Social insufficiency. Employment of disabled people in Russia Legal aspect of solving problems of disabled people

Criteria for assessing disability in ITU institutions

Introduction

The radical political and socio-economic transformations that have occurred in Russia over the past decade have led to fundamental changes social policy states in relation to people with disabilities, contributed to the formation of new approaches to solving the problems of disability and social protection of people with disabilities.
The main provisions of state policy towards people with disabilities are reflected in Federal Law“On the social protection of disabled people in the Russian Federation” (No. 181 of November 24, 1995), which contains new interpretations of the concepts of “disability” and “disabled person”, new positions for the definition of disability.
The implementation of this Law required the development of a modern concept of disability, the creation of a new methodological basis for its definition and assessment, and the transformation of the medical and labor examination service into a medical and social examination.
In 1997, “Classifications and temporary criteria used in the implementation”, developed by CIETIN employees, were published. medical and social examination", approved by the Decree of the Ministry of Labor and social development of the Russian Federation and the Ministry of Health of the Russian Federation No. 1/30 dated January 29, 1997, as well as methodological recommendations for their use for employees of medical and social examination and rehabilitation institutions (Moscow, 1997, CBNTI. Issue 16).
In the period 1997-2000. new approaches to defining disability have been widely introduced into the practice of ITU institutions. Their practical application has shown significant advantages modern positions medical and social examination to improve social protection of disabled people.
At the same time, the fundamental difference between the criteria of medical and social examination and the criteria of medical and labor examination, the stereotype of previous thinking, and some imperfections of new methodological approaches have caused certain difficulties in practical work ITU Bureau.
In 1999-2000 CIETIN staff studied the initial experience of applying the “Classifications and temporary criteria used in the implementation of medical and social examination” in the practice of 72 ITU bureaus of general and specialized profiles of different constituent entities of the Russian Federation and all clinical departments of CIETIN, where the data of expert rehabilitation diagnostics of 654 examined persons
Comments and suggestions made by ITU service specialists and CIETIN staff, as well as representatives public organizations disabled people, doctors of treatment and preventive institutions, scientists of research institutes, etc. were carefully analyzed and, taking them into account, the necessary adjustments and additions were made to the basic concepts, classifications, criteria and methods for assessing disabilities in the implementation of medical and social examination, which are presented in these guidelines.

1. Basic concepts
1.1. 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.
1.2. 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.
1.3.Health is a state of complete physical, mental and social well-being, and not just the absence of illness and physical defects.
1.4.Impaired health - physical, mental and social ill-being associated with loss, anomaly, disorder of the psychological, physiological, anatomical structure and (or) function of the human body.
1.5. Disability is a deviation from the norm of human activity due to a health disorder, which is characterized by a limitation in the ability to carry out self-care, movement, orientation, communication, control over one’s behavior, learning, work and play activities (for children).
1.6. Social disability is the social consequences of a health disorder, leading to limitation of a person’s life activity and the need for his social protection or assistance.
1.7. Social protection is a system of state-guaranteed economic, social and legal measures that provide people with disabilities with conditions for overcoming, replacing, and compensating for limitations in life activities and aimed at creating equal opportunities for them to participate in the life of society as other citizens.
1.8. Social assistance is periodic and (or) regular activities that help eliminate or reduce social disadvantage.
1.9. Social support - one-time or occasional short-term activities in the absence of signs of social insufficiency.
1.10. Rehabilitation of disabled people is a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for limitations in life activity caused by health problems with persistent impairment of body functions. The goal of rehabilitation is to restore the social status of a disabled person, achieve financial independence and social adaptation.
1.11. Rehabilitation potential is a complex of biological, psychophysiological and personal characteristics of a person, as well as social and environmental factors that allow, to one degree or another, to compensate or eliminate his limitations in life.
1.12. Rehabilitation prognosis is the estimated probability of realizing the rehabilitation potential.
1.13. Clinical prognosis is a scientifically based assumption about the further outcome of the disease based on comprehensive analysis clinical and functional characteristics of health disorders, the course of the disease and the effectiveness of treatment.
1.14. Specially created conditions for labor, household and social activities - specific sanitary and hygienic, organizational, technical, technological, legal, economic, microsocial factors that allow a disabled person to carry out labor, household and social activities in accordance with his rehabilitation potential.
1.15. Special jobs for employing disabled people - jobs that require additional measures on labor organization, including adaptation of main and auxiliary equipment, technical and organizational equipment, additional equipment and provision of technical devices, taking into account the individual capabilities of people with disabilities.
1.1.16. Auxiliary means are special additional tools, objects, devices and other means used to compensate or replace impaired or lost body functions and facilitate the adaptation of a disabled person to the environment.
1.17. Full working capacity – working capacity is considered full if the functional state of the body meets the requirements of the profession and allows performing production activities without harm to health.
1.18. Profession is a type of work activity (occupation) of a person who has a complex of special knowledge, skills and abilities acquired through education, training, and work experience. The main profession should be considered work of the highest qualification or performed more long time.
1.19. Specialty is a type of professional activity improved by special training; a certain area of ​​work, knowledge.
1.20. Qualification - level of preparedness, skill, degree of suitability for performing work certain profession, specialty or position, determined by rank, class, rank and other qualification categories.
1.21. Constant outside help and care
– provision by an outsider of constant systematic assistance and care in meeting the physiological and everyday needs of a person.
1.22. Supervision is observation by an outsider, necessary to prevent actions that could cause harm to the disabled person and the people around him.
2. Classification of violations of the basic functions of the human body:
2.1. Disorders of mental functions (perception, memory, thinking, intelligence, higher cortical functions, emotions, will, consciousness, behavior, psychomotor functions).
2.2. Language and speech disorders - disorders of oral and written, verbal and non-verbal speech that are not caused by mental disorders; disorders of voice formation and speech form (stuttering, dysarthria, etc.).
2.3. Impaired sensory functions (vision, hearing, smell, touch, vestibular function, tactile, pain, temperature and other types of sensitivity; pain syndrome).
2.4. Violations of statodynamic functions ( motor functions head, torso, limbs, statics, coordination of movements).
2.5.Visceral and metabolic disorders, nutritional disorders (circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity).
2.6. Disfiguring disorders (structural deformations of the face, head, torso, limbs, severe external deformity; abnormal openings of the digestive, urinary, respiratory tracts; disturbance of body size: gigantism, dwarfism, cachexia, excess weight).
3. Classification of violations of the basic functions of the human body according to severity
A comprehensive assessment of various qualitative and quantitative indicators characterizing persistent impairment of body functions provides for the identification of predominantly four degrees of impairment:
1st degree - minor functional impairment
2nd degree - moderate dysfunction
3rd degree - severe dysfunction
4th degree - significantly pronounced dysfunction.

4. Classification of the main categories of life activity and limitations of life activity according to the degree of severity.
4.1. Self-care ability- ability to independently satisfy basic physiological needs, perform daily household activities and personal hygiene skills.
The ability for self-care is the most important category of human life, presupposing his physical independence in the environment.
Self-care abilities include:
satisfaction of basic physiological needs, management of physiological functions;
maintaining personal hygiene: washing the face and entire body, washing and combing hair, brushing teeth, trimming nails, hygiene after physiological functions;
dressing and undressing outerwear, underwear, hats, gloves, shoes, using fasteners (buttons, hooks, zippers);
eating: the ability to bring food to the mouth, chew, swallow, drink, use cutlery and cutlery;
fulfilling everyday household needs: purchasing food, clothing and household items;
cooking: cleaning, washing, cutting food, cooking it, using kitchen utensils;
use of bed linen and other bedding; making the bed, etc.;
washing, cleaning and repairing linen, clothing and other household items;
use of household appliances and appliances (locks and latches, switches, taps, lever devices, iron, telephone, household electric and gas appliances, matches, etc.);
cleaning the premises (sweeping and washing the floor, windows, wiping dust, etc.).

To realize the ability for self-care, the integrated activity of practically all organs and systems of the body is required, violations of which in various diseases, injuries and defects can lead to a limitation of the ability to self-care.
Parameters when assessing limitations in the ability to self-care may be:
needs assessment aids ah, the possibilities of correcting the ability to self-care with the help of auxiliary aids and adaptation of the home;
assessment of the need for outside help in meeting physiological and everyday needs;
assessment of the time intervals through which such need arises: periodic need (1-2 times a week), long intervals (once a day), short (several times a day), constant need.

Limitation of the ability to self-care according to severity:
I degree - ability for self-care with the use of aids.
The ability for self-care and independent performance of the above actions is maintained with the help of technical means, adaptation of housing and household items to the capabilities of a disabled person.
II degree – the ability to self-care with the use of aids and with partial assistance from other persons.
The ability to self-service with the help of technical means, adapting housing and household items to the capabilities of a disabled person is retained with the mandatory partial assistance of another person, mainly to fulfill everyday needs (cooking, buying food, clothing and household items, washing clothes, using some household appliances, cleaning the premises and etc.).
III degree – inability to self-care and complete dependence on other persons (the need for constant outside care, assistance or supervision). The ability to independently perform most of the vital physiological and household needs, even with the help of technical means and adaptation of housing, is lost, the implementation of which is possible only with constant help other persons.

4.2. Ability to move independently– the ability to independently move in space, overcome obstacles, maintain body balance within the framework of everyday, social, and professional activities.

The ability to move independently includes:
- independent movement in space: walking on level ground at an average pace (4-5 km per hour for a distance corresponding to average physiological capabilities);
- overcoming obstacles: going up and down stairs, walking on an inclined plane (with an inclination angle of no more than 30 degrees),
- maintaining body balance when moving, at rest and when changing body position; the ability to stand, sit, get up, sit down, lie down, maintain the adopted posture and change the position of the body (turns, bending the body forward, to the sides),
- performing complex types of movement and movement: kneeling and rising from the knees, moving on the knees, crawling, increasing the pace of movement (running).
- use of public and personal transport (entry, exit, movement within the vehicle).
The ability to move independently is achieved through the integrated activity of many organs and systems of the body: musculoskeletal, nervous, cardiorespiratory, organs of vision, hearing, vestibular apparatus, mental sphere, etc.
When assessing ambulation ability, the following parameters should be analyzed:
- the distance a person can move;
walking pace (normally 80-100 steps per minute);
walking rhythm coefficient (normally 0.94-1.0);
duration of double step (normally 1-1.3 sec)
movement speed (normally 4-5 km per hour);
need and ability to use auxiliary aids.
Limitation of the ability to move independently according to severity:

I degree – the ability to move independently with the use of aids with a longer investment of time, fragmentation of execution and a reduction in distance.
The ability to move independently is retained when using assistive devices with a decrease in speed when performing movement and movement, with a limitation in the ability to perform complex types of movement and movement while maintaining balance.
In the first degree, the ability to move is characterized by a moderate decrease in speed (up to 2 km per hour), pace (up to 50-60 steps per minute), an increase in the duration of the double step (up to 1.8-2.4 seconds), a decrease in the coefficient rhythm of walking (up to 0.69-0.81), reduction in movement distance (up to 3.0 km), fragmentation of its implementation (breaks every 500-1000 m or 30-60 minutes of walking) and the need to use aids.
II degree – the ability to move independently with the use of aids and partial assistance from other persons.
The ability to move independently and move with the help of assistive devices, adapt housing and household items to the capabilities of a disabled person, and involve another person when performing certain types of movement and movement (complex types of movement, overcoming obstacles, maintaining balance, etc.) is retained.
In the second degree - the ability to move is characterized by a pronounced decrease in speed (less than 1.0 km per hour), walking pace
(less than 20 steps per minute), increasing the duration of a double step (less than 2.7 seconds), decreasing the rhythmicity coefficient of walking (less than 0.53), the fragmentation of its execution, reducing the distance of movement mainly within the apartment if it is necessary to use aids and partial assistance other persons.
III degree – inability to move independently, which is possible only with the help of other persons.

4.3. Learning ability– the ability to perceive and reproduce knowledge (general education, professional, etc.) and master skills and abilities (professional, social, cultural, everyday).
The ability to learn is one of the important integrative forms of life, which depends, first of all, on the state of mental functions (intelligence, memory, attention, clarity of consciousness, thinking, etc.), the safety of communication systems, orientation, etc. Learning also requires the use the ability to communicate, move, self-care, determined by the psychological characteristics of the individual, the state of the locomotor system, visceral functions, etc. The ability to learn is impaired in diseases of various body systems. Of all the life activity criteria, learning disabilities have the greatest social significance in childhood. It is equivalent to impaired ability to work in adults and is the most common cause social insufficiency of the child.

Characteristics educational activities include:
content of training (obtaining education at a certain level and in a certain profession);
teaching aids (including special technical means for training, equipment for training places, etc.);
the learning process, including forms of learning (full-time, part-time, part-time, at home, etc.), teaching methods (group, individual, interactive, open, etc.);
learning conditions (in terms of severity, intensity and harmfulness);
terms of study.

When assessing the degree of learning disability, the following parameters should be analyzed:
education, availability of professional training;
volume of training according to general or special state educational standards;
opportunity to study at an educational institution general type or in a correctional educational institution;
terms of study (normative-non-normative);
the need to use special technologies and (or) educational aids.
the need for assistance from other persons (except training personnel);
the level of cognitive (mental) activity of a person in accordance with the age norm;
attitude towards learning, motivation for learning activities;
the possibility of verbal and (or) non-verbal contact with other people;
state of communication systems, orientation, especially sensory, motor functions of the body, etc.;
the state of visual-motor coordination for mastering writing techniques, graphic skills, and manipulative operations.
Learning disability by severity

I degree - the ability to learn, master knowledge, skills and abilities in full (including obtaining any education in accordance with general state educational standards), but in non-standard terms, subject to a special regime educational process and (or) using auxiliary means.
II degree – the ability to learn and acquire knowledge, skills and abilities only according to special educational programs and (or) educational technology in specialized educational and educational correctional institutions with the use of aids and (or) with the help of other persons (except for teaching staff).
III degree – learning disability and inability to acquire knowledge, skills and abilities.

4.4. Ability to work– a state of the human body in which the totality of physical and spiritual abilities allows for the implementation of a certain volume and quality of production (professional) activity.
Ability to work includes:
- The ability of a person, in terms of his physical, psychophysiological and psychological capabilities, to meet the requirements imposed on him by industrial (professional) activities (in terms of the complexity of work, conditions of the working environment, physical severity and neuro-emotional tension).
- The ability to reproduce special professional knowledge, skills and abilities in the form of production (professional) labor.
- A person’s ability to carry out production (professional) activities in normal production conditions and in a normal workplace.
- A person’s ability for social and labor relationships with other people in the work team.

Limitation of ability to work according to severity
I degree - the ability to perform professional activities in normal production conditions with a reduction in qualifications or a decrease in volume production activities; inability to perform work in the main profession.
II degree – ability to perform work activities
in normal production conditions with the use of auxiliary equipment, and (or) at a special workplace, and (or) with the help of other persons;
in specially created conditions.

III degree – inability or impossibility (contraindication) to work.

4.5. Orientation ability– ability to be determined in time and space
The ability to orient is carried out through direct and indirect perception of the environment, processing the information received and adequately defining the situation.
Orientation ability includes:
- The ability to determine time based on surrounding signs (time of day, time of year, etc.).
- The ability to determine location based on the attributes of spatial landmarks, smells, sounds, etc.
- The ability to correctly locate external objects, events and oneself in relation to temporal and spatial reference points.
- The ability to realize one’s own personality, mental image, diagram of the body and its parts, differentiation of “right and left”, etc.
- The ability to perceive and adequately respond to incoming information (verbal, non-verbal, visual, auditory, gustatory, obtained through smell and touch), understanding the connection between objects and people.
When assessing orientation limitations, the following parameters should be considered:
state of the orientation system (vision, hearing, touch, smell)
state of communication systems (speech, writing, reading)
ability to perceive, analyze and adequately respond to information received
the ability to realize, identify one’s own personality and external temporal, spatial conditions, and environmental situations.

Limitation of the ability to orient in terms of severity:

I degree - ability to orientation, subject to the use of aids.
The ability to locate oneself in place, time and space is retained with the help of auxiliary technical means (mainly improving sensory perception or compensating for its impairment)
II degree – the ability to navigate, requiring the help of other persons.
The possibility of awareness of one’s own personality, one’s position and definition in place, time and space remains only with the help of other persons due to a decrease in the ability to understand oneself and the outside world, understand and adequately define oneself and the surrounding situation.
III degree – inability to navigate (disorientation) and the need for constant supervision.
A condition in which the ability to orient oneself in place, time, space and one’s own personality is completely lost due to the lack of ability to understand and evaluate oneself and the environment.

4.6. Ability to communicate– the ability to establish contacts between people by perceiving, processing and transmitting information.

When communicating, the interaction and interaction of people takes place, the exchange of information, experience, skills, and performance results occurs.
In the process of communication, a community of feelings, moods, thoughts, and views of people is formed, their mutual understanding, organization and coordination of actions are achieved.
Communication is carried out mainly through means of communication. The main means of communication is speech, the auxiliary means are reading and writing. Communication can be carried out using both verbal (verbal) and non-verbal symbols. In addition to the preservation of speech, communication requires the preservation of orientation systems (hearing and vision). Another condition for communication is normal condition mental activity And psychological characteristics personality.
Communication abilities include:
the ability to perceive another person (the ability to reflect his emotional, personal, intellectual characteristics)
the ability to understand another person (the ability to comprehend the meaning and significance of his actions, actions, intentions and motives).

The ability to exchange information (perception, processing, storage, reproduction and transmission of information).
- the ability to develop a joint interaction strategy, including the development, implementation and monitoring of the implementation of the plan, with possible adjustments if necessary.

When assessing the limitations of the ability to communicate, the following parameters should be analyzed, characterizing primarily the state of the communication and orientation systems:
ability to speak (smoothly pronounce words, understand speech, pronounce and produce verbal messages, convey meaning through speech);
ability to listen (perceive oral speech, verbal and other messages);
the ability to see, read (perceive visible information, written, printed and other messages, etc.);
ability to write (encode language into written words, compose written messages, etc.);
ability for symbolic communication ( nonverbal communication) – understand signs and symbols, codes, read maps, diagrams, receive and transmit information using facial expressions, gestures, graphic, visual, sound, symbols, tactile sensations).

Possibility of contacts with an expanding circle of people: family members, close relatives, friends, neighbors, colleagues, new people, etc.

Limitation of the ability to communicate by severity
I degree – the ability to communicate, characterized by a decrease in speed, a decrease in the volume of assimilation, reception, transmission of information and (or) the need to use auxiliary means.
The possibility of communication is preserved when the speed (tempo) of oral and writing, reducing the speed of assimilation and transmission of information in any way while understanding its semantic content.
II degree - the ability to communicate using aids and the help of others.
It remains possible to communicate using technical and other auxiliary means that are not typical for the usual establishment of contacts between people, and the assistance of other persons in receiving and transmitting information and understanding its semantic content.
III degree - inability to communicate and the need for constant outside help.
A condition in which contact between a person and other people is impossible, mainly due to the loss of the ability to understand the semantic content of received and transmitted information.

4.7. Ability to control your behavior– the ability to understand and behave appropriately, taking into account moral, ethical and socio-legal norms.
Behavior – inherent in man interaction with the environment, mediated by its external (motor) and internal (mental) activity. When control over one's behavior is violated, a person's ability to comply with the legal, moral, aesthetic rules and norms officially established or established in a given society is violated.
The ability to control one's behavior includes:
The ability to understand oneself, one’s place in time and space, one’s social status, state of health, mental and personal qualities and properties.
The ability to evaluate one’s own actions, actions, intentions and motives of another person with an understanding of their meaning and meaning.
The ability to perceive, recognize and adequately respond to incoming information.
Ability to correctly identify people and objects.

The ability to behave correctly in accordance with moral, ethical and socio-legal norms, to maintain established public order, personal cleanliness, order in appearance etc.
- Ability to correct assessment situation, adequacy of development and choice of plans, goal achievement, interpersonal relationships, performance of role functions.
- The ability to change your behavior when conditions change or behavior is ineffective (plasticity, criticality and variability).
- Ability to understand personal safety (understanding external danger, recognizing objects that can cause harm, etc.)
- The usefulness of using tools and sign systems in managing one’s own behavior.
When assessing the degree of limitations in the ability to control one's behavior, the following parameters should be analyzed:
presence and nature of personal changes
degree of preservation of awareness of one’s behavior
the ability for self-correction, or the possibility of correction with the help of other persons, therapeutic correction;
the direction of the impairment of the ability to control one’s behavior in one or more areas of life (industrial, social, family, everyday life);
duration and persistence of violations of control over one’s behavior;
stage of compensation for behavioral defect (compensation, subcompensation, decompensation);
state of sensory functions.

Debunking the myth about the existence of a "non-working" group. In fact, it is not the group that is important, but the OST

Quite a long time ago, back on August 22, 2005, Ministry of Health and Social Development Russian Federation has developed, in my opinion, a very important document for every disabled person: CLASSIFICATIONS AND CRITERIA,
USED ​​IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION OF CITIZENS BY FEDERAL STATE INSTITUTIONS OF MEDICAL AND SOCIAL EXAMINATION
After 3 years (!) it even began to be used in the development of IPR. In its new form it is customary to indicate 7 factors and not just the OST, as before. Since in the disabled environment and not only in it there is the concept of a “non-working group” and people often even refuse a more advantageous group in order to get a “working” one, we will use the language of formal criteria in order to finally really understand something. I must warn you right away - I'm not a lawyer but just an amateur common sense. So, I ask you to evaluate these arguments of professional lawyers. So, let's get to the most heavy in groups.
"Criteria for determining first disability group is a violation of human health with a persistent, significant disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation one from the following categories of life activity or their combination and causing the need for his social protection:
self-service abilities of the third degree;
ability to move third degree;
orientation abilities of the third degree;
communication abilities of the third degree;
ability to control one's behavior to the third degree.
14. The criterion for establishing the second group of disability is a person’s health impairment with a persistent severe 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 of them and necessitating his social protection:
self-service abilities of the second degree;
mobility ability of the second degree;
orientation abilities of the second degree;
communication abilities of the second degree;
ability to control one's behavior to the second degree;
learning abilities of the third, second degrees;
ability to work third, second degrees."
As we see, the ability to work is mentioned only when applied to second group. In this regard, I question the concept of a "non-work group". Even if a person was given the first group, this does not mean anything with in terms of opportunity to work.
If you gave the second one, defining OST = 3, then look what it is:
3rd degree - inability to work or impossibility (contraindication) of work.

This means that in the ITU protocol it might be entry " contraindication work." This is not an impossibility. A person can say: “Even though it is contraindicated, I have to harm my health, otherwise my family will die of hunger.”
And only if “inability to work” is included in the minutes of the meeting of the ITU bureau, and this entry is also included in the IPR and in the pink certificate, then a disabled person of group 2, OST = 3, can actually get a job and present evidence that he is not very disabled wants. In my opinion, such an entry should appear only in cases where the disabled person is a complete “vegetable” and the inability to work is “just so rushing.” In all other cases, prepared a disabled person may require a “correct” entry.
By the way, for a better understanding of the previous material, I’ll give a quote from the criteria for what this concept is "degree", and along the way "ability":

For example
ability to independent movement- the ability to independently move in space, maintain body balance when moving, at rest and changing body position, to use public transport:
2nd degree - the ability to move independently with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to move independently and need constant assistance from others;

Ability to communication- the ability to establish contacts between people by perceiving, processing and transmitting information:

2nd degree - the ability to communicate with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to communicate and need for constant help from others;
And finally, the queen of all abilities and degrees, reigning unchallenged during Zurabov’s time: the ability to labor activity- ability to carry out work activities in accordance with the requirements for the content, volume, quality and conditions of work:

2nd degree - the ability to perform labor activities in specially created working conditions with the use of auxiliary technical means and (or) with the help of other persons;
3rd degree - inability to work or impossibility (contraindication) of work.
(I removed the definitions of the 1st degree throughout, since it is not important for understanding the rest.) Currently, it is the OST that determines the size of the pension. Added 04/07/09: Since cases of a sharp decrease in OST have become more frequent, even in group 1, if a person works, the abolition of OST has become urgent and is not far off: promised by Ms. Golikova since 2010.

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Specialists from the Bureau of Medical and Social Expertise recognized 20-year-old Muscovite Ekaterina Prokudina, who has been suffering from childhood cerebral palsy and cannot move independently, is a disabled person of the second group, effectively depriving her of the opportunity to undergo annual sanatorium-resort treatment, the girl’s mother, Marina Prokudina, told RIA Novosti.

In accordance with the rules for recognizing a person as a disabled person, approved by a decree of the Government of the Russian Federation of February 20, 2006, recognition of a citizen as a disabled person is carried out during a medical and social examination based on a comprehensive assessment of the state of the citizen’s body based on an analysis of his clinical, functional, social, everyday, professional, labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation.

Conditions for recognizing a citizen as disabled are:

Impaired health with a persistent disorder of body functions caused by diseases, consequences of injuries or defects;
- limitation of life activity (complete or partial loss by a citizen of the ability or ability to carry out self-service, move independently, navigate, communicate, control one’s behavior, study or engage in labor activities);
- the need for social protection measures, including rehabilitation.

The presence of one of these conditions is not a sufficient basis for recognizing a citizen as disabled.

Depending on the degree of disability caused by a persistent disorder of body functions resulting from diseases, consequences of injuries or defects, a citizen recognized as disabled is assigned disability group I, II or III, and a citizen under the age of 18 is assigned the category “disabled child.”

Disability of group I is established for 2 years, groups II and III - for 1 year.

If a citizen is recognized as disabled, general illness, work injury, occupational disease, disability since childhood, disability due to injury (concussion, mutilation) associated with military operations during the Great Patriotic War are indicated as the cause of disability. Patriotic War, war injury, illness acquired during military service, disability associated with the disaster at the Chernobyl nuclear power plant, the consequences of radiation exposure and direct participation in the activities of special risk units, as well as other reasons established by the legislation of the Russian Federation.

Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year, and disabled children - once during the period for which the child is assigned the category "disabled child".

Citizens are assigned a disability group without specifying a period for re-examination, and citizens under 18 years of age are assigned the category “disabled child” until the citizen reaches the age of 18:

No later than 2 years after the initial recognition as disabled (establishment of the category “disabled child”) of a citizen who has diseases, defects, irreversible morphological changes, dysfunctions of organs and body systems according to the list according to the appendix;
- no later than 4 years after the initial recognition of a citizen as disabled (establishment of the category “disabled child”), if it is revealed that it is impossible to eliminate or reduce during implementation rehabilitation activities the degree of limitation of a citizen’s life activity caused by persistent irreversible morphological changes, defects and dysfunctions of organs and systems of the body.

The list of diseases, defects, irreversible morphological changes, dysfunctions of organs and systems of the body for which the disability group (category “disabled child” until the citizen reaches the age of 18) is established without specifying the period for re-examination:
1. Malignant neoplasms (with metastases and relapses after radical treatment; metastases without an identified primary focus when treatment is ineffective; severe general condition after palliative treatment, incurability (incurability) of the disease with severe symptoms of intoxication, cachexia and tumor disintegration).
2. Malignant neoplasms of lymphoid, hematopoietic and related tissues with severe symptoms of intoxication and severe general condition.
3. Inoperable benign neoplasms brain and spinal cord with persistent pronounced violations motor, speech, visual functions and pronounced liquorodynamic disturbances.
4. Absence of the larynx after it surgical removal.
5. Congenital and acquired dementia (severe dementia, mental retardation severe, profound mental retardation).
6. Diseases nervous system with a chronic progressive course, with persistent severe impairments of motor, speech, and visual functions.
7. Hereditary progressive neuromuscular diseases, progressive neuromuscular diseases with impairment bulbar functions(swallowing functions), muscle atrophy, impaired motor functions and (or) impaired bulbar functions.
8. Severe forms of neurodegenerative brain diseases (parkinsonism plus).
9. Complete blindness in both eyes if treatment is ineffective; a decrease in visual acuity in both eyes and in the better-seeing eye up to 0.03 with correction or a concentric narrowing of the field of vision in both eyes up to 10 degrees as a result of persistent and irreversible changes.
10. Complete deaf-blindness.
11. Congenital deafness with the impossibility of hearing endoprosthetics (cochlear implantation).
12. Diseases characterized by increased blood pressure with severe complications from the central nervous system (with persistent severe impairment of motor, speech, visual functions), heart muscles (accompanied by circulatory failure IIB III degree and coronary insufficiency III IV functional class), kidneys (chronic renal failure IIB Stage III).
13. Ischemic disease hearts with coronary insufficiency of III IV functional class of angina and persistent circulatory disorder IIB III degree.
14. Respiratory diseases with a progressive course, accompanied by persistent respiratory failure II III degree, in combination with circulatory failure IIB III degree.
15. Liver cirrhosis with hepatosplenomegaly and portal hypertension of III degree.
16. Unremovable fecal fistulas, stomas.
17. Severe contracture or ankylosis of large joints of the upper and lower extremities in a functionally disadvantageous position (if endoprosthesis replacement is impossible).
18. Terminal stage chronic renal failure.
19. Unremovable urinary fistulas, stomas.
20. Congenital anomalies of bone development muscular system with severe persistent impairment of the function of support and movement when correction is impossible.
21. Consequences of traumatic injury to the brain (spinal cord) with persistent severe impairment of motor, speech, visual functions and severe disorder functions pelvic organs.
22. Defects upper limb: amputation area shoulder joint, disarticulation of the shoulder, shoulder stump, forearm, absence of the hand, absence of all phalanges of four fingers of the hand, excluding the first, absence of three fingers of the hand, including the first.
23. Defects and deformations of the lower limb: amputation of the area hip joint, disarticulation of the thigh, thigh stump, lower leg, absence of the foot.

Medical and social examination a citizen is carried out at the bureau at the place of residence (at the place of stay, at the location of the pension file of a disabled person who has left for permanent residence outside the Russian Federation).

In the main bureau, a medical and social examination of a citizen is carried out in case he appeals the bureau’s decision, as well as in the direction of the bureau in cases requiring special types examinations.

In the Federal Bureau, a medical and social examination of a citizen is carried out in the event of an appeal against the decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination.

A medical and social examination can be carried out at home if a citizen cannot come to the bureau (main bureau, Federal Bureau) for health reasons, as confirmed by the conclusion of an organization providing medical and preventive care, or in a hospital where the citizen is being treated, or in absentia by decision of the relevant bureau.

The decision to recognize a citizen as disabled or to refuse to recognize him as disabled is made by a simple majority vote of the specialists who conducted the medical and social examination, based on a discussion of the results of his medical and social examination.

A citizen (his legal representative) can appeal the decision of the bureau to the main bureau in month period on the basis of a written application submitted to the bureau that conducted the medical and social examination, or to the main bureau.

The bureau that conducted the medical and social examination of the citizen sends it with all available documents to the main bureau within 3 days from the date of receipt of the application.

The Main Bureau, no later than 1 month from the date of receipt of the citizen’s application, conducts a medical and social examination and, based on the results obtained, makes an appropriate decision.

If a citizen appeals the decision of the main bureau, the chief expert in medical and social examination for the relevant constituent entity of the Russian Federation, with the consent of the citizen, may entrust the conduct of his medical and social examination to another group of specialists from the main bureau.

The decision of the main bureau can be appealed within a month to the Federal Bureau on the basis of an application submitted by a citizen (his legal representative) to the main bureau that conducted the medical and social examination, or to the Federal Bureau.

The Federal Bureau, no later than 1 month from the date of receipt of the citizen’s application, conducts a medical and social examination and, based on the results obtained, makes an appropriate decision.

Decisions of the bureau, the main bureau, the Federal Bureau can be appealed to the court by a citizen (his legal representative) in the manner established by the legislation of the Russian Federation.

Classifications and criteria, used in the implementation of medical and social examination of citizens by federal government agencies medical and social examination, approved by order of the Ministry of Health and Social Development of December 23, 2009.

The classifications used in the implementation of medical and social examination of citizens determine the main types of dysfunctions of the human body, caused by diseases, consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and the severity of the limitations of these categories.

The criteria used when carrying out medical and social examination of citizens determine the conditions for establishing disability groups (the category “disabled child”).

TO main types of dysfunctions of the human body relate:

Violations of mental functions (perception, attention, memory, thinking, intelligence, emotions, will, consciousness, behavior, psychomotor functions);
- violations of language and speech functions (violations of oral and written, verbal and non-verbal speech, disorders of voice formation, etc.);
- disturbances of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);
- violations of static-dynamic functions (motor functions of the head, torso, limbs, statics, coordination of movements);
- dysfunctions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity;
- disorders caused by physical deformity (deformations of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, violation of body size).

In a comprehensive assessment of various indicators characterizing persistent dysfunctions of the human body, four degrees of their severity are distinguished:

1st degree - minor violations,
2nd degree - moderate violations,
3rd degree - severe disturbances,
4th degree - significantly pronounced violations.

The main categories of human life include: the ability to self-service; ability to move independently; ability to orientate; ability to communicate; the ability to control one's behavior; ability to learn; ability to work.

In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished:

Self-care ability- a person’s ability to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills:

1st degree - the ability to self-service with a longer investment of time, fragmentation of its implementation, reduction of volume using, if necessary, auxiliary technical means;
2nd degree - the ability to self-care with regular partial assistance from other persons using auxiliary technical means if necessary;
3rd degree - inability to self-care, need for constant outside help and complete dependence on other persons.

Ability to move independently- the ability to independently move in space, maintain body balance when moving, at rest and when changing body position, to use public transport:

1st 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;
2nd degree - the ability to move independently with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to move independently and need constant assistance from others.

Orientation ability- the ability to adequately perceive the environment, assess the situation, the ability to determine the time and location:

1st degree - the ability to navigate only in a familiar situation independently and (or) with the help of auxiliary technical means;
2nd degree - the ability to navigate with regular partial assistance from other persons using, if necessary, auxiliary technical means;
3rd degree - inability to navigate (disorientation) and the need for constant assistance and (or) supervision of other persons.

Ability to communicate- the ability to establish contacts between people by perceiving, processing and transmitting information:

1st degree - ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use, if necessary, assistive technical aids; in case of isolated damage to the organ of hearing, the ability to communicate using non-verbal methods and sign language translation services;
2nd degree - the ability to communicate with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to communicate and need for constant help from others.

Ability to control your behavior- the ability to self-awareness and adequate behavior taking into account social, legal and moral ethical norms:

1st 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;
2nd degree- constant reduction of criticism of one’s behavior and environment with the possibility of partial correction only with the regular help of other people;
3rd degree- inability to control one’s behavior, the impossibility of correcting it, the need for constant help (supervision) from other persons.

Learning ability- the ability to perceive, remember, assimilate and reproduce knowledge (general education, professional, etc.), mastery of skills and abilities (professional, social, cultural, everyday):

1st degree- ability to learn, as well as to obtain education at a certain level within the framework of government educational standards in general purpose educational institutions using special teaching methods, a special training regime, using, if necessary, auxiliary technical means and technologies;
2nd degree- the ability to learn only in special (correctional) educational institutions for students, pupils, children with disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies;
3rd degree- learning disability.

Ability to work- ability to carry out work activities in accordance with the requirements for the content, volume, quality and conditions of work:

1st degree- the ability to perform work 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 lower-skilled work under normal working conditions;
2nd degree- the ability to perform labor activities in specially created working conditions with the use of auxiliary technical means and (or) with the help of other persons;
3rd degree- inability to engage in any work activity or impossibility (contraindication) of any work activity.

The degree of limitation of the main categories of human life activity is determined based on an assessment of their deviation from the norm corresponding to a certain period (age) of human biological development.

Melenchuk Saveliy Gennadievich

3rd year student, department social work YuI Siberian Federal University, Russian Federation, Krasnoyarsk

IN modern world there are many social problems. These problems hinder the development and normal functioning society. Their solution is possible only through the coordinated activities of the state and society. This activity is carried out in any state, but it is not always effective, according to various reasons, such as lack of funding, lack of knowledge about the causes of social inequality and ways to overcome it, and, sometimes, from the unpreparedness of society itself for change.

Thus, one of the most important social problems in Russia, on this moment, is the problem of childhood disability. Disabled people constitute a special category of the population. Disability is associated with a persistent health disorder that leads to limited life activity and necessitates social protection. State policy towards persons with disabilities is aimed at solving problems of this nature. Disability should be considered as one of the forms of social inequality. This means that society does not perceive people with disabilities as full-fledged members of society. This fact suggests that existing social conditions limit the activity of this population group. Which, in turn, hinders the integration of disabled children into society.

Therefore, despite the fact that Russia is a social state that guarantees equal rights and freedoms for every person and citizen, regardless of any differences, people with disabilities cannot always take advantage of their constitutional rights. This characterizes childhood disability as one of the most important social problems.

Problem: Can we say that the rights of disabled children guaranteed by the state are fully realized?

Hypothesis: The rights of children with disabilities guaranteed by the Constitution of the Russian Federation and other laws are not fully realized in practice.

The object of the study is children with disabilities.

The subject of the study is the situation of disabled children and the problems they face in modern Russia.

The goal is to determine to what extent the rights of disabled children guaranteed by the state are realized.

Objectives: - describe the concepts of “disabled person” and “disabled child”;

· consider the list of guaranteed rights of disabled children;

· draw up a questionnaire and conduct a survey of disabled children;

· determine to what extent the guaranteed rights of disabled children are realized.

Research methods: theoretical - analysis, systematization, generalization: empirical - questioning.

In accordance with the Federal Law “On Social Protection of Disabled Persons in the Russian Federation”: 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 activities and necessitating the need for his social protection. Consequently, the concept of a disabled person is enshrined in law. And it denotes the category of people with disabilities who need help and social protection.

Depending on the degree of impairment of body functions and limitations in life activity, persons recognized as disabled are assigned a disability group, and persons under the age of 18 are assigned the category “disabled child.” A disabled child is an individual under the age of 18 inclusive with deviations in physical or mental development, who has limitations in life caused by congenital, hereditary or acquired diseases, consequences of injuries, necessitating his social protection. Accordingly, childhood disability has a certain age limit. Thus, children with disabilities constitute a separate group that requires a special approach when implementing assistance programs.

The manual for medical and labor examination defines “disability” in childhood as “a state of persistent social maladaptation caused by chronic diseases or pathological conditions, sharply limiting the possibility of including a child in age-appropriate educational and pedagogical processes, in connection with which there is a need for constant additional care, assistance or supervision.” It follows from this that children with disabilities are not adapted to independent integration into public life and need social protection.

According to the Analytical Bulletin of the Federation Council, until 1979, the presence of disabled children entitled to receive social benefits was not recognized at all in the USSR, since disability was defined as “a persistent impairment (decrease or loss) of general or professional working capacity due to illness or injury.” . The status of a “disabled child” was first officially introduced in the USSR during the International Year of the Child, declared by the UN in 1979. Consequently, until 1979, disabled children were not recognized in the USSR, and they were not provided with assistance. Which, in turn, negatively affected the condition of children with disabilities, since the rehabilitation of disabled people is more effective the earlier it begins.

At the moment, according to official data from the Federal State Statistics Service, the number of disabled children receiving social benefits aged 0 to 17 in the Russian Federation in 2012 is 568,000 people.

As noted by I.V. Larikov, today in Russia there is progressive legislation that provides conditions for the integration of disabled children into society. It is based on international treaties and other international acts signed by Russia, containing generally recognized principles and norms international law, following the norms of the Constitution of the Russian Federation, which declares the primacy of international law. Thus, Russia adheres to the position of the world community on issues of providing children with disabilities with acceptable living conditions.

According to Article 7 of the Constitution of the Russian Federation, Russia is a social state, “the policy of which is aimed at creating conditions that ensure a decent life and free development of people.” Accordingly, the policy of the Russian Federation is aimed at increasing the level and quality of life and providing opportunities for people to realize their potential.

It is obvious that the opportunity to realize oneself as a full-fledged member of society is an important factor for a child with disabilities that influences his later life. In accordance with the law “On the Fundamentals of Social Services for the Population in the Russian Federation,” social services created in Russia “provide assistance in professional, social, and psychological rehabilitation to disabled people, persons with disabilities, juvenile delinquents, and other citizens who find themselves in difficult life situations and in need of rehabilitation services". This indicates that disabled children in the Russian Federation should be provided with assistance in various fields life.

According to the Law of the Russian Federation “On State Pensions in the Russian Federation,” a social pension and supplements to it are established for disabled children. Also, in accordance with Art. 18 of the Law “On Social Protection of Disabled Persons in the Russian Federation” educational institutions, social protection bodies, communication, information, physical culture and sports institutions ensure continuity of upbringing and education, social adaptation of disabled children. Moreover, if it is impossible to raise and educate disabled children in general or special preschool and educational institutions the state pledged to provide them with a full general education or individual program at home. It follows that educational process is aimed both at the rehabilitation of disabled children and at socialization and education. And the state, in turn, must ensure open access for disabled children to the educational process.

The Town Planning Code of the Russian Federation guarantees the provision of conditions for people with disabilities to have unhindered access to social and other facilities. In accordance with the decree of the Government of the Russian Federation, disabled children under the age of 16 are given free medications according to doctors’ prescriptions, free dispensing of drugs according to doctors’ prescriptions and free dispensing of prosthetic and orthopedic products by enterprises and organizations of the Ministry of Labor and Social Development of the Russian Federation is provided. Thus, the state guarantees a wide range of rights and services to children with disabilities.

However, I.V. Larikova believes that Russian state policy in this area contradicts the law - both in the field of family and in the field of education and rehabilitation.

In order to identify the degree of implementation guaranteed rights disabled children at 9 populated areas Russian Federation, through personal questioning and questioning via the Internet, a survey was conducted that covered 67 children with disabilities. The gender and age composition of the respondents is represented by 23 boys and 44 girls, of which 11 people are aged 11-13 years, 31 people are 14-16 years old and 25 people are aged 17-18 years.

Analysis of answers to the question “Does the state provide you with assistance?” showed that 87% of disabled children receive state assistance, and 13% of respondents do not receive assistance from the state. This fact can be explained by the fact that, perhaps, some children with disabilities do not need help or by the fact that the child is not registered with social protection authorities.

Based on the results of the question “What types of assistance does the state provide to you?” It was possible to find out that 89% of the surveyed disabled children receive financial assistance, 30% receive sanatorium treatment, 40% receive medication, and only 18% of respondents receive state aid all of the above. Accordingly, assistance is distributed unevenly among needy children with disabilities.

In this regard, 77% of respondents note that the assistance provided by the state is not enough for them and only 23% of disabled children among those receiving state assistance consider it sufficient. Thus, the problem of insufficient state assistance for children with disabilities is confirmed.

65 children out of 67 receive education, which is 93%, respectively, 2 children do not receive education - 3% of the number of respondents.

Analysis by answering the question “How is your training going?” gave following results: 33 surveyed children with disabilities receive education in a general educational institution, 24 out of 67 surveyed children study in a special educational institution for children with disabilities, and 10 respondents study at home. Based on the results of this question, we can say that almost all children with disabilities receive education, mostly in special educational institutions and at home, rather than in general educational institutions, which indicates that inclusive education for children with disabilities in Russia is still remains inaccessible.

Having analyzed the answers to the question regarding the barrier-free movement of disabled children along the streets and buildings, it was possible to find out that 39% of respondents always encounter problems when moving, 18% of respondents often encounter problems, 23% do not often, and 20% of disabled children never do not encounter problems when moving around the street and buildings. Judging by the results of the answers to the question, we can say with a fair degree of confidence that in Russia there is still no complete “barrier-free environment” that would ensure the absence of problems in the movement of children with disabilities and people with disabilities, in general, along the street and buildings.

Disabled children themselves assess the implementation of state policy aimed at supporting children with disabilities in the following way: 19% of respondents believe that state policy is being implemented to the fullest extent, 62% of respondents claim that the policy is being implemented not fully, but 19 % are difficult to estimate. Accordingly, children with disabilities are convinced that the state does not fully realize its potential in protecting the rights, freedoms and interests of children with disabilities. Children with disabilities are either not satisfied with government assistance or, for the most part, rate their satisfaction as average, which is a problem that needs to be addressed.

Disabled children themselves see possible ways to solve the above problem by creating an accessible environment, not in words, but in deeds, as 42% of respondents think. 28% of respondents speak about the inevitability of a change in public opinion for the greatest assistance and protection of disabled children. The fact that help is needed not only for children, but also for their parents is evidenced by 9% of responses. The need for free sanatorium-resort treatment is noted by 16% of respondents, and an increase in the amount of financial assistance by 61% of disabled children. The option to build special schools and rehabilitation centers was voiced by 28% of respondents, and 20% of respondents spoke about covering the problems of children with disabilities in the media.

Thus, disabled children see the prevailing importance in providing the greatest assistance and protection for themselves in increasing material assistance, as universal remedy, with the help of which disabled children and their families will be able to purchase the necessary goods and services to improve the rehabilitation process and life.

And the final question of the questionnaire showed that 8% of respondents were quite satisfied with their lives, 17% of respondents were mostly satisfied with their current situation, and 27% of the surveyed disabled children were somewhat satisfied with their lives. A large number of respondents, namely 37%, are mostly dissatisfied with their lives, but 11% are completely dissatisfied with the way they live. Accordingly, there are much more children with disabilities who are dissatisfied with their living conditions at the moment than there are disabled children who are satisfied with their living conditions. life situation. This is explained by a combination of the above problems and factors.

Thus, after analyzing the answers to the questionnaire, we can say with a fair degree of confidence that childhood disability in modern Russia is one of the most important social problems. The situation of children with disabilities at the moment is not one of the best.

Through analysis, comparison of legislation and survey results, it was possible to find out that insufficient state assistance, expressed in minimal financial assistance, cannot compensate for the costs of families for the rehabilitation of children. The prevailing negative public opinion also complicates the processes of rehabilitation and socialization of children with disabilities. Underdeveloped infrastructure, lack of inclusive education and inadequate legislative measures and standards - all this worsens living conditions, making a child with disabilities feel unwanted and segregated from society.

Thus, the hypothesis that the rights of children with disabilities guaranteed by the Constitution of the Russian Federation and other laws are not fully realized in practice has been confirmed.

Bibliography:

  1. Analytical bulletin of the Federation Council of the Federal Assembly of the Russian Federation. Protection of children's rights in the Russian Federation, 2007. [Electronic resource] - Access mode. - URL:: http://www.council.gov.ru/print/inf_sl/bulletin/item/285/
  2. Town Planning Code of the Russian Federation dated December 29, 2004 No. 190-FZ. [Electronic resource] - Access mode. - URL: http://www.consultant.ru/popular/gskrf/15_1.html#p103
  3. Law of the Russian Federation “On State Pensions in the Russian Federation” dated November 20, 1990 No. 340-1. [Electronic resource] - Access mode. - URL: http://www.consultant.ru/document/cons_doc_LAW_34222/ (date of access: 09/15/2014).
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