Organisation of Medical and Social Assistance in the Context of Reforming Inpatient Social Care for Disabled Children with Mental Disorders in Moscow Region

Background: the Russian Federation is currently undergoing an intensive process of reform of residential social care, with the aim of improving the quality of life and for people with disabilities to realise their civil rights. No studies on analysing the quality of rehabilitation activities in residential social institutions were found in the available literature, which became the basis for the present study. The aim of the research is to study the process of rehabilitation activities in children’s boarding homes of the Moscow region for children with mental illnesses (hereinafter referred to as ChBH), to identify factors that influence the effectiveness of recommended and implemented rehabilitation measures for children with disabilities, and to analyse the existing quality criteria of rehabilitation services for disabled people in ChBH. Material and Methods: the content analysis of the main legal and regulatory documents that ensure the implementation of medical and social care, the process of providing rehabilitation service and ways of assessing their effectiveness was conducted. Results: residential children’s homes care for 4.2 per cent of the total number of disabled children in the region. The high need for rehabilitation services is determined by the prevalence of significantly pronounced impairments of mental and other vital functions among the inmates of boarding homes. The main tasks of residential children’s homes are to provide therapeutic, psychological and social assistance, as well as assistance in education and leisure activities. Serious gaps in staffing have been identified: the actual number of residents per one specialist significantly exceeds the norms, which negatively affects the quality of services. Rehabilitation activities are reflected in the personal files of residents, but no record of their results is kept. The Ministry of Social Development is responsible for implementing the measures recommended in individual rehabilitation and habilitation programmes (hereinafter referred to as IPRAH) for children with disabilities. According to the results of the evaluation of IPRAHs, the lack of results in the socially significant categories of life activity reaches 86 per cent. The procedure for independent assessment of the quality of services is regulated by law, but it is difficult for residents of children’s homes. The procedure for monitoring the quality of social services is not enshrined in normative acts. Conclusion: the identified shortcomings in the provision of rehabilitation services: lack of qualified specialists, territorial location, absence of clear criteria for assessing the results of rehabilitation measures and monitoring their provision to children with mental illness in residential institutions, require the development of an improved model for the provision of services to this contingent of citizens.

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