Importance of community-based services for persons with disabilities: Availability and quality International frame June 2012,Belgrade Dr.Vasilka Dimoska Specialist in social medicine and health management Consultant for social services Board member of EASPD

Disability - human rights issue!!!! Definition complex and controversial Approach:Medical model->Social model Persons with disability have rights to be equal members of the society!!! Human rights approach Awareness New initiatives Inclusion in the society

International frame for improvement of rights and equal opportunity for persons with disability in the society UN Convention on the rights of persons with disabilities Council of Europe Action Plan 2006/2015 The European Disability Strategy International development goals: - Economic, human and social development; - Integrative approach= Prevention + rehabilitation

Key words in the reform of the system Decentralization De-institutionalization New system of opportunity Institutional care Social services on the local level/community based service European social model

Society for all Inclusion in the regular services - Kindergarten - Primary school (inclusive program) - Occupational therapy - Employment Specialized services person centered approach

Community – based services for persons with disabilities System of new opportunity Driving force for changes Development of the capacity and capability of the person Support to the families 4A rules for community based services (Accessibility, Availability, Affordability, Accountability)

Steps in the process Need for collaboration!!! Regional level->European level->International level Macro level - National strategy Micro level - Local Action Disability Plans Deming wheel PDCA(plan-do-check-act) Planning Provision Monitoring/Evaluation Improvement

Regulatory mechanisms Operative instruments for control, coordination and improvement of the process of service provision on macro and micro level Opportunity for different service providers Balance between demand and offer/supply Create rules in the system of service provision FUNCTIONS Normative function Corrective function Promotion and continuous improvement of service delivery

THE GATE-KEEPING MECHANISMS (Referral, information and direct access to social services) At the level of the general system of social service (macro): Needs assessment (which types of services are needed) Elaboration of territorial maps of needs and services Defining national access criteria to social services At individual level (micro): Assessment of the individual situation Decision making and orientation to community services

Quality mechanisms (principle/standards) General principles (rights based, values and basic standards) Technical standards, taking into account more specific quality requirements for different categories of services

CONTRACTING AND FUNDING MECHANISMS Call for offers/tenders/project applications for social services at local/national level Licensing/authorisation of social service providers Purchasing and contracting of social services at community level Funding of social services at community level

THE INTERNAL REGULATORY MECHANISMS Manuals of policies and procedures; Internal regulations (human resources, relations with users, safety regulations etc.) Quality management and improvement procedures; Strategic planning procedures and follow up; Internal and external communication procedures ; Evidence-based decisions and measures etc.

MONITORING AND EVALUATION MECHANISMS At macro level (the system of social services at local level) Monitoring of social service provision at local level Periodic evaluations and articulation with the gate- keeping system at macro level ; At the level of service providers (micro) Internal evaluation of service providers (self- evaluations) External evaluations of the social service Auditing and control procedures Regular monitoring of service delivery.

THE OVERALL SYSTEM OF INFORMATION AND FEEDBACK Data collection and flow of information that ensures the transparency of the system at all levels, and facilitates decision making and planning

What we are looking for ? Quality of Services : Respect human dignity and fundamental rights Results orienteded Tailor-made to each individual Ensure security to all users, including the most vulnerable Participative and empower users to take decisions on their own Holistic and continuous Provided in partnership with communities and other actors Provided by skilled professionals working under good employment and working conditions Managed in a transparent way and accountable

European Quality of Life Principles EASPD - Values - Quality of life for all Dignity Emotional well-being Equal opportunitiesInterpersonal relations Independent living Personal development Participation in the society Self-determination Contribution to the society Social inclusion/equal rights

European Requirements for Quality in Social Services of General Interest 1. Rights 2. Person centred 3. Comprehensiveness 4. Participation 5. Partnership 6. Result Orientation 7. Good Governance Source: Positioning Paper Disability High Level Group June 2007

Improvement initiatives Service improvement Proof of effectives and efficiency Support concept Addressing needs/consumer satisfaction Involvement of persons with disability in the process respecting the principle Nothing about us without us