St. Petersburg is a city of federal significance which constitutes a subject of the Russian Federation and an administrative centre of North-Western Federal Okrug.

The total area (with subordinate territories) is 1 million 439 thousand square kilometres. The city area borders on Leningradskaya Oblast and on Finland along the Gulf of Finland.

The overall number of permanent residents is 4 million 567,9 thousand persons. Density of population amounts to 3,17 persons per square km. About 63,3 per cent of the residents are people of active working age, 12,4 per cent are under working age, whereas 24,3 per cent are above working age. The average age of the population is 40,9.

The Governess of the city is Mrs. Valentina Matvienko, who was vested with the authorities of head of the administration of the city of St. Petersburg on December 22, 2006.

Rehabilitation and social protection of people with disabilities
Basic information

As of May 1, 2007, the total number of people recognised disabled and registered with the social protection authorities is 754.237 (16,7 per cent of the city population).

Each year, around 55-60 thousand persons in St. Petersburg confer the status of disabled for the first time at the institutions of medical and social examination. Almost a third of them are people of active working age, around 3 per cent of them are children. Up to 90 thousand people (of which almost 8 per cent are children) are recognized disabled after re-examination. An individual rehabilitation programme is developed by the institutions of medical and social examination for each disabled individual with positive predictive estimate and positive potential for rehabilitation. Over 15 thousand individual rehabilitation programmes are developed each month by the institutions of medical and social examination.

Since individual rehabilitation programmes for the eligible disabled were put in practice two years ago, more than a quarter of people with disabilities registered in the Automated Information System “Digital Social Register of the Population” have received an individual rehabilitation programme from the institutions of medical and social examination (as a result of the first or a recurring examination) and have embarked on its realisation (189.465 persons, or 25,1 per cent). Among disabled citizens of active working age who have sound rehabilitation prospects (currently 123.767 persons), almost half have received an individual rehabilitation programme and have embarked on its realisation (58.753 individuals, or 47,5 per cent). Out of all disabled children residing in the city (13.667), almost 70 per cent (9.370, or 68,6 per cent) have received an individual rehabilitation programme and are using the respective rehabilitation services.

Administrative authorities of the system of social protection of the community of St. Petersburg are in charge of the organisation of rehabilitation of people with disabilities, co-ordination of activities of rehabilitation institutions and provision of necessary support to disabled citizens in the realisation of an individual rehabilitation programme.

All district divisions of social protection of the community include highly qualified specialists responsible for the execution of individual rehabilitation programmes in each district. They receive and consult citizens who are in progress of the realisation of an individual rehabilitation programme, provide counselling, designate the social rehabilitation service providers, assign the disabled citizens to concrete rehabilitation institutions, and render assistance to parents of disabled children in the realisation of an individual rehabilitation programme.

Over two years of individual rehabilitation programme practice, more than 240 thousand individual rehabilitation programmes have been implemented. More than 35 thousand disabled people in need of social rehabilitation sought assistance from the district divisions of communal social protection; almost half of them were assigned by the specialists of the district divisions of communal social protection to the specialized social rehabilitation service providers.

The Department of Methodological Guidance on Rehabilitation Issues with the City Committee for Labour and Communal Social Protection is in charge of organisation, co-ordination and guidance of rehabilitation activities of divisions of social protection of the community.

Methodological Council for the Issues of Rehabilitation of the Disabled with three permanent working groups was established with the City Committee for Labour and Social Protection of the Community in order to effectively co-ordinate the efforts of municipal authorities of St. Petersburg, public institutions, non-governmental and other organisations of St. Petersburg aimed at the organisational and methodological support of the process of comprehensive rehabilitation.

The three working groups are designed to implement the following tasks:
• Co-ordination of rehabilitation institutions (the group is composed of heads and specialists of rehabilitation institutions);
• Co-ordination and organisation of district divisions for communal social protection (the group is composed of rehabilitation specialists from district divisions for communal social protection);
• Interdepartmental commission for co-ordination of efforts in the field of rehabilitation of the disabled (comprises representatives of all agencies and structures, including those of federal level which are engaged in the rehabilitation process and in the implementation of individual rehabilitation programmes).

At present, pursuant to the Concept of Development of System of Social Protection of the Community of St. Petersburg for 2006-2010 accepted by the Resolution of the Government of St. Petersburg No. 559 of May 16, 2006, the city has embarked upon the establishment of specialized institutions – centres for social rehabilitation of children and adults with disabilities. The institutions are being established in each city district. By the end of 2007, more than 100 of social rehabilitation divisions will have been created within the planned framework of such institutions. Efforts are made on the city level in order to improve the legislation of St. Petersburg in the field of social protection of the community, to establish the system of standards and norms of social support and rehabilitation, to set up mechanisms regulating the performance of social service providers irrespective of their ownership, to ensure the effective co-ordination of authorities and organisations of all forms within the framework of social protection and rehabilitation.

Most medical rehabilitation services are provided to disabled citizens by out-patient clinics, by city and district consulting and diagnostic centres, by specialized departments of city hospitals, by clinics with medical universities and research institutes, and on an in-home basis. Rehabilitation departments are being widely established within the city system of health care.

Education and training for children with limited abilities and disabilities is provided by both specialized (corrective) and comprehensive schools. The latter if needed receive psychological, medical and social support and are provided with special training facilities. St. Petersburg maintains a large network of specialized (corrective) schools and pre-school institutions: 58 schools and boarding schools and 362 pre-school institutions for children with speaking disorders, visual and hearing impairments, locomotive disabilities, mental impairments, developmental disorders and severe failures of central nervous system.

Occupational rehabilitation is realized through basic, secondary and higher vocational training institutions (both specialized and general). Furthermore, disabled citizens receive support in obtaining employment opportunities from both specialized and general employment agencies. Pursuant to the law of St. Petersburg, a quota system is set for the city enterprises in order to ensure the employment opportunities for people with disabilities. According to the quota, in 2006 more than 16 thousand employment opportunities were created for the disabled by the city enterprises. About 10 thousand disabled individuals seeking employment applied to the communal employment agency for the information. A third of them were consequently employed and more than a half of them conferred the status of unemployed, a respective welfare and other benefits, including free training courses provided through employment agency.

A few specialized vocational training schools within the jurisdiction of the City Committee for Labour and Social Protection of the Community operate in St. Petersburg and provide specialized training to people with different disabilities:

1. Vocational Rehabilitation Lyceum was established in 1943. The institution provides vocational training for people with disabilities of the 1st and 2nd categories aged from 16 to 40. The duration of the training programme is from 1 to 2 years. The students can receive one of 11 professional qualifications and specializations, including seamstress, typewriting, shoemaking, machine knitting, PC user.

The total number of students is 395, more than 100 of them receive training in the Lyceum’s affiliate in the federal Research Centre of Medical and Social Examination, Prosthetics and Rehabilitation named after G. Albrecht. Each year 175-190 students leave the Lyceum with a qualification; more than 50 per cent find a respective job opportunity, 10-15 per cent opt for in-house occupation.

2. Vocational Rehabilitation Centre. The centre was established in February 1996 under the International Social Project of the Federal Ministry of Labour and Social Issues of Germany, Ministry of Labour and Social Development of the Russian Federation, and the municipal administration of St. Petersburg. The project activities were based on the 25-year experience of a similar German centre operating in Frankfort on the Main.

The Vocational Rehabilitation Centre provides vocational training to people with disabilities aged 18 to 45. The training is based on the methodologies for basic, secondary and supplementary vocational education. Over 1200 individuals with disabilities have received training since the opening of the Centre. The share of the Centre’s students subsequently employed is 65 per cent. This result is achieved through the active co-operation with the employment agency and through the job fairs for the disabled held annually from 1997.

A specialized “Centre for Medical and Social Rehabilitation of the Visually Impaired” provides basic rehabilitation services and preliminary training for the visually impaired (mostly those who acquired the visual impairment at the adult age). The duration of the training course is 2,5 months.

The Centre implements comprehensive rehabilitation programmes for people with visual disability aimed at the effective integration of individuals with severe visual dysfunctions and a complete loss of sight into the society. The Centre provides social rehabilitation services to the visually impaired of the 1st and 2nd category both on out-patient and on in-patient (residential) basis.

Social rehabilitation services are mainly provided by departments and centres for social rehabilitation within the governmental system of social protection of the community.

A network of institutions for social protection within municipal and district jurisdiction was established and currently effectively operates in the city in order to implement the respective social and rehabilitation services.

Among the municipal institutions within the jurisdiction of the Committee of Labour and Social Protection of the Community one should mention 12 in-patient residential institutions providing social support: 8 psychoneurologic residential institutions and 4 boarding homes for children. These institutions currently provide boarding and housing to 6.800 citizens (including 6.150 adults and 650 children) in need of permanent assistance, care and supervision.

Tenants of residential institutions receive the necessary range of social, medical, psychological, training and rehabilitation services. The institutions are equipped with vocational facilities and centres for comprehensive rehabilitation:
• A rehabilitation centre equipped with facilities for vocational training, social adaptation, development of compensatory and adaptation skills in young disabled people with congenital mental disorders aged 16 to 40 has been operating on the basis of psychoneurologic residential institution No. 10 for 15 years. The tenants also receive curative physical training and use recreational facilities.
• An affiliate of this residential institution, Social Centre for Rehabilitation of Disabled by Birth, operates in the settlement of Shapki of Leningradskaya Oblast. The Centre with the support of a Russian-Finnish project works with young disabled people to equip them with the basic adaptation and independent living skills, to provide occupational and recreational activities for disabled children and people disabled by birth.
• Rehabilitation Centre with the Boarding Home for Children with Mental Disabilities No. 1 is soon to be put in operation. The Centre includes a residential complex for 100 patients, a production unit for 150 work places, including 50 work places for the disabled living in their families, and a recreational and curative unit with a cinema and concert hall and several gyms. The Centre’s aim is to develop and test the state-of-the-art social rehabilitation technologies and to implement individual programmes of rehabilitation of people with disabilities. The Centre is currently realising a complex of programmes of medical, educational and occupational rehabilitation (with vocational training and guidance), as well as measures for social adaptation and preparation of young disabled people to the independent life through operating a training residential unit.
• A rehabilitation department is been established with the Children Boarding School No. 5.

In September 2006 a City Centre for Social Rehabilitation of the Disabled was opened in the town of Pushkino. The Centre provides comprehensive social rehabilitation services on an out-patient basis (up to 100 visits daily) and on an in-patient basis (84 residential places). The Centre is focused on the individual rehabilitation programmes and provides social and psychological rehabilitation (which includes development of basic social and self-care skills), occupational rehabilitation (vocational guidance, basic vocational training and activities), recreational activities and physical training. The Centre is equipped with a state-of-the-art gym, a swimming pool, a cinema and concert hall, a specialized social rehabilitation unit for in-patient services with training apartments for the preparation of the disabled to the independent life. This Centre will become the main city centre for the development of advanced state-of-the-art social rehabilitation technologies, new forms and methods of rehabilitation, specialist training and re-training.
A special emphasis in St. Petersburg is put on rehabilitation assistance to disabled children. In order to facilitate the comprehensive rehabilitation of children with disabilities, regional targeted medical and social programmes “Children with Disabilities” were developed and implemented in 1998-2003 in St. Petersburg. From 2004, interdepartmental Plans of Support to Children with Disabilities and their Families have been realised with the participation of the Committee of Labour and Social Protection of the Community, Committee for Healthcare, Committee for Education and District Administrations of St. Petersburg.

These plans and programmes aimed at the rehabilitation of children residing in boarding institutions foresee a range of measures focused on the improvement of children’s living conditions and social and medical services (acquisition of medical equipment, setting up training facilities, introduction of new rehabilitation techniques – horse riding, psychological counselling, art therapy, physical training, units for occupational therapy). The institutions promote an open doors policy which encourages children to participate in communal events, in-school tournaments and festivities visited by a large number of guests. Individuals able to lead an independent life after finishing the boarding school receive municipal accommodation and employment opportunities in the city.

Rehabilitation institutions and departments are being established in all city districts in order to facilitate the assistance to children living in their families.

Currently, four centres of social rehabilitation of disabled children operate on the territory of St. Petersburg in the form of legal entities, departments for rehabilitation are opened in 12 city districts under public institutions and Comprehensive Centres for Social Support to the Community (as many as 59 rehabilitation departments operated at the beginning of 2007).

Social rehabilitation centres and departments provide the following range of social rehabilitation services:
1. Social rehabilitation services:
1.1. Adaptation to social and living conditions: development and restoration of essential self-care skills, including hygienic care, food assumption, basic household chores (basic cooking, washing, ironing, cleaning, use of household appliances);
1.2. Adaptation to social environment: development of social and communication skills (communication with the family, friends, strangers, familiarity with services and officials who can be applied for help, visiting shops, theatres, money management skills), basic personal safety skills at home and elsewhere; legal counselling for families of disabled children;
1.3 Training on how to use technical rehabilitation aids and prosthetic and orthopaedic devices;
1.4 Consulting on accessibility of the environment and on adaptation of housing facilities and workplaces, assistance in the selection of technical aids and assistive technologies.
1.5. Social and cultural rehabilitation (art therapy, music therapy, game therapy, other kinds of recreational therapy).

2. Social rehabilitation services also include a range of occupational (vocational) rehabilitation activities, such as:
• occupational guidance in the form of testing, counselling, selection;
• basic vocational training;
• co-ordination with vocational institutions, enterprises and district employment agencies aimed at training and subsequent employment of adolescents with limited abilities.

3. Psychological rehabilitation services are provided to disabled children and members of their families, especially parents. These services include psychological diagnostics, counselling, corrective activities, psychological training.

4. Adaptive physical training is aimed at development of physical, psychological, functional and mental abilities of disabled people. Physical training activities include adaptive physical education, motive recreation, sportive events. In order to ensure effective physical training activities, centres and departments are being equipped with gyms and swimming pools.

One of the key problems related to the process of comprehensive rehabilitation is inadequate organizational and methodological support of the rehabilitation system, and in particular:
• Lack of regulations for the development and realization of individual rehabilitation programmes and for individual rehabilitation programme performance assessment after the completion of the individual rehabilitation programme;
• A range of organizational and methodological documents regulating the performance of rehabilitation service providers (standard regulations of a rehabilitation institution, standard material, technical and staffing provision of a rehabilitation institution, rehabilitation programmes for an institution, regulations of performance and assessment, regulation of licensing and accreditation related issues in the rehabilitation system);
• Rehabilitation standards (a list of rehabilitation services and means of rehabilitation for the disabled by general dysfunctions and limitations; procedures of implementation of rehabilitation activities);
• Adequate staffing of the rehabilitation system. Development and realization of programmes for training and re-training of rehabilitation professionals for institutions, services and public authorities in the rehabilitation system (through the system of contracting out of training services for rehabilitation specialists).

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