No abstract

The deinstitutionalization of social care in Lithuania started in 2012 after the adoption of the strategic guidelines by the Ministry of Social Security and Labour. The goal of this reform was to improve the care conditions and introduce new community-based services for persons with disabilities. Almost ten years of the reform resulted in only five percent of persons with disabilities who moved to community settings, mainly group-living homes. The slow-motion of the reform, as well as the tensions in the communities, suggests the need for a thorough analysis of the process of deinstitutionalization and its improvement. Bronfenbrenner’s ecological theory is applied as a conceptual and methodological tool for understanding the roles of deinstitutionalization agents at different levels, including the Ministry of Social Security and Labour, municipalities, non-governmental organizations, social care institutions, and local communities. All of these agents are involved and diversely interact among themselves during the transformation process of the social care system. The ecological theory provides the necessary integrated approach to the analysis of the process of deinstitutionalization of the social care system at the micro-, meso-, exo-, and macro levels. Deinstitutionalization and the trajectories of its participants reveal resilient connections with different fields of the ecological system and show that different system components not only represent different systems but become microsystems themselves that affect all elements in the ecological system. The complexity of environmental systems constitutes the basis of ecological systems theory. It serves as a lens to guide the analysis of the transformation of a particular person’s life in the context of deinstitutionalization. Herewith, it is an appropriate tool for understanding the impact of deinstitutionalization on specific local communities.

Lithuanian social, health care legislation and preparedness of these systems in Vilnius municipality to comply with obligations of Article 19 of UN Convention on the Rights of Persons with Disabilities are analysed in this article. Results show unpreparedness of municipality to ensure human right standards for persons with disabilities.

Purpose This paper aims to explore the symbolic meanings of physical places and social spaces for community members with and without disabilities in the process of relocation of people with disabilities into the communities. It particularly focuses on the potential of city events to become places for interacting with each other. Design/methodology/approach The data was gathered using two methods: drawing ecological maps (indicating places a person visits) and conducting interviews with people with disabilities and other community members. The ecological map is based on the theory of Bronfenbrenner (1979, 1986). Empirical data was gathered in four Lithuanian communities by drawing ecological maps and conducting interviews with community members with disabilities (35) and without disabilities (24). Findings Data shows that two groups occasionally overlap in physical locations but seldom interact socially. However, city events which are rare, but provide a clearer structure for persons with disabilities and are attractive to other community members as well, offer a good starting point for inclusion. Research limitations/implications Further research of community places where people with disabilities live and act could focus on, first, the gender differences in people with disabilities participation; second, on the challenging versus nonchallenging community environments and their role in the people with disabilities learning to live and act as community members and citizens. It is also essential to explore the meaning of privacy in the participation of people with disabilities, and the potential of private and less private places to facilitate their inclusion. Practical implications In the context of the ongoing deinstitutionalization, it is essential to identify the means of and desirable support for people with disabilities for their interaction in cafés, markets, bus stops and street corners, which encompass fewer preconditions for preparation. This implies, that practitioners should consider developing the abilities of people with disabilities to cope with the “chaotic order” of social gatherings. However, community-based citizenship implies not only festive city events but participation in decision-making. Thus, social policy actors should consider including people with disabilities in the community councils, increasing information accessibility and thus implementing the vision of an inclusive community. Originality/value The originality and value of the research lies in revealing the “framed” nature of people with disabilities participation. This type of participation is determined by their institutional experience, financial means and whose appearance (“coming in groups”) is frequently noticed by the community members.

[straipsnis, santrauka, reikšminiai žodžiai lietuvių kalba; santrauka ir reikšminiai žodžiai anglų kalba] Anksčiau atliktų tyrimų rezultatai rodo, kad kochlearinė (klausos) implantacija kartu su nuosekliai įgyvendinama klausos lavinimo programa gali užtikrinti sėkmingą kurčių vaikų socialinę integraciją. Kochlearinė implantacija Lietuvoje atliekama nuo 1998 metų. Iki 2017 metų pabaigos šalyje implantuoti 377 asmenys, dauguma iš jų – vaikai. Daugelis šios srities tyrimų yra skirta klinikiniams ar technologiniams kochlearinės implantacijos aspektams nagrinėti, tačiau trūksta darbų, kuriuose būtų nagrinėjami sveikatos politikos ir socialinės integracijos klausimai. Straipsnyje apžvelgiama dabartinė kochlearinės implantacijos sistema, implantacijų paplitimas ir paciento kelias. Tyrime derinami teisės aktų bei kitų dokumentų analizės ir aprašomosios statistikos metodai. Straipsnio autorių žiniomis, tai pirmas tyrimas, skirtas kochlearinės implantacijos sistemos apžvalgai Lietuvoje.