LITHUANIAN QUARTERLY JOURNAL OF ARTS AND SCIENCES
Volume 40, No.2 - Summer 1994
Editor of this issue: Robert A. Vitas, Lithuanian Research & Studies Center
Copyright © 1994 LITUANUS Foundation, Inc.
1993 AMERICAN-LITHUANIAN DISABILITY AND REHABILITATION EXCHANGE PROGRAM MAY 15-25, 1993
Michigan Department of Education
I was invited to be part of the 1993 American delegation to Lithuania for the following reasons. First, as a Rehabilitation Specialist with Michigan Rehabilitation Services—a public agency that assists persons with disabilities toward independence and employment. Second, I was actively involved with the 1992 American-Lithuanian Exchange Program when two disabled consumer representatives from the Lithuanian Invalid Society and Commission for the Blind came to Lansing, Michigan.
Goals for 1993 Conference
I was requested to share with the Lithuanian Government, social agencies, disability societies, and disabled consumers the rehabilitation systems we use to help our citizens with disabilities achieve independence and employment. More specifically, I was prepared to discuss the history, evolution, and legislation of vocational rehabilitation in the United States; the relationship between vocational rehabilitation, community agencies, and the medical rehabilitation system, and the training (academic and work experience) required of rehabilitation specialists and professionals in the U.S.
Current State of Rehabilitation and Disability in Lithuania
During the two-week conference, formal presentations were made regarding rehabilitation systems in the U.S. to the following groups: the Social Welfare Department Directors and staff; Labor Department—Employee Exchange personnel; Disability Claims doctors and staff; Ministry of Social Security; Disabled Compensatory Technical Center; Rehabilitation Medical Conference personnel; Council for Disabled Affairs; Association for the Physically Disabled—Vilnius; Disabled Sports Club of Kaunas; Disabled Artists—Vilnius; and individual persons with disabilities and their families.
Attitude and Legislation
During presentations and discussion that followed, I was impressed by the openness and honesty with which government, social agency staff, and consumers admitted that attitudinal changes and public awareness toward persons with disabilities must change from the social rejection and isolation during the Soviet occupation of the past fifty years. The current attitude reflects sensitivity and support for persons with disabilities to have equal rights and full participation in a political, cultural, social, and economic life. The greatest testimonial to this is the Law on Social Integration of the Disabled adopted on 28 November 1991. The law establishes guarantees for the disabled—however, implementation in reality has not occurred. Nevertheless, a small budget had been allocated to disability organizations for 1992 (90 million talons) and increased by 400 percent in 1993 (385 million talons.) Continued budget expansion is critical to program creation, training efforts, and service provision.
In the United States, rehabilitation is both an economic and a social program. Our data proves decade after decade that every dollar spent on rehabilitation services returns nine dollars in new taxes when a disabled person returns to work, and decreases or terminates government support through Social Security or welfare. Once employed a person becomes an economic contributor to society and a consumer of products and services. Work creates a participating and involved human being, rather than a dependent and unfulfilled burden to society. Also, every society needs participating members at all levels of ability. Not to integrate a large segment of our population is a loss and waste to both the individual and society.
Accessibility in Lithuania is a major barrier for disabled persons. Public buildings, public transportation, housing, recreational and entertainment facilities, public areas and services, and employment are almost inaccessible. It goes without saying—if people cannot access, then they cannot participate. Our experiences in the U.S. show that making new construction accessible adds little expense, and sometimes is less expensive. To renovate existing buildings, creative thinking and careful planning can result in low or no-cost modifications of architectural barriers or service policies. Rehabilitation engineers, occupational therapists, and building Contractors can work together to create access. Also, tax rebates for private business give incentives and financial stimulus for creating accessibility. The legislation that requires new buildings to be accessible to Lithuania is a good beginning.
Today centers for independent living provide information and referral services; attendant care training and management; peer counseling; create and identify social, recreational, vocational programs and services; advocate for housing and transportation services; create and support legislation. Many persons with disabilities are employed at Independent Living Centers. They become role models, core community partners, and national forces representing the needs and abilities of persons with disabilities. Lithuanian systems changes in government, medicine, and the community will not take place without consumer empowerment, expertise, commitment, and involvement.
Qualifications and Training of Personnel
The Lithuanian rehabilitation model consists of acute medical intervention and Social Security payments. In the U.S. rehabilitation is seen as a continuum where many persons and professionals (medicine. Social Security and/or welfare, insurance companies, independent living centers, rehabilitation facilities, community mental health workers, vocational rehabilitation specialists, out-patient medical facilities and adjunct medical specialists, community education programs, employers, tax incentives, family members, etc.) function as a team— either concurrently or sequentially—depending on the consumers' needs and desires. Rehabilitation is seen as a life long process from birth, disease, or injury with periods of active and inactive medical and community involvement. In the U.S. medicine and rehabilitation is big business and therefore academic and continuing education is a substantial partner together with employers. Successful rehabilitation is an achievable outcome when all involved partners come together to discuss, plan, and commit resources (time, expertise, money) in order to re-integrate a disabled person back into their community as a participating and contributing member.
This same model can be readily applied in Lithuania. Many natural teams already exist, such as the consumer, their family, the church, the medical community, the disability societies, government (national and/or local), educational institutions (if the consumer is a student), employers (if the consumer is an employee), cultural, social recreational entities, etc. What is needed is a systematic approach to involve these partners in the planning process, assuring active and informed consumer participation, and developing or locating the needed expertise and services for independence and/or employment. A rehabilitation specialist or coordinator is an important function and that role can be implemented by a rehabilitation specialist, social worker, psychologist, special educational teacher, rehabilitation nurse, occupational therapist. Many disciplines can function in that capacity with in-service training. The personal characteristics critical to a successful rehabilitation specialist or coordinator are vision, creativity, innovation, flexibility, good communication and listening skills, energy, good organizational skills and high frustration tolerance. Also, opportunities for rehabilitation specialists to communicate, share, and learn from each other is critical so that professional improvement and growth continues.
1. The Law on Social Integration of the Disabled is clear, comprehensive, and detailed. It must be implemented. Sufficient budget must be allocated for staffing, training, and service provision. Rehabilitation specialists should be placed in each Labor Exchange Department in the 54 dues and communities. The training and integration should be minimally a five-year plan.
2. Local communities need to be held accountable for implementation of the law and developing local councils to address the needs of the disabled is the first step. Consumers, rehabilitation professionals, employers, and government officials should make up these advisory councils, with oversight from the Ministry of Social Security. Clear consequences for non-compliance should exist.
3. Persons with disabilities need to be empowered to make choices and be responsible for their lives. The Invalid Society and disability organizations can be valuable in organizing such efforts at the national and local levels. This activity is already established through the Disabled Council.
4. Accessibility is of paramount importance. The law already addresses new construction. The next step should be access to public buildings: public transportation needs to have lifts, special buses should be available to take persons with disabilities to medical appointments, school, work, etc. (The Invalid Society has several such buses.) Due to the age of most buildings in Lithuania, this challenge will be expensive and extensive. However, with an aging society, as well as integrating persons with disabilities into society, this commitment is needed.
5. Training of rehabilitation specialists can be both a university degree program and skills can be developed through in-service training. The Michigan model has nationwide recognition as a leader in rehabilitation. Exchange visits for teaching can be arranged.
For immediate results in-service training can be provided through a rehabilitation hospital program (Vilnius, Kaunas, or Palanga) in conjunction with the Ministry of Social Security and local communities. Six to ten locations for pilot programming can be identified, with monthly or quarterly in-service training planned and scheduled. Continued exchanges with the University of Michigan and State of Michigan programs can be developed for this effort.
A rehabilitation specialist can be added to the rehabilitation medical teams in Vilnius, Kaunas, and Palanga immediately. This person can identify and address social rehabilitation issues and needs within the medical team and coordinate the person's return to the local community.
Much work needs to be done to create a program for social rehabilitation in Lithuania. If the partners (government, the local community, and the consumer) will make a commitment to work toward this goal, then Lithuania should be able to create a plan and programs that would parallel the success achieved in Michigan and the United States for persons with disabilities to become integrated and contributing members of society.