According to state data, a total of 10,688 people received social rehabilitation services in 2022, of which 61% were children.
Social rehabilitation services are offered, for example, by social workers, psychologists, physiotherapists, speech therapists, special educators and occupational, music and creative therapists. The State spent just over 16 million euros on the service in 2022.
According to the Ministry, there are currently several problems with the provision of social rehabilitation.
One problem is that the same professionals provide services through different systems, sometimes in duplicate.
For example, a child can receive the services of a speech therapist or psychologist either from the school, from the family doctor or through the social rehabilitation service. There is also vocational rehabilitation. Therefore, from a person’s point of view, the path to help is not clear, but depends on which “door” you walk through first.
Kristi Kähär, support and services advisor at the Chamber of Disabled People, also said that the current system is illogical and burdensome for people.
“Take for example a disabled child who should receive the services of a speech therapist at school, but cannot. Then the parent instead turns to the family doctor, who has a therapy fund through which people can be referred to a speech therapist AND the third option is also social rehabilitation, which is a complex service, where a person must need multiple services, and there are also many situations where a person is assigned a social rehabilitation service, even though he may need only a speech therapist service, not a speech therapist, special educator and psychologist at the same time,” Kähär said.
The unclear and sometimes duplicative rehabilitation system has also brought with it complications in exchanging the necessary data.
Marilin Vaksman, chairwoman of the board of the Union of Rehabilitation Institutions, said that since social rehabilitation institutions are not currently providers of health services under the law, they cannot, for example, access the health portal (the former story digital) and do not have a clear vision of what services the person who turns to them has received elsewhere.
“There is no unified system and even today family doctors may not know that a person is going to a rehabilitation institution. If he does not say it himself, it will not come out anywhere,” he said.
In the development plan, the Ministry highlights as a problem that the person and their loved ones have to move existing data about themselves on paper or as digital files from one institution to another, and people do not have the possibility to see in a digital environment, the reach and services they can receive.
In the future, a doctor may refer you to an occupational therapist or speech pathologist
The Ministry proposes that, to provide people with clear and logical help, services should instead be organized through the health system.
The proposal is to use the current budget of rehabilitation services to increase the volume of health services, such as current health services such as physiotherapy, speech therapy and psychological treatment.
According to the state, a healthcare provider, such as a family doctor or specialist, should assess what kind of help a person needs and then refer them to the right specialist. This means that in addition to making a diagnosis, the healthcare professional also describes the type of help the person needs.
“Already in October, speech therapists, clinical psychologists and physiotherapists were added to the list of healthcare professionals. Today, medical specialists can also refer people to these specialists. This does not necessarily have to go through the family doctor,” said Brit Tammiste , responsible for policies for children with special needs at the Ministry of Social Affairs.
Institutions may provide services that are not helpful to the individual
The social rehabilitation service is currently a complex service. This means that the social rehabilitation team has at least three specialists who provide services to people.
Tammiste explained that today it is the rehabilitation institutions themselves that evaluate which services and to what extent people need them.
Currently, the type of service offered to a certain target group, such as children or people with mental disorders, is not standardized, according to Tammiste. Currently, rehabilitation facilities can also offer people services they don’t necessarily need as part of the package.
“Currently it is not described that if there is, for example, a person with certain health needs, what should be done with him, according to the evidence, in the rehabilitation service. Perhaps if a person turns to one or another service provider, the content of the services currently offered varies and may not even directly address a person’s needs,” Tammiste said.
According to Tammiste, there is currently a lot of haphazardness in the provision of social rehabilitation services and the effectiveness of these services is not currently evaluated.
“We would like to see the performance of services evaluated in the future,” Tammiste said.
In the future, you will no longer need to have a disability to get help
While currently a person can receive complex services consisting of multiple specialists with state funding, even if in reality they only need one specific specialist, the opposite situation is also possible.
So, for example, it is not possible to receive social rehabilitation services for children and adults who have not been diagnosed with a serious disability, but who still need help.
“Sometimes, following a trauma, an accident or an illness, this need for rehabilitation can even be temporary. In this way the person would get the help they need immediately, as soon as they need it, instead of have to start applying First for disability, because this process takes time. A person can only have half the years of help, after which he can already return to work or his livelihood will improve significantly,” explained Vaksman.
According to the state plan, in the future, the presence of the degree of disability would no longer be a determining factor, and services would be intended for all those who need them.
Family doctors have not completed basic rehabilitation training
Marilin Vaksman, president of the board of directors of the Association of Rehabilitation Institutions, said that the association itself is pleased that the state is reviewing the organization of the rehabilitation service. She said the union currently sees several bottlenecks in rehabilitation, some of which are being addressed by the state.
Vaksman said the social rehabilitation service is currently underfunded, there is too much bureaucracy and data is not circulating between institutions. At the same time, according to him, there are currently no evaluations of the impact of services on people.
According to Vaksman, the system proposed by the state, in which instead of rehabilitation institutions has a more important role than before, a doctor who is supposed to map a person’s need for help, can create a situation in which not everyone who needs help get noticed.
“Today, if a rehabilitation institution wants to be a partner of the Social Insurance Council, there must be at least one specialist who has completed basic rehabilitation training at the Pärnu College of the University of Tartu. Here is an overview of the entire rehabilitation system “Yes offers social assistance and various interventions are discussed, how something helps. I can’t imagine that all family doctors now go through this basic training or that every family doctor center has to have a person who has completed this training,” she said.
Disability Alliance: There is a lot of ambiguity in the proposed system
Kristi Kähär, advisor for support and services at the Chamber of People with Disabilities, said that the Chamber generally supports the idea that the rehabilitation system should have a single organization and source of funding. He said there is currently a lot of ambiguity in the state’s thinking, and the House of Persons with Disabilities currently does not understand how a person will navigate the new system.
“I wouldn’t want to be skeptical that anything is going to disappear. But there’s definitely a danger here that if we move all these services over to health care, where there’s also a lack of money, these services are not going to disappear for people in the system. But I think that this is now the right place to start these discussions,” said Kähär.
Kähär said that rehabilitation services are available for very different target groups – both children with disabilities, people with mental disorders and, for example, people with visual impairments – but it is currently unclear how these target groups could receive services.
Kähär said there was currently no clarity on who would refer people to services under the new system. “It actually doesn’t seem very logical for a family doctor to start organizing this, because it’s actually case management, and for that you need to have a separate operator in the system who shapes that journey for the person,” he said.
“I don’t want to believe that a doctor will put together this package of services for a person, it still has to be a team effort, as is the case now in rehabilitation, that specialists evaluate the person’s needs, not just one specific doctor,” He he said.
Interest groups can submit feedback on the draft bill on amending the Social Security Law and other laws until early March.
2024-01-29 03:01:00
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