes a person disabled is not so much the objective state of his health as the inability (for various reasons) of himself and society as a whole to organize full development and social functioning in the conditions of precisely this state of health.

Considering disorders of the musculoskeletal system, it should be noted that pathology of the musculoskeletal system can be a consequence of a congenital defect, the consequences of injuries, degenerative-dystrophic changes in the musculoskeletal system.

In accordance with the International Nomenclature of Impairments, Disabilities and Social Disabilities, movement disorders are presented in a fairly differentiated manner. Movement disorders are classified as follows:

due to the complete or partial absence of one or more limbs, including amputations;
due to the absence of one or more distal parts of the limbs (finger, hand, foot);
due to the absence or impairment of voluntary mobility of four limbs (quadriplegia, tetraparesis);
due to the absence or impairment of mobility of the lower extremities (paraplegia, paraparesis);
due to impaired voluntary mobility of the upper and lower limbs on one side (hemiplegia);
due to impaired muscle strength of the lower extremities;
due to impaired motor functions of one or both lower extremities.

The consequence of these violations is restrictions on life activity in the sphere of self-care and movement.

All causes of disability (both congenital and acquired) can be divided into medical-biological, socio-psychological, economic and legal.

Medical and biological reasons consist in the formation of pathologies. Among them the main places are occupied by:

pathology of pregnancy;
consequences of injuries (including birth);
poisoning;
accidents;
hereditary diseases.

The reasons for the formation of pathologies also include poor organization of medical care:

irregularity of examinations by specialists;
most often disabled people due to mental and nervous diseases are not covered by medical examination;
there is no systematic observation by doctors;
there are no specialized medical institutions - rehabilitation treatment departments, rehabilitation centers;
severity of the pathology.

Among biological reasons, the age of the parents, especially the mother, at the birth of the child is primarily important. Among the socio-psychological causes of disability are:

a) low educational level of parents, their low literacy in matters of education and training;
b) poor living conditions (lack of sufficient communal amenities in everyday life, poor sanitary and hygienic conditions).

Social and psychological reasons can be family, pedagogical, household, etc.

Among economic and legal reasons disability, the low material income of the family, ignorance and practical non-use of their rights to receive one or another type of benefits, allowances, and the provision by health and social protection institutions of the population of the required amount of medical and social assistance to people with disabilities are of significant importance.

The lag in income levels from the rising cost of living, the decline in consumption standards, and the protein and vitamin deficiency experienced by certain segments of the population directly affect both the health of adults and especially the health of children, making it difficult to correct the development of those who need enhanced care and additional assistance for their medical, psychological, pedagogical and social rehabilitation. Lack of healthy lifestyle skills, unsatisfactory nutritional standards, and consumption of substitute alcoholic beverages also adversely affect health. There is a direct and significant correlation between socio-economic difficulties and the increase in disability.

As a result of transport injuries, an unprecedented number of residents are dying, while the number of people losing their health is many times higher. Military conflicts also result in mass disability of both direct participants in hostilities and the civilian population.

Provisions on the protection of the rights of persons with disabilities are also contained in many international documents. The most integrative of them, covering all aspects of the life of people with disabilities, are the Standard Rules for the Equalization of Opportunities for Persons with Disabilities, approved by the UN in 1994.

The ideology of these rules is based on the principle of equal opportunity, which assumes that persons with disabilities are members of society and have the right to remain in their communities. They should receive the support they need through the regular health, education, employment and social services systems. There are 20 such rules in total.

Rule 1 - Understanding of Issues - provides States with an obligation to develop and promote programs aimed at increasing people with disabilities' understanding of 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 problems should become an important part of educational programs for disabled children and rehabilitation programs. Persons with disabilities could help develop understanding of the issue through the activities of their own organizations.

Rule 2 - health care - requires measures to be taken 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 scale of disability or eliminate its consequences; ensure full participation in such programs of persons with disabilities and members of their families on an individual basis, as well as organizations of persons with disabilities in the planning and evaluation process.

Rule 3 - rehabilitation - involves the provision of rehabilitation services to people with disabilities in order to enable them to achieve and maintain an optimal level of independence and functioning. States are required to develop national rehabilitation programs for all groups of persons with disabilities. Such programs should be based on the actual needs of persons with disabilities and the principles of their full participation in society and equality. Such programs should include, but are not limited to, basic training to restore or compensate for lost function, counseling for persons with disabilities and their families, development of self-reliance, and provision of services such as assessment and guidance as needed. Persons with disabilities and their families must have the opportunity to participate in the development of programs aimed at changing their situation.

States should recognize that all persons with disabilities who require assistive devices must have the ability, including the financial means, to use them. This may mean that assistive devices should be provided free of charge or at a cost that is affordable to people with disabilities and their families.

Subsequent rules establish standards regarding the removal of barriers between a disabled person and society, providing persons with disabilities with additional services that would allow them and their families to realize their rights.

Thus, in the field of education, states have recognized the principle of equal opportunities in primary, secondary and higher education for children, youth and adults with disabilities in integrated structures. Education for people with disabilities is an integral part 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 dedicated 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 the inclusion of persons with disabilities in the 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 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. States must take into account the costs that people with disabilities and their families often suffer as a result of their disability when providing assistance, and provide financial support and social protection to those who have taken care of the person with a disability. Social security programs should also encourage people with disabilities themselves to find work that generates income or restores their income.

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 foster care services, as well as have additional opportunities to care for disabled people. States must remove all undue barriers to individuals seeking to either adopt a child with a disability or provide care for an adult with a disability.

The rules provide for the development of standards to ensure the inclusion of people with disabilities in cultural life and participation in it 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 persons 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 involving the development of methods for access and participation in these activities for people with disabilities, the provision of information and the development of training programs, and the encouragement of sports organizations that expand opportunities for the inclusion of people with disabilities in participation in sports activities . 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, the standard rules include the promotion of measures aimed at ensuring the equal participation of persons with disabilities in the religious life of their community.

In the area 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.

When considering the creation of data banks on persons with disabilities, which would contain statistics on available services and programs, as well as on different groups of persons with disabilities, the need to protect individual privacy and freedom must be taken into account. Programs should be developed and supported to study the 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. Survey technology and criteria need to be developed and improved, while measures are taken to facilitate the participation of persons 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. At all stages of decision-making, organizations of persons with disabilities should be involved in the development of plans and programs concerning persons with disabilities or affecting their economic and social situation; Where possible, the needs and interests of persons with disabilities should be included in overall development plans rather than considered separately.

The standard rules recommend economically and in other ways to encourage and support the creation and strengthening of organizations of persons with disabilities, members of their families and (or) persons defending their interests, as well as to ensure an advisory role for organizations of persons with disabilities in decision-making on issues affecting persons with disabilities.

States are responsible for ensuring adequate training at all levels of personnel involved in the development and implementation of programs and services related to persons with disabilities.

Special aspects of the standard rules are devoted to responsibility for the ongoing monitoring and evaluation of the implementation of national programs and for the provision of services aimed at ensuring equal opportunities for persons with disabilities, as well as other provisions.

The years that have passed since the adoption of the standard rules, the analysis of the experience of their application, and the achievements of democratic and humanistic development have made it possible to raise international legislation on the rights of persons with disabilities to a new level.

Based on these documents, the Council of Europe adopted an Action Plan to promote the rights and full participation of people with disabilities in society: improving the quality of life of people with disabilities in Europe, 2006-2015. It reaffirms the universal, indivisible and interrelated nature of all human rights and fundamental freedoms and emphasizes the need for people with disabilities to be able to enjoy them without discrimination. The proportion of people with disabilities in the European population is estimated at 10-15%, and it is noted that the main causes of disability are diseases, accidents and the disabling living conditions of older people. It is predicted that the number of people with disabilities will constantly increase, also due to an increase in average life expectancy.

The main areas of activity are: participation of people with disabilities in political and public life, in cultural life; information and communications; education; employment, career guidance and training; architectural environment; transport; living in the local community; health protection; rehabilitation; social protection; legal protection; protection from violence and abuse; research and development, raising awareness.

The main purpose of the Disability Action Plan is to serve as a practical tool for developing and implementing effective strategies to ensure the full participation of people with disabilities in society.

Analyzing the content of modern documents regulating the obligations and technologies of states to implement equal rights and opportunities for people with disabilities (persons with limited health capabilities), we can conclude that the result of the major political, economic, social and technological changes in recent years is a radical transformation of public consciousness and at the same time - a global change in the paradigm of social policy regarding people with disabilities: a transition from the concept of “patient” to the concept of “citizen”.

The development of information and communication technologies, changes in demography and social relations, the legislative framework and the mentality of the population lead to the fact that the processes of social exclusion that affected people with disabilities (as well as representatives of national minorities, migrants, the poor, etc.) ), are considered reversible. The integration of disabled people is now interpreted not as the inclusion of some separate part into a single whole, but as the integration of disabled people and society. The understanding of activities to provide social support measures to disabled people as unidirectional public charity, albeit comprehensively regulated by law, is gradually being overcome, and the task of the state is now considered to be the creation of conditions so that all categories of people, with all special needs, can freely and equally exercise their universal rights .

Attitudes towards people with disabilities are changing: they are no longer seen as patients in need of care who do not contribute to society, but as people who need barriers to their rightful place in society to be removed. These obstacles are not only of a social and legal nature, but also the rudiments of the attitude that still exists in the public consciousness towards people with disabilities only as victims of biological and social impairment. It is characteristic that European parliamentarians, despite the developed ideas and effective technologies of comprehensive social rehabilitation, which have proven their effectiveness throughout the second half of the 20th century, still consider it urgent to stimulate the transition from the outdated medical model of disability to a model related to the implementation of a complex of social human rights . It can be briefly formulated that the strategy of isolation and segregation is replaced by a strategy of social inclusion - this implies not only inclusive learning, but generally inclusive social functioning.

The transformation of the patient paradigm into the citizen paradigm assumes that the basis for providing all necessary types of support is not a diagnosis, not a list of existing disorders and methods of their medical correction, but a whole person, whose rights and dignity are not subject to derogation. As a result, since the last years of the 20th century. Until now, in many European countries there has been such a transformation of social policy towards people with disabilities, which allows a person with disabilities to control his own life and act as the main expert in assessing measures of social support and social services organized by state and local governments.

The Action Plan identifies groups of people with disabilities who are particularly in need of equal opportunity services: women (and girls) with disabilities; people with complex and complex disabilities who require a high level of support; elderly people with disabilities.

The basic principles that should guide all decision-making bodies and program developers for the social inclusion of people with disabilities are:

prohibition of discrimination;
equality of opportunity, full participation of all people with disabilities in the life of society;
respect for differences and viewing disability as part of humanity's inherent diversity;
the dignity and personal autonomy of persons with disabilities, including freedom to make their own decisions;
equality between men and women;
participation of people with disabilities in all decisions that affect their lives, both at the individual level and at the level of the entire society, through organizations representing them.

Of great importance for the implementation of the rights of persons with disabilities is the Convention on the Rights of Persons with Disabilities, adopted by the General Assembly of the PLO on December 6, 2006, as well as the European Social Charter, revised on May 3, 1996, to which Russia has also joined.

Both of these international instruments emphasize the importance of disability issues as an integral part of their respective sustainable development strategies.

For our country, the problem of providing assistance to persons with disabilities is one of the most important and pressing, since the increase in the number of disabled people acts as a stable trend in social development, and there is no data yet indicating a stabilization of the situation or a change in this trend.

In addition, the general negative characteristics of population reproduction processes, depopulation processes, and a decrease in the birth rate place high demands on the social and labor resources of the future. Disabled people are not only persons in need of special social assistance, but also a possible significant reserve for the development of society. It is believed that in the first half of the 21st century. they will constitute at least 10% of the total workforce in industrialized countries Comprehensive rehabilitation of children with disabilities due to diseases of the nervous system. Methodological recommendations. - M.; St. Petersburg, 1998. - T. 2. - P. 10.

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1.2 The role of social workers in the rehabilitation of people with disabilities

Disabled people as a social category of people are surrounded by healthy people in comparison with them and need more social protection, help, and support. These types of assistance are defined by legislation, relevant regulations, instructions and recommendations, and the mechanism for their implementation is known. It should be noted that all regulations relate to benefits, allowances, pensions and other forms of social assistance, which are aimed at maintaining life and passive consumption of material costs. At the same time, disabled people need assistance that could stimulate and activate disabled people and suppress the development of dependent tendencies. It is known that for a full, active life of disabled people it is necessary to involve them in socially useful activities, develop and maintain connections between disabled people and a healthy environment, government agencies of various profiles, public organizations and management structures. Essentially, we are talking about the social integration of disabled people, which is the ultimate goal of rehabilitation.

According to the place of residence (stay), all disabled people can be divided into 2 categories:

Those living in boarding homes;

Living in families.

The specified criterion - place of residence - should not be perceived as formal. It is closely connected with the moral and psychological factor, with the prospects for the future fate of disabled people.

It is known that the most physically severely disabled people live in boarding homes. Depending on the nature of the pathology, adult disabled people are kept in boarding homes of a general type, in psychoneurological boarding schools, children - in boarding homes for the mentally retarded and physically disabled.

The activity of a social worker is also determined by the nature of the pathology of a disabled person and correlates with his rehabilitation potential. To carry out adequate activities of a social worker in boarding homes, knowledge of the features of the structure and functions of these institutions is necessary.

General boarding houses are designed for medical and social services for people with disabilities. They accept citizens (women over 55 years old, men over 60 years old) and disabled people of groups 1 and 2 over 18 years of age who do not have able-bodied children or parents obligated by law to support them.

The objectives of this boarding house are:

Creating favorable living conditions close to home;

Organizing care for residents, providing them with medical care and organizing meaningful leisure time;

Organization of employment of disabled people.

In accordance with the main objectives, the boarding house carries out:

Active assistance in the adaptation of disabled people to new conditions;

Household facilities, providing applicants with comfortable housing, equipment and furniture, bedding, clothing and shoes;

Organization of meals taking into account age and health status;

Medical examination and treatment of disabled people, organization of consultative medical care, as well as hospitalization of those in need in medical institutions;

Providing those in need with hearing aids, glasses, prosthetic and orthopedic products and wheelchairs;

In general boarding houses there are young disabled people (from 18 to 44 years old). They make up about 10% of the total population. More than half of them are disabled since childhood, 27.3% due to a general illness, 5.4% due to a work injury, 2.5% other. Their condition is very serious. This is evidenced by the predominance of disabled people of group 1 (67.0%).

The largest group (83.3%) consists of disabled people with consequences of damage to the central nervous system (residual effects of cerebral palsy, polio, encephalitis, spinal cord injury, etc.), 5.5% are disabled due to pathology of internal organs.

The consequence of varying degrees of dysfunction of the musculoskeletal system is the limitation of motor activity of disabled people. In this regard, 8.1% need assistance, 50.4% move with the help of crutches or wheelchairs, and only 41.5% move independently.

The nature of the pathology also affects the ability of young disabled people to self-care: 10.9% of them cannot serve themselves, 33.4% serve themselves partially, 55.7% fully.

As can be seen from the above characteristics of young disabled people, despite the severity of their health condition, a significant part of them are subject to social adaptation in the institutions themselves, and in some cases, integration into society. In this regard, factors influencing the social adaptation of young disabled people become of great importance. Adaptation suggests the presence of conditions that facilitate the implementation of existing and the formation of new social needs, taking into account the reserve capabilities of the disabled person.

Unlike older people with relatively limited needs, among which vital needs and those related to prolonging an active lifestyle predominate, young disabled people have needs for education and employment, for the fulfillment of desires in the field of recreational leisure and sports, for starting a family, etc.

In the conditions of a boarding home, in the absence of special workers on staff who could study the needs of young disabled people, and in the absence of conditions for their rehabilitation, a situation of social tension and dissatisfaction of desires arises. Young disabled people are essentially in conditions of social deprivation; they constantly experience a lack of information. At the same time, it turned out that only 3.9% would like to improve their education, and 8.6% of young disabled people would like to get a profession. Among the wishes, requests for cultural work dominate (418% of young disabled people).

The role of the social worker is to create a special environment in the boarding home and especially in those departments where young disabled people live. Environmental therapy occupies a leading place in organizing the lifestyle of young disabled people. The main direction is the creation of an active, effective living environment that would encourage young disabled people to engage in “independent activities”, self-sufficiency, and a departure from dependent attitudes and overprotection.

To implement the idea of activating the environment, one can use employment, amateur activities, socially useful activities, sporting events, organization of meaningful and entertaining leisure, and training in professions. Such a list of outside activities should only be carried out by a social worker. It is important that all staff are focused on changing the style of work of the institution in which young disabled people are located. In this regard, a social worker needs to be proficient in methods and techniques of working with persons serving people with disabilities in boarding homes. Given such tasks, the social worker must know the functional responsibilities of medical and support staff. He must be able to identify commonalities and similarities in their activities and use this to create a therapeutic environment.

To create a positive therapeutic environment, a social worker needs knowledge not only of a psychological and pedagogical plan. Often we have to resolve legal issues (civil law, labor regulation, property, etc.). Solving or assisting in solving these issues will contribute to social adaptation, normalization of relationships among young disabled people, and, possibly, their social integration.

When working with young disabled people, it is important to identify leaders from a contingent of people with a positive social orientation. Indirect influence through them on the group contributes to the formation of common goals, the unity of disabled people in the course of activities, and their full communication.

Communication, as one of the factors of social activity, is realized during work and leisure time. A long stay of young disabled people in a kind of social isolation ward, such as a boarding house, does not contribute to the formation of communication skills. It is predominantly situational in nature, characterized by superficiality and instability of connections.

The degree of socio-psychological adaptation of young disabled people in boarding homes is largely determined by their attitude towards their illness. It is manifested either by denial of the disease, or a rational attitude towards the disease, or “withdrawal into the disease.” This last option is expressed in the appearance of isolation, depression, constant introspection, and avoidance of real events and interests. In these cases, the role of the social worker as a psychotherapist is important, who uses various methods to distract the disabled person from a pessimistic assessment of his future, switches him to everyday interests, and orients him to a positive perspective.

The role of the social worker is to organize the social, everyday and socio-psychological adaptation of young disabled people, taking into account the age interests, personal and characterological characteristics of both categories of residents.

Providing assistance in the admission of disabled people to an educational institution is one of the important functions of the participation of a social worker in the rehabilitation of this category of persons.

An important section of a social worker’s activity is the employment of a disabled person, which can be carried out (in accordance with the recommendations of a medical labor examination) either in normal production conditions, or in specialized enterprises, or in home conditions.

At the same time, the social worker must be guided by regulations on employment, on the list of professions for people with disabilities, etc. and provide them with effective assistance.

When implementing the rehabilitation of disabled people living in families, and especially living alone, moral and psychological support for this category of people plays an important role. The collapse of life plans, discord in the family, deprivation of a favorite job, breaking of habitual connections, deterioration of financial situation - this is not a complete list of problems that can maladapt a disabled person, cause a depressive reaction in him and be a factor complicating the entire rehabilitation process. The role of the social worker is complicity, penetration into the essence of the psychogenic situation of the disabled person and an attempt to eliminate or at least mitigate its impact on the psychological state of the disabled person. A social worker must, in this regard, have certain personal qualities and master the basics of psychotherapy.

Thus, the participation of a social worker in the rehabilitation of disabled people is multidimensional in nature, which presupposes not only a comprehensive education and awareness of the law, but also the presence of appropriate personal characteristics that allow a disabled person to trust this category of workers.

1.3 Forms and methods of solving social problems of disabled people

Historically, the concepts of “disability” and “disabled person” in Russia were associated with the concepts of “disability” and “sick”. And often methodological approaches to the analysis of disability were borrowed from healthcare, by analogy with the analysis of morbidity. Since the beginning of the 90s, the traditional principles of state policy aimed at solving the problems of disability and people with disabilities due to the difficult socio-economic situation in the country have lost their effectiveness.

In general, disability as a problem of human activity in conditions

limited freedom of choice, includes several main aspects: legal; social-environmental; psychological, socio-ideological aspect, anatomical and functional aspect.

Legal aspect of solving problems of disabled people.

The legal aspect involves ensuring the rights, freedoms and responsibilities of people with disabilities.

The President of Russia signed the Federal Law “On Social Protection of Disabled Persons in the Russian Federation.” Thus, the especially vulnerable part of our society is given guarantees of social protection. Of course, the fundamental legislative norms regulating the position of a disabled person in society, his rights and responsibilities are necessary attributes of any rule of law state. Persons with disabilities are entitled to certain conditions for obtaining education; provision of means of transportation; for specialized housing conditions; priority acquisition of land plots for individual housing construction, farming and gardening, and others. For example, living quarters will now be provided to disabled people and families with disabled children, taking into account their health status and other circumstances. Disabled people have the right to additional living space in the form of a separate room in accordance with the list of diseases approved by the government of the Russian Federation. However, it is not considered excessive and is subject to payment in a single amount. Or another example. Special conditions are being introduced to ensure the employment of disabled people. Now for enterprises, institutions, organizations, regardless of their form of ownership, with more than 30 employees, a quota is established for hiring disabled people - as a percentage of the average number of employees (but not less than three percent). The second important provision is the right of people with disabilities to be active participants in all those processes that relate to decision-making regarding their life activities, status, etc.

Social-environmental aspect .

The social-environmental includes issues related to the microsocial environment (family, work collective, housing, workplace, etc.) and the macrosocial environment (city-forming and information environments, social groups, labor market, etc.).

A special category of “objects” of service by social workers is a family in which there is a disabled person or an elderly person in need of outside help. A family of this kind is a microenvironment in which a person in need of social support lives. It seems to draw her into the orbit of an acute need for social protection. A special study found that out of 200 families with disabled members, 39.6% have disabled people. For a more effective organization of social services, it is important for a social worker to know the cause of disability, which may be due to a general illness (84.8%), associated with being at the front (disabled war veterans - 6.3%), or have been disabled since childhood (6.3 %). Belonging to a particular group of a disabled person is related to the nature of benefits and privileges. The role of the social worker is to, based on awareness of this issue, facilitate the implementation of benefits in accordance with existing legislation. When approaching the organization of work with a family that has a disabled person or an elderly person, it is important for a social worker to determine the social affiliation of this family, establish its structure (full, incomplete). The significance of these factors is obvious; the methodology of working with families is associated with them, and the different nature of the family’s needs depends on them. Of the 200 families surveyed, 45.5% were complete, 28.5% were single-parent (mainly mother and children), 26% were single, among whom women predominated (84.6%). It turned out that the role of a social worker as an organizer, mediator, executor is most significant for these families in the following areas: moral and psychological support, medical care, social services. Thus, it turned out that the greatest need for social protection of all surveyed families is currently grouped around social and everyday problems; the most vulnerable from the point of view of social protection, single disabled citizens need the delivery of food and medicine, cleaning of the apartment, and attachment to social service centers. The lack of demand for moral and psychological support for families is explained by the lack of development of needs of this kind, on the one hand, and the established national traditions in Russia, on the other. Both of these factors are interconnected. It is necessary to formulate the scope of activity of a social worker. In addition to those responsibilities that are set out in regulatory documents and qualification characteristics, taking into account the current situation, it is important not only to perform organizational and intermediary functions.

Other types of activities are acquiring a certain relevance, including: awareness of the population about the possibility of wider use of the services of a social worker, the formation of the needs of the population (in a market economy) in protecting the rights and interests of disabled citizens, the implementation of moral and psychological support for the family, etc. Thus, The role of a social worker in interaction with a family with a disabled person or an elderly person has many aspects and can be presented in the form of a number of successive stages. The beginning of work with a family of this kind should be preceded by the identification of this “object” of influence by the social worker. In order to fully cover families with an elderly person or a disabled person who need the help of a social worker, it is necessary to use a specially developed methodology.

Psychological aspect.

The psychological aspect reflects both the personal psychological orientation of the disabled person himself and the emotional and psychological perception of the problem of disability by society. Disabled people and pensioners belong to the category of the so-called low-mobility population and are the least protected, socially vulnerable part of society. This is due, first of all, to defects in their physical condition caused by diseases that lead to disability, as well as to the existing complex of concomitant somatic pathologies and reduced motor activity, characteristic of most representatives of older ages. In addition, to a large extent, the social vulnerability of these population groups is associated with the presence of a psychological factor that shapes their attitude towards society and complicates adequate contact with it.

Psychological problems arise when disabled people are isolated from the outside world, both as a result of existing illnesses and as a result of the unsuitability of the environment for disabled people in wheelchairs, when habitual communication is broken due to retirement, when loneliness occurs as a result of the loss of a spouse, when characterological features as a result of the development of the sclerotic process characteristic of older people. All this leads to the emergence of emotional-volitional disorders, the development of depression, and behavioral changes.

Social and ideological aspect.

The socio-ideological aspect determines the content of the practical activities of state institutions and the formation of state policy regarding people with disabilities. In this sense, it is necessary to abandon the dominant view of disability as an indicator of the health of the population, and perceive it as an indicator of the effectiveness of social policy, and realize that the solution to the problem of disability lies in the interaction of the disabled person and society.

The development of social assistance at home is not the only form of social service for disabled citizens. Since 1986, the so-called Social Service Centers for Pensioners began to be created, which, in addition to social assistance departments at home, included completely new structural units - day care departments. The purpose of organizing such departments was to create unique leisure centers for older people, regardless of whether they live in families or are alone. It was envisaged that people would come to such departments in the morning and return home in the evening; During the day, they will have the opportunity to be in a cozy environment, communicate, spend time meaningfully, participate in various cultural events, receive one hot meal and, if necessary, pre-medical care. The main task of such departments is to help older people overcome loneliness, a secluded lifestyle, fill existence with new meaning, and create an active lifestyle, partially lost due to retirement.

In recent years, a new structural unit has appeared in a number of Social Service Centers - the Emergency Social Assistance Service. It is intended to provide emergency assistance of a one-time nature, aimed at maintaining the livelihoods of citizens in dire need of social support. The organization of such a service was caused by changes in the socio-economic and political situation in the country, the emergence of a large number of refugees from hot spots of the former Soviet Union, homeless people, as well as the need to provide urgent social assistance to citizens who found themselves in extreme situations due to natural disasters, etc. .

Anatomical and functional aspect.

The anatomical and functional aspect of disability involves the formation of a social environment (in the physical and psychological senses) that would perform a rehabilitation function and contribute to the development of the rehabilitation potential of a disabled person. Thus, taking into account the modern understanding of disability, the focus of the state’s attention when solving this problem should not be violations in the human body, but the restoration of its social role function in conditions of limited freedom. The main emphasis in solving the problems of people with disabilities is shifting towards rehabilitation, based primarily on social mechanisms of compensation and adaptation. Thus, the meaning of rehabilitation of disabled people lies in a comprehensive multidisciplinary approach to restoring a person’s abilities for everyday, social and professional activities at a level corresponding to his physical, psychological and social potential, taking into account the characteristics of the micro- and macro-social environment.

Comprehensive solution to the problem of disability.

A comprehensive solution to the problem of disability involves a number of measures. We must start by changing the content of the database on people with disabilities in state statistical reporting, with an emphasis on reflecting the structure of needs, range of interests, level of aspirations of people with disabilities, their potential abilities and the capabilities of society, with the introduction of modern information technologies and equipment for making objective decisions.

It is also necessary to create a system of comprehensive multidisciplinary rehabilitation aimed at ensuring relatively independent life activities for people with disabilities. It is extremely important to develop the industrial basis and sub-sector of the social protection system that produces products that make the life and work of disabled people easier. A market for rehabilitation products and services must emerge, determining supply and demand for them, creating healthy competition and facilitating targeted satisfaction of the needs of people with disabilities. It is impossible to do without a rehabilitation social and environmental infrastructure that helps disabled people overcome physical and psychological barriers to restoring connections with the outside world.

And, of course, we need a system of training specialists who are proficient in the methods of rehabilitation and expert diagnostics, restoring the abilities of disabled people for everyday, social, professional activities, and ways of forming the mechanisms of the macro-social environment with them.

Thus, solving these problems will make it possible to fill the activities of the currently created state services for medical and social examination and rehabilitation of disabled people with new content.

2. Social rehabilitation as a direction of social work

2.1 Essence, concept, main types of rehabilitation

The WHO Committee (1980) defined medical rehabilitation:

Rehabilitation is an active process, the goal of which is to achieve complete restoration of functions impaired due to illness or injury, or, if this is unrealistic, the optimal realization of the physical, mental and social potential of a disabled person, his most adequate integration into society. Thus, medical rehabilitation includes measures to prevent disability during the period of illness and help the individual achieve the maximum physical, mental, social, professional and economic usefulness of which he will be capable within the framework of the existing disease. Among other medical disciplines, rehabilitation occupies a special place, since it considers not only the state of the organs and systems of the body, but also the functional capabilities of a person in his daily life after discharge from a medical institution.

According to the WHO international classification, adopted in Geneva in 1980, the following levels of medical, biological and psychosocial consequences of illness and injury are distinguished, which must be taken into account when carrying out rehabilitation:

damage (impaiment) - any anomaly or loss of anatomical, physiological, psychological structures or functions;

impairment of life (disability) - loss or limitation of the ability to carry out daily activities resulting from damage in a manner or within limits considered normal for human society;

social restrictions (handicap English) - restrictions and obstacles to fulfilling a social role that is considered normal for a given individual arising as a result of damage and disruption of life.

In recent years, the concept of “health-related quality of life” has been introduced into rehabilitation. At the same time, it is the quality of life that is considered as an integral characteristic that must be focused on when assessing the effectiveness of the rehabilitation of sick and disabled people.

A correct understanding of the consequences of the disease is of fundamental importance for understanding the essence of medical rehabilitation and the direction of rehabilitation effects.

The optimal solution is to eliminate or completely compensate for the damage through restorative treatment. However, this is not always possible, and in these cases it is desirable to organize the patient’s life in such a way as to exclude the influence of the existing anatomical and physiological defect on it. If the previous activity is impossible or negatively affects the state of health, it is necessary to switch the patient to such types of social activity that will most contribute to the satisfaction of all his needs.

The ideology of medical rehabilitation has undergone significant evolution in recent years. If in the 40s the basis of policy regarding chronically ill and disabled people was their protection and care, then in the 50s the concept of integrating sick and disabled people into ordinary society began to develop; Particular emphasis is placed on their training and their receipt of technical aids. In the 70s and 80s, the idea of maximum adaptation of the environment was born. Environments for the needs of sick and disabled people, comprehensive legislative support for people with disabilities in the field of education, healthcare, social services and employment. In this regard, it becomes obvious that the medical rehabilitation system depends to a very large extent on the economic development of society.

Despite significant differences in medical rehabilitation systems in different countries, international cooperation in this area is increasingly developing, and the question of the need for international planning and development of a coordinated program for the rehabilitation of physically disabled persons is increasingly being raised. Thus, the period from 1983 to 1992 was declared by the UN as the International Decade of Disabled Persons; In 1993, the UN General Assembly adopted the “Standard Rules for the Equalization of Opportunities for Persons with Disabilities,” which should be considered a benchmark in the field of rights of persons with disabilities in UN member countries. Apparently, further transformation of ideas and scientific-practical tasks of medical rehabilitation is inevitable, associated with the socio-economic changes gradually occurring in society. General indications for medical rehabilitation are presented in the report of the WHO Expert Committee on the Prevention of Disability in Rehabilitation (1983). These include: a significant decrease in functional abilities; decreased learning ability; special exposure to environmental influences; disturbances in social relationships; violations of labor relations.

General contraindications to the use of rehabilitation measures include concomitant acute inflammatory and infectious diseases, decompensated somatic and oncological diseases, severe intellectual-mnestic disorders and mental illnesses that impede communication and the patient’s ability to actively participate in the rehabilitation process.

In our country, based on materials from the All-Union Research Institute of Social Hygiene and Health Organization named after. N A Semashko (1980), of the total number of people hospitalized in therapeutic departments, 8.37 per 10,000 of the total population need rehabilitation treatment, in the surgical department - 20.91 per 10,000, neurological - 21.65 per 10,000 of the total population ; in general, from 20 to 30% are subject to follow-up treatment, depending on the main profile of the department, which requires 6.16 beds per 10,000 population. In outpatient rehabilitation, according to data from N. A. Shestakova et al. (1980), 14-15% of those who applied to the clinic need it, and about 80% of them are people with consequences of damage to the musculoskeletal system.

The basic principles of medical rehabilitation are most fully outlined by one of its founders, Renker (1980):

1. Rehabilitation should be carried out starting from the very onset of illness or injury and until the person’s full return to society (continuity and thoroughness).

2. The problem of rehabilitation must be solved comprehensively, taking into account all its aspects (complexity).

3. Rehabilitation should be accessible to everyone who needs it (accessibility).

4. Rehabilitation must adapt to the constantly changing structure of diseases, and also take into account technological progress and changes in social structures (flexibility).

Taking into account continuity, there are inpatient, outpatient, and in some countries (Poland, Russia) - sometimes also sanatorium stages of medical rehabilitation.

Since one of the leading principles of rehabilitation is the complexity of impacts, only those institutions in which a complex of medical, social and professional pedagogical activities are carried out can be called rehabilitation. The following aspects of these events are highlighted (Rogovoy M. A. 1982):

1. Medical aspect - includes issues of treatment, treatment-diagnostic and treatment-and-prophylactic plan.

2. Physical aspect - covers all issues related to the use of physical factors (physiotherapy, exercise therapy, mechanical and occupational therapy), with increasing physical performance.

3. Psychological aspect - acceleration of the process of psychological adaptation to the life situation that has changed as a result of the disease, prevention and treatment of developing pathological mental changes.

4. Professional - for working people - prevention of possible reduction or loss of ability to work; for disabled people - if possible, restoration of working capacity; This includes issues of determining ability to work, employment, occupational hygiene, physiology and psychology of work, and labor training and retraining.

1. Social aspect - covers issues of the influence of social factors on the development and course of the disease, social security of labor and pension legislation, the relationship between the patient and family, society and production.

2. Economic aspect - the study of economic costs and the expected economic effect of various methods of rehabilitation treatment, forms and methods of rehabilitation for planning medical and socio-economic measures.

2.2 Legal support for social rehabilitation of persons with disabilities

In order to provide qualified assistance to disabled people, a social worker must know the legal, departmental documents defining the status of a disabled person, his rights to receive various benefits and payments, and more. The general rights of persons with disabilities are formulated in the UN Declaration on the Rights of Persons with Disabilities. Here are some excerpts from this legal international document:

- “Disabled people have the right to respect for their human dignity”;

-“Disabled people have the same civil and political rights as other persons”;

- “Disabled people have the right to measures designed to enable them to gain as much independence as possible”;

- “Disabled persons have the right to medical, technical or functional treatment, including prosthetic and orthopedic devices, to restoration of health and status in society, to education, vocational training and rehabilitation, to assistance, consultation, employment services and other services ";

- “Disabled people must be protected from any kind of exploitation.”

Fundamental legislative acts on disabled people have been adopted in Russia. Of particular importance for determining the rights and responsibilities of people with disabilities, the responsibility of the state, charitable organizations, and individuals are the laws “On social services for elderly citizens and disabled people” (1995), “On social protection of people with disabilities in the Russian Federation” (1995).

Even earlier, in July 1992, the President of the Russian Federation issued a Decree “On scientific support for the problems of disability and disabled people.” In October of the same year, decrees “On additional measures of state support for people with disabilities” and “On measures to create an accessible living environment for people with disabilities” were issued.

These rule-making acts determine the relations of society and the state towards disabled people and the relations of disabled people with society and the state. It should be noted that many provisions of these rule-making acts create a reliable legal framework for the life and social protection of people with disabilities in our country.

The Law “On Social Services for Elderly and Disabled Citizens” formulates the basic principles of social services for elderly and disabled citizens: respect for human and civil rights; provision of state guarantees in the field of social services; equal opportunities to receive social services; continuity of all types of social services; orientation of social services to the individual needs of elderly citizens and people with disabilities; responsibility of government bodies at all levels for ensuring the rights of citizens in need of social services, etc. (Article 3 of the Law).

Social services are provided to all elderly citizens and people with disabilities, regardless of gender, race, nationality, language, origin, property and official status, place of residence, attitude to religion, beliefs, membership in public associations and other circumstances (Article 4 of the Law).

Social services are provided by decision of social protection authorities in institutions under their jurisdiction or under agreements concluded by social protection authorities with social service institutions of other forms of ownership (Article 5 of the Law).

Social services are provided exclusively with the consent of people who need them, especially when it comes to placing them in stationary social service institutions. In these institutions, with the consent of those served, labor activities can be organized under the terms of an employment contract. Persons who have entered into an employment contract receive the right to annual paid leave of 30 calendar days.

The law provides for various forms of social services, including:

social services at home (including social and medical services);

semi-stationary social services in departments of day (night) stay of citizens in social service institutions;

stationary social services in boarding homes, boarding houses and other stationary social service institutions;

urgent social services (usually in urgent situations: catering, provision of clothing, shoes, overnight accommodation, urgent provision of temporary housing, etc.)

social, socio-psychological, medical and social consulting assistance.

All social services included in the federal list of state-guaranteed services can be provided to citizens free of charge, as well as on the terms of partial or full payment.

The following social services are provided free of charge:

1) single citizens (single married couples) and disabled people receiving a pension in an amount below the subsistence level;

2) elderly citizens and disabled people who have relatives but receive pensions below the subsistence level;

3) elderly people and disabled people living in families whose average per capita income is below the subsistence level.

Social services at the level of partial payment are provided to persons whose average per capita income (or the income of their relatives, members of their families) is 100-150% of the subsistence level.

Social services are provided on a full payment basis to citizens living in families whose average per capita income exceeds the subsistence level by 150%.

As of January 1, 2005, all elderly citizens and people with disabilities, without exception, in more than half of the constituent entities of the Russian Federation, where wages for the entire working-age population were less than 150% of the subsistence level, needed full or partial payment for social services. More than 80% of the country's population is below the poverty line. Poverty is especially high in regions such as Novgorod, Pskov, Ivanovo, Kirov, Penza, Saratov, Orenburg, and Chita regions; Republics of Mari El, Chuvashia, Kalmykia, Adygea, Dagestan, Ingushetia, Kabardino-Balkarian, Karachay-Cherkess, North Ossetia, Udmurtia, Altai Republic, Tyva.

It is clear that the administrations of these regions of the country are not able to provide not only payment for social services for the elderly and disabled, but also social benefits for unemployment, poverty and others provided for by law. The entire population of these regions, young and old, receives income below the subsistence level and requires social benefits. Federal authorities are forced to cover all expenses for social services for the elderly and disabled.

The Law “On Social Services for Elderly and Disabled Citizens” divides the social service system into two main sectors - state and non-state.

The public sector is formed by federal and municipal social service agencies.

The non-state sector of social services unites institutions whose activities are based on forms of ownership that are not state or municipal, as well as persons engaged in private activities in the field of social services. Non-state forms of social services are provided by public associations, including professional associations, charitable and religious organizations.

Significant issues of social protection of disabled people received a legal basis in the Law “On Social Protection of Disabled People in the Russian Federation”. The law defines the powers of government bodies (federal and constituent entities of the Russian Federation) in the field of social protection of disabled people. It reveals the rights and responsibilities of medical and social examination bodies, which, on the basis of a comprehensive examination of a person, establishes the nature and degree of the disease that led to disability, the disability group, determines the work schedule of working disabled people, develops individual and comprehensive rehabilitation programs for disabled people, gives medical and social conclusions, makes decisions that are binding on government bodies, enterprises and organizations, regardless of their form of ownership.

The law establishes the terms of payment for medical services provided to disabled people, reimbursement of expenses incurred by the disabled person himself, and his relationship with the rehabilitation authorities for the social protection of disabled people.

The law obliges all authorities, heads of enterprises and organizations to create conditions that allow people with disabilities to freely and independently use all public places, institutions, transport, move freely on the street, in their own homes, in public institutions, etc.

The law provides for benefits for priority receipt of appropriately equipped housing. In particular, disabled people and families with disabled children are given a discount of at least 50% on rent and utility bills, and in residential buildings that do not have central heating, on the cost of fuel. Disabled people and families that include disabled people are given the right to priority receipt of land plots for individual housing construction, gardening, and farming (Article 17 of the Law).

The Law pays special attention to ensuring the employment of people with disabilities. The law provides financial and credit benefits to specialized enterprises that employ disabled people, as well as enterprises, institutions and organizations of public associations of disabled people; establishing quotas for hiring people with disabilities, in particular, for organizations, regardless of organizational and legal forms and forms of ownership, the number of employees in which is more than 30 people (the quota for hiring people with disabilities is set as a percentage of the average number of employees, but not less than 3% ). Public associations of disabled people and their enterprises, organizations, the authorized capital of which consists of the contribution of a public association of disabled people, are exempt from mandatory quotas of jobs for disabled people.

The law defines legal norms for resolving such significant issues of employment of disabled people as the equipment of special workplaces, working conditions of disabled people, the rights, obligations and responsibilities of employers in ensuring the employment of disabled people, the procedure and conditions for recognizing a disabled person as unemployed, state incentives for the participation of enterprises and organizations in ensuring the livelihoods of disabled people .

The Law considers in detail the issues of material support and social services for people with disabilities. Significant benefits and discounts are provided for paying for utilities, for purchasing disability devices, tools, equipment, paying for sanatorium and resort vouchers, for using public transport, purchasing, and technical care for personal by road transport, etc.

In addition to federal laws, social workers need to know departmental documents that provide reasonable interpretations of the application of certain laws or their individual articles.

A social worker also needs to know problems that have not been solved by legislation or have been solved but not implemented in practice. For example, the Law “On Social Protection of Disabled Persons in the Russian Federation” does not allow the production of vehicles that do not have adaptations for the free use of urban transport by disabled persons, or the commissioning of housing that does not provide adaptations for the free use of this housing by disabled persons (Article 15 Law). But are there many buses and trolleybuses on the streets of Russian cities equipped with special lifts, with the help of which disabled people in wheelchairs could climb onto a bus or trolleybus independently? Both decades ago and today, residential buildings are put into operation without any devices that would allow a disabled person to freely leave his apartment in a wheelchair, use an elevator, go down a ramp onto the sidewalk adjacent to the entrance, etc., etc. Data the provisions of the Law ‹‹0 for the social protection of disabled people in the Russian Federation” are simply ignored by everyone who is legally obliged to create the necessary conditions for the normal life of disabled people.

The current legislation practically does not protect the rights of children with disabilities to a decent and secure existence. The legislation provides for such amounts of social assistance for children with disabilities that directly push them to any work, including “work”, which is discussed by crime - begging, since a person deprived of everything necessary since childhood cannot live on a disability pension. condition.

But even if financial problems are solved and the living environment of disabled people is completely reorganized, they will not be able to take advantage of the benefits provided without the appropriate equipment and devices. We need prosthetics, hearing aids, special glasses, notebooks for writing texts, books for reading, strollers, cars for transportation, etc.

Thus, a special industry is needed for the production of disabled equipment and equipment. There are such enterprises in the country. They largely meet the diverse needs of people with disabilities. But in comparison with Western models of wheelchair equipment, our domestic ones lose in many ways: they are heavier, less durable, larger in size, and less convenient to use.

2.3 The problem of social rehabilitation of disabled people and the main ways and means of solving it today

The socio-demographic structure of society, while always remaining heterogeneous, presupposes the identification of several generalized human cohorts in it, which can be represented, on the one hand, by a group of direct producers-consumers of material, socio-political, and spiritual values, on the other - conditionally their “pure” consumers (negative or positive type).

Each of the selected cohorts is expedient in its own way, necessary for the harmonization of social development, and a decrease or increase in their total number, relative to a certain critical value, becomes a significant unfavorable factor in the threat of non-preservation of the socio-spiritual, economic disadvantage of any human population. According to the literature, the meaning of the presence in society of a cohort of producer-consumers (adult, working-age population, labor force of society) is well understood, based on the number that largely determines the stability and development of the country’s population as a whole, but the significance of the cohort of “pure” consumers requires some additional discussion.

According to their socio-demographic affiliation, “pure” consumers, as already indicated earlier, are divided into two types that transform into each other (positive and negative). Positive “net” consumers include: children of various age groups, nursing mothers and women on maternity leave, mothers of many children, people of older age groups, forced migrants, non-production employees, law enforcement officials, military personnel and some other groups of the population .

The beginning of strategic rehabilitation work should, in a short time, lead to an increase in demand for the labor of disabled people in social production, especially in those areas that will be transferred to “home production”, constituting a specialized segment of the country’s domestic and foreign markets, a special job market, Modern The economic situation in Russia will not allow the already created internal market of jobs for the disabled group to be substituted and will require comprehensive work to create it. Existing centers and departments for rehabilitation work with disabled people should be

the functions of socio-psychological, career guidance, and educational work with disabled people have been transferred, aimed at the speedy introduction of disabled people into socially useful work in the relevant sectors of the “domestic industry”.

The stated point of view on the further development of the system of social rehabilitation for people with disabilities requires specification and clarification in its content, taking into account the real processes of reforming the national economy in each individual region of the country, bringing its conclusions to the discussion procedures in the Duma offices, at meetings of federal and regional government organizations, trade unions and public organizations in Russia. According to existing statistical data in the city of Novosibirsk and the Novosibirsk region as of January 1998, the following were registered: 50,574 disabled people in all districts of the city, 38,401 disabled people living in the regions of the region, 11,320 disabled people identified in the largest industrial centers of the Novosibirsk region. This fact clearly indicates the real workforce that people with disabilities represent, especially those who can be classified as adults.

For such people, working conditions are most suitable not in production, but at home, which, accordingly, makes it urgent to quickly resolve the issue of creating the previously mentioned home production (“home industry”) in the Novosibirsk region. The specifics of the organization of the latter will be largely determined by the real capabilities of its potential participants. In terms of their range, the goods produced by these people can be presented in the form of the following list. Products of group production of disabled people from childhood can be: various toys and souvenirs (especially traditional crafts of Russians), vegetables, fruits, berries, mushrooms, flowers and industrial plants grown by them, printed materials, books, various teaching materials, manuals for improving the quality of education in correctional classes of general education and specialized schools, raised domestic and industrial animals, birds, fish, baked bakery products, containers for packaging food and non-food products, feed, biologically active food additives, medicines, etc.

Production of gaming equipment, sports equipment, pottery, dishes, simple household tools, carved wooden products, alcoholic beverages, soft drinks in the form of small batches, according to folk recipes, printing sets for the publication of mass-market book products, book binding, product creation work computers, if the latter have a special keyboard, the manufacture of the special keyboard itself and other products could become basic directions in the development of the “home industry” with the participation of visually impaired people.

Thus, regardless of the severity, nature (type) of disability, each of the identified groups of people can find a place in a new type of monopoly, disabled, industrial production.

Considering the fact that the main groups of diseases that lead to disability in the population of the Novosibirsk region, most often, are diseases of the circulatory system, malignant diseases and injuries, the progression of which continues, albeit slowly, after a person receives disability, threatening possible exacerbations, with the deployment of “home industry" it is necessary to provide for the creation of a mobile medical correctional and preventive service, with the task of minimizing the risk of recurrence of the above diseases and injuries when working with industrial equipment at home, especially since the bulk of the products produced by all groups of disabled people will be created in their apartments, in places of their concentration, often simply unsuitable for the optimal placement of the main industrial units of future production.

The possibility cannot be ruled out that already operating disabled production facilities, part of the empty space of some state enterprises, a number of social and cultural institutions, and, of course, part of the living space in the apartment of a disabled person may be transferred to its jurisdiction.

The process of deploying the “home industry” itself will not require the investment of large amounts of money, but will involve the creation of a special regional or municipal service for its service with its own warehouses, transport, places of sale, sales of finished products, sources of replenishment of consumables and materials, equipment and instruments, places rapid repair of the latter, relying in its activities on specialized funds, banks, insurance companies, life support services of the city of Novosibirsk and the largest industrial cities of the Novosibirsk region. To carry out successful work on organizing and launching a “home industry”, in addition to the development and implementation of appropriate business plans, it is necessary to create professionally oriented programs of educational work with people with disabilities and creative teams capable of implementing them, thereby motivating future workers “ home industry" positive motivation for the upcoming work and helping them quickly get involved in the latter. The Regional Center for Social Rehabilitation for Disabled People and its staff, strengthened by joint work with employees of research and educational institutes, universities, and academies of Novosibirsk, can become a permanent center for such methodological and educational work.

The professional qualifications of this team are already quite high and are capable of starting an immediate course of education and training for mentally intact disabled people in Novosibirsk and the region, with the aim of preparing them for work in “home production”. The main content of such an initial preparatory course will be:

1. Increasing their general educational level;

2. Development of skills and abilities to effectively use your potential of intuitive, associative and hypothetical thinking;

3. Development of communication skills;

4. Discussion of conflict problems and ways to quickly and easily get out of a conflict situation;

5. Development of the talent of a disabled person, his hyperabilities (including proscopy), general level of spirituality, health;

6. Development of all types of memory;

7. Development of the hand (small sensory-kinetic movements);

8. Development of eloquence;

9. Providing assistance in determining the social role function of the individual in future production (teacher, educator, educator, mentor);

10. Development of feeling the state of another person;

11. Development of knowledge and skills of mutual assistance in the event of the emergence of new somatic and mental diseases with the widespread use of means and methods of traditional medicine;

12. Training in methods of adequately assessing one’s own physiological and mental capabilities when engaging in any form of socially useful activity. Each of the above sections of the training program, previously separately, has already proven its educational and pedagogical significance for a person’s future life, and illustrations of its effects have been repeatedly given in the scientific literature. The following people wrote about this directly or indirectly: K. K. Platonov (1986), I. V. Bushmarin (1992), E. Yu. Vetrova (1992), V. V. Nikolaeva (1987), A. A. Kriulina (1989 ), G. E. Leevik (1989), N. V. Rozhdestvenskaya (1996), V..V. Zenkovsky (1995) and many others. Simultaneously with training disabled people in socially useful labor skills and developing “home industry,” it is necessary to begin creating the material and technical base for future disabled industries. Its completion can be carried out by the disabled person taking a preferential loan or credit from the state or a private person, through the inclusion of the latter in the active implementation of any innovative project, on the security of part of his property, a leasing form of use of equipment, instruments, computers or in some other form . Significant assistance in this matter can be provided to a disabled person by specialized public and private institutions, firms, and banks involved in supporting the activities of modern consumer cooperation, the principles of which were described in detail in the classical economic works of V. S. Nemchinov (1969), A. V. Chayanov ( 1925, 1991).

To summarize what has been said, we can say that the main direction of modern work on the social rehabilitation of disabled people is not the further improvement of the already existing service for their social protection, existing social and rehabilitation medical care, although activities in these aspects remain relevant, having a good prospect for their improvement in ensuring the protection of disabled people from the negative impact of natural and social environmental factors, and the development of their social and production activity, the degree of their involvement in socially useful work, reducing the number of disabled people who make the basis of their future activities the motive of preserving life at any cost. The development of “home industry” today is in many ways a key point, using the labor of disabled people, stabilizing the Russian economy, especially in the territories of Russia located beyond the Urals.

Thus, the rational employment of disabled people in the workplace (as written in the collection of methodological recommendations edited by V. N. Strizhakov “Information and methodological support for the rehabilitation process of disabled people” in 1997) in various sectors of the “home industry”, in the conditions of the development of market economy of a legal Russian state, based on the general principles of rehabilitation, with the constant use to support this important direction, as if completing the course of its rehabilitation, of the already existing regulatory framework at the federal and regional levels, is the most important goal of rational reform of the entire existing system of rehabilitation of people with disabilities in Russia , and in its West Siberian region (using the example of Novosibirsk) and their survival.

Conclusion

As a result of the work done, we came to the conclusion that social rehabilitation of people with disabilities has a program of rehabilitation measures that allows an individual not only to adapt to his condition, but in the most optimal situation to develop self-help skills and create a network of social connections.

Having analyzed the scientific literature on the social rehabilitation of people with disabilities, we found that social rehabilitation is aimed at helping people with disabilities not only adapt to their environment, but also have an impact on their immediate environment and on society as a whole, which facilitates their integration into society.

We also found that for our country the problem of providing assistance to persons with disabilities is one of the most important and pressing, since the increase in the number of disabled people acts as a stable trend in our social development, and there is no data yet indicating stabilization of the situation or a change in this trends.

Having carried out this study, we identified the content of the concepts of “disability”, “disabled people”, “rehabilitation”, forms and methods of solving social problems of people with disabilities, legal support for social rehabilitation of people with disabilities. The tasks we set were completed.

Thus, we come to the final conclusion that social rehabilitation of disabled people is the restoration of abilities for social functioning.

References

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Self-care abilities 3rd degree (inability to self-care, need for constant outside help and complete dependence on other persons);

Mobility level 3 (inability to move independently and need constant assistance from others);

Orientation abilities of the 3rd degree (disorientation and need for constant help and (or) supervision of other persons);

Communication abilities 3 degrees (inability to communicate and need for constant help from others);

Ability to control one’s behavior 3rd degree (inability to control one’s behavior, inability to correct it, need for constant help (supervision) of other persons).

Criteria for determining Group II Disability is a health disorder of a person with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of one of the following categories of life activity or a combination thereof and necessitating the need for his social protection:

Ability for self-care 2nd degree (ability for self-care with regular partial assistance from other persons using auxiliary technical means if necessary);

Ability to move 2nd degree (ability to move independently with regular partial assistance of other persons using assistive technical means if necessary);

Orientation ability 2nd degree (ability to orient with regular partial assistance from other persons using, if necessary, auxiliary technical means);

Communication ability 2nd degree (ability to communicate with regular partial assistance of other persons using auxiliary technical means if necessary);

Ability to control your behavior 2nd degree (constant reduction of criticism of your behavior and the environment with the possibility of partial correction only with the regular help of other people);

Learning abilities 3 and 2 degrees (inability to learn or ability to learn only in special (correctional) educational institutions for students, pupils with developmental disabilities or at home under special programs using, if necessary, auxiliary technical means and technologies);

Ability to work 3 and 2 degrees (inability to work or impossibility (contraindication) of work or the ability to perform work in specially created working conditions, with the use of auxiliary technical means and (or) with the help of other persons).

Criteria for determining Group III Disability is a health disorder of a person with a persistent, moderately severe disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a limitation of the ability to work of the first degree or limitation of the following categories of life activity in their various combinations and causing the need for his social protection:

Self-service abilities of the 1st degree (the ability to perform self-service with a longer investment of time, fragmentation of its implementation, reduction in volume, using auxiliary technical means, if necessary);

Ability to move I degree (the ability to move independently with a longer investment of time, fragmentation of execution and reduction of distance using, if necessary, auxiliary technical means);

Orientation abilities of the 1st degree (the ability to orient only in a familiar situation independently and (or) with the help of auxiliary technical means);

Communication abilities of the 1st degree (ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use of auxiliary technical aids if necessary);

Ability to control one’s behavior I degree (periodically occurring limitation of the ability to control one’s behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction);

Learning abilities of the 1st degree (the ability to learn, as well as to obtain a certain level of education within the framework of state educational standards in general educational institutions using special teaching methods, a special training regime, using, if necessary, auxiliary technical means and technologies).

Category "disabled child" is determined in the presence of disabilities of any category and any of the three degrees of severity (which are assessed in accordance with the age norm), causing the need for social protection.

6. 36Organization of obstetric and gynecological care in Kazakhstan. Measures to combat abortion.

Obstetric and gynecological care is provided in the following APOs:

1) organizations of primary health care (hereinafter - PHC):

polyclinic (city, district, rural);

medical outpatient clinic, paramedic and obstetric station, medical center;

2) healthcare organizations providing consultative and diagnostic assistance (hereinafter - KDP):

Consultative and diagnostic centers/polyclinics.

In primary health care organizations, pre-hospital and qualified medical care without round-the-clock medical supervision for the protection of women’s reproductive health is provided by general practitioners, local therapists/pediatricians, paramedics, obstetricians and nurses.

In KDP health care organizations, specialized medical care without round-the-clock medical supervision for the protection of women’s reproductive health is provided by obstetrician-gynecologists and other specialists.

The operating hours of state and non-state APOs providing a guaranteed volume of free medical care are established in accordance with current legislation.

Obstetric and gynecological departments (offices) as part of health care organizations PHC and KDP organize obstetric and gynecological care for women outside and during pregnancy, in the postpartum period, provide family planning and reproductive health services, as well as prevention, diagnosis and treatment of gynecological diseases of the reproductive systems by:

1) dispensary observation of pregnant women in order to prevent and early identify complications of pregnancy, childbirth and the postpartum period, distinguishing women “by risk factors”;

2) identifying pregnant women who need timely hospitalization in day hospitals, pregnancy pathology departments of maternity hospitals, specialized medical institutions with extragenital pathology, in compliance with the principles of regionalization of perinatal care;

3) referral of pregnant women, women in labor, and postpartum women to receive specialized and highly specialized medical care to medical organizations at the republican level;

4) conducting prenatal education for pregnant women in preparation for childbirth, including partner childbirth, providing the opportunity for pregnant women to visit a maternity facility where childbirth is planned, informing pregnant women about warning signs, about effective perinatal technologies, the principles of safe motherhood, breastfeeding and perinatal care;

5) providing patronage to pregnant and postpartum women;

6) consultation and provision of services on issues of family planning and reproductive health;

7) examination of women of fertile age with the appointment, if necessary, of an in-depth examination using additional methods and the involvement of specialized specialists for the timely detection of extragenital, gynecological pathology and their registration at the dispensary;

8) depending on the level of reproductive and somatic health, women are included in dynamic observation groups for timely preparation for a planned pregnancy in order to improve pregnancy outcomes for the mother and child;

9) organizing and conducting preventive examinations of the female population for the purpose of early detection of extragenital diseases;

10) examination and treatment of gynecological patients using modern medical technologies, including in inpatient settings;

11) identification and examination of gynecological patients to prepare for hospitalization in specialized medical organizations;

12) medical examination of gynecological patients, including rehabilitation and sanatorium-resort treatment;

13) performing minor gynecological operations using modern medical technologies;

14) ensuring continuity of interaction in the examination and treatment of pregnant women, postpartum women, and gynecological patients;

15) conducting an examination of temporary disability for pregnancy, childbirth and gynecological diseases, determining the need and timing of temporary or permanent transfer of an employee for health reasons to another job, referring women with signs of permanent disability for medical and social examination in the prescribed manner;

16) provision of medical, social, legal and psychological assistance;

17) advanced training of doctors and paramedical personnel in accordance with the current legislation of the Republic of Kazakhstan;

18) introduction into practice of modern safe diagnostic and treatment technologies, measures of prevention and rehabilitation of patients, taking into account the principles of evidence-based medicine;

19) implementation of sanitary and anti-epidemic (preventive) measures to ensure the safety of staff and patients and prevent the spread of infection;

20) carrying out activities in the field of informing and improving the sanitary culture of the population on various aspects of a healthy lifestyle, preserving the reproductive health of women, preparing for motherhood, breastfeeding, family planning, preventing abortion and sexually transmitted infections, including HIV infection and other socially significant diseases;

21) analysis of performance indicators of obstetric and gynecological departments (offices), statistical accounting, assessment of the effectiveness and quality of medical care, development of proposals for improving obstetric and gynecological care;

22) conducting educational work with the population, doctors and midwives in the following forms: individual and group conversations, lectures, stained glass windows, publications in print and electronic media (television, radio and the Internet). Educational work is carried out jointly with centers for the formation of a healthy lifestyle. Accounting for the work done is kept in the register of information and educational work of the medical organization according to form 038-1/u, approved by the order of the acting. Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation of healthcare organizations”, registered in the Register of State Registration of Normative Legal Acts under No. 6697.

First place should be given to health education work among the population (male and female) using its various forms (lectures, conversations, films, radio, television, print, exhibitions, posters, brochures, leaflets, memos, question and answer evenings and etc.).

O.K. Nikonchik points out that over the course of a number of years, the percentage of primigravidas and nulliparous women among the total number of women resorting to abortion remains the same (about 10%). In her opinion, this fact indicates the insufficient effectiveness of the sanitary and educational work of antenatal clinics.

Providing the population with effective contraceptives is of great importance in reducing the number of abortions. In fact, they exist, but either they are not used in sufficient quantities, or they are used ineptly. This is indicated by the above data from O. E. Cherpetsky, according to which 52% of women going for an abortion did not use them, and 40% used them ineptly or resorted to ineffective, even harmful to health, methods (coitus interruptus). According to materials from O.K. Nikonchik, 30-35% of women who have regular sex life do not protect themselves from pregnancy. In this regard, it is useful to organize special receptions on this issue in antenatal clinics and sell contraceptives.

A big role should be played by well-organized social and legal assistance in antenatal clinics, especially in combination with home patronage for pregnant women, which makes it possible to understand the conditions of their life and family relationships. Improving the living conditions of pregnant women is also one of the tasks of antenatal clinics.

Particular attention should be paid to first-time pregnant women and women who often resort to abortion, as well as to persons who have resorted to criminal interventions for the purpose of abortion.

Practice has shown that the best results in reducing the number of abortions were achieved where the public was involved in this work and where the fight against abortion was supported by the implementation of planned plans for the construction of children's institutions, maternity hospitals, gynecological departments, etc.

Komsomol and trade union organizations of institutions, industrial enterprises, and educational institutions should be involved in the fight against abortion. Energetic work is needed to identify and bring to justice those who engage in criminal abortions.

O. K. Nikonchik provides interesting data regarding new proposals put into practice in some areas of the country and aimed at reducing the number of abortions. These include the organization of people's universities for newlyweds (Syzran), dispensary observation of women who often resort to abortions (Kuibyshev region), the establishment of consultations on marriage hygiene at the registry office (Voronezh region), a lecture hall for men (Sevastopol), the organization of a health university for women (Tula region).

Of great importance in the fight against abortion will be a further increase in the well-being of the population, the implementation of government measures to encourage motherhood, the further growth of housing construction, child care institutions and an increase in the cultural level of Soviet people.

1. 37Main types of institutions for the protection of motherhood and childhood. Their functions.

aWomen's clinics are dispensary-type medical and preventive institutions that provide all types of preventive and therapeutic care for pregnant and gynecological patients, as well as implementing the necessary measures to protect and promote women's health. They can exist as independent institutions, or as part of maternity hospitals, clinics, medical and sanitary units of industrial enterprises or other medical institutions.

Consultations provide medical obstetric and gynecological care to women of the assigned territory, are involved in the introduction into practice of modern methods of diagnosis and treatment, advanced forms and methods of outpatient obstetric and gynecological care, carry out sanitary and educational work among the population, and provide assistance to women in matters of legal protection in accordance with the law. on the protection of motherhood and childhood, carry out preventive measures aimed at preventing complications of pregnancy, childbirth, the postpartum period, and gynecological diseases; ensure continuity and connection in the examination and treatment of pregnant and sick women with other medical and preventive institutions (maternity hospitals, emergency medical care stations, children's clinics).

Each independent antenatal clinic includes: obstetrics and gynecology offices, medical specialists (therapist, dentist), treatment rooms, for psychoprophylactic preparation of pregnant women for childbirth, for mothers’ school classes, pregnancy prevention, a social and legal worker, an operating room with a rest room for patients, etc. If the consultation is part of another medical institution, then some of its rooms are used to serve women.

The work of the antenatal clinic is based on a territorial-precinct principle, according to which the entire territory served by the consultation is divided into medical areas. The site is served by an obstetrician-gynecologist and a midwife. Consultations are held daily at a time convenient for the population (optimal hours from 8 to 20). Typically, each local doctor conducts alternating morning and evening appointments, which gives a woman the opportunity to see “her” doctor at a time convenient for her. Pre-registration for appointments on all days of the week and calling a doctor to your home can be made by telephone or directly through the consultation reception.

The patronage work of antenatal clinics consists of visiting pregnant women (mainly by a midwife or doctor), postpartum women and gynecological patients in order to familiarize themselves with their living conditions, monitor the patients’ compliance with doctor’s prescriptions and adherence to the recommended regimen, and establish the health status of women who did not show up for appointments. doctor or not hospitalized in a hospital, teaching women the rules of personal hygiene, etc.

You can always get advice from the legal adviser of the antenatal clinic on issues of maternal and child health, labor, recreation, etc.

Medical and sanitary units (MSU) serve workers directly at industrial enterprises and belong to outpatient medical institutions. They include clinics, hospitals, workshop health centers, as well as dispensaries, nurseries, and diet canteens. Many medical units have an antenatal clinic and an obstetric and gynecological department in a hospital and thus provide the entire volume of obstetric and gynecological care to female workers. In addition to serving the workers of their enterprise, many medical units also provide assistance to the population living in the area of their location.

Women's clinics within the medical unit are created and operate on a workshop basis. The responsibilities of obstetricians and gynecologists working in medical units include: studying the working conditions of women; selection of pregnant women subject to health improvement in sanatoriums; recommendations for dietary nutrition for pregnant women in the enterprise canteen; conducting an examination of temporary disability; development of therapeutic and recreational measures to prevent and reduce temporary disability of women; employment of female workers who have undergone gynecological diseases or operations, or who are often and long-term ill; participation in medical examinations of female employees (mandatory preliminary upon entry to work and periodic); organizing a sanitary asset on your site; participation in the development and implementation of activities carried out by the administration of an industrial enterprise and public organizations on labor protection and women's health. To prevent gynecological morbidity, each industrial enterprise creates personal hygiene rooms with separate cabins with rising showers (bidets), shower units and a room for short-term rest for female workers after hygiene procedures. Personal hygiene rooms are located, as a rule, near the place of work of women, and in large enterprises - in each workshop. Where it is impossible to equip stationary personal hygiene rooms, mobile cabins with shower units and tanks for warm water are organized.

Consultations “Marriage and Family” are a relatively new form of medical service to the population and are designed to provide them with specialized treatment, preventive and advisory assistance on the medical aspects of family and marital relations. They are organized in the capitals of union republics, republican, regional (territorial) centers, and other cities with a population of over 500 thousand people and are divisions of antenatal clinics. They provide medical assistance to the population on infertility (male and female), conduct in-depth outpatient examination and treatment of women and men suffering from reproductive disorders, provide consultations on medical aspects of family planning (individual selection of modern contraceptives to prevent unwanted pregnancy for newlyweds, families with increased risk of having a sick child), on psychological issues of intra-family communication, on sexual disorders (outpatient examination and treatment of married couples suffering from sexual disorders), medical and genetic examination of families with hereditary pathology is carried out, sanitary and educational work is carried out on issues of marital hygiene.

Medical genetic consultations. In the Soviet healthcare system, there are 2 types of medical genetic institutions: regional medical genetic offices and republican (interregional) medical genetic consultations.

Medical genetics rooms are usually deployed in regional hospitals. The tasks of regional offices, in addition to medical genetic counseling itself (assessing the risk of having a child with a particular pathology), include promoting medical genetic knowledge among doctors and the population, as well as assisting doctors and families in diagnosing a number of hereditary diseases. They also conduct some genetic studies (determining the set of chromosomes, simple biochemical tests, etc.). If necessary, families are referred to republican (interregional) medical genetic consultations.

The objectives of republican medical-genetic consultations are an in-depth examination of patients with hereditary pathology (or suspected of it) and determination of genetic risk in the most complex cases, prenatal diagnosis of hereditary pathology, organization and conduct of mass examinations of all newborns for phenylketonuria and hypothyroidism.

Medical genetic counseling. A relatively new type of medical care for spouses (or one of them), aimed at preventing the birth of a child with hereditary diseases or congenital malformations.

There are 2 types of medical genetic counseling: prospective, which is carried out before the birth of a child, and retrospective, carried out after the birth of a sick child and associated with assessing the risk of recurrence of the disease.

In what cases is it advisable to seek medical genetic consultation for prospective counseling? Firstly, this is necessary if one of the spouses or their close relatives has hereditary diseases or congenital defects. In these cases, it is more advisable to seek consultation before pregnancy, so that, taking into account the geneticist’s conclusion, you can plan a pregnancy or refuse it.

Secondly, prospective counseling includes counseling for pregnant women. Sometimes a woman, in the period immediately preceding pregnancy, or at the beginning of it, without even knowing it, takes medications, undergoes X-ray or radioisotope examination, or suffers from certain diseases. In such cases, it is also advisable to seek medical genetic consultation to find out whether such effects will affect the condition of the fetus.

The third reason for treatment can and should be repeated spontaneous abortions (miscarriages) in the early stages of pregnancy, as well as infertility of spouses. It is known that in more than 50% of cases, miscarriages in the first 3 months of pregnancy are associated precisely with chromosomal pathology, which can be detected in a latent form in one or both spouses. Therefore, in married couples where the wife has had 2 or more early spontaneous miscarriages, chromosome testing should be one of the elements of their medical examination.

The issue regarding genetic testing for infertility is more complex. Those genetic diseases that can lead to infertility in women are usually manifested by delayed puberty and absence of menstruation (amenorrhea), and in such cases, medical genetic counseling and examination are absolutely necessary. If sexual development proceeds normally and there are no menstrual irregularities, we can firmly assume that the cause of infertility is not related to chromosome disorders and consultation with an infertility specialist, and not a geneticist, is necessary.

In men, a manifestation of genetic disorders leading to infertility is aspermia (lack of sperm in the ejaculate). Therefore, if a similar anomaly is detected in a spouse, genetic testing is very advisable. In cases of infertility (male or female), genetic research should be preceded by consultation with appropriate specialists - a gynecologist or sex therapist.

The second type of medical genetic counseling is retrospective, carried out when the family already has (or had) a sick child and the spouses are concerned about the likelihood of the next child being born healthy. This type of counseling is more common. The fact is that in most families, young, healthy spouses, whose relatives did not have similar diseases, usually have no obvious reasons to turn to a geneticist and the birth of a sick child is unexpected for them.

Indications for retrospective consultation are: the birth of a child (fetus) with any congenital malformations; delay in his psychomotor or physical development and the presence of seizures; intolerance to certain foods in a child, repeated vomiting, chronic diarrhea; progressive jaundice of newborns, enlarged liver or spleen; chronic bronchopulmonary diseases, death of a newborn child from intestinal obstruction; decreased hearing or vision in a child; change in the color and odor of urine; impaired pigmentation of the skin and mucous membranes; paresis and paralysis of unknown origin. Consultation in these cases may be undertaken at the initiative of the family. There are many other indications for contacting a geneticist - for example, the presence of an unclear pathology of the blood system, intolerance to some medications, etc., but the recommendation to consult a geneticist in these cases is usually given by the attending physician.

In any case, counseling begins with establishing an accurate diagnosis for a sick child or a sick parent or relative - depending on what was the reason for the appeal. To do this, sometimes it is necessary to resort to special genetic examination methods - chromosome analysis, biochemical studies, studying the nature of skin patterns on the palms and fingers, etc., and in some cases, additional methods of clinical examination - X-ray, neurological, study of electrocardio- and electroencephalogram. This is due to the difficulty of identifying hereditary diseases, the number of which is very large (more than 3,500 diseases caused by single genes alone are known). In addition, many hereditary diseases are similar not only to each other, but also to diseases of a non-hereditary nature.

In each case, when a family first applies to a medical genetic consultation, detailed information about the development of the disease, living conditions, past diseases, etc. is collected, a pedigree of at least 4 generations is compiled, and, if necessary, the tasks of additional research are determined. The consultation usually ends with the issuance of a medical genetic report.

It should be borne in mind that some hereditary diseases are clinically manifested already at the birth of a child, while others appear only after a few months or even years. At the same time, the development of the disease can sometimes be prevented by timely treatment. That is why all newborns are necessarily examined to identify certain hereditary diseases, the list of which depends on the characteristics of the region.

The decision-making process during retrospective consultation on the advisability of having a next child is influenced by both the magnitude of the risk (a risk above 10% is considered high in genetics) and the nature of the disease. For example, even a 50% risk of having a child with six fingers cannot be a reason to refuse to plan a pregnancy, since this defect can be easily eliminated surgically. At the same time, even with a 5-6 percent risk of having a child with severe mental retardation or blindness, most spouses prefer to abstain from further childbearing. Of course, the nature of the recommendation is also influenced by the presence of healthy children in the family, the age of the spouses, their socio-cultural level and other factors.

It is useful to know that if previously a geneticist ended the consultation by identifying the genetic risk and explaining it to the family in an accessible form, giving the spouses the right to decide for themselves what to do, now, due to advances in medicine, it has become possible to directly study the intrauterine fetus. Such studies are united by the concept of prenatal (prenatal) diagnostics, the methods of which depend on the type of pathology, gestational age and a number of other factors. What does prenatal diagnosis of developmental defects and hereditary diseases provide?

Chapter 1.: General provisions of social protection of the Russian Federation

In Russian legislation, the definition of disability is based on the model of disability recognized by the state.

In Soviet times, the concepts of “disabled person” and “disability” were defined based on the economic model. So, according to Art. 18 of the USSR Law “On State Pensions” of 1956, disability is a permanent or long-term loss of ability to work.

In the 90s, the definition of disability in legislation changed due to the influence of the medical and social model of disability. The definition of the concept of “disabled person” was enshrined in the USSR Law “On the basic principles of social protection of disabled people in the USSR” (Article 2): “a disabled person is a person who, due to limited life activity due to physical or mental disabilities, needs social assistance and protection” .

The development of the medical and social model in Russia was influenced by the review information published in 1993 by M.V. Korobov “International classification of impairments, disabilities and social disabilities and the possibility of its use in practical medical and social examination”, in which the author proposed using this classification to clarify the criteria for disability, determine the needs of disabled people in rehabilitation measures and evaluate the effectiveness of its results.

Finally, the medical and social approach in defining the concept

“disabled” was enshrined in the Federal Law “On Social Protection of Disabled Persons in the Russian Federation”. In accordance with Art. 1 of this Law, 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 limitation of life activity and necessitating his social protection. According to the same article, disability is a complete or partial loss of a person’s ability or ability to provide self-care, move independently, navigate, communicate, control one’s behavior, study and engage in work.

In 1997, the Decree of the Ministry of Labor and Social Development of the Russian Federation and the Order of the Ministry of Health of the Russian Federation approved the Classifications and temporary criteria used when conducting

medical and social examination, which became the basic document serving the Decree of the Government of the Russian Federation of August 13, 1996 No. 965 “On the procedure for recognizing citizens as disabled.”161 The basis for these Classifications was the International Nomenclature of Violations, Limitations and Social Disabilities translated into Russian in 1994 insufficiency.162 Currently, there are Classifications and criteria used in the implementation of medical and social examination, which were approved in 2009163 (Classifications and criteria). They are based on the same principles and approaches as the previous Classifications. Thus, Russian legislation is based on a scientifically developed and accepted by the international community medical and social model of disability.

After the adoption of the Federal Law “On Social Protection of Disabled Persons in the Russian Federation,” a new definition of the concept of “disability” was introduced, contained in the Classifications and temporary criteria adopted in 1997, used in the implementation of medical and social examination. According to clause 1.1.2. According to these Classifications, disability is a social insufficiency due to a health disorder with a persistent disorder of body functions, leading to limitation of life activity and the need for social protection.

No. 630, these Classifications were canceled; there is currently no legal definition of the concept of “disability” in Russian legislation.

The definition of the concept of disability in modern legislation can only be identified through a consistent analysis of legal norms. From paragraph 4 of Art. 3 of the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” dated December 10, 1995 No. 195-FZ, it follows that disability is a difficult life situation that objectively disrupts the life of a citizen, which he cannot overcome on his own. However, such a definition does not reflect the essence of disability.

The concept of “disabled person” currently enshrined in legislation was consistent with the international documents that existed at the time of its introduction, since the general methodological basis for defining this concept is both in the Federal Law “On Social Protection of Disabled Persons in the Russian Federation” and in the World Program of Action for Persons with Disabilities and in the Standard Rules for Equal Opportunities for Persons with Disabilities was the ICF, adopted in 1980. However, after the adoption of the ICF in 2001 and the Convention on the Rights of Persons with Disabilities in 2006, the definition of the concept of “disabled person” contained in Russian legislation became outdated and no longer corresponds to modern international acts, since it does not indicate such an element of disability as the inability of the external environment to accommodate the disabled person. In this regard, the development of a new definition is currently very relevant.

Considering the issue of introducing a new concept into legislation

“disabled person”, it is necessary first of all to dwell on the terminology used. In Russia, the Latin word “invalid” is used to designate persons with significant health impairments, which means “unfit”. This word appeared in Russian in the 18th century. in relation to military personnel for whom the consequences of injuries did not allow them to support and serve themselves. In the 19th century disabled people began to include all persons who have lost the ability to support and serve themselves due to poor health.

In modern scientific and socio-political literature, there has been a tendency not to use the term “disabled” to designate people with health problems, explaining this on ethical grounds. There is an opinion that this word insults dignity, discriminates against rights, instills the idea of one’s own inferiority and thereby interferes with the normal formation of personality. The term “disabled person” is intensively replaced by the terms “person with disabilities” (sometimes “... health” is added), “person with disabilities”, “person with visual impairments (or other impairments)”, etc. For example, the First International Festival of Young Disabled People, held in Moscow in 1992, proposed the term

“disabled person” should be replaced with the concept “impaired condition”, since there are no people called disabled people, but there are persons with different physical, mental, etc. states.

Disputes about replacing the word “disabled” with other terms are not new. In the 30s, the Soviet medical community discussed the question of whether this term should be used, and such names as “limitedly able to work”, “persistently disabled”, etc. were proposed.

Since this trend may be reflected in legislation, it is necessary to dwell in more detail on the use of relevant terms.

The term “person with disabilities” is the Russian translation from English of the North American term “people with disabilities”. This term does not reflect the specifics of a citizen’s condition, because it does not determine in what area of life a given person’s capabilities are limited (in health, commercial activity, creativity, prestigious recreation opportunities, etc.).

The terms “person with disabilities”, “person with disabilities”, “person with visual impairments (hearing, etc.)” reflect the specifics of a citizen’s condition, but the Latin term

“disabled” allows the formation of a generalizing noun – disability, which is impossible when using the above terms.

The term “disabled person” most clearly conveys the essence of the phenomenon compared to other terms in the Russian language. Therefore, its replacement is especially unacceptable in legislation, since legal technique requires clarity and uniformity of the terminology used.

Yu.V.’s proposal seems unfounded. Ivanchina to exclude the term “disabled person” from the Labor Code of the Russian Federation and replace it with the terms “ability to work” and “incapacity for work.” Firstly, such an innovation will contradict the rule on the use in labor law of concepts of other branches of law in the same meaning that is given to them “ parent" industries.

Secondly, the concept of “disabled” is broader than the concept of “disabled”, since it covers both temporarily disabled persons and persons with permanent disabilities. Directly for disabled people (who can conditionally be classified as persons with permanent disabilities), the Labor Code of the Russian Federation171 (Labor Code of the Russian Federation) provides for a number of benefits (Articles 92, 94, 96, 99, 113, 128, 179, 224). Using the general concept of “disabled” will not allow us to distinguish this category and additional definitions will have to be introduced (temporarily disabled, permanently disabled, etc.).

Thirdly, as noted above, it is incorrect to equate disability with incapacity for work. Not every disabled person can be recognized as having limited ability to work. In the Classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination, three degrees of limitation of the ability to work are established (clause “g”, clause 6):

I degree - the ability to perform labor activities in normal working conditions with a decrease in qualifications, severity, intensity and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions;

II degree – ability to perform labor activities in specially created conditions using auxiliary technical means;

III degree – the ability to perform labor activity with significant assistance from other persons or the impossibility (contraindication) of its implementation due to existing limitations in life activity.

As an example, consider the case of determining the degree of working ability of a disabled person with the absence of lower limbs, who has the profession of “programmer”. This disabled person can work full-time at home or in the office and does not require specially created working conditions. Therefore, he cannot be recognized as having limited ability to work, based on the specified Classifications and criteria, although he is undoubtedly disabled.

Thus, labor legislation must contain special legal norms that ensure that disabled people exercise their right to work (rules limiting the involvement of disabled people in night work and overtime work, the preferential right to remain at work when the number or staff of employees is reduced, etc. ). Based on the analysis carried out, it is not possible to differentiate the legal regulation of the work of disabled people without using the term “disabled person”.

The concepts “disabled person” and “disability” cannot be regarded as equivalent due to the fact that “one of them characterizes a subject, a person, and the second – a special state of health or even a social category.” Thus, both concepts must be defined in legislation.

In order to bring Russian legislation into line with the Convention on the Rights of Persons with Disabilities, amendments to the Law on Social Protection of Persons with Disabilities were prepared in March 2014, according to which the definition of the concept of “disabled person” is expected to be stated in a new edition: “a disabled person is a person who has impairment of health with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, violations of the anatomical structure of the body, its organs and systems, leading to limitation of life activity and causing the need for its social

protection." However, the proposed changes, in our opinion, do not solve

the problem of compliance of the subject with international documents. The new legal concept of “disabled person” must meet the following requirements:

1. The definition must use the terms contained in the ICF.

2. The definition must indicate that a person’s health impairment entails both a limitation of his capabilities and social restrictions that this person faces. It is advisable to define disability using the phrase “limitation of life activity”, and social limitations – using the phrase “reduced adaptability to the social environment”, the use of which indicates the need to adapt the environment to the disabled person.

3. Since, from the point of view of law, a person becomes disabled after being recognized as such by competent specialists, this should also be recorded in the definition. The need to reflect this circumstance in the definition, in particular, is indicated by S.Yu. Golovina 174i V.S. Tkachenko.

Taking into account the above, we can give the following definition: a disabled person is a person who has a change in health, established by the conclusion of a medical and social examination, due to a persistent violation of the functions and systems of the body, leading to a limitation of life activity, expressed in the complete or partial loss of the ability to independently carry out household, social and professional activities , as well as a decrease in adaptability to the social environment and causing the need for its social protection.

The concept of “disabled person” defines a person with certain properties. The concept of “disability” should reflect the properties of a person defined as disabled. Consequently, based on the formulated definition of “disabled person” to be enshrined in legal acts

we can propose the following definition of “disability”: disability is a change in a person’s health due to a persistent violation of the functions and systems of the body, leading to limitation of life activity, expressed in the complete or partial loss of the ability to independently carry out household, social and professional activities, as well as a decrease in adaptability to social environment and causing the need for its social protection.