Organizational and Methodological Foundations for the Formation of Rehabilitation for Children and Adolescents at the Municipal Level

The research is dedicated to the development of organizational and methodological approaches to the formation of a rehabilitation service for children and adolescents at the municipal level. The study analyzes the state of health of the child population of the city of Arzamas, Nizhny Novgorod Oblast, for the period from 1999 to 2004, including demographic indicators, the level of morbidity, and disability among children and adolescents aged 0 to 18 years. The research examines the organization of the rehabilitation process in institutions of different jurisdictional affiliation — health care, education, and social protection of the population — and substantiates the necessity of forming a unified territorial rehabilitation service that ensures the comprehensiveness, continuity, and sequential implementation of rehabilitation measures.

Relevance of the Problem

The development of methods and principles for the rehabilitation of children and adolescents throughout the world is driven by the deterioration of the situation among the child population, as well as by adverse changes occurring in their state of health [139].

In the Russian Federation, socio-economic transformations have led to a decline in the standard of living for the majority of the population, have caused profound changes in the life activities of Russian families, contributing to the intensification of crisis phenomena within them. As a result, such phenomena as child homelessness, social orphanhood, early alcoholism and drug addiction, a threatening increase in child and adolescent criminality, and an increase in the number of children who have become victims of criminal assault, exploitation, and violence have become widespread [10,11,62,63,64,65,166,200,324].

Changes in society have also negatively affected the state of health of children and adolescents. Official data, as well as specialized studies [47,301], indicate an increase in overall morbidity, child disability, a decline in the rates of physical development, a significant increase in diseases with a chronic, relapsing course, and a rise in the frequency of psychosomatic health deviations [22,120,151,166,179,196,320].

An analysis of the current situation of the child population has identified the main directions of state policy with regard to children and adolescents, oriented toward a socially significant final result. The significance of rehabilitation as a form of prevention and as an essential component in the system of measures for preserving and strengthening health, improving conditions for survival, full development, and socialization of children has especially increased [9,60,75,104,152,155,176,272].

The provision of rehabilitation assistance to children has begun to be carried out in institutions of different jurisdictional affiliation (health care, education, social protection of the population). However, no methodology for their interaction has been developed, and the basic principles of rehabilitation, such as comprehensiveness, continuity, and the sequential implementation of rehabilitation measures, are not being fulfilled. In connection with this, there arises a necessity for the formation of a unified territorial rehabilitation service that unites the actions of specialists of different profiles, the definition of its structure, management system, and the significance of individual rehabilitation interventions in the overall rehabilitation process. This determined the goals and objectives of the research.

Goal of the Work: the development of organizational and methodological approaches to the formation of a rehabilitation service for children and adolescents at the municipal level.

Tasks:

1. Assessment of the need of children and adolescents aged 0 to 18 years in the city of Arzamas for rehabilitation measures based on the study of their health status for the period from 1999 to 2004.

2. Analysis of the organization and effectiveness of the rehabilitation process in institutions of different jurisdictional affiliation.

3. Scientific substantiation of the structure and conditions for the functioning of a pediatric rehabilitation service at the municipal level.

4. Testing of a comprehensive system of rehabilitation for children and adolescents under conditions of an organizational experiment.

Scientific Novelty

1. For the first time, the structure and conditions for the functioning of a rehabilitation service for children and adolescents at the municipal level have been developed and scientifically substantiated.

2. Criteria for the need for individual stages and periods of rehabilitation for children and adolescents have been formed, taking into account the规律 of the development of the rehabilitation process.

3. Criteria for the formation of rehabilitation groups, programs, and routes for children and adolescents at different stages of rehabilitation have been developed and scientifically substantiated.

4. From the position of a systemic approach, the mechanism of managing the rehabilitation system at the municipal level has been theoretically substantiated.

Practical Significance

The results of the conducted comprehensive socio-hygienic and clinical-social research made it possible:

• to substantiate and implement organizational principles for the formation of a rehabilitation service under city conditions;

• with minimal expenditures to improve the quality of development and the effectiveness of the implementation of individual rehabilitation programs for children and adolescents;

• to identify the most promising forms of interaction of rehabilitation subdivisions;

• to raise the level of social protection of children and adolescents;

• to improve the health indicators of the child population;

• to raise the level of social-environmental adaptation of patients and disabled persons;

• to influence the quality of work on the prevention of childhood morbidity and disability in the city;

• to rationally use municipal financial, material, and informational resources.

Implementation of the Research Results

The developed dissertation positions (methodology for conducting the social stage of rehabilitation at the basis of municipal centers for social protection of the population, organizational-distribution methods of management, methodology for the formation of rehabilitation groups, methodology for the formation of intra-institutional rehabilitation programs and routes, a comprehensive system of rehabilitation for children and adolescents) have been introduced into the activities of health care institutions, social protection of the population, and education of the city of Nizhny Novgorod and the city of Arzamas, Nizhny Novgorod Oblast.

Presentation of the Work

The main provisions of the dissertation were reported and discussed at the regional conference of rehabilitologists "Medical-Social Rehabilitation of Disabled Persons" (Bogorodsk, 1998), the regional scientific-practical conference "Management of the Quality of Medical Care to the Population of the Nizhny Novgorod Oblast" (Nizhny Novgorod, 1998), an international seminar on family life issues: "Primary Prevention of Violence in the Family" (Minneapolis, Minnesota, USA, 1999), an international conference "Interaction of Local Self-Government Bodies and Non-Commercial Organizations in Working with Children with Limited Health Opportunities" (Nizhny Novgorod, 2001), a scientific session "Modern Solutions to Scientific Problems in Medicine" (Nizhny Novgorod, 2002), a scientific-practical conference "Rehabilitation of Children with Limited Opportunities" (Arzamas, 2004), an international scientific-practical conference "Small Social Group: Sociocultural and Sociopsychological Aspects" (Nizhny Novgorod, 2004).

Based on the materials of the dissertation, 13 works have been published.

Propositions to be Defended

1. Methodological approaches to the formation of rehabilitation groups, intra-institutional programs, and inter-institutional rehabilitation routes, based on the study of the dynamics of micro-social groups with consideration of the child's age, social status, stage of the rehabilitation process, and level of provision with rehabilitation resources.

2. The integration of the medical, psychological-pedagogical, and social components of the rehabilitation program as the main condition for the effectiveness of rehabilitation measures for children and adolescents at each stage of the rehabilitation process.

3. A model of step-by-step organization of rehabilitation for children and adolescents, including those from socially disadvantaged families, as the optimal option for conducting measures of comprehensive rehabilitation of the child contingent at the municipal level, ensuring comprehensiveness, continuity, sequence, and succession of rehabilitation.

Structure and Volume of the Dissertation

The dissertation is presented on 202 pages of typed text and consists of an introduction, a literature review, a chapter on the scope and methods of research, three chapters of original observations, a conclusion, conclusions, practical recommendations, and appendices. The list of used literature includes 343 domestic and 37 foreign sources. The work is illustrated by 27 tables and 21 figures. The appendix presents samples of maps used in the research, regulatory documents, expert-rehabilitation and informational-reference documentation, and forms of implementing the results of the research in practice.