Handicap International/ Regional expertise program in the field of social services
for people with disabilities/ South East Europe 2007-2009
MODULE 1B- The process of social service provision for people with disabilities
CHAPTER 1.B.2 – What are social services and how do we approach this domain in relation with the disability field?
OVERVIEW OF THE CHAPTER 1.B.2
The main goal of this chapter is to introduce a broad definition of social services in relation with the disability sector, as well as to describe the main types of social services that have to be accessible for people with disabilities at community level.
The description is based on a human rights perspective of disability and promotes the elements of community-based social services.
The chapter intends also to make you familiar with several concepts that are currently promoted at European level, in relation with the modernization of social services.
- SOCIAL SERVICES FOR PEOPLE WITH DISABILITIES – THE ESSENTIAL COMPONENT OF AN ENABLING SYSTEM
Is there an acknowledged (unique) definition of social services around Europe?
No, there is actually no common definition of social services among the European countries.
Handicap International acknowledges the fact that social services can be approached and defined in two ways:
- a narrow sense, implying referrals to services that address strictly social needs of the people (housing, personal care and personal assistance, social care services for children, elderly and persons with special needs, participation in social/ community life, support services, social security and other types of social protection measures etc)
- a broader sense, referring also to a wider range of services with social function like education, basic health care and access to employment.
In the context of this program, we chose to consider that social servicescover a large and diversified range of services which are intended to improve the living standards of the population, especially of individuals and groups in vulnerable or risk situations. They are linked to national welfare schemes and are important tools for the implementation of public policies in the field of social protection, non-discrimination, the fight against poverty and exclusion. They are not conditioned by the contribution of the users and their aim is to enhance capacities of individuals for their full inclusion and participation in society. They respond to social needs and social deficits, which cannot be managed by the market, or which can be even generated by the market[1].
The States are responsible for ensuring the access of all citizens to social services.
By choosing this perspective, we say implicitly that a large variety of community services are impacting on the life of people with disabilities, and all these services have to be accessible to people who need them: early intervention programs, education, day care and rehabilitation services, vocational training and access to employment, housing, primary health care, leisure services, various support services like personal assistants, assistive technologies, interpreters etc.
We say also that it is the responsibility of the States (either central or local authorities) to guarantee the access of citizens to social services in communities.
We have to pay very much attention to this aspect in our countries. This formulation highlights that the States remain the guarantor of the access to social services, even if the States do not deliver the services themselves. In other words, it means that even when services are provided by private providers (NGOs, for-profit companies, volunteers etc.), the local or central authorities have the ultimate responsibilities related to the access of citizens to these social services. This aspect represents a significant shift in perspective in the social sector.
It is in fact the basis of what we call “welfare mix”[2] and it represents a major stake within the decentralisation of social services in our countries. Very often, States consider that because NGOs deliver social services at local level, they are not responsible anymore for the access of citizens to those particular services. This is of course not true. No matter who delivers the service, the State remains always the ultimate responsible in front of citizens.
Social services as an enabling system
The social services are an important tool for the reduction of poverty and exclusion of people with disabilities. They provide the frame for exercising the fundamental human rights (access to education, health care, housing, vocational training), as well as more specific rehabilitation or therapeutic interventions. The promotion of an enabling system becomes the key aspect for achieving these goals.
An enabling system is “a system of services oriented towards supporting people with disabilities to reach and maintain their optimal level of independence and social participation. This goal is achieved through ensuring them equal access to mainstream services existing at the community level (ordinary medical, social, education, and employment services), with individualised support services according to each one’s needs and expectations, and referral to specialised services when needed”[3].
The final goal of any service addressed to people with disabilities is the active participation of the person in the social life. This is why these services often target activities related to social autonomy, the personal development and the individual well-being; they cannot always have, like other economic or commercial activities, objective and measurable results, in the short term. The monitoring and evaluation, as well as the funding of these services must take into account this aspect.
For all these reasons, social services at community level have to be accessible for all citizens, including people with disabilities. They have to be available and affordablefor these people. They have to be provided at good quality standards. They have to be organized in a way that reflects the choice and interests of people with disabilities. They have to enhance the personal development and facilitate the progress of the person towards full participation in the social and, as much as possible, economic life.
The shift in paradigm in social service delivery
One of the major transformations worldwide, during the last decades, is related with a change of paradigm in the field of disability: from a medical and protective model to a social and inclusive one, focusing on rights, equal opportunities and full participation of people with disabilities in the social and economic life of the community.
This shift in paradigm impacts the sector of social services in South East Europe as well.
The development of a wider spectrum of accessible and qualitative social services for people with disabilities at community level, as close as possible to people’s home, represents currently a major change of perspective for this region. From large residential settings in remote areas to community based services, from the medical and “defectologic” approach of the past regimes to a provision of social services based on the respect of human rights, of choice, needs and interests of people with disabilities, makes these recent evolutions challenging and ambitious.
However, the modernization of social services in the Balkans is taking place in a good ‘momentum’. At European level, the modernization of social services is an ongoing process as well, benefiting from the contribution of numerous stakeholders that are significant for the social services sector: the EU, the Council of Europe, the representative European platforms in the social and disability sectors etc. In the attached bibliography, you can find several documents that have been recently released at European level (positioning documents or even specific ‘communications’), that shows that this preoccupation for the social sector’s modernisation in Europe is very significant.
- THE RIGHT BALANCE BETWEEN THE PROVISION OF MAINSTREAMED AND SPECIALISED SERVICES – THE TWIN TRACK APPROACH
One of the specific aspects of the disability-related services is the need for the right balance between mainstreamed services and specialized ones provided at community level, within the so called twin track approach.
This concept, already acknowledged and used in many other policy areas (gender related policies, children’s rights etc.), was initiated in the disability sector by DFID in the 2000 Paper called “Disability, poverty and development”[4]. In relation with its own strategies, DFID outlined a “twin-track approach” to disability and development focusing on “addressing inequalities between disabled and non-disabled persons in all strategic areas of [its] work” and “supporting specific initiatives to enhance the empowerment of people with disabilities”.
In other words the twin track approachaffirms the necessity of mainstreaming disability effectively in all development and policy making initiatives and, parallel to this, encourages all additional initiatives that address the more specific needs and qualities of disabled people, in order to achieve the people’s participation and inclusion.
Fig.1 The twin track approach in disability and development (DFID, 2000, p.11)
This perspective ensures that all community members, regardless of their position or abilities, have the opportunity to reach their full development potential through adequate measures in the community.
In the social services sector, the twin track approachallows the promotion of a wide network of community based social services, complementary one with another, and ensuring a so called ‘continuity of care’, aiming at social inclusion of people with disabilities.
It is a very useful approach for South East Europe, in order to eliminate the false questioning (and the reductionist choice) of either mainstreaming or specialized measures in the field of social services for people with disabilities.
In an inclusive community, all types of services that lead to participation of people with disabilities, and the full respect of their human rights are equally needed, as we can see in the picture below:
Fig.2 Twin track approach in disability-related services, towards an inclusive community
Between all these services it should exist a functional link and this link should be reflected in both policy measures and regulatory procedures at local level (like the gatekeeping/orientation procedures, for example).
Let’s approach briefly each type of service that is described in the picture above:
The access of people with disabilities to regular(or mainstream) services in the community (education, health care, vocational training and employment, housing, social services and social protection) is a fundamental right, as for any other citizen. People with disabilities should be able to access these services without any constraint or conditioning.
In order to facilitate this process, a specific category of social services is developed in the disability field called support services. Their basic role is to enhancethe self-determination and participation of people with disabilities in society. They are the chain for facilitating the access of people with disabilities to various services and resources of the community, in the context in which the disability situation prevents them to access these resources naturally. The support services are key elements for mainstreaming disability and include, for example:
the provision of ortho-prosthetic and assistive devices,
personal assistant schemes,
personalised budgets,
support teachers for accessing education in regular schools,
support persons and mediators for accessing employment,
sign interpreters for persons with sensorial disabilities,
accessible housing or home adaptations,
in-home support for independent livingetc.
Support services can be considered sometimes a form of specialised services. However, their particularity is that they are not provided in segregating environments, but rather facilitating the active participation of people with disabilities in daily activities. It is maybe significant to say
In the Balkan region, these support services are completely insufficient, both in terms of spectrum and quantity. Their development is a crucial step for the modernisation of the sector.
The specialised services are an extended category of social services, also needed, in order to address sometimes more complex needs of persons with severe/multiple disabilities. They have to be provided in the community as well, based on a person-centred approach, respecting the choice and interests of the users and their families. The specific rehabilitation services, the residential care in small family-like settings, the respite care units, the sheltered workshops for severely disabled, the specialised day care centres for persons with very complex needs and dependency, are only few examples of the services that should be developed at the community level, for responding to these specific needs of people with disabilities.
Several examples of mainstream, support and specialized services for people with disabilities are presented in Attachment 1.
- ADDITIONAL CONCEPTS RELATED WITH THE SOCIAL SERVICES SECTOR
Continuity and comprehensive spectrum of services
The twin track approach is linked, in the disability sector, with the concepts of “large spectrum of services” and of “continuity of care and support”.
The spectrum of services required at community level means that a large variety of measures have to be developed at local level in order to respond to the needs of people with disabilities. Since social services have to respect a clear person-oriented character, the changing and various needs of people with disabilities,all along their lifetime,determine the need for a wide variety and typology of services: from early intervention to educational services, health care and rehabilitation, vocational training and access to employment, day care, housing, support services, leisure and travel-related services etc. Each of these services covers a specific part of life (and needs) of people, enabling them to participate better in communities.
The continuity of care refers to a specific requirement in the disability sector. It means that between all services provided for people with disabilities, strong functional and informational links have to be developed, allowing the person to benefit from appropriate services during all stages of life. This requirement is particularly important at the passage from oneage group to another (e.g. from the primary to the secondary school, from the childhood to adulthood, from the educational stage to employment, from employment to retreat, as well as when the person needs simultaneous education and rehabilitation services etc) when some specific support services might be needed additionally. This particularity of the disability service sector is very important when designing the system of regulatory procedures, at national level. The fact that the organization and funding of services involves usually different types of authorities and regulatory procedures (for children and adults, for education and health care, for day care and residential services etc) impacts significantly the coordination among gatekeepers, service providers and users themselves. The lack of these functional links between them can often create gaps in the provision of care for persons passing from one stage of life to another, or from a specific need for services to another.
The 4 A’s in social service provision for people with disabilities
The following parameters are often used as general principles (and sometimes good governance indicators) for the modern social service provision, in the disability sector. These requirements are acknowledged at European level and are often included in official documents or position papers, in relation with the modernization of social services. They are also known as the “4 A’s” of social service provision and they resume in an accurate way the main characteristics of a qualitative system of services at community level:
- Accessibility of social services - Services can be reached and used by all citizens who need them.
In the context of this report and of social service provision in general, the accessibility has to be considered in a broad and multi-layered sense, and often includes the reference to the services’ availability and affordability (the next two parameters described in this paragraph). In South East Europe, making community services accessible for people with disabilities represents a major stake and challenge. This aspect involves not only a transformation of the built environment (as usually considered in the region), but also a reform of the referral and information systems – the gate keeping mechanisms – , the correct assessment of people needs, the local assessment and mapping of existing and needed services, the reform of the funding and cost calculations per service etc.
- Availability- Services exist and are available when needed.
This parameter plays an important role in South East Europe: the region faces a significant lack of basic services for people with disabilities, both in terms of geographical coverage and typology. Making new services available at community level represents a priority, which involves, of course, new technical and financial resources, as well as additional qualifications and staff.
- Affordability-Social services must have a reasonable price for all citizens who need them.
This refers to all measures required to allow to the marginalised populations the financial access to social services at community level.
- Accountability – Service providers are financially and organisationally transparent.
This parameter refers not only to the transparency of the financial management of the service (clear unit costs per service and per users, an accurate accountability system at the level of the service, a transparent flow of resources and expenditures etc), but also at the overall organisation of the service: clear manuals of policies and procedures, internal regulations, a qualitative and transparent staff management.
In addition to these 4A parameters, the good qualityof the service (analysed against quality principles and related standards), its sustainabilityand the continuous improvementrepresent the main elements for good governance in the social services sector.
In terms of advocacy message, the most common expression summarizing these important requirements is the one that promotes the “development of qualitative and accessible social services at community level” since these two key (overarching) aspects are often used for incorporating all other parameters described above.