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UBC Theses and Dissertations

Rehabilitation in Canada : policies and provisions : a study of obstacles to the implementation of comprehensive… Choy, Ivy Fung-Tsing 1965

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REHABILITATION IN CANADA:  POLICIES AND PROVISIONS  A study o f o b s t a c l e s t o the implementation of comprehensive r e h a b i l i t a t i o n s e r v i c e s f o r Canadians  by IVY FUNG-TSING CHOY ALLAN S. HARTLEY JANET KERR MICHAEL SIEBEN  T h e s i s submitted i n P a r t i a l F u l f i l l m e n t o f the requirements f o r the Degree o f MASTER OF SOCIAL WORK i n the S c h o o l o f S o c i a l Work  Accepted as conforming t o the s t a n d a r d r e q u i r e d f o r the degree o f Master o f S o c i a l Work  School o f S o c i a l Work.  1965 The U n i v e r s i t y  of B r i t i s h  Columbia  In the  r e q u i r e m e n t s f o r an  British  mission  for reference  for extensive  p u r p o s e s may  be  cation  of  written  Department  of  degree at  the  study.  copying of the  Library  Head o f my  permission.  Columbia,  fulfilment  University  of  of  s h a l l make i t f r e e l y  this thesis  agree for  that  Department  shall  not  per-  scholarly or  t h a t ; c o p y i n g or  for f i n a n c i a l gain  The U n i v e r s i t y o f B r i t i s h V a n c o u v e r 8, Canada  the  I further  I t i s understood  this thesis  w i t h o u t my  that  and  g r a n t e d by  representatives.  this thesis in partial  advanced  Columbia, I agree  available  his  presenting  be  by publi-  allowed  In p r e s e n t i n g  this thesis i n partial  f u l f i l m e n t of the  requirements f o r an advanced degree a t the U n i v e r s i t y of B r i t i s h Columbia,  I agree that  f r e e l y a v a i l a b l e f o r reference  the L i b r a r y and study.  s h a l l make i t I further  agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s .  I t i s understood  that  copying or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l  gain  s h a l l not be allowed without my w r i t t e n  School o f S o c i a l Work The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada.  permission.  In the  r e q u i r e m e n t s f o r an  British  mission  for reference  for extensive  p u r p o s e s may  be  advanced  of  and  written  Department  of  Library  Head o f my  permission.  Columbia,  fulfilment  University  shall  this thesis  agree for  that  of  per-  scholarly  Department  shall  of  make i t f r e e l y  or  t h a t , c o p y i n g or  for f i n a n c i a l gain  The U n i v e r s i t y o f B r i t i s h V a n c o u v e r 8, Canada  the  I further  I t i s understood  this thesis  w i t h o u t my  study.  the  in partial  degree at  the  copying of  g r a n t e d by  representatives.  cation  this thesis  Columbia, I agree that  available  his  presenting  not  be  by publi-  allowed  ABSTRACT I t s h o u l d be a x i o m a t i c t h a t R e h a b i l i t a t i o n i s p a r t o f t h e s o c i a l p o l i c y o f any modern s t a t e . When Canada signed t h e U n i t e d Nations C h a r t e r , she pledged h e r s e l f t o implement a comprehensive range o f h e a l t h s e r v i c e s f o r her people. Health s e r v i c e s according t o United Nations d e f i n i t i o n s , have always i n c l u d e d t h e f i v e major a s p e c t s o f p r e v e n t i o n , d i a g n o s i s , treatment, r e s t o r a t i o n and r e h a b i l i t a t i o n . The purpose o f t h i s study, which i s t h e f i r s t o f a planned s e r i e s , i s t o examine what p r o g r e s s Canada has made toward t h e implementation of t h a t promise, made t o h e r p e o p l e i n 1948. I t s focus i s on i d e n t i f i c a t i o n of the b a r r i e r s l e g a l , p o l i t i c a l , economic s o c i a i c a h c i a d m i n i s t r a t i v e which m i t i g a t e a g a i n s t the r e a l i z a t i o n o f t h i s n a t i o n a l l y s e t o b j e c t i v e . The study began w i t h the h y p o t h e s i s t h a t because i n modern i n d u s t r i a l i z e d s o c i e t i e s , programmes o f r e h a b i l i t a t i o n s e r v i c e s u s u a l l y stem from a l e g i s l a t i v e base, the l o g i c a l p l a c e t o b e g i n i d e n t i f i c a t i o n and a n a l y s i s of o b s t a c l e s t o implementation o f a f u l l range o f s e r v i c e s , would be a review of t h e s t a t u t o r y p r o v i s i o n s f o r s e r v i c e s . I f o b s t a c l e s were i d e n t i f i e d a t t h i s l e v e l , t h e i r e f f e c t on t h e p a t t e r n i n g and l e v e l s o f s e r v i c e s c o u l d then be examined and i n d i c a t i o n s c o u l d be o b t a i n e d as t o how f a r a m o d i f i c a t i o n o f the l e g i s l a t i v e s t r u c t u r e o f s e r v i c e s might c o n t r i b u t e t o t h e development o f a more comprehensive system. As a p r e l u d e t o t h i s a n a l y s i s i t was necessary f i r s t t o d e l i n e a t e what i s e n t a i l e d i n the concept o f a comprehensive system o f s e r v i c e s and t o d e f i n e the terms " d i s a b i l i t y " and "handicap". I n t e r n a t i o n a l s o u r c e s were used e x t e n s i v e l y , and i t was found t h a t i n s p i t e o f w i d e l y d i f f e r i n g p o l i t i c a l , economic and s o c i a l i n s t i t u t i o n s , and arrangements, t h e r e was almost complete agreement on the b a s i c p r i n c i p l e s o f r e h a b i l i t a t i o n . Ten major p r i n c i p l e s were i d e n t i f i e d and r e c o r d e d . Next an attempt was made t o i d e n t i f y c r i t e r i a f o r r e h a b i l i t a t i o n goals as r e l a t e d t o the i n d i v i d u a l d i s a b l e d p e r s o n . I t was found t h a t both t h e n a t i o n a l and the i n t e r n a t i o n a l m a t e r i a l c o n s u l t e d was geared t o v o c a t i o n a l r e h a b i l i t a t i o n as a g o a l and t h a t most statements d i d not take s u f f i c i e n t cognisance o f t h e person who cannot reach t h i s g o a l , but who might a c h i e v e a d i f f e r e n t l e v e l o f achievement and s a t i s f a c t i o n . An attempt was made t o c l a s s i f y these g o a l s i n a way which would be u s e f u l both t o c l i e n t s and a g e n c i e s . Because each country has implemented t h e b a s i c r e h a b i l i t a t i o n p r i n c i p l e s i n i t s own way, t h e r e i s no one system o f s e r v i c e s which can be used as a model f o r a comprehensive system. However, working from t h e base o f t h e p h i l o p s o p h y and the t e n p r i n c i p l e s , i t was found p o s s i b l e t o c l a s s i f y t h e k i n d and range of s e r v i c e s which would have t o be i n c l u d e d i n a comprehensive scheme. This was s p e l l e d out f o r use i n t h i s study and i n f u t u r e p r o j e c t s i n t h e s e r i e s as a " t o u c h s t o n e " or model p r o f i l e o f s e r v i c e s w i t h a c a u t i o n a r y reminder t h a t no.system o f s e r v i c e s i s or s h o u l d be s t a t i c and t h a t r e h a b i l i t a t i o n i t s e l f i s a c o n s t a n t l y e v o l v i n g concept. I t i s a n t i c i p a t e d t h a t i t w i l l serve a t l e a s t as a u s e f u l base a g a i n s t which t o examine a wide range o f problems r e l a t i n g t o r e h a b i l i t a t i o n i n f u t u r e p a r t s o f the s e r i e s .  ii The many f a c e t e d n a t u r e o f r e h a b i l i t a t i o n as a concept was next examined i n more d e t a i l because t h e t o t a l concept needs t o permeate the whole range o f s e r v i c e s . Emphasis was p l a c e d on t h e concept o f r e h a b i l i t a t i o n not j u s t as a s e t o f s e r v i c e s but as a p r o c e s s , a " f o r ward movement towards a g o a l " which t h e c l i e n t chooses and which t h e v a r i o u s r e h a b i l i t a t i o n p e r s o n n e l h e l p him t o r e a c h . The study then f o c u s e s on an examination o f t h e c u r r e n t Canadian picture i n rehabilitation. T h i s was preceded by a b r i e f summary o f the e a r l y developments i n r e h a b i l i t a t i o n i n Canada, s t r e s s i n g t h e " p i e c e m e a l " and " c a t e g o r i a l " approach c h a r a c t e r i s t i c o f t h e times, and the unique f e a t u r e s i n t h e Canadian s i t u a t i o n . M a t e r i a l f o r t h i s was o b t a i n e d from t h e g e n e r a l l i t e r a t u r e , t o g e t h e r w i t h m a t e r i a l o b t a i n e d from the o f f i c e o f the N a t i o n a l C o o r d i n a t o r o f R e h a b i l i t a t i o n f o r Canada and from correspondence w i t h t h e P r o v i n c i a l C o o r d i n a t o r s o f f i c e s l o f n i n e p r o v i n c e s , e x c l u d i n g Quebec. The r o l e o f t h e f e d e r a l government was then a n a l y s e d , w i t h p a r t i c u l a r r e f e r e n c e £ 0 i t s r e s p o n s i b i l i t i e s under t h e d i v i s i o n o f c o n s t i t u t i o n a l powers made under t h e B r i t i s h North America Act o f 1867. The s p e c i f i c groups f o r whose r e h a b i l i t a t i o n the f e d e r a l government has r e s p o n s i b i l i t y a r e then r e f e r r e d t o . ; The p o l i c y o f t h e f e d e r a l government i n i t s attempts t o a s s i s t the provinces to carry t h e i r r e s p o n s i b i l i t y f o r r e h a b i l i t a t i o n services i s c r i t i c a l l y reviewed. There i s then a c l o s e r examination o f the t h r e e s p e c i f i c a c t r e l a t i n g t o t h e d i s a b l e d i n Canada, f i r s t t h e D i s a b l e d Persons Allowance A c t , s e c o n d l y t h e V o c a t i o n a l R e h a b i l i t a t i o n o f t h e D i s a b l e d A c t , and t h i r d l y t h e r e l e v a n t s e c t i o n s o f t h e T e c h n i c a l and Vocational Training Act. There i s next a f o c u s s i n g on the e f f e c t s of t h i s l e g i s l a t i v e s t r u c t u r e on t h e p a t t e r n i n g o f s e r v i c e s i f i one p a r t i c u l a r p r o v i n c e , B r i t i s h Columbia. Emphasis i s l a i d on t h e r e l a t i o n s h i p between t h e r o l e o f t h e P r o v i n c i a l C o o r d i n a t o r , t h e p l a c e o f t h e government a g e n c i e s , and the important r o l e o f v o l u n t a r y a g e n c i e s . M a t e r i a l f o r t h i s s e c t i o n was gathered from government s t a t i s t i c s , Royal Commission Reports, surveys and r e p o r t s o f l o c a l a g e n c i e s , i n t e r v i e w s w i t h t h e P r o v i n c i a l C o o r d i n a t o r and t h e P r o v i n c i a l C o n s u l t a n t i n R e h a b i l i t a t i o n f o r the P r o v i n c e o f B r i t i s h Columbia as w e l l as w i t h t h e p e r s o n n e l o f s e l e c t e d r e p r e s e n t a t i v e a g e n c i e s o f f e r i n g a broad coverage o f the spectrum o f s e r v i c e s i n B r i t i s h Columbia. As a c o n t r a s t , the n e i g h b o u r i n g p r o v i n c e o f Saskatchewan was s e l e c t e d as an i l l u s t r a t i o n o f t h e d i f f e r i n g ways i n which i d e n t i c a l f e d e r a l s t a t u t e s can be i n t e r p r e t e d and f o l l o w e d , and th e d i f f e r i n g ways i n which a p r o v i n c i a l programme o f r e h a b i l i t a t i o n s e r v i c e can be s t r u c t u r e d and a d m i n i s t e r e d . In Saskatchextfan, t h e p r o v i n c i a l government of t h e C o - o p e r a t i v e Commonwealth F e d e r a t i o n p a r t y coming i n t o o f f i c e i n the 1945, took an a c t i v e r o l e i n t h e r e h a b i l i t a t i o n f i e l d from t h e time i t f i r s t took o f f i c e , u n t i l i t s d e f e a t i n 1962, t h e now famous "medicare i s s u e . "  iii  T h i s government interpreted i t s own s t a t u t e s and those of the f e d e r a l government v e r y b r o a d l y , i n c l u d i n g from the b e g i n n i n g s o c i a l l y handicapped groups such as the M e t i s . In r e l a t i o n t o the f e d e r a l a c t s , i t i n c l u d e d groups such as a l c o h o l i c s i n i t s concept of the " d i s a b l e d " which i s not y e t a common p r a c t i c e i n the r e s t o f Canada. T h i s government's approach was a l s o c h a r a c t e r i z e d by an e x t e n s i v e use of the "needs" t e s t r a t h e r t h a n the means t e s t as a base from which to o f f e r r e h a b i l i t a t i o n h e l p t o the e n t i r e f a m i l y i f n e c e s s a r y . W h i l e the "needs" t e s t i s used i n B r i t i s h Columbia a l s o t h e r e are a number of r e s t r i c t i o n s i n i t s use, which do not operate i n Saskatchewan, such as a "maximum f l o o r " of f i n a n c i a l a i d which might be below the l e v e l of h e l p an i n d i v i d u a l or f a m i l y needed i n order t o become r e h a b i l i t a t e d . Among the f i n d i n g s of the study are the f o l l o w i n g (1) t h a t the f a t e of a Canadian n e e d i n g r e h a b i l i t a t i o n sew i c e s depends v e r y much on which p a r t of Canada he l i v e s i n . Even w i t h i n h i s own p r o v i n c e , h i s neighbour a c r o s s the s t r e e t who happens t o l i v e w i t h i n the b o u n d a r i e s of another m u n i c i p a l i t y may f a r e f a r b e t t e r than he does. (2) The k i n d and amount of h e l p he r e c e i v e s would appear t o be determined by t h r e e f a c t o r s (a) the n a t u r e of the h e l p a v a i l a b l e under the statutes, (b) the l i b e r a l i t y or r i g i d i t y of t h e i r i n t e r p r e t a t i o n by the authorities of t h i s p a r t i c u l a r l o c a l i t y (c) the a v a i l a b i l i t y of the k i n d o f h e l p he needs through the v o l u n t a r y a g e n c i e s ( 3 ) a l l the attempts by the F e d e r a l government t o overcome the o b s t a c l e s posed by the c o n s t i t u t i o n a l d i v i s i o n of powers have not r e s u l t e d i n " n a t i o n a l minimum" f l o o r or s e r v i c e below which no Canadian s h a l l be allowed to f a l l , d e s p i t e many r e i t e r a t i o n s by the f e d e r a l government t h a t t h i s i s the i n t e n t , both of the l e g i s l a t i o n and of the e f f o r t s to a s s i s t the p r o v i n c e s which the f e d e r a l government has made to d a t e . ( 4 ) In essence, the f e d e r a l r o l e i s b a s i c a l l y l i m i t e d t o a s s i s t i n g the p r o v i n c e s w i t h whatever s e r v i c e s or f a c i l i t i e s the p r o v i n c e s themselves are w i l l i n g t o i n i t i a t e . ( 5 ) The c o n c l u s i o n i s i n e s c a p a b l e t h a t the e f f e c t of the p r e s e n t c o n s t i t u t i o n a l d i v i s i o n of powers on the development of comprehensive r e h a b i l i t a t i o n s e r v i c e s i s an impeding one. (6) In e f f e c t , the p r o v i n c e s and the v o l u n t a r y s o c i t i e s c a r r y f u l l r e s p o n s i b i l i t y and the major p o r t i o n of the l o a d , w i t h o u t h a v i n g e i t h e r the l e g i s l a t i v e a u t h o r i t y or the f i n a n c i a l c a p a c i t y . A s e r i e s of recommendations broad,and s p e c i f i c , a r e then made. They i n c l u d e (1) Changing the B r i t i s h North America Act as a n e c e s s a r y s t e p t o the f l e x i b i l i t y of p a t t e r n i n g needed to make Canada's R e h a b i l i t a t i o n S e r v i c e s comprehensive.(2) That the F e d e r a l government s h o u l d assume a v i g o r o u s r o l e as the s t a n d a r d s e t t i n g body i n the f i e l d o f r e h a b i l i t a t i o n s e r v i c e s , and s h o u l d implement the concept of a n a t i o n a l minimum of s e r v i c e . T h i s i s viewed as a n e c e s s i t y whether the f e d e r a l government c o n t i n u e s i t s p o l i c y o f e x t e n d i n g f i n a n c i a l a i d to the p r o v i n c e s , or whether a d i f f e r e n t system of l e g i s l a t i v e and f i s c a l r e s p o n s i b i l i t y i s e v e n t u a l l y worked out. A s e r i e s o f " r e s e a r c h q u e s t i o n s " a r i s i n g out of t h i s study are w i t h the i n t e n t t h a t these w i l l form a nucletra of f u r t h e r r e s e a r c h up s t u d i e s l a t e r i n the s e r i e s .  listed follow-  ACKNOWLEDGEMENTS  We wish t o acknowledge our s p e c i a l thanks and a p p r e c i a t i o n t o Mrs.  Mary Tadych, our t h e s i s a d v i s o r , who d i r e c t e d  her d i r e c t i o n and encouragement.  the p r o j e c t , f o r  We a l s o wish t o thank Mr. C. E .  Bradbury, P r o v i n c i a l C o o r d i n a t o r f o r the P r o v i n c e o f B r i t i s h Mr.  Frank Hatcher,  Rhona Lucas,  P r o v i n c i a l R e h a b i l i t a t i o n C o n s u l t a n t and ':-> Mrs.  E x e c u t i v e S e c r e t a r y o f the D i v i s i o n f o r t h e Guidance o f  the Handicapped, Community Chest in  Columbia,  and C o u n c i l , who gave o f t h e i r  i n t e r v i e w s and i n s t e e r i n g us t o sources  of material.  time  We a r e a l s o  i n d e b t e d to t h e p e r s o n n e l o f a number o f government and v o l u n t a r y agencies who granted us i n t e r v i e w s and allowed us t o see t h e i r  facilities,  and  so c o u r t e o u s l y answered our many q u e s t i o n s .  We a l s o w i s h t o thank  Mr.  I a n Campbell, N a t i o n a l C o o r d i n a t o r , and Mr. K e i t h Armstrong, o f t h e  Canadian R e h a b i l i t a t i o n C o u n c i l f o r t h e i r a s s i s t a n c e . to  t h e P r o v i n c i a l C o o r d i n a t o r s o f a l l the p r o v i n c e s  We a l s o owe thanks  ( except Quebec) f o r  t h e i r h e l p f u l l e t t e r s f u l f i l l i n g r e q u e s t s f o r i n f o r m a t i o n , and t h e i r generous o f f e r t o h e l p us i n any way they  could.  V  TABLE OF CONTENTS Page Abstract  ii  Acknowledgements  v  Tables and Charts  vii  Introduction  viii  Nature of the study. A p r i o r i assumptions  Rationale f o r the study  SECTION I PROFILE OF THE PROBLEM Chapter 1  Perspectives and D e f i n i t i o n s International Perspective. Rehabilitation C l a s s i f i c a t i o n o f handicapped groups.  Chapter 2  defined  Analysis of R e h a b i l i t a t i o n as a Composite Concept R e h a b i l i t a t i o n as a Philosophy. As a set of p r i n c i p l e s , As a process. As a series o f stages. As a Series o f Services. C r i t e r i a f o r successful r e h a b i l i t a t i o n . C l a s s i f i c a t i o n of r e h a b i l i t a t i o n goals. I d e n t i f i c a t i o n of necessary Services. P r o f i l e s of a "model" System of Services. P r o f i l e of the E a r l y Developmental Pattern of R e h a b i l i t a t i o n Services i n Canada  Chapter 3  E a r l y services o f the voluntary agencies. Entrance of the Government into the F i e l d . Piecemeal and Categorial Approach. Developments i n the T h i r t i e s . Developments i n the Post World War I I Period. Developments i n the F i f t i e s and S i x t i e s . SECTION I I THE ROLE OF THE FEDERAL GOVERNMENT IN REHABILITATION Chapter 4  The L e g i s l a t i v e Base for R e h a b i l i t a t i o n i n Canada  Services  The B r i t i s h North America Act. The Constitutional D i v i s i o n o f Power. The Role of the Federal Government Analysed. Current Interpretations.  VI  Chapter 5  Federal R e s p o n s i b i l i t y f o r the R e h a b i l i t a t i o n of S p e c i f i c Groups Programmes' f o r Mariners, Indians, Eskimos, Veterans and the B l i n d , Some H i s t o r i c a l Anomalies.  Chapter 6  Federal F i n a n c i a l Assistance to the Provinces i n Rehabilitation An overview. Health Grants Programmes Viewed as an Example. The Hospital and Diagnostic Services Act. SECTION I I I  CRITIQUE OF SPECIFIC FEDERAL AIDS RELATING TO REHABILITATION Chapter 7  Critique of the Disabled Persons Allowances Act  Chapter &  C r i t i q u e of the Vocational R e h a b i l i t a t i o n of of the Disabled Act  Chapter 9  Critique of the Technical and Vocational Act  Training  SECTION IV PROFILE OF THE PATTERNING OF REHABILITATION SERVICES IN A PARTICULAR PROVINCE - BRITISH COLUMBIA Chapter 10  R e h a b i l i t a t i o n Servic es i n B r i t i s h Columbia, with Special Reference of the L e g i s l a t i v e Base. E f f e c t s of the D i v i s i o n of Responsibility of the Patterning of Services. SECTION V PROFILE OF A DIFFERENT PERSPECTIVE ON REHABILITATION THE SASKATCHEWAN APPROACH  Chapter 11  R e h a b i l i t a t i o n i n Saskatchewan  Chapter D_2  Conclusions and Recommendations  VI t  TABLES AND  Table  No.  Schedule A  Activities  1.  2.  3.  4.  5.  6.  7.  8.  9.  10.  11.  CHARTS IN THE TEXT  of Daily  Living  Chapter I I  p.20  P r o v i n c i a l Percentage o f Rejected Applicants  Chapter V I I  p.9  O r g a n i z a t i o n Chart - C i v i l i a n R e h a b i l i t a t i o n Program  Chapter V I I I  p.4  R e h a b i l i t a t i o n Cases and Cost o f Support Compared t o Incomes  Chapter V i l l i  p.9  Payments to P r o v i n c e s and P r o v i n c i a l Populations  Chapter V I I I  p.23  F i n a n c i a l S t a t u s B e f o r e and After Rehabilitation  Chapter V I I I  p.24  O c c u p a t i o n B e f o r e and Rehabilitation  Chapter V I I I  p.25  Chapter V I I I  p.26  Chapter IV  p.8  Chapter X  p.26  Cause of D i s a b i l i t y i n New Admission, G.F. Stong Centre  Chapter X.  p.59  Employment S t a t u s of D i s c h a r g e d P a t i e n t s from G.F. S t r o n g  Chapter X.  p.60  After  D i s a b i l i t y Groups by Age, and L o c a t i o n  Sex,  F e d e r a l Payments and Program Breakdown Primary Cause o f D i s a b i l i t y Accepted Cases o f D i s a b l e d Allowance  in  PART I  OBSTACLES ORIGINATING IN THE LEGISLATIVE BASE OF SERVICES  viii INTRODUCTION The r o l e of r e h a b i l i t a t i o n i s becoming increasingly important i n modern s o c i e t i e s *  Congenital d i s a b i l i t i e s , accidents, and the degener-  ative diseases of the l a t e r part of the l i f e s p a n w i l l continue to tax our knowledge and resources i n the remaining decades of the twentieth century, Bike most modern states, Canada i s concerned with the implementation of  a comprehensive system o f r e h a b i l i t a t i o n services f o r her people.  We  pledged ourselves to t h i s as a nation when, i n 1948, we signed the United Nations Charter,  The recent Royal Commission on Health Services reminds  us how f a r we have yet to go. One way i n which we might hasten our progress i s t o examine our current pattern of services t o see what changes might need to be made i f we are to reach the goal of comprehensive r e h a b i l i t a t i o n services a v a i l a b l e to  a l l Canadians who need them.  This i s e s p e c i a l l y necessary at the  present time because the Royal Commission stated that i t was outside i t s terms of reference to consider anything other than the health aspects of  rehabilitation.  In modern times, r e h a b i l i t a t i o n i s a welfare matter  a l s o , and i t Was that great Canadian, Harry Cassidy, who gave a d e f i n i t i o n of welfare services which i s almost synonomous with some modern d e f i n i t i o n s of r e h a b i l i t a t i o n , viien he da?ined them as " Those organized a c t i v i t i e s which are primarily and d i r e c t l y concerned with the conservation, protection and improvement o f human resources." Yet there are s t i l l s u r p r i s i n g l y few studies of Canadian s o c i a l programmes made by Canadians,  This i s not because Canada has not had her  experts i n the welfare f i e l d who have constantly striven t o bring t h i s need home t o us.  As f a r back as 1949, Leonard Marsh said " We need t o  record and analyse the o r i g i n s , development and current progress of l e g i s l a t i o n , programmes, and :.. . i n s t i t u t i o n s . , .in  a l l the various f i e l d s of  welfare, ... A great deal has happened i n the las;t twenty to f i f t y years. ... Are these developments and t h e i r lessons recorded?" In the years since 1949,  some very i n t e r e s t i n g developments and experiments i n the f i e l d of  ix  r e h a b i l i t a t i o n s e r v i c e s have taken p l a c e i n Canada. we have a d e q u a t e l y r e c o r d e d  Can i t be s a i d t h a t  them, i n t e r p r e t e d them and l e a r n e d t h e l e s s o n s  they can t e a c h u s a s t o o u r f u t u r e d i r e c t i o n s ?  When we l o o k a t t h e  wealth o f m a t e r i a l o f t h i s k i n d which some o t h e r  c o u n t r i e s produce i t  might perhaps be s a i d w i t h t r u t h t h a t Canada i s t e n d i n g l e s s o n s o f h e r own development. appropriate  t o overlook the  I t was w i t h t h i s i n mind t h a t i t seemed  t o the w r i t e r t o inaugurate a s e r i e s o f studies i n the area o f  comprehensive r e h a b i l i t a t i o n s e r v i c e s } t h a t a u s e f u l f o c u s would be t o concentrate  on i d e n t i f y i n g t h e o b s t a c l e s , l e g a l , p o l i t i c a l ,  economic,  s o c i a l and a c l m i n i s t r a t i v e - which o p e r a t e as b a r r i e r s t o t h e implementation o f a comprehensive range o f s e r v i c e s , because t h i s would be t h e n e c e s s a r y p r e l u d e t o d e v i s i n g ways o f d e a l i n g w i t h them. Accordingly,  this first  p a r t o f t h e s t u d y was undertaken w i t h t h e  a s s i s t a n c e o f f o u r s t u d e n t s working f o r t h e i r M a s t e r ' s Degree i n S o c i a l Work a t t h e S c h o o l o f S o c i a l Work, U n i v e r s i t y o f B r i t i s h Columbia, and forms t h e t h e s i s r e q u i r e m e n t f o r t h a t d e g r e e .  A l o g i c a l place t o begin  appeared t o be t h e l e g i s l a t i v e base o f s e r v i c e s s i n c e t h e p r o v i s i o n o f r e h a b i l i t a t i o n s e r v i c e s i n most modem c o u n t r i e s u s u a l l y stems from t h i s level. far  I t was p o s t u l a t e d  reaching  t h a t o b s t a c l e s e x i s t i n g a t t h i s l e v e l would have  r e s u l t s on t h e e x i s t i n g p a t t e r n o f s e r v i c e s and would need t o  be r e v i e w e d most c a r e f u l l y i n any p l a n n i n g has  t h e r e f o r e been c a l l e d  Services."  I t should  f o r change.  " A Study o f O b s t a c l e s  be t h e f o r e r u n n e r  i n v e s t i g a t e other obstacles  P a r t 1 o f t h e study  i n t h e L e j . s l a t i v e Base f o r  o f a s e r i e s o f p r o j e c t s which w i l l  i n g r e a t e r depth i n f u t u r e y e a r s ,  ^  1 T h i s i n t r o d u c t i o n h a s been w r i t t e n b y Mrs. Mary Tadych, D i r e c t o r o f t h e T h e s i s p r o j e c t , t o g i v e t h e r a t i o n a l e and background o f t h e present s t u d y , as t h e f i r s t o f a planned s e r i e s .  SECTION  I  PROFILE OP THE PROBLEM  TABLE OP CONTENTS Page Chapter I:  Perspectives and Definitions  International perspectives on r e h a b i l i t a t i o n . The concept of r e h a b i l i t a t i o n defined Chapter I I :  An Analysis of Rehabilitation as a Composite Concept  Rehabilitation as a philosophy. Rehabilitat i o n as a set of p r i n c i p l e s . Rehabilitation viewed as a process. Rehabilitation viewed as a series of services. Rehabilitation viewed as a set of f a c i l i t i e s . The organizat i o n of r e h a b i l i t a t i o n Chapter I I I :  1  10  P r o f i l e of the Development Pattern of Rehabilitation i n Canada  Early developments i n r e h a b i l i t a t i o n i n Canada. World War II and early post-war period. Developments during the 1950's. Developments i n the 1960's  61  i  CHAPTER I PERSPECTIVES AND DEFINITIONS  International Perspective on Rehabilitation Crippling disease and injury respect no international boundaries.  The a f f l i c t i o n s of mankind and the s o c i a l or  economic consequences of those a f f l i c t i o n s are as common to Asians as to Americans.  Pain, doubt, fear, anxiety, discourage-  ment, and the f i n a l surrender to d i s a b i l i t y are universal emotions and experiences. Just as r e h a b i l i t a t i o n seems to c a l l forth the best i n individual and community understanding and e f f o r t , so the challenge of man's attempt to conquer his own handicaps appear to s t r i k e a chord of deep response i n the area of international concern and cooperation.  The character of r e h a b i l i t a t i o n  services which have been developed  i n various countries through-  out the world i s necessarily different by reason of the s o c i a l , economic, c u l t u r a l and p o l i t i c a l variations and requirements. This, however, does not negate the importance and necessity of the sharing of ideas and knowledge, of encouragement, guidance, cooperation and f i n a n c i a l assistance among the countries of the world. It i s s i g n i f i c a n t that some of the most f r u i t f u l cooperation among countries has taken place i n the f i e l d of r e h a b i l i t a t i o n of the handicapped.  A world federation of  -  2 -  voluntary agencies has been i n existence since 1922 when the International Society for the Welfare of Cripples was founded to study causes of c r i p p l i n g diseases, c o l l e c t and disseminate information and to stimulate action f o r the benefit of the physically disabled by l o c a l national and international organizations.  The Society has also sponsored a productive  series of international conferences.  At the Eighth World Congress  i n New York i n I960, i n keeping with the times, the Society adopted the new name of "The International Society for Rehab i l i t a t i o n of Disabled". At the governmental l e v e l , when the World Health Organization came into being i n 1948, i t inherited the functions of the antecedent organizations of the League of Nations and has since made i t s own unique contributions to the f i e l d of r e h a b i l i t a t i o n .  Its stated purpose i s to aid attainment  by a l l peoples of the world of the highest possible l e v e l of health.  Its a c t i v i t i e s i n the areas of p u b l i c i t y and informa-  t i o n , research and promotion of standards, preventive health measures, technical advice, and supplies and the training of personnel through fellowships and seminars, backed by the tremendous weight of i t s authority and prestige have proven of immense value i n stimulating the coordination of world e f f o r t on behalf of the disabled. Two of i t s most notable contributions bear special mention.  The f i r s t i s the International Labour Office Re-  commendation concerning vocational r e h a b i l i t a t i o n of the disabled, which was unanimously adopted by the International Labour Office Conference i n June, 1955 as follows:  - 3 Vocational r e h a b i l i t a t i o n services should be made available to a l l disabled persons whatever the o r i g i n and nature of t h e i r d i s a b i l i t y and whatever t h e i r age, provided they can be prepared for and have reasonable prospects of securing and retaining, suitable employment. This was adopted by the 78 member states as a formal I.L.O. Instrument. The significance of this i s best expressed i n the words of the Director General of the International Labour O f f i c e . But the adoption of an international instrument i s not the end of the a f f a i r ; i t i s only a beginning. Under the Constitution of the I.L.O. each member state, must, withi n eighteen months a f t e r the close of the Conference, consider whether to give effect to a Recommendation by l e g i s l a t i o n or other means; a statement on t h i s action must then be submitted f o r information to the Internat i o n a l Labour O f f i c e . Subsequently, members have to report at appropriate intervals the position of the law and practice i n t h e i r countries on the subject matter of the Recommendation and any action they may have taken on i t . With this information, the Conference can see what p o s i t i v e action has resulted from i t s previous decisions. Even more important, then reports can prepare the ground for the organization to provide any further adviee or assistance which a country might need and ask fori We have already received reports from a number of countries.... Some of the reports state that the standards set are already subs t a n t i a l l y covered i n t h e i r own l e g i s l a t i o n . Others indicate that further action i s being considered. To bring l e g i s l a t i o n up to the l e v e l indicated i n the Recommendation. We anticipate that the I.L.O. w i l l be able to expand i t s technical assistance services to help governments which wish to create or improve services f o r the disabled.1  David A. Morse, Planning for Victory over Disablement, "Way Back to Working Life",Address given by D.A. Morse, Dir.-Gen. of the  A second important contribution was that of the Expert Committee on Medical Rehabilitation which published i t s report i n 1958.  While t h i s has not been proclaimed an 'international- -  instrument  1  as vocational r e h a b i l i t a t i o n recommendation was,  nevertheless, the experts agreed "that medical r e h a b i l i t a t i o n forms the fourth phase i n the whole scheme of health and medical measures applicable to an i n d i v i d u a l or to a communi t y - namely the promotion of health, the prevention of disease the treatment of disease and medical rehabilitation.""^ So there are already some i d e n t i f i e d areas of agreement on p r i n c i p l e s and standards at the international l e v e l . Nevertheless,  the pattern of r e h a b i l i t a t i o n services to be  developed and implemented i n each i n d i v i d u a l country must be adapted and geared to the actual need, the pattern and l e v e l of development of the related services,as well as to the s o c i a l and economic setting of the people, as recognized and by themselves.  decided  One of the f i r s t problems facing a country i s  i t s own d e f i n i t i o n of the term " r e h a b i l i t a t i o n " . The Concept of Rehabilitation Defined The term 'Rehabilitation' has been variously defined. The American National Council on Rehabilitation defined i t as  International Labour O f f i c e , Geneva at the Seventh World Congress of the International Society for the Welfare of Cripples, London, 1957. Proceedings of the Seventh World Congress published by the Central Council of the Caape of Cripples, London, 1957, pp. 263-4. ''"Expert Committee on Medical Rehabilitation World Health Organization Technical Report Series, No. 158, p. 5.  -  5 -  the "... restoration of the handicapped to the f u l l e s t physical, mental, s o c i a l , vocational and economic usefulness of which they are capable."  1  Perhaps, t h i s d e f i n i t i o n i s too i d e a l as  i t i s doubtful as to how many individuals presently  living  can be said to be ' f u l l y ' developed according to t h e i r potentialities.  The Canadian Department of IIHealth and Welfare has  stressed that the aim of r e h a b i l i t a t i o n i s not only to restore human capacities, but to cultivate and conserve residual 2  abilities.  In both of these d e f i n i t i o n s , the focus i s on  restoring the 'residual' d i s a b i l i t i e s of the handicapped person. The definitions offered by A l l e n , provides us with a broader focus of the concept*  Looking at i t i n terms of i t s  objectives, A l l e n stated that i t i s "... making a person aware of his potential and then providing him with the means of attaining that potential."  In a more s p e c i f i c sense, he used  i t to mean the "... combination of d i s c i p l i n e s , techniques and specialized f a c i l i t i e s which are intended to provide physical restoration, psychological adjustment, personal and vocational counseling, job training and placement."  4  Allen's  first  "^National Council on Rehabilitation, Cleveland 1944, p. 6. Department of Health and Welfare, Research and S t a t i s t i c s D i v i s i o n . Rehabilitation Services i n Canada. Part I . Health Care Series, Memorandum No. 8, Ottawa I960, p. 3. •5  A l l e n , S. Rehabilitation: A Community Challenge. John Wiley & Sons, Inc., New iork, I9t>o, pp. J L - 2 . 4  Ibid.  -  6  -  d e f i n i t i o n i s important as i t introduces the concept of i n d i v i d u a l motivation. In the f i n a l analysis, the success of the r e h a b i l i t a t i o n process i t i s very much up to the c l i e n t - the basic p r i n c i p l e of self-determination. It i s here also where the concept of 'Habilitation' comes i n , to be applied to the process of not only restoring, but achieving independence, self-care and work-potential i n the f i r s t instance. This applies especially to the group of children,who have been disabled from early l i f e on, owing to congenital or other reasons. Distinctions between the terms " d i s a b i l i t y " and "handicap" were f i r s t enunciated by Kenneth Hamilton and have since become part of the l i t e r a t u r e of rehabilitation.''" A handicap i s the cumulative result of the obstacles which d i s a b i l i t y interposes between the individual and his maximum functional l e v e l . I t i s an individual thing, composed of the barriers which the handicapped person must surmount i n order to a t t a i n the f u l l e s t physical, mental, s o c i a l , vocational and economic usefulness of which he i s capable. Thus, a 'disabled' person i s "an individual with a condition of physical, mental or emotional impairment which can be quantitati v e l y and q u a l i t a t i v e l y evaluated i n medical or other objective terminology." A 'handicapped' person, on the other hand, i s "an individual with a condition of physical, mental or emotional impairment i n which the emphasis i s on the cumulative results  Hamilton Kenneth. Counselling the Handicapped i n the Rehabilitation. Ronald Press, New York, 1950, p. 17.  - 7 which the d i s a b i l i t y has interposed between the individual and his maximum functional l e v e l . " A 'disabled* person may or may not be 'handicapped' while a 'handicapped' person always has a d i s a b i l i t y .  The  l a t t e r , of course, determines the handicap by causing a measureable loss i n the individual's capacity and by creating barriers which the 'handicapped' person must surmount i n order to a t t a i n the maximum usefulness of which he i s capable and to achieve independence. The concept of the handicapped individual has been broadened i n recent years.  Generally speaking, " r e h a b i l i t a -  t i o n " to date has tended to be oriented primarily towards the physically handicapped, and the majority of i t s resources are geared to the medical and vocational r e h a b i l i t a t i o n of such patients.  Consequently, r e h a b i l i t a t i o n f a c i l i t i e s f o r the  following groups have, i n one way or another, been greatly overlooked and neglected. 1.  The Mentally Handicapped; Included i n t h i s group  are the mentally i l l as well as the mentally retarded i n d i viduals.  The former category includes the variety of patients  ranging from the mildly 'neurotic' to the severely 'psychotic' where expert psychiatric and other services are needed f o r t h e i r treatment and r e h a b i l i t a t i o n .  In the l a t t e r category,  there are the 'mildly' retarded who are able to function r e l a t i v e l y 'independently' i n society, the moderately retarded who wilh t r a i n i n g and supervision can contribute something to t h e i r own support, and the 'severely' retarded who need  custodial i n s t i t u t i o n a l i z e d care. 2.  The Emotionally Handicapped: There i s some doubt  as to where t h i s g£oup should he c l a s s i f i e d . They have been l i s t e d under the "mentally" handicapped, but t h i s has l e d to confusion. They need psychiatric and other related services f o r t h e i r r e h a b i l i t a t i o n , though they may not be "mentally i l l " i n the l a y sense of the term. 3. The S o c i a l l y Handicapped:  This i s a miscellaneous  group, which appears under a number of c l a s s i f i c a t i o n s . may include  It  c e r t a i n disadvantaged c u l t u r a l groups, such as  the Indian and the Eskimo -sometimes separately l i s t e d as the " c u l t u r a l l y handicapped" and also recent immigrants , minority c u l t u r a l and r e l i g i o u s groups, such as the Doukhobours and the H u t t e r i e s . l t c e r t a i n l y included migrant labouring groups. I t might also include i n some c l a s s i f i c a t i o n s the "marginal!' group on s o c i a l assistance, the socalled multi-problem family and the vagrant. Some c l a s s i f c a t i o n s include the alcoholic aid the drug addict. 4.  Children with Special Needs" Included i n t h i s group  are the so called "exceptional" children who are i n need of special education. I t has been estimated that 3$ of the nation's children are mentally retarded and need special program and f a c i l i t i e s f o r the f u l l e s t development of t h e i r capacities. On the other side of the continuum are the ten to  - 9 15?° who are 'gifted*, whose i n t e l l e c t u a l p r o t e n t i a l i t i e s can only he achieved  and developed when properly guided by the  environment, by challenge and stimulation.  In the B r i e f by  Canadian Mental Health Association to the Royal Commission on Health Services, 1962, i t was stated that 5$ - 10$ of school children show symptoms of emotional and mental disorder s u f f i c i e n t l y serious to require the help of s p e c i a l l y trained personnel.  S i m i l a r l y , children with multiple handicaps such  as deafness together with blindness also need an increase i n the specialized range of services. 5.  Old People: Included  i n t h i s category are the  'aged* who are bed-bound and home-bound, where the r e h a b i l i t a t i o n 'goal' l i e s at the l e v e l of self-care and the a c t i v i t i e s of d a i l y l i v i n g , without ever reaching the 'goal' of gainful employment.  CHAPTER I I AN ANALYSIS OF REHABILITATION AS A COMPOSITE CONCEPT  Any attempt to assess the extent to which Canada may be said to have a comprehensive system of r e h a b i l i t a t i o n services must be related to an analysis of the concept of r e h a b i l i t a t i o n i t s e l f as a composite involving many elements. Rehabilitation  attempts often f a i l because one of the v i t a l  components i n the r e h a b i l i t a t i o n process was overlooked. It i s proposed to make a review of r e h a b i l i t a t i o n i n i t s varied aspects to serve as a kind of "touchstone" which l a t e r phases of the study can refer to as the parts of the study r e l a t i n g to s p e c i f i c services and programmes are undertaken i n the future. Rehabilitation  as a Philosophy  The philosophy of r e h a b i l i t a t i o n can be said to be the rationale behind any r e h a b i l i t a t i o n program recognized and developed i n any country,  While i t i s not intended to dwell  on t h i s , nevertheless, i t i s important enough to be noted because many of our f a i l u r e s i n r e h a b i l i t a t i o n can be traced to a f a i l u r e to imbue services rendered to the handicapped person with the " l i v i n g breath" of the philosophy.  - 11 In western countries, i t i s said that the JudaeoChris-tian heritage has played an important role i n the i n creased interest i n r e h a b i l i t a t i o n i n recent years.  However,  the philosophic base from which r e h a b i l i t a t i o n begins i s fundamentally related to two moral p r i n c i p l e s to which most of mankind i n modern societies would subscribe: 1.  Value of the Human Being. The dignity and worth of  the i n d i v i d u a l i s to be cherished and respected regardless of how severe his d i s a b i l i t y may be.  This includes his rights  to be assisted i n the unfolding of his personality and the development of his p o t e n t i a l i t i e s for his own sake and f o r the good of society as a whole. 2.  Membership i n Society. The mutual dependence and  trust which form the base of a society's organization imply that the person with a d i s a b i l i t y , l i k e anyone else, should partake of the a c t i v i t i e s that society has to o f f e r i n so f a r as he i s able.  Consequently, society i s obliged to establish  schools, hospitals and work opportunities that w i l l meet the needs of a l l i t s members.  When special needs are evident,  special arrangements to accomodate them are implied. In short, i t can be said that the philosophy  i s echoed  i n the Universal Declaration of Human Rights adopted and proclaimed by the United Nations' General Assembly on December 10, 1948: Everyone has the right to a standard of l i v i n g adequate for the health and well-being of hims e l f and of his family, including food, clothing, housing, medical care and necessary s o c i a l services, and the right to security i n the  - 12  -  event of unemployment, sickness, d i s a b i l i t y , widowhood, old age or other lack of l i v e l i hood i n circumstances beyond his control. ( A r t i c l e 25 (1)). S i m i l a r i l y , a corresponding view i s expressed by the World Health Organization with regard to children as follows: Every c h i l d has the right to develop his potentials to the maximum. This implies that a l l children, irrespective of whether or not they suffer from mental or physical handicap, should have every access to the best medical diagnosis and treatment, a l l i e d therapeutic services, nursing and s o c i a l services, educat i o n , vocational preparation, and employment. They should be able to s a t i s f y f u l l y the needs of t h e i r own p o t e n t i a l i t i e s and become, as f a r as possible, independentand useful members of society.1 P r i n c i p l e 5 of the United Nations Declaration on the Rights of the Child, adopted by the Commission on Human Rights of the United Nations i n 1959 "The c h i l d who  states: i s physically, mentally or s o c i a l l y  handicapped s h a l l be given the special treatment, education 1  and care required by his particular condition." Rehabilitation as a Set of Principles One way to view r e h a b i l i t a t i o n i s to see i t as a set of p r i n c i p l e s flowing from the value system of i t s philosophic base.  Again, many of our f a i l u r e s i n the f i e l d of r e h a b i l i t a -  t i o n can be traded to the v i o l a t i o n of one or more of these principles i n some way or to some degree.  W.H.O. Technical Report Series No. 75, Organization.  Hence the principles  Geneva, World Health  - 13 play a prominent role i n any assessment of comprehensive  ser-  vices. 1.  The Principle of Individualization: People with the  same or s i m i l a r d i s a b i l i t y have different needs and thus required a f l e x i b l e and variable overall treatment plan geared:..-, to the p a r t i c u l a r individual person.  I f r e h a b i l i t a t i o n i s to  be t r u l y successful, every step i n the process must be caref u l l y planned to take into account the patient's attitudes, his tolerance, and his eventual goal.  General laws of behavior  and disease e n t i t i e s are important i n understanding the s p e c i f i c character of the individual and his needs, but there i s no such thing as a standard method f o r handling similar cases.  As a consequence,  the concept of V a r i a b i l i t y i n Treat-  ment should be used. 2.  The Principle of Comprehensive Treatment: The many  ramifications of adjustment to d i s a b i l i t y require attention to the individual's physical, emotional and s o c i a l problems i n cluding economic matters and the nature of his interpersonal relations at home and i n the wider community.  The  importance  of 'treating the person as a whole' becomes more important when such areas are realized to be interdependent; improvement i n one area often depends on improvement i n others. consequence,  Thus, as a  a whole range of services; health, medical, educa-  t i o n a l , s o c i a l , psychological, vocational are required.  This  does not preclude the use of 'normal' or 'general' services available i n the community whenever and wherever possible.  - 14 "5* The Principle of Adequacy: This p r i n c i p l e evaluates services both quantitatively and q u a l i t a t i v e l y .  There should  be s u f f i c i e n t coverage i n every area of need i n the range of services and the adequacy of the standards i n dealing with the problems. 4.  The Principle of A v a i l a b i l i t y : Rehabilitation  services should be available to any person i n need of them regardless of which l o c a l i t y he i s from.  Provisions must be  made to ensure that such person knows where he i s to start his enquiries about services.  He should be able to begin i n  his own p a r t i c u l a r place of residence, r u r a l or urban, even though he may have to go outside his community f o r some of the time i n order to get the services he requires. 5.  The Principle of the M u l t i - d i s c i p l i n a r y Approach:  This principle recognized that no one d i s c i p l i n e can meet a l l the r e h a b i l i t a t i o n needs of the handicapped person through i t s own resources.  Hence the many para-medical personnel to be  found i n the r e h a b i l i t a t i o n f i e l d today.  Basic to the "team  approach" i s a common understanding and broad evaluation of the needs of the handicapped person, plus joint planning and regular review with clear delineation who s h a l l carry which roles and f o r how long. In r e f e r r i n g to the s t a f f s of r e h a b i l i t a t i o n centres, A l l e n pointed out that there i s some chance f o r the s t a f f to err i n the d i r e c t i o n of one extreme or another; toward jealous assumption of prerogatives by one p a r t i c u l a r d i s c i p l i n e or toward the undiscerning insistence upon a l l members of  the r e h a b i l i t a t i o n team exerting their e f f o r t s upon each and every patient, regardless of whether he may have any r e a l need for some of the services.1 Team cooperation seems to be taken f o r granted whereas i t i s a c t u a l l y d i f f i c u l t to achieve. the patient can sense i t . constant  Where team "differences" exist,  These would be eliminated through  s t a f f education, group discussion of both patient  and methods, d e f i n i t i v e leadership on the part of the or coordinator. ment team may  administer  There should be recognition that the t r e a t -  operate out i n the community outside of the  setting of the r e h a b i l i t a t i o n centre and the h o s p i t a l . 6. may  The P r i n c i p l e of Patient-centred Approach; This  be seen as a c o r o l l a r y of the M u l t i - D i s c i p l i n a r y Approach,  where the patient i s conceived the r e h a b i l i t a t i o n team.  as a member of and central to  Though this does not necessarily  always follow i n practice, i t implies a f l e x i b l e approach which adapts service to the disabled person as contrasted with f i t t i n g a l l patients into a single regimen.  Above a l l ,  i t focuses attention upon the point of view and attitudes of the personnel,  t h e i r positive attitude and warmth provide a  bridge which permits the patient to move toward his r e h a b i l i t a t i o n 'goal'. 7.  The P r i n c i p l e of Integration and  Coordination:  Coordination of services requires a process of understanding and agreement between individuals and agencies which permits  A l l e n , S., Rehabilitation: A Community Challenge, op.cit., p. 64.  - 16 them to function e f f e c t i v e l y together to secure a more promising result f o r the disabled person.  Integration, on the other hand,  implies not merely the understanding and harmony as between services but the uniting of those services for a common purpose and to a ciommon end.  Although coordination i s both necessary  and important among community r e h a b i l i t a t i o n agencies, the keystone i n the development of successful r e h a b i l i t a t i o n of the handicapped  i s integration of aims and services; an applica-  t i o n of a l l services necessary to insure the patient's restorat i o n to his f u l l e s t capacity.  "Whereas the p r i n c i p l e of  comprehensive services points to horizontal integration of a variety of d i s c i p l i n e s at a given time, the p r i n c i p l e of long range planning stresses integration of present and  proposed  services.""'* 8.  The P r i n c i p l e of Recognition of the Time Dimension:  Rehabilitation i s a continuous process that applies to the i n d i v i d u a l as long as she needs help, and to society so long as conditions exist that interfere with the welfare of any group of i t s c i t i z e n s .  Rehabilitation should begin at the time  of recognition of any type of d i s a b i l i t y that interferes with 'satisfactory' s o c i a l functioning and performance, health, education, work or other areas.  Without early diagnosis and  Dean W. Roberts, The Planning of Rehabilitation Centers, "Evolution of the Rehabilitation Center Concept", Proceedings of the Institute on Rehabilitation Centers Planning, Chicago, February 25, March 1, 1957, published by U.S. Dept. of Health, Education and Welfare, U.S. Government Printing Office, Washington, D.C. 1957, p. 13.  - 17 treatment, with each passing month, the result w i l l be a greater f i x a t i o n of the d i s a b i l i t y thus reducing the opportuni t y for restoring the physical, mental, s o c i a l and economic function of the patient. 9.  The Principle of Maximum Integration  of the Handi-  capped into the Community: The 'handicapped' i n d i v i d u a l should not be separated from the 'normal' community except when and only for as long as necessary.  Blind children, for example,  should be placed or kept i n the ordinary kindergarten or school as much as possible. 10.  The Principle of Community Responsibility and  Participation: Experts and services alone cannot solve the problem of the attitude of the public to the disabled.  The  l o c a l blueprint for r e h a b i l i t a t i o n , the f a c i l i t i e s , the personnel, the services, the recreational  opportunities,  the job p o s s i b i l i t i e s , the public attitude, w i l l a l l be created i n and by the community.  Only acceptance of the 'handi-  capped* on equal terms w i l l offer r e a l opportunity for the success of r e h a b i l i t a t i o n e f f o r t s .  The role of the volunteer  services may range from voicing the need for r e h a b i l i t a t i o n to entire p a r t i c i p a t i o n i n direct services to the handicapped . Rehabilitation Viewed as a Process A dictionary d e f i n i t i o n of process i s "forward movement, progressive or continuous proceeding ... and advance ... passage".  It i s often forgotten "that the essence of r e h a b i l i t a -  - 18 -. t i o n i s that i t i s a process with a l l that t h i s implies. I t i s t r u l y a passage f o r the "patient" or " c l i e n t " and i t should be a passage toward a goal. The 'Goal' i n the Rehabilitation Process Restoration and achievement of maximum function of a b i l i t i e s that are l e f t i s the ultimate 'goal' of r e h a b i l i t a t i o n f o r people of a l l ages and d i s a b i l i t i e s .  Thus, i t must  be realized that the r e h a b i l i t a t i o n process i s a r e l a t i v e matter depending on the unique condition of the i n d i v i d u a l . Regardless of how 'limited* the l e v e l of 'goal' i s , effort should be made to help the person's achievement.  We can speak  of 'levels of possible goals' that might be c l a s s i f i e d as follows: 1.  Competitive employment i n the labour market.  2.  Employment under special (sheltered ) conditionst  remunerative or f o r s o c i a l s a t i s f a c t i o n . 3.  Working at home f o r remunerative, occupational or  diversional purposes. 4. Training i n homemaking s k i l l s f o r the disabled homemaker. 5.  Training i n communication s k i l l s : such as i n speech  or writing from the blind c h i l d to the bed-ridden and adult stroke patient. 6.  Training i n a c t i v i t i e s of d a i l y l i v i n g : these may  range from self-care a c t i v i t i e s such as eating, dressing, t o i l e t i n g , to wheel-chair s k i l l s , locomotive s k i l l s and use of  - 19 public transportation and f a c i l i t i e s i n public b u i l d i n g s .  1  7. Achievement of a c t i v i t i e s leading to personal s a t i s f a c t i o n : t h i s would include a c t i v i t i e s as painting with the use of teeth or feet; recreational or any other diversional or "self-expression" a c t i v i t i e s which a bed-ridden person may wish to t r y out. Whaterver l e v e l of goal the handicapped person may set himself, because r e h a b i l i t a t i o n i s a process, i t can usually be achieved only through a series of steps. Case-Finding This i s the sine qua non of r e h a b i l i t a t i o n .  It i s not  l i s t e d as the f i r s t step i n the process because i t i s the i n dispensable  " f i r s t a c t i v i t y " without which the r e h a b i l i t a t i o n  process cannot begin. medical diagnosis.  Sometimes, t h i s s e r v i c e ^ i s equated with  S t r i c t l y speaking, i t i s a broader concept.  It i s also a most controversial area i n r e h a b i l i t a t i o n i n the sense that i n most countries a compulsory r e g i s t r y i s not considered a good way.  Another case-finding device i s through a  designated agency which serves as a central place i n the community where the handicapped can go and to be advised as to where to proceed.  Regardless of how t h i s service i s to be  performed, i t should include medical, educational, and s o c i a l aspects.  vocational  While case-finding usually begins with a  medical diagnosis, t h i s i s only one aspect.  The phrase " A c t i v i t i e s of Daily L i v i n g was coined by Dr. Howard Rusk and has since come into general use i n the Rehabilitation f i e l d . He covers t h i s topic extensively i n his book Rehabilitat i o n Medicine, the C.V. Mosby Co. St. Louis, 1958, p. 146.  - 20 Schedule A - A c t i v i t i e s of Daily Living  CLASSIFICATION OF PATIENTS ACCORDING TO INDEPENDENCE FUNCTIONAL ACTIVITIES GROUP I II III  IV  PATIENT NEEDS HELP LIGTING  All A.D.L.  PATIENT IS INDEPENDENT  ASSISTANCE Patient not ready f o r any functional a c t i v i t y  A.D.L. Bed and wheel chair a c t i v i t i e s : Self-care a c t i v i t i e s A.D.L. Bed a c t i v i t i e s Wheel chair a c t i v i t i e s Self-care a c t i v i t i e s bating a c t i v i t i e s Dressing a c t i v i t i e s Toilet activities Travel: Private care (from wheel chair) A.D.L. Travel: Placing wheel chair into car. Ambulation i n p a r a l l e l bars: To standing position Standing and walking  A.D.L. Bed and wheel chair a c t i v i t i e s Self-care a c t i v i t i e s Travel: Private care (from wheel chair)  A.D.L. Bed and wheel chair a c t i v i t i e s Self-care a c t i v i t i e s Travel: Private car (from wheel chair) Placing wheel chair into car  Ambulation: 30 feet inside Climbing: "5-inch steps with r a i l VI  Ambulation: Climbing: 3 to 8 inch steps with r a i l 2 to 6-inch curbs  A.D.L. Bed and wheel chair a c t i v i t i e s Self-care a c t i v i t i e s Travel: Private car (from wheel chair' Placing wheel chair into car Ambulation: 40 feet inside  A.D.L. Bed and wheel chair a c t i v i t i e s Self-care a c t i v i t i e s Travel: Private care (from wheel chair), (standing Elevation: wheel chair, bed, toilet Ambulation: 40 to 80 feet i n side Climbing: 10 to 12 8-inch steps with r a i 6 to 8-inch curb A.D.L.: Wheel chair and ambulatory Ambulation: 80 to 120 feet continuously Cross street while l i g h t changes including curbs Climbing: 12 to 15 8-inch steps with r a i l Travel: Private car; public transportation (bus).  - 21 Steps i n the Rehabilitation Process 1.  The Assessment or Evaluation of Client  Assessment i s the f i r s t step i n the process and l i k e so much i n the f i e l d of r e h a b i l i t a t i o n i s a composite concept i n i t s e l f . It involves (a) Medical Evaluation: To establish the nature and  ex-  tent of the d i s a b i l i t y ; appraise the general (total) health status of the i n d i v i d u a l i n order to determine his capacities and l i m i t a t i o n s ; ascertain i f physical restoration services might remove, correct, or minimize the d i s a b i l i t y condition(s); and contribute a sound medical basis for selection of a r e h a b i l i t a t i o n objective.  Medical evaluation i s a continuing  or recurring a c t i v i t y throughout the r e h a b i l i t a t i o n process, not just a mere i n i t i a l step. (b) S o c i a l Evaluation: This involves securing s o c i a l history material which, taken as a whole, brings the c l i e n t into focus as an i n d i v i d u a l d i s t i n c t from others and points up his potential f o r benefiting from the r e h a b i l i t a t i o n process. S o c i a l history i s necessary for a diagnosis of the t o t a l problem and i s the background against which planning and treatment are undertaken.  This would include the understanding  of the family; his c u l t u r a l and economic background of the c l i e n t , and his p a r t i c u l a r l i f e  experiences.  (c) Psychological Evaluation: This results from a synthesis of psychometric data and information obtained  during  interviewing, counselling, and other aspects of the r e h a b i l i t a t i o n process,.  Psychological evaluation i s not an isolated  -  22  -  service but i s closely related to counseling and a l l other r e h a b i l i t a t i o n services.  Psychological tests, especially such  personality or projective tests, may  be valuable at any point  of the process, as they throw l i g h t on the person's reaction to himself as well as to the environment.  They may  also be  useful i n vocational planning as well as to see i f psychiatric help i s needed before a patient can benefit from r e h a b i l i t a t i o n . (d) Vocational Evaluation: This i s viewed as  gathering,  interpreting, analysing and synthesizing a l l the vocational s i g n i f i c a n t data regarding the i n d i v i d u a l and r e l a t i n g them to occupational requirements and opportunities. r e l a t i n g work and vocational t r a i n i n g history and  These include: family  opportunities, personal adjustment, mobility and family circumstances.  It i s especially important to r e l a t e the  results of vocational evaluation i n to the needs and wishes of the i n d i v i d u a l , as well as to t r a i n i n g opportunities and types of jobs available<near  the c l i e n t ' s home.  Relocation  of the family to enable the handicapped bread winner to get a suitable job may  have to be considered but i s not usually  resorted to except i n extreme circumstances i n a number of countries.  In other countries, i t i s expected accepted  planned for, with considerable help to the family both i n planning and 2.  follow-up. Rehabilitation Diagnosis:  The r e h a b i l i t a t i o n diagnosis i s the second step i n the process.  It brings together s i g n i f i c a n t data to enable an  - 23 evaluation to be made regarding: (a) the i d e n t i f i c a t i o n of problems, (b) the appraisal of r e h a b i l i t a t i o n objective or goal, (c) the i d e n t i f i c a t i o n of r e h a b i l i t a t i o n services needed. Determination of e l i g i b i l i t y for services may be necessary i n certain cases, and may create obstacles to the carrying out of the next phase of the process. 3»  The Rehabilitation Plan and i t s Implementation:  In planning and making the necessary arrangements for the program of services the basic principle should be observed that the c l i e n t needs to participate i n the planning and a s s i s t himself as f a r as possible. The counselling relationship which should be available to the handicapped person at each stage of the process should be devoted to and a s s i s t i n g the c l i e n t to involve himself i n the treatment plans and to make the best use of the program of services offered. Planning, l i k e diagnosis, i s an on-going, changing and developing thing as the client and his circumstances change, and thus should be continuously re-evaluated as to i t s appropriateness. 4.  Follow-up of Evaluation:  1  After the patient has learned and mastered whatever techniques are required for dealing with his d i s a b i l i t y , the  Sometimes, the term 'evaluation' i s used i n r e l a t i o n to follow-up and should not be confused with the use of the term 'evaluation' i n the assessment phase. When i t i s used i n r e l a t i o n to follow-up i t refers to the evaluation of the t o t a l helping process.  - 24 counselor should continue to help him to cope with problems i n the new s i t u a t i o n by means of follow-up v i s i t s .  Evaluation  should also be made as to the adequacy and s u i t a b i l i t y of the patient's functioning i n r e l a t i o n to his capacities and the objectives i n the r e h a b i l i t a t i o n process both at home i n his d a i l y - l i v i n g , and afterwards, i n his new work placement i f the r e h a b i l i t a t i o n goals reached so f a r . Evaluation should also be made as to the adequacy and s u i t a b i l i t y of the person's functioning i n r e l a t i o n to his capacities and the objectives i n the r e h a b i l i t a t i o n process.  In certain cases,  i t may be necessary to encourage patient to reach a higher l e v e l of achievement than the o r i g i n a l i n the r e h a b i l i t a t i o n goal; i n others i t may be necessary to help him accept the r e a l i t y of a "lower" or less demanding goal than the one o r i g i n a l l y set. Sometimes some of'the steps i n the r e h a b i l i t a t i o n process are formulated as "principles of the r e h a b i l i t a t i o n process" or "principles of the placement process" which makes r e h a b i l i t a t i o n l i t e r a t u r e so confusing at times.  One formulation  of these principles i s to be found i n the monograph "The Placement Process i n Vocational Rehabilitation Counselling" published by the U.S. Department of Health, Education and Welfare, which i s as follows: (l) Action must be based upon adequate diagnostic information and accurate and r e a l i s t i c interpretation of the information that i s secured.  -  25  -  (2) ^ach r e h a b i l i t a t i o n c l i e n t must be served on the basis of a sound plan. (3) Guidance and counseling of c l i e n t s and close supervision of a l l services are essential at each step of the process. (4) Bach service must be thoroughly rendered and followed-up. (5) The cooperation and involvement  of the c l i e n t and  a l l others concerned with his r e h a b i l i t a t i o n i s necessary and must be secured before adequate r e h a b i l i t a t i o n can be accomplished. (6) Adequate records must be kept."** It has been impossible to review the steps i n the r e h a b i l i t a t i o n process without refering to the r o l e of the counsellor.  There are d i f f e r i n g views as to whether there  should be one single counsellor through the entire process to ensure continuity or whether i t i s more feasible to expect that the person on the treatment team taking major responsi b i l i t y f o r counselling the c l i e n t may vary at any given moment and should do so as the c l i e n t progress through the various phases of the process.  Who should be designated to  the •counsellor role' and what training should best equip a person f o r i t are questions which have not yet been s a t i s f a c t o r i l y  U.S.. Dept. of Health, Education and Welfare, Office of Vocat i o n a l Reh. The Placement Process i n Vocational Rehabilitation Counselling. Thomason, Bruce and Barrett, Albert M., (ed.) tf.S. Government Printing Office Washington, U.S.A. Rehab. Service Series #545, p . 42.  - 26 answered i n r e h a b i l i t a t i o n .  Social workers have sometimes l a i d  claim to p r i o r i t y i n the counsellor r o l e . known to claim a monopoly i n i t .  Some have even been  Although the s o c i a l worker  c e r t a i n l y f i l l s this role f o r some of the time during the r e h a b i l i t a t i o n process, i t i s by no means clear at present how this function should be allocated i n the d i f f e r e n t stages i n the r e h a b i l i t a t i o n process.  The counsellor role i s viewed  as that of a person, who through a professional relationship, helps assess the c l i e n t ' s psychological readiness f o r change, helps him deal with any 'inner obstacle' of his own attitudes and feelings which may hinder his reaching of his r e h a b i l i t a t i o n goals, interacts with him i n such a way as to maximize his assets, yet at the same time, fosters r e a l i s t i c s e l f acceptance of the d i s a b i l i t y by the c l i e n t . I f the task of the counsellor seems a formidable one, i t s d i f f i c u l t i e s are minor compared to the tasks which the r e h a b i l i t a t i o n process usually involved f o r the c l i e n t .  An-  other way of viewing r e h a b i l i t a t i o n , and an essential one i n the understanding of the t o t a l process i s to view i t as a series of stages, each involving the mastery of certain tasks, which the c l i e n t must undergo i n most instances i f he i s successf u l l y to achieve his r e h a b i l i t a t i o n goal.. Although the term 'adjustment' i s i n bad odour i n some quarters, i t i s perhaps the best one to indicate what i s involved for the c l i e n t .  In  some way, hopefully, a constructive one, he must come to terms with his d i s a b i l i t y .  The Adjustment Process i n Rehabilitation The c l i e n t undergoing r e h a b i l i t a t i o n goes through a number of stages i n adapting to his d i s a b i l i t y .  These have  been variously i d e n t i f i e d i n r e h a b i l i t a t i o n l i t e r a t u r e .  One  approach i s to view the stages as adaptive processes of the ego.  1  Prom t h i s viewpoint, there are three phases of "re-  covery" i n the r e h a b i l i t a t i o n process. 1.  Emergency Reactions to Stress of Onset of D i s a b i l i t y :  Under the impact of sudden and severe stress, such as occurs with severe injury or i l l n e s s , emergency defence mechanisms such as repression and denial are called into play i n order to protect the patient from the f u l l impact of the s t r e s s f u l situation.  Thus, the patient may  'forget' the experience  or claim that he hardly f e l t the pain following the amputat i o n of his l e g by a r a i l r o a d locomotive.  This defense  mechanism can also operate where i t s onset i s gradual or has been present since b i r t h .  These reactions are universal and  normal and are not necessarily an indication that the person i s neurotica  There i s also often a period of depression  following the i n i t i a l 2. ate  shock.  Transitional Phase:  As a person i s able to appreci-  more c l e a r l y the extent of his d i s a b i l i t y or the seriousness  "^See the paper by Jay Bisgyer "The Adaptive Processes of the Ego" i n Proceedings of the Workshop: Practice of Social Work i n Rehabilitation given at the University of Chicago, I960.  -  28  -  of his i l l n e s s , additional reactions tend to occur.  At the  r e a l i t y l e v e l , the person i s confronted with certain factors, such as the effect of the d i s a b i l i t y on h i s a b i l i t y to f u l f i l l his roles as spouse, worker, parent, or i n the case of a c h i l d , the role of student.  He i s also confronted with some l i m i t a -  tions of function and possibly some effects on h i s general health.  While a person does not usually f u l l y accept a l l the  implications of his d i s a b i l i t y , at f i r s t , nevertheless i n this phase he should begin to allow these r e a l i t y considerations to predominate.  When t h i s happens, such responses are considered  "normal" f o r this phase. Certain responses also occur at the unconscious l e v e l . These psychological factors are related to the personality structure together with symbolic implications of the experience.  The injury may have a variety of meanings, such as  r e a l i z a t i o n of long-awaited punishment; confirmation of hidden feelings of loathsomeness  and shame; and increase i n dependency  that i s unconsciously deeply wished f o r . A certain amount of discharge of emotional tension i s inevitable i n the course of successful treatment and a certain amount of indulgence of the patient i s required. 3.  Phase of Later Convalescence, the Readjustment to  Outside Living: During this phase, the complications of the problems of 'secondary gain' through i l l n e s s may occur.  In  the case of a child h i s handicap may bring him special attent i o n , such as the presidency of his class, and protective attitudes on the part of certain teachers and class-mates, or give him a special place within his family group.  Adults too  may be overproteeted by t h e i r f a m i l i e s .  Instead, the patient  i s now required to make an adaptation to a new r e a l i t y .  He  must return to a competitive world recognizing that he i s less well equipped than formerly to cope with the competition. Together with the deleterious effect of well meaning but overprotective r e l a t i v e s and friends, the patient may wish to c l i n g on to h i s dependency.  These needs may go back to c h i l d -  hood experience and psychiatric treatment may be needed before they can be worked through. 4.  Some Indications of Malfunctioning of the Adaptive  Process; (a) a prolonged shock stage of emergency defenses, (b) prolonged depression or the absence of i t , and (c) the s a c r i f i c e of r e h a b i l i t a t i o n i n favor of secondary gain. In such instances, extra help and services are necessary, especially those of psychiatric nature, before the patient can move along and foreward i n the r e h a b i l i t a t i o n process. D i s a b i l i t y and the Body Image One of the fascinating paradoxes of the human condition i s that the human body, which unites us as a b i o l o g i c a l species, gives r i s e i n each of us, on a psychological l e v e l , to a bodyimage that i s one of the subtly unique features of the individual personality.  This body-image which b a s i c a l l y has to do with how  a person's body seems to him i s not only of the body as a whole, but also of different parts of the body.  One person takes pride  i n his muscular development and others are preoccupied with the  - 30. condition of the stomach or heart. body image i s c u l t u r a l l y determined.  To a certain extent, the But the intimate associa-  t i o n of body image with a person's sense of his own worth and his place among other people goes even deeper than t h i s . Thus, the r e h a b i l i t a t i o n worker should r e a l i z e that he i s treating not only disabled limbs, organs and bodies, but that he i s treating the patient's body image of the broken limb, a t rophied muscles, blinded eyes or paralyzed body or malfunctioning heart or lungs.  Just as surely as the psychiatrist does,  the r e h a b i l i t a t i o n worker i s treating the patient's personality,insofar as the patient's sense of personal worth, his conception of his relations to other people, his hopes and fears, his f e e l ings of disgust, g u i l t , shame, wounded pride, are involved i n the p a r t i c u l a r organ or limb or body system that has been disabled. The adult patient who has suffered sudden disablement has two kinds of adjustment to make: f i r s t he must adjust hims e l f to the r e a l i s t i c limitations and adaptations imposed by the d i s a b i l i t y and then he i s suddenly called upon to modify his bodyimage, his conception of himself, his relations to people, his work, i n accordance with the nature and extent of disablement. In the process of revising his body image, the patient may experience a reawakening of long-forgotten c o n f l i c t s and associations with emotionally painful events and feelings of the past, the result being that he f a l l s back on immature patterns of behaviour characteristic of his childhood.  This psychological ad-  justment may be a temporary phase or i t may have implications for the patient f a r more c r i p p l i n g to his t o t a l functioning as a person, than the physical d i s a b i l i t y i t s e l f .  -  31  -  Human Motivation and the Rehabilitation Process Human motivation i s a complex phenomenon.  The l i t e r a t u r e  on the subject, while vast, indicates how l i t t l e wefreally know about i t .  It i s not a simple thing to motivate a patient to  work toward h i s own recovery as the situation depends very much on conscious and unconscious needs; needs f o r love and attention, dependency s t r i v i n g s and struggles against them; feelings of h o s t i l i t y and g u i l t .  These patterns are found i n  the development of every individual and d i f f i c u l t i e s arise when they have been imperfectly resolved i n the course of maturation.  The onset of a d i s a b i l i t y may reactivate e a r l i e r  p a r t i a l l y repressed attitudes to dependency and to authority which may  interfere with the patient's cooperation i n the  treatment plan.  The r e h a b i l i t a t i o n team should be a l e r t to  these forces which impair motivation. The disabled individual may  equate service from others  with love and attention previously denied him i n the past; punishment of those who neglected him; or r e t r i b u t i o n f o r his own h o s t i l i t y and g u i l t .  Just as the victim of sudden d i s -  ablement must work through the inevitable depression he f e e l s , so he must work through h i s dependency needs as he becomes aware of the nature and extent of h i s d i s a b i l i t y . patients who  Even those  show good motivation f o r r e h a b i l i t a t i o n and  progress rapidly may tend to have occasional b r i e f lapses.  In  some instances a certain degree of dependency w i l l be inescapable; the patient cannot be e n t i r e l y s e l f - s u f f i c i e n t and he  - 32 must be encouraged to accept t h i s .  The question as to how much  dependency such patients must accept and how much responsibili t y and i n i t i a t i v e they should be encouraged to assume i n t h e i r future adjustment  i s , of course, entirely dependent upon  the severity of the d i s a b i l i t y and the patient's resources f o r developing new s k i l l s and interests. Thus, these factors w i l l determine how much and to what extent the patient w i l l u t i l i z e the r e h a b i l i t a t i o n resources and his p a r t i c i p a t i o n and cooperation w i l l i t s success or f a i l u r e .  determine  While efforts should always be made  to help patients overcome these inner obstacles, sometimes the reasons f o r the lack of success of the r e h a b i l i t a t i o n process do not seem to be due to "inner obstacles" of this nature.  Every r e h a b i l i t a t i o n service has i t s quota of  " b a f f l i n g " cases, where r e h a b i l i t a t i o n goals seem to have been set within the c l i e n t ' s competency to achieve both physically and psychologically and to everyone's surprise, She client f a i l s to achieve them.  Converselyy, we are equally surprised  by those c l i e n t s who achieve r e h a b i l i t a t i o n goals that no one would have estimated would have been physically possible f o r them. Rehabilitation Viewed as a Complex of Services Yet another way of viewing r e h a b i l i t a t i o n i s to see i t as a series of services.  A r e h a b i l i t a t i o n service i s the  application of a combination of talents and methods, usually professional or technical i n character, which produce a result;  - 33 the a l l e v i a t i o n of the consequences of d i s a b i l i t y .  In d i s -  cussing these services, they w i l l be generally divided into f i v e main categories: medical, psychological, s o c i a l , vocational and educational.  It must be noted that there i s no clear-cut  d i v i d i n g l i n e between them and services do often overlap i n t h e i r functions. 1.  Medical Services: Faced with a growing number of  disabled persons and a larger percentage of aging  population,  medicine i s called upon tbsaccept a larger r e s p o n s i b i l i t y for the s o c i a l and economic welfare of the patient, and thus the attention on r e h a b i l i t a t i o n .  Modern r e h a b i l i t a t i o n medieien  involves not only the services of the general p r a c t i t i o n e r and the various s p e c i a l i s t s including the psychiatrist but adequate services i n diagnosis, examination, laboratory studies, X-ray, therapy, drug prescription, team evaluation of d i s a b i l i t y , and reconstructive surgery and many other special services. The practice of r e h a b i l i t a t i o n for any doctor rests on the convict i o n that his r e s p o n s i b i l i t y continues beyond the stage of acute i l l n e s s or the convalescence from surgery; that i t must continue u n t i l the patient has been trained to l i v e and work to the maximum effectiveness permitted bji his d i s a b i l i t y . generally recognized  I t i s also  that the d e f i n i t i v e medical guidance, the  sound prescription f o r treatment and therapy procedures, can come only from the doctor. S^yaiujpsing:  The p r i n c i p a l contributions of the nurse  i n r e h a b i l i t a t i o n care are i n the areas of r e h a b i l i t a t i o n nursing  - 34 service management, c l i n i c a l teaching and basic bedside nursing. In the controlled environment of a hospital r e h a b i l i t a t i o n service, the nurse must recognize and u t i l i z e the hygiene, n u t r i t i o n , exercise, elimination, relaxation, recreation, and occupational preparation which contribute markedly toward maximum p o s s i b i l i t y of successful r e h a b i l i t a t i o n . 3»  Physical Therapy;  This service supervises  and  carries out a program designed to accomplish the maximum of physical restoration.  It consists of active and  passive  exercise, often against resistance, to develop strength, muscle re-education,  increased range of motion.  Various  exercise devices such as pulleys, weighs, wheels, steps,  and  walking r a i l s are used to bring about the desired r e s u l t s . Heat from lamps, p a r a f f i n baths and the l i k e , water and heat i n whirlpool baths or tanks e l e c t r i c a l stimulation or sound waves, massage of injured parts are a l l designed to increase c i r c u l a t i o n , r e l i e v e pain, relax muscles, and make the patient f e e l better.  Instruction i n d a i l y a c t i v i t i e s or home exercise  routines, as well as certain testing and measuring f o r diagnostic or prognostic purposes, i s also part of the physical therapist's job.  In some European countries this profession includes the  "medical gymnast" as well. 4. Speech and Hearing Therapies:  Services to  supervise  and carry out a program which i s designed to correct or to compensate for defects i n speech or hearing.  This type of  therapy i s directed at speech or hearing disorders which may  - 35 be either organic or functional i n nature and which may  be  either congenital or the sequelae of disease or injury.  Skill  i s required i n the testing and evaluation of hearing loss through the use of modem acoustical equipment.  Speech read-  ing, correction, and conservation of speech contribute to the conquest of disorders which halt or interrupt the patient's communication with the world around him. t  5.  Corrective Therapies: This service supervises and  carries out a program which consists of medically prescribed physical a c t i v i t y , primarily exercise and s e l f - c a r e . A series of conditioning exercises, ambulation, and s o c i a l i z a t i o n a c t i v i t i e s are given to the bed, wheel-chair, patient.  aor ambulant  Highly individualized routines may be devised for  each patient or the work may  be done i n groups.  Gymnasium-  type f a c i l i t i e s and equipment, swimming pools, and adapted gear for bed exercise form the working tools f o r the corrective therapist. 6.  Prosthetics and Orthotics: These services supervise  and carry out a program which include the selection, f i t t i n g , and t r a i n i n g i n the use of prescribed gadgets, braces, a r t i f i c i a l limb, wheel-chair  and other devices.  crutches,  These devices  o f f e r support to help maintain body alignment against weakened segments; to encourage early motion and function i n order to prevent atrophy from disuse; to increase function of permanently weakened muscles; to replace function t o t a l l y and permanently l o s t either from muscle weakness or from loss of body parts.  - 36  -  Thus, they are not only h e l p f u l as a more dynamic approach to present treatment and resultant recovery i h patients with many diseases and i n j u r i e s , hut also may  be considered as a necessity  i n promoting s e l f - s u f f i c i e n c y f o r the patient with residual permanent severe d i s a b i l i t y . 7.  Psychological Services: Much of the work of  psychologists i n the area of r e h a b i l i t a t i o n has stressed the observation that psychological disturbance of those with d i s a b i l i t i e s i s related to psycho-social factors to which the patient i s reacting"rather than to s p e c i f i c and unique effects of the disease process.  Physical defect, f o r example, has a  unique, personal and often deep, unconscious significance for the disabled person.  It also has s o c i a l significance as i t  i s the grounds upon which class and caste d i s t i n c t i o n s are made. The r o l e of the psychologist, then, l i e s i n the area of objective assessment of the i n t e l l e c t u a l and emotional a b i l i t y and d i s a b i l i t y ; a measurement of the potential of the d i s abled patient..  In the more serious cases, involving deep-  seated neuroses or psychoses, where r e f e r r a l for psychiatric or neurological consultation i s indicated, the psychologist  may  act as l i a i s o n i n Interpreting psychiatric findings f o r the rest of the r e h a b i l i t a t i o n s t a f f and helping them to carry through treatment recommendations.  This service requires the  use of various diagnostic tests as, tests of i n t e l l i g e n c e , achievement, aptitude® and personality and various methods, individual or group, to be administered  and interpreted  according to psychological principles and techniques. Like the psychologist, the psychiatrist i s concerned with assessment and treatment, "but h i s area i s more focused on |fhe emotional aspect of the patient, the psychological hazards of h i s d i s a b i l i t y , and the acceptance of the handicap.  The problem of motivation i s an extremely  complicated  one, which, i n i t s technical aspects, involves the psychiatric approach to r e h a b i l i t a t i o n .  I t i s i n this area that the  psychiatrist with his p a r t i c u l a r insight into the deep-lying i r r a t i o n a l and unconscious forces that determine the d i r e c t i o n and intensity of motivations, can make a s p e c i f i c cont r i b u t i o n to the r e h a b i l i t a t i o n team.  In recommending ways  of handling patients that transcend the narrowly  common-sense  approa.ch.es, the psychiatrist acts as consultant, h i s role i s thus also advisory and educational. 8.  S o c i a l Services. Social Work: Implicit i n s o c i a l  work philosophy i s the deep b e l i e f i n the i n t e g r i t y of the individual, i n his capacity and right to determine the way of l i f e that i s best f o r him.  Coupled with this b e l i e f i n s e l f -  determination i s the conviction that man, to a t t a i n f u l l s e l f r e a l i z a t i o n , must know the choices of action possible f o r him, and should be able to look to society to assist him i n obtaining those basic health and welfare services he i s unable to obtain through h i s own e f f o r t s .  In s o c i a l work terms, man i s  viewed as a whole human being who brings to his present s i t u a t i o n a s i g n i f i c a n t past and aspirations f o r the future.  - 38 Translated into r e h a b i l i t a t i o n efforts, t h i s means that s o c i a l workers'in r e h a b i l i t a t i o n view the person with a  physical  and mental handicap i n terms of the psycho-social forces that have helped to shape him,  i n terms of the potential that he  possesses, with his resources of past and present, for a meaningful l i f e . emphasis not  This view of the handicapped person places  only knowing the individual patient but upon f u l l  knowledge of the resources of family, friends, and  over-all  community as they have affected and w i l l continue to affect the outcome of r e h a b i l i t a t i o n e f f o r t s .  One  can say,  then,  that s o c i a l work i s concerned with helping individual and  families  groups to repair damage i n s o c i a l functioning which has  occured as a result of the f a u l t y interplay between s o c i a l resources and  individual need and as a result of i n s u f f i c i e n t  development or a v a i l a b i l i t y of individual resources for the execution of designated s o c i a l roles. sources may  These individual re-  be of a s o c i a l , economic, c u l t u r a l ,  physiological,  i n t e l l e c t u a l or psychological nature. The  b e l i e f i n change and  growth i s seen as related  the uniqueness of the person and his situation and opportunities available  for i t to take place and  to  the  to be nurtured.  B r i e f l y , then, the s o c i a l caseworker's r e s p o n s i b i l i t y i n the r e h a b i l i t a t i o n plan i s to help to i d e n t i f y the d i r e c t i o n  and  potential strength of the patient's motivation for recovery, training, work, i f not for l i f e i t s e l f . i s not enough.  The  But,  identification  caseworker then has the r e s p o n s i b i l i t y to  help the patient find t h i s himself, help to fan i t , enhance i t ,  - 39  -  but mostly, to help the patient put i t to work i n his interest.  own  One s o c i a l worker has said that major value of  s o c i a l casework should be the conviction that his basic, most useful function i s to help motivate the unmotivated. Psychiatrist and psychologist have pointed out that acceptance or resistance to r e h a b i l i t a t i o n depends on the 'premorbid' personality, that i s the sum t o t a l of the individual and his l i f e experience (including his present s i t u a t i o n ) . It includes his i n t e l l e c t u a l functioning; the state of his physical health, and his conscious and unconscious needs.  In fact, i t  can very well be that the unconscious factors are more important determinants than conscious factors during t h i s  process,  as shown i n s i m i l a r cases responding i n opposite ways to t h e i r disabilities. One common kind of reaction to permanent d i s a b i l i t y i s the desire of the i n d i v i d u a l to return to his previous disabled state; to be regarded as non-disabled l i k e anyone else.  non-  and to be treated  The means by which the patient can prevent  himself from f u l l y comprehending his r e a l i t y s i t u a t i o n are termed by p s y c h i a t r i s t s as the mental defense mechanisms of 'denial' and  'flight'.  Denial has been defined as "the r e j e c t i o n  by a person of some easily recognizable and  consensually  validated aspect of external r e a l i t y so that the person thinks, speaks, or acts as i f the aspect of r e a l i t y did not, i n fact, exist."  P l i g h t serves the same function as denial except that  the individual avoids coming into physical contact with the external r e a l i t i e s that may  cause him emotional pain.  It must  -  40  -  be realized that these methods of defense are deeply rooted i n the human personality, going way back into childhood. Also, t h i s reaction to chronic d i s a b i l i t y should not be confused with either the regressive tendencies that may be associated with i l l n e s s or the use of i l l n e s s to f u l f i l l neurotic needs. In dealing with clients i n this group, the caseworker can u t i l i z e the concepts of ego psychology, applied to the casework process to help the c l i e n t achieve a more r e a l i s t i c orientation and to u t i l i z e various resources available to him. Perception, memory and the anxiety accompany these defences. In situations of this kind, the worker may be able to help the c l i e n t to examine why he has been r e s i s t i n g acknowledgment of his d i s a b i l i t y and evaluate the negative effects t h i s has on his s o c i a l functioning.  The goal here i s to help the c l i e n t  to give up f i g h t i n g f o r a state of health or s o c i a l functioning which cannot be achieved and to redirect his energies into a c t i v i t i e s more constructive.  While i t would be damaging to  some c l i e n t s to be faced with this kind of s e l f knowledge, there are many c l i e n t s who can be helped by these means and this i s often an important part of the s o c i a l worker's contribution. In the case of disabled young children, the mother-child relationship may constitute an obstacle to their effective rehabilitation.  Proper understanding of the dynamic nature  of this relationship as well as the involvement of the 'bodyimage' both of the child and mother, i s neeessary f o r diagnosis, evaluation and r e f e r r a l .  - 41 Other Aspects of the S o c i a l Worker's Role i n Rehabilitation 1. Communication and Interpretation of S o c i a l Findings to the Team: As a member of the team, the worker gathers knowledge about the c l i e n t , his family and his community which he communicates to the others. information  From his direct contact, he  contributes  regarding the c l i e n t ' s feelings and attitude toward  his i l l n e s s , his past responses to c r i s i s , his capacities and strength i n using service.  The assessment of family r e l a t i o n -  ships and equilibrium i s another important area.  The reacr-  tions of the family members toward the c l i e n t are v i t a l factors which a f f e c t his recovery.  The worker also has the respons-  i b i l i t y to determine the various r e a l i t y needs related to i l l n e s s and to help c l i e n t to meet them.  Lastly, the worker  should also bring unmet needs to the attention of the communi t y and help i n creating new  resources i n meeting the,  2. Preparing c l i e n t to Use Services Other than Casework: Often, i t i s necessary that casework service be offered to prepare an i l l person to use other services.  This  may  simply be a concrete service as temporary domestic help and arrangements f o r medical care, or more complex involvement i n f a m i l i a l attitudes and resistance to treatment by means of the various casework treatment techniques. 3 . Concurrent Treatment: The worker's role i n concurrent treatment depends to a great extent upon the setting and function of the agancy.  His  s e r v i c e s may  be on an e n v i r o n m e n t a l  a c l a r i f i c a t i o n and the  client.  and s u p p o r t i v e l e v e l  and  i n s i g h t g i v i n g a c c o r d i n g t o the needs of  1  4. S e r v i c e s t o c l i e n t ' s f a m i l y , r e l a t i v e s and  collaterals  such as employer and l a n d l o r d . 5. L o c a t i o n and use of a v a r i e t y of community r e s o u r c e s for  the b e n e f i t o f the c l i e n t and h i s f a m i l y . 6. Group work s k i l l s and s e r v i c e s i n c l u d i n g group  therapy. 9.  E d u c a t i o n a l S e r v i c e s : The  f i e l d o f " S p e c i a l Educa-  t i o n " i s d e f i n e d as the e d u c a t i o n a l program which i s planned by p u b l i c or p r i v a t e agencies  f o r the e d u c a t i o n of t h e v a r i o u s  groups of e x c e p t i o n a l c h i l d r e n . A c h i l d i s d e f i n e d as educat i o n a l l y e x c e p t i o n a l i f h i s d e v i a t i o n i s of such a k i n d and degree t h a t i t i n t e r f e r e s w i t h h i s development under o r d i n a r y c l a s s r o o m procedures and n e c e s s i t a t e s s p e c i a l e d u c a t i o n e i t h e r i n c o n j u n c t i o n w i t h the r e g u l a r c l a s s o r i n a s p e c i a l c l a s s or s c h o o l f o r h i s maximum development.  Specifically, special  e d u c a t i o n i s concerned w i t h the f o l l o w i n g types of e x c e p t i o n a l children: The v i s \ 3 a ! 3 . y handicapped: T h i s group can be d i v i d e d i n t o two c a t e g o r i e s : ( l ) The b l i n d who o t h e r t h a n v i s i o n ; and  a r e educated t h r o u g h channels  (2) The p a r t i a l l y s i g h t e d who  are a b l e  These c l a s s i f i c a t i o n a r e t a k e n from "The R o l e of the Caseworker i n R e h a b i l i t a t i o n " by C e l i a Benney i n S o c i a l Casework, March 1955, pp. 118-121.  - 43 to use v i s i o n i n acquiring educational s k i l l s . The acoustically handicapped: In educating the acousti c a l l y handicapped, educators are interested i n two groups. The f i r s t consists of the deaf i n whom the sense of hearing i s non-functional f o r the ordinary purposes of l i f e .  This group  includes the congenitally deaf and the adventitiously deaf. The second group comprises the hard-of-hearing, although defective,  i s functional with or without hearing a i d . The crippled and neurologically impaired: Included i n  this i s a large group of physically handicapped children who suffer from neurological and non-sensory impairments to whom the  word 'crippled' i s sometimes applied as a general term.  These consist of three major groupings: (1) brain-injured or neurologically impaired children such as the e p i l e p t i c , those suffering from organic behavior disorders, and others who have a retarded development  i n the processes of speech,  language, reading, writing and arithmetic that i s due to cerebral dysfunction.  (2) orthopedically handicapped children, where the  impairment which interferes with normal functions of bones, j o i n t s , or muscles, whether they are born with such handicaps or have acquired them l a t e r through poliomyelitis, tuberculosis or accidents.  (3) children with special health  problems as muscular dystrophy, hemophilia and those with low vitality. Speech-handicapped  children: There are two major kinds  of speech defects: ( l ) functional speech defects, which are due to inadequate learning, perseveration, imitative habits, emo-  -  44  -  t i o n a l factors, and inadequate auditory discrimination; and (2)  organic speech defects, which are due to structural mal-  formations or neurological dysfunction. Gifted Children! Attempts to improve the education of g i f t e d children i n schools may be divided into three categories: (1) Acceleration: this i s defined as progress through an educational program at rates faster or ages younger than the conventional, according to the evaluation of each c h i l d and his needs.  (2) Special classes:for the most part,  these classes are provided f o r the top one to three per cent of i n t e l l e c t u a l l y able children. The class needs to be smaller than the average, and the course of study requires enrichment i n both depth and breadth.  (3) Enrichment: the g i f t e d youngster  needs a broad background of interrelated knowledge that i s meaningful to him.  Rich resources must be available i n the  classroom i n the form of books, audio-visual aids, a r t materials, and elementary science equipment.  Group d i s -  cussion, group projects, independent study, research, and c r i t i c a l and creative thinking are encouraged, so that he may r e a l i z e himself most completely and make his maximum contribut i o n to his fellow men. Mentally retarded children: Three general categories can be seen under the educational program: (1) the dependent mentally retarded who need continuing help i n caring for personal needs and are unable to be trained to any degree i n self-care and economic usefulness or i n s o c i a l i z a t i o n . (2) the trainable mentally retarded.  The education provided  for this group must aim at helping him to adjust to his immediate environment so that he may  become as f a r as possible a con-  tented member of his family and community.  This means provid-  ing the trainable child with r e a l - l i f e experiences which w i l l develop acceptable attitudes, adequate personal habits, health habits, safety habits, working habits, and the a b i l i t y to express himself i n language.  (3)  the educable mentally  retarded.  This group have a minimum educability i n the academic subjects of school - usually not beyond the Grade 5 or 6 l e v e l .  With  adequate t r a i n i n g , their s o c i a l adjustment w i l l enable them to get along independently i n the community.  They have minimum  occupational adequacy to a degree that w i l l enable them, as adults, to support themselves p a r t i a l l y or t o t a l l y at an adult l e v e l , usually i n unskilled or semi-skilled occupations, may  but  require some s o c i a l supervision. Emotionally disturbed children; Prom the educator's  point of view, a c h i l d i s considered  emotioaaikly  disturbed  when his behavior i s so inappropriate that regular class attendance has a disrupting effect on the rest of the class, places undue pressure on the teacher, and furthers the d i s turbance of the p u p i l himself.  Methods of dealing with the  emotionally disturbed c h i l d may  be divided into the following  categories: ( l ) he may  be l e f t i n a regular class with special  help provided through s p e c i a l counsellors, therapists, remedial teachers, and other school personnel.  (2) he may  be placed i n  a special class i n a regular school or i n a s p e c i a l day  centre.  (3) he may be placed i n a r e s i d e n t i a l school or treatment c entre.  - 46 Delinquent and pre-delinquent children; Delinquency may be defined as behavior by non-adults which violates s p e c i f i c l e g a l norms as the norms of a particular s o c i e t a l i n s t i t u t i o n with s u f f i c i e n t frequency or seriousness so as to provide a firm basis f o r l e g a l action against the behavior of the i n d i vidual or group.  In the treatment  of these children, teachers  should be trained i n mental health courses i n the understanding of such children.  Also, special educational services of the  following categories should be provided to a s s i s t the teacher i n dealing with a pre-delinquent or delinquent c h i l d .  These  include the services of school psychologists, school nurses, v i s i t i n g teachers or school s o c i a l workers, mental health consultants, school counsellors, remedial teachers and school adjustment services or c h i l d guidance c l i n i c s . S o c i a l l y handicapped children; These would include the children of the s o c i a l l y disadvantaged  groups previously men-  tioned - the marginal "group', the minority groups, the migrant and th4 immigrants and others.  In Canada, this would include  Eskimoes, Indians, Doukhobours, and others.  They are some-  times referred to as the " c u l t u r a l l y disadvantaged"  or the  " c u l t u r a l l y deprived". Special educational provisions for handicapped adults; Some c l a s s i f i c a t i o n of special educational services include any "special educational" f a c i l i t i e s which have to be set up f o r adults outside the regular training and educational programmes, especially when these are aimed at enabling the adult to qualify for one of the regular or special vocational t r a i n -  - 47 i n g programmes, f o r example, a requirement o f Grade 10 t o qualify.  Others i n c l u d e t h i s i n t h e l a t t e r  10. V o c a t i o n a l  classification.  Services  1. O c c u p a t i o n a l  Therapy:  T h i s s e r v i c e s u p e r v i s e s and c a r r i e s out a program aimed a t r e s t o r i n g f u n c t i o n and e n a b l i n g t h e p a t i e n t t o work o r t o pursue c r e a t i v e i n t e r e s t s . Manual and i n d u s t r i a l  skills  a r e developed as a means o f promoting b e t t e r m o t i o n , s t r e n g t h and  c o o r d i n a t i o n , b u t a l s o as a means o f h e l p i n g t h e p a t i e n t  t o go back t o work.  C r e a t i v e a r t s and c r a f t s , r e c r e a t i o n a l  a c t i v i t i e s , s e l f - h e l p d e v i c e s and programs, and t e s t i n g f o r a b i l i t y t o hold a job, are a l l part of t h i s s p e c i f i c therapy. In a d d i t i o n t o the p h y s i c a l r e s t o r a t i o n technique, the t h e r a p i s t i s i n t e r e s t e d i n t h e mental and p s y c h o l o g i c a l a d j u s t ment o f t h e p a t i e n t .  Wood-working shops, bench l a t h e s and  o t h e r machines,, hand and power t o o l s , hand looms, and o t h e r c r a f t devices help the p a t i e n t t o r e g a i n h i s working a b i l i t y and  tolerance o r t o prepare f o r a d d i t i o n a l v o c a t i o n a l t r a i n i n g . The  o c c u p a t i o n a l t h e r a p i s t may a l s o be c a l l e d upon to,  d e v e l o p and t e a c h t h e handicapped i n d i v i d u a l how t o l i v e s e l f r s u f f i c i e n t l y i n h i s home environment.  I n some programs, t h e  o c c u p a t i o n a l t h e r a p y i s almost f u n c t i o n a l and p r a c t i c a l , i n o t h e r s i t may be more d i v e r s i o n a r y , as i n t h e case o f t h e chronically i l l ,  the mentally disturbed, or the e l d e r l y .  - 48 2. Work Evaluation: Vocational evaluation means to gather, to interpret, to analyze and to synthesize a l l the vocational s i g n i f i c a n t data regarding the i n d i v i d u a l and to relate them to occupat i o n a l requirements and opportunities.  The patient i s usually  assessed i n a vocational evaluation laboratory where experiences which simulate conditions i n employment are offered but do not include d e f i n i t i v e vocational t r a i n i n g . This service i s of value to the patient i n determining the relationship of his capacities and d i s a b i l i t i e s to a given occupation and are designed to build up his confidence  i n h i s a b i l i t y to over-  come the vocational handicap inherent i n his d i s a b i l i t y . 3.  Work-Schemes:  These range from work f o r the home-bound; sheltered workshop as well as schemes organized  by the handicapped per-  sons themselves. 4. Vocational Placement and Follow-up: The c l i e n t must be helped to obtain insight and motivat i o n adequate to help him move into this f i n a l phase of the r e h a b i l i t a t i o n process.  An appraisal of client progress  through the r e h a b i l i t a t i o n process to the placement stage must be made to determine whether the c l i e n t i s ready f o r placement. The placement of the c l i e n t may be performed by the training agency, by the former employer who rehires the c l i e n t , the employment o f f i c e , or by the c l i e n t himself i n securing h i s own job.  Before the case can be 'closed as  - 49 r e h a b i l i t a t e d ' the c o u n s e l o r should work c o n c u r r e n t l y and  con-  t i n u o u s l y w i t h whatever s o u r c e , u n t i l employment can be d e t e r mined as s u i t a b l e i n t h a t the c l i e n t i s h a p p i l y and o p t i m a l l y employed a c c o r d i n g t o h i s c a p a b i l i t i e s and p o t e n t i a l s and tShat t h e employer, t o o , i s s a t i s f i e d . For b o t h the i n i t i a l and subsequent f o l l o w - u p c o n t a c t s , a schedule s h o u l d be prepared and met.  I t i s important t h a t  the worker s t a y c l o s e t o the s i t u a t i o n , so he w i l l know how t h e c l i e n t i s a d j u s t i n g , how  the employer i s r e a c t i n g , what  problems a r e d e v e l o p i n g , whether he s h o u l d remove the c l i e n t from the j o b , and o t h e r d e t a i l s e s s e n t i a l t o h i s g i v i n g  proper  s e r v i c e to both. 11.  Other Necessary  S e r v i c e s t o Help I n t e g r a t e Handi-  capped People I n t o Community: I f the p r i n c i p l e of r e t u r n i n g the p a t i e n t t o h i s own  environment and community as soon as  p o s s i b l e i s f o l l o w e d as a sound t h e r a p e u t i c measure, then the next decade s h o u l d show c o n s i d e r a b l e i n c r e a s e i n the f o l l o w i n g t y p e of s e r v i c e which do not l e a d t o easy c l a s s i f i c a t i o n . Homemaker o r housekeeper s e r v i c e : T h i s s e r v i c e p r o v i d e s t h e performance o f p e r s o n a l and household  t a s k s by an e x p e r i -  enced and mature person, not o r d i n a r i l y a p r o f e s s i o n a l person but not merely a domestic  either.  A l s o , h e l p and  direction  a r e g i v e n t o the d i s a b l e d woman i n s i m p l i f i e d methods of food p r e p a r a t i o n and l a u n d r y a c t i v i t i e s ; t h e p h y s i c a l c a r e and  self-  h e l p c l o t h i n g f o r p r e s c h o o l c h i l d r e n , and f a m i l y c o - o p e r a t i o n  - 50 and d e v e l o p i n g independence i n young c h i l d r e n i n the t o t a l home management problem.  I t i s a l s o n e c e s s a r y t o enable o l d  o r i n f i r m p e o p l e , whether d i s a b l e d o r n o t , t o remain i n t h e i r own homes.  I t should a l s o be used t o r e l i e v e the p a r e n t s of  handicapped c h i l d r e n f o r shopping, h o l i d a y s and r e c r e a t i o n purposes. T r a n s p o r t a t i o n s e r v i c e s : T h i s form of s e r v i c e i s o f t e n o v e r l o o k e d , y e t i t s absence can n u l l i f y the e f f o r t s o f a l l the o t h e r s e r v i c e s put t o g e t h e r .  A s u b s t a n t i a l number o f h a n d i -  capped people w i l l never be a b l e t o use the p u b l i c t r a n s p o r t a t i o n system.  Some homebound and bedbound people c o u l d and  s h o u l d be a b l e t o l e a v e t h e i r homes i f t h i s s e r v i c e were available®  Even i f i t i s not p o s s i b l e t o t a k e some h a n d i -  capped people o u t s i d e t h e i r homes more t h a n a few times a y e a r , t h i s s e r v i c e s h o u l d be a v a i l a b l e t o them. A d a p t a t i o n s i n h o u s i n g - p u b l i c b u i l d i n g s : The  handi-  capped person cannot become a f u l l y f l e d g e d member o f the community u n l e s s c e r t a i n a d a p t a t i o n i n housing and p u b l i c b u i l d i n g s become e s t a b l i s h e d p o l i c y : - ramp, i n s t a l l a t i o n o f r a i l a l o n g s i d e t o i l e t f a c i l i t i e s ; doors wide enough f o r the passage of w h e e l - c h a i r s and l i g h t - s w i t c h e s low enough t o be o f reach. S p e c i a l housing h o s t e l f a c i l i t i e s : I t i s not  the  u s u a l type o f b o a r d i n g home but where some a s s i s t a n c e i s o f f e r e d t o t h e p h y s i c a l l y , m e n t a l l y and e m o t i o n a l l y handicapped. I t i s the "next" stage o r a l t e r n a t e t o the day o r n i g h t h o s p i t a l . I n c l u d e d under these a r e " h o s t e l s " and "half-way" houses as w e l l as f o s t e r homes f o r people w i t h v a r i o u s d i s a b i l i t i e s .  - 51 Recreation s e r v i c e s : This i s necessary t o integrate t h e handicapped p e r s o n as f a r a s p o s s i b l e w i t h s p e c i a l p r o v i s i o n s as camping f a c i l i t i e s .  A l s o i n c l u d e d a r e a c t i v i t i e s as B l i n d  B o w l i n g League, P a r a p l e g i c Basket b a l l Team. Home c a r e s e r v i c e s : The range o f s e r v i c e s encompassed i n t h i s concept make i t d i f f i c u l t medical,  t o c l a s s i f y as e i t h e r a  psychological, educational or s o c i a l service.  I t may  range a l l the way from v e r y complex h o s p i t a l - home care schemes i n w h i c h s e v e r a l members o f the h o s p i t a l team, d o c t o r , n u r s e , p h y s i o t h e r a p i s t , speech t h e r a p i s t , o c c u p a t i o n a l t h e r a p i s t , s o c i a l worker v i s i t the home t o c a r r y out a h i g h l y concentrated  treatment p l a n t o r e g u l a r v i s i t s by one member o f  the treatment o n l y such as the p h y s i o - t h e r a p i s t . Educational  (and t r e a t m e n t ) s e r v i c e s t o handicapped  ( c h i l d r e n ) i n t h e i r own homes: For many r e a s o n s , any comprehensive  scheme o f r e h a b i l i t a t i o n s e r v i c e s w i l l i n v o l v e a number o f  s e r v i c e s i n t h i s category.  Though expensive and time consuming,  t h e y cannot be o v e r l o o k e d .  I t i s known as " V i s i t i n g Teacher" o r  "Home Teacher"' f o r c h i l d r e n . T r a v e l l i n g d i a g n o s t i c and treatment s e r v i c e s : I n any c o u n t r y as l a r g e and as s p a r s e l y p o p u l a t e d as Canada, s e r v i c e s o f t h i s k i n d must i n e v i t a b l y p l a y a c o n s i d e r a b l e c a l l f o r many c r e a t i v e a d a p t a t i o n s  part.  They  by t h e treatment team and  o f t e n i n v o l v e some f l e x i b i l i t y i n c e r t a i n r o l e s , e s p e c i a l l y that of counsellors. 12.  Income maintenance programme: T h i s type o f s e r v i c e  w h i c h i s a s i n e qua non o f a l l the o t h e r s , as f a r as the d i s -  a b l e d person and h i s f a m i l y i s concerned, i s o f t e n l i s t e d under w e l f a r e s e r v i c e s as allowances.  'maintenance g r a n t s ' o r as  social  I t should a p p l y not j u s t t o the g r a n t i n g of  l i v i n g s t i p e n d s d u r i n g v o c a t i o n a l t r a i n i n g , but t o a whole range of income maintenance s e r v i c e s , temporary or permanent, c o v e r i n g not o n l y the d i s a b l e d person but a l s o h i s f a m i l y . The  ensurance of cash income d u r i n g s i c k n e s s and  i s not o n l y a n e c e s s a r y  disability  s e r v i c e i n modern i n d u s t r i a l s o c i e t y ,  but o f t e n a c t s as p r e v e n t i v e measure a g a i n s t i n c r e a s e d d i s a b i l i t y and dependency. 13.  S e r v i c e s t o f a c i l i t a t e c o o r d i n a t i o n and i n t e g r a t i o n :  T h i s type of s e r v i c e i s p r i m a r i l y important  in rehabilitation.  I t i s one t h i n g t o e n u n c i a t e the p r i n c i p l e s , b u t , q u i t e ano t h e r t o t r a n s l a t e them i n t o p r a c t i c e . have made use o f the 'case-conference'  Members of the team for this function.  At  t h e community l e v e l , l o c a l and r e g i o n a l r e h a b i l i t a t i o n committees are u s e f u l devices.  These need t o be strengthened  by  t i o n c o u n c i l s a t the p r o v i n c i a l and n a t i o n a l l e v e l s .  coordinaThis  k i n d of s e r v i c e i s s t i l l one of the most d i f f i c u l t and c h a l l e n g i n g , but must be undertaken i n any comprehensive scheme of services. 14.  P u b l i c i n f o r m a t i o n and e d u c a t i o n a l s e r v i c e s : The  v a l u e of s e r v i c e s aimed p r i m a r i l y a t e d u c a t i n g the p u b l i c i n the understanding  of the handicapped and  i n c r e a s i n g acceptance  o f them as i n d i v i d u a l s and c i t i z e n s , i s one of the most c o n t r o v e r s i a l areas i n the r e h a b i l i t a t i o n f i e l d . c l u d e d here because much informed  It is in-  o p i n i o n tends t o the view  t h a t such s e r v i c e s have a v a l i d r o l e and w i l l p l a y an i n c r e a s i n g l y i m p o r t a n t one as more people l i v e t o the l a t t e r p a r t of the 15.  life-span. P e r s o n n e l t r a i n i n g schemes: As a l l of t h e s e s e r -  v i c e s r e q u i r e a s u f f i c i e n t supply of s u i t a b l y t r a i n e d personnel t o operate them, i t i s a x i o m a t i c  t h a t no comprehensive scheme  of r e h a b i l i t a t i o n s e r v i c e s can operate s a t i s f a c t o r i l y w i t h o u t a s e r v i c e o f e d u c a t i o n a l programs, f o r the m u l t i p l i c i t y of p e r s o n n e l r e q u i r e d i n the w e l f a r e f i e l d today.  As i t i s  b a s i c a l l y an e d u c a t i o n a l problem i t w i l l not be d e a l t w i t h i n t h i s s t u d y , but i t i s mentioned because subsequent a n a l y s i s o f s p e c i f i c r e h a b i l i t a t i o n programmes l a t e r i n the s t u d y f i n d that i n s u f f i c i e n c y  may  of s u i t a b l e p e r s o n n e l i s a r e c u r r i n g  problem i n e v a l u a t i n g t h e e f f i c i e n c y of r e h a b i l i t a t i o n  ser-  vices. 16.  R e s e a r c h and  t i o n can be c o n s i d e r e d these areas. and  s t a t i s t i c s : No scheme of r e h a b i l i t a -  complete u n l e s s i t i n c l u d e s s e r v i c e s i n  A major d i f f i c u l t y i s the inadequacy of s t a t i s t i c s  l a c k of u n i f o r m i t y of measurements among t h o s e s t a t i s t i c s  available. Continuing  r e h a b i l i t a t i o n i s needed not o n l y i n m e d i c a l ,  but a l s o i n r e l a t e d a r e a s i n r e h a b i l i t a t i o n t h a t might e q u a l l y be i n c l u d e d under the h e a d i n g of 'education' aspects.  and  These l a t t e r have o f t e n not r e c e i v e d  a t t e n t i o n , and y e t t h e y a r e b a s i c t o any  welfare sufficient  e v a l u a t i o n of the  - 54 adequacy and  e f f i c i e n c y of r e h a b i l i t a t i o n  services.  Rehabilitation Viewed as a Set of F a c i l i t i e s Another view of r e h a b i l i t a t i o n sees i t as a set of f a c i l i t i e s , that i s buildings or i n s t i t u t i o n s i n which certain d e f i n i t e services are given to patients.  This would include  hospitals, r e h a b i l i t a t i o n wings or wards or departments i n hospitals,  r e h a b i l i t a t i o n centres, sheltered workshops, voca-  t i o n a l training schools and  any special i n s t i t u t i o n s or  schools for p a r t i c u l a r s d i s a b i l i t i e s . This i s not seen as overlapping the view of r e h a b i l i t a t i o n as a set of services, but rather a recognition that certain services i n r e h a b i l i t a t i o n cannot be given even though personnel and and  space may  be adequate unless certain  equipment are also present.  facilities  Some of these f a c i l i t i e s of  course involve very expensive equipment.  This raises  the  important factor of " c a p i t a l costs" often a deterring i n establishment of such f a c i l i t i e s .  factor  While i t i s impossible  to describe a l l of these f a c i l i t i e s f u l l y , two w i l l be  singled  out as d i s t i n c t i v e of modern trends i n r e h a b i l i t a t i o n .  These  are the r e h a b i l i t a t i o n centre and The Rehabilitation  the sheltered workshop.  Centre  The development of t h i s type of f a c i l i t y has place mostly since World War  taken  II.  A r e h a b i l i t a t i o n centre i s defined as "a f a c i l i t y which i s operated for the primary purpose of assisting i n the r e h a b i l i t a -  t i o n of handicapped and d i s a b l e d persons through an program of m e d i c a l , p s y c h o l o g i c a l , s o c i a l and e v a l u a t i o n and vision."  1  integrated  vocational  s e r v i c e s under competent p r o f e s s i o n a l super-  Thus, i t f u n c t i o n s as one  grounds f o r such c o o p e r a t i v e  of the b e s t t e s t i n g  endeavor, and the  'team approach'  i s the accepted method o f c o l l a b o r a t i o n between t h e  disciplines.  I t s e r v e s as a means of communication and p r o v i d e s a u n i f i e d basis f o r viewing patients.  Each member of the team p l a y s h i s  p a r t i n implementing t h i s approach by c o n t r i b u t i n g h i s  respect-  i v e s k i l l s , by u n d e r s t a n d i n g the s p e c i a l i z e d knowledge of h i s team-mates, and by a d j u s t i n g h i s treatment emphasis t o the i n t e g r a t e d treatment  process.  Other g u i d i n g p r i n c i p l e s i n r e h a b i l i t a t i o n o p e r a t i o n , such as ' i n d i v i d u a l i z a t i o n ' ; 'comprehensive and  'the whole  integrative services';  centre man';  'patlent-centre  approach'; which have been d i s c u s s e d under the s e c t i o n on p r i n c i p l e s , are a l s o  important.  Others have p o i n t e d  out the v i t a l n e c e s s i t y of d i r e c t  and d e t a i l e d m e d i c a l s u p e r v i s i o n .  This implies s p e c i f i c a l l y ,  the a c t u a l e x a m i n a t i o n of each p a t i e n t , r e v i e w of d i a g n o s i s , c o n s i d e r a t i o n of p a s t m e d i c a l h i s t o r y , and the c o m p l e t i o n of needed l a b o r a t o r y t e s t s and X-rays.  This study i s necessary  i n o r d e r t o determine whether the p a t i e n t i s r e a d y t o undert a k e a r e h a b i l i t a t i o n program i n a c e n t r e and whether such a program can r e a s o n a b l y be expected t o m a t e r i a l l y a s s i s t i n h i s p h y s i c a l or m e n t a l r e c o v e r y , i n g handicap, and  " A l l a n , S.,  i n h i s adjustment t o the remain-  i n h i s r e s t o r a t i o n t o s o c i a l and  R e h a b i l i t a t i o n , o p . c i t . , p.  46.  work  activity. I t has been s a i d t h a t v e r y few c e n t r e s a r e t r u l y comprehensive, and t h a t they tend t o be e i t h e r " m e d i c a l l y " oriented or "vocationally" oriented.  A l s o some t a k e o n l y o u t -  p a t i e n t s , which o f t e n means t h e y cannot s t a r t procedures  e a r l y enough.  rehabilitation  A l s o , they have tended t o concent-  r a t e m o s t l y on p a t i e n t s w i t h o r t h o p a e d i c d i s a b i l i t i e s .  Few  o f these t a k e p a t i e n t s w i t h p h y s i c a l d i s a b i l i t i e s o t h e r than o r t h o p e d i c , though t h e r e has been a t r e n d t o i n c l u d e n e u r o l o g i c a l l y d i s a b l e d and s t r o k e p a t i e n t s . Even fewer t a k e mental p a t i e n t s , f o r whom t h e r e i s g r e a t need f o r rehabilitation facilities.  N e v e r t h e l e s s , c e n t r e s on t h e whole  do good work and made a g r e a t advance i n the h i s t o r y o f rehabilitation. The S h e l t e r e d Workshop Workshops can be c l a s s i f i e d i n a number o f ways: by the type o f work performed; by t h e c l i e n t e l e s e r v e d , o r by t h e i r aims and o b j e c t s .  R e g a r d l e s s o f these d i f f e r e n c e s , t h e  s h e l t e r e d workshop b a s i c a l l y p r o v i d e s a work e x p e r i e n c e  without  the s t r e s s and t e n s i o n o f c o m p e t i t i v e employment, t h e i r f u n c tions being:  1  1. To p r o v i d e a l a b o r a t o r y f o r v o c a t i o n a l d i a g n o s i s and e v a l u a t i o n .  Thompson, N e l l i e , Z., The Role o f t h e Workshop i n R e h a b i l i t a ' t i p n . (Ed.) A Report o f t h e N a t i o n a l I n s t i t u t e on t h e Role o f the Workshop i n R e h a b i l i t a t i o n , B e d f o r d , Penn. Wash., D.C. A p r i l , 1958, p. 43.  -  57  -  2. To provide a p r a c t i c a l and r e a l i s t i c setting for vocational t r a i n i n g and adjustment. 3 . To provide a setting for a sustained  focus on the  t o t a l needs of the i n d i v i d u a l , especially for motivation, vocational exploration, and 4.  try-out.  To provide a controlled environment with a graduated  amount of shelter between physical restoration and  vocational  rehabilitation. 5.  To provide therapeutic work experiences.  6.  To provide follow-up services.  7.  To provide g a i n f u l employment.  8.  To provide purposeful a c t i v i t i e s not necessarily  remunerative. Sheltered workshops can exist by themselves or be attached to larger units as the hospital or the r e h a b i l i t a t i o n centre.  This i s also true with the work-evaluation unit.  The term 'vocational evaluation unit' i s sometimes used, and i s synonymous with the terms 'prevocational and  'vocational diagnostic u n i t ' .  evaluation u n i t  1  The f i r s t two terms are  used to emphasize the unit's function of establishing vocat i o n a l goals, and to d i f f e r e n t i a t e i t from a therapy shop. As such, i t i s used extensively by state vocational r e h a b i l i t a t i o n agencies to c l a r i f y and  establish objectives for their  clients. The National Institute on Workshop Standards defined sheltered workshop as a work-oriented r e h a b i l i t a t i o n f a c i l i t y which provides a controlled working environment and i n d i v i d -  - 58 u a l i z e d v o c a t i o n a l programs and g o a l s .  I t u t i l i z e s the work  e x p e r i e n c e and o t h e r r e l a t e d s e r v i c e s t o a s s i s t t h e h a n d i capped person t o p r o g r e s s toward a normal l i v i n g and a p r o ductive vocational status. There a r e g e n e r a l l y two broad c a t e g o r i e s : ( l ) The t r a d i t i o n a l type of workshop which p r o v i d e s s h e l t e r e d employment and o t h e r s e r v i c e s i n t h e a r e a o f s o c i a l and p e r s o n a l adjustment.  The term i n d u s t r i a l workshop f o r s h e l t e r e d  employment has been used t o d e s c r i b e t h i s c a t e g o r y o f shops. (2) The r e h a b i l i t a t i o n workshop w h i c h c o n c e n t r a t e s on t h e p r e p a r a t i o n o f handicapped i n d i v i d u a l s f o r c o m p e t i t i v e employment. I n a d d i t i o n t o remunerative  o r on-the-job  t r a i n i n g or  employment, t h e workshop p r o v i d e s , through i t s own  facilities  o r o t h e r community r e s o u r c e s , m e d i c a l examinations  and super-  v i s i o n , s o c i a l and p e r s o n a l adjustment.  Retraining f a c i l i t i e s ,  i n t h e sense used as c o n t r a s t e d w i t h t h e p r e v o c a t i o n a l t r a i n ing  u n i t s o r workshop o p e r a t i o n s , a r e those programs f o r  a c t u a l l y t e a c h i n g a t r a d e o r s k i l l which can be used as a means o f g e t t i n g a j o b i n i n d u s t r y o r r u n n i n g a s m a l l b u s i n e s s . T h i s s e r v i c e may be p a r t o f t h e o r d i n a r y s c h o o l t r a i n i n g facilities. The O r g a n i z a t i o n o f R e h a b i l i t a t i o n S e r v i c e s From t h e i n d i v i d u a l p a t i e n t ' s p o i n t o f v i e w , someone must take t h e r e s p o n s i b i l i t y i n i n i t i a t i n g t h e r e h a b i l i t a t i o n p r o c e s s and i n c o o r d i n a t i n g the v a r i o u s s e r v i c e s a c c o r d i n g t o  - 59 i t s ongoing changing nature for the patient's benefits. At present, i n both United States and Canada, there i s not a single group agency or individual to whom this r e s p o n s i b i l i t y i s allocated.  At t r a n s i t i o n a l points, with  no clear a l l o c a t i o n , the patient often gets l o s t . he return to i n his planning f o r the next stage? look a f t e r him i n his waiting period?  Whom can Who w i l l  Who w i l l re-assume  the r e s p o n s i b i l i t y to continue the plan i f the patient i s finished with the r e h a b i l i t a t i o n centre?  I f the patient  i s not placed i n employment, what alternatives are open to him?  How i s he to appeal?  Is this the r e s p o n s i b i l i t y of  the Social worker? the doctor, or the vocational placement worker? Patients often have to be helped to locate and use the services and someone must assume the r e s p o n s i b i l i t y i n replanning, and reassessing continuously during the process especially i n the case of children.  Many, though not a l l  services should be made available to c l i e n t s i n t h e i r own communities i n l i n e with r e h a b i l i t a t i o n plans they have chosen for  themselves. Co-ordination and integration are the two major  problems i n the organization of r e h a b i l i a t i o n services. I t has been pointed out that co-ordination implies a horizontal functioning e f f e c t i v e l y together of the various services, whereas integration implies the uniting of those services f o r a common purpose and to a common end, which i s longitudinal or long-range i n nature i n each individual case.  Although co-  - 60 ordination i s necessary and  important, the major need i n success-  f u l r e h a b i l i t a t i o n i s the integration of i t s aims and  services.  This idea of integration applies not only to the need for agencies working together to develop a complete r e h a b i l i t a t i o n program for the disabled i n d i v i d u a l , nor only to the various individuals involved functioning cooperatively for the benefit of the handicapped person, but also to recognition by a l l d i s c i p l i n e s that the patient requires a t o t a l program, an application at the proper time of the services necessary to insure his restoration to f u l l e s t  capacity.  Of equal importance to community integration of services i s integration with public opinion and action. to this e f f o r t i s communications.  Basic  Within a community this  cari&be achieved through councils of r e h a b i l i t a t i o n , agencies and organizations, u t i l i z i n g common f a c i l i t i e s or buildings, group meetings, and joint planning e f f o r t s . As between i n d i v i d u a l workers, i t can be achieved through s t a f f meetings and discussions, exchange v i s i t s to agencies, educational  interpretation, publications, and work-  ing agreements or a f f i l i a t i o n s and the "case conference", method. Communication to the general public by newspapers, radio, t e l e v i s i o n , distributed material, open house i n v i t a t i o n s , and  exhibits i s decidedly e f f e c t i v e .  Lay p a r t i c i p a t i o n through  volunteer workers i n agencies and fund-raising assignments are other methods of establishing rapport with the 'man street'.  i n the  CHAPTER I I I PROFILE OF THE DEVELOPMENTAL PATTERN OF REHABILITATION I N CANADA  E a r l y Developments i n R e h a b i l i t a t i o n i n Canada I n Canada, as elsewhere t h e e a r l i e s t e f f o r t s t o h e l p the handicapped were made by p r i v a t e r e l i g i o u s and c h a r i t a b l e o r g a n i z a t i o n s , which s e t up i n s t i t u t i o n s t o care f o r t h e b l i n d , t h e d e a f and f o r c r i p p l e d c h i l d r e n . When government entered  the f i e l d  i t d i d s o , as e l s e -  where i n t h e "piecemeal" f a s h i o n o f s i n g l i n g out c e r t a i n " c a t e g o r i e s " o f d i s a b l e d persons f o r whom i t would services.  I n Canada, t h e s e were l i m i t e d f o r many y e a r s t o  war v e t e r a n s , and  provide  workmen and t h e b l i n d , d e a f , t h e t u b e r c u l o n s  some o r t h o p a e d i c a l l y d i s a b l e d p e r s o n s , e s p e c i a l l y c h i l -  dren. Some o f t h e s i g n i f i c a n t developments i n t h e s e e a r l y years included the formation  o f t h e Canadian N a t i o n a l I n s t i t u t e  for  t h e B l i n d i n 1918. The o r g a n i z a t i o n o f t h e O n t a r i o  for  C r i p p l e d C h i l d r e n by l o c a l R o t a r y c l u b s took p l a c e i n  1922. and  Society  The Canadian J u n i o r Red Cross s e t up i t s handicapped c r i p p l e d c h i l d r e n ' s fund i n t h e same y e a r .  As i n d u s t r i -  a l i z a t i o n i n c r e a s e d , so d i d t h e number o f impaired workmen. W i t h O n t a r i o t a k i n g t h e l e a d i n 1914,  most o f t h e p r o v i n c e s  - 62 had passed a Workmen's Compensation A c t by  1920.  I n 1921, a s e l e c t committee o f the O n t a r i o l e g i s l a t u r e s t u d i e d the f e a s i b i l i t y o f a p r o v i n c i a l r e h a b i l i t a t i o n p l a n and recommended an expanded program f o r d i s a b l e d workers.  The  Workmen's Compensation A c t was amended i n 1924 t o i n c o r p o r a t e broad p r o v i s i o n s f o r r e h a b i l i t a t i o n i n the compensation  system,  and v o c a t i o n a l t r a i n i n g and placement s e r v i c e s were s u p p l i e d i n s e l e c t e d cases where needed. Developments D u r i n g the D e p r e s s i o n Years P r o g r e s s was s l o w i n subsequent y e a r s d u r i n g the 1930's. The O n t a r i o Workmen's Compensation Board s e t up departments  of  p h y s i o t h e r a p y and o c c u p a t i o n a l t h e r a p y d u r i n g the 1930's, and. a s e p a r a t e r e h a b i l i t a t i o n department o f f i c e r s i n 1938.  employing r e h a b i l i t a t i o n  Quebec R o t a r y Clubs founded a s o c i e t y f o r - -  C r i p p l e d C h i l d r e n i n 1930, and j o i n e d w i t h the O n t a r i o S o c i e t y t o form the Canadian C o u n c i l f o r C r i p p l e d C h i l d r e n i n 1937. B u t , g e n e r a l l y , d i s a b l e d persons were ovelooked d u r i n g the d e p r e s s i o n y e a r s b.when l a r g e numbers o f a b l e - b o d i e d persons were unemployed and the p u b l i c purse was p i n c h e d .  1  World War I I and E a r l y Post-War P e r i o d I t was d u r i n g t h e e a r l y y e a r s o f World War I I t h a t the o r d i n a r y c i t i z e n was i n c l u d e d f o r t h e f i r s t time i n a government sponsored programme i n the r e h a b i l i t a t i o n f i e l d .  True,  t h i s was l i m i t e d t o one a s p e c t o n l y - t h a t o f v o c a t i o n a l r e habilitation.  N e v e r t h e l e s s , i t was a m i l e s t o n e i n Canadian  - 63  -  developments i n r e h a b i l i t a t i o n when, i n 1942, Vocational Training Co-ordination t r a i n i n g program was  tinder the  Act, a federal-provincial  i n i t i a t e d which was  t o be a v a i l a b l e t o  a l l t r a i n a b l e p e r s o n s , c i v i l i a n or v e t e r a n .  I n 1943» the  N a t i o n a l Employment S e r v i c e e s t a b l i s h e d a S p e c i a l Placement Section to provide  c o u n s e l l i n g and placement s e r v i c e s t o  persons w i t h o c c u p a t i o n a l  handicaps s e e k i n g g a i n f u l employ-  ment i n c l u d i n g the p h y s i c a l l y d i s a b l e d . thousands of persons r e q u i r i n g v o c a t i o n a l  These s e r v i c e s helped re-establishment  a s s i s t a n c e but were, o f c o u r s e , i n s u f f i c i e n t f o r t h o s e r e q u i r i n g m e d i c a l and  s o c i a l r e h a b i l i t a t i o n as a  preliminary  measure. The  key development d u r i n g t h i s p e r i o d , however,  the comprehensive program worked out f o r the d i s a b l e d U s i n g a g r e a t v a r i e t y of new  was  veterans.  t e c h n i q u e s and f a c i l i t i e s adapted  t o the i n d i v i d u a l needs of each war  c a s u a l t y , the department  demonstrated t h a t most handicapped v e t e r a n s c o u l d be e s t a b l i s h e d under an i n t e g r a t e d program of m e d i c a l ,  repsycho-  l o g i c a l , e d u c a t i o n a l and v o c a t i o n a l r e h a b i l i t a t i o n s e r v i c e s provided  by a h i g h l y q u a l i f i e d , m u l t i - d i s c i p l i n a r y team.  Many of the most s u c c e s s f u l methods o f r e h a b i l i t a t i o n of  the  s e v e r e l y handicapped, i n c l u d i n g s e l e c t i v e placement, were developed t h r o u g h t h i s program.  Many o t h e r a g e n c i e s  and  s e r v i c e s d u r i n g the e a r l y post-war y e a r s were eager t o a p p l y the methods l e a r n e d from veterans' r e h a b i l i t a t i o n t o o t h e r groups o f d i s a b l e d .  - 64 New  national voluntary societies were formed to combat  chronic conditions such as a r t h r i t i s and rheumatism, cancer, deafness, diabetes, heart disease^; multiple s c l e r o s i s , muscular dystrophy and poliomyelitis.  The  efforts of these groups were  focused on medical research, public education, and various patient services, c h i e f l y f o r medical r e h a b i l i t a t i o n . Other long established agencies, too, such as the V i c t o r i a n Order of Nurses, became increasingly concerned with r e h a b i l i t a t i o n of the chronically  ill.  Rehabilitation services for workers disabled  by  i n d u s t r i a l accidents or diseases expanded rapidly also. outpatient  r e h a b i l i t a t i o n centre was  established  An  i n Vancouver  by the B r i t i s h Columbia Workmen's Compensation Board i n  1942.  The Quebec Compensation Commission set up a Rehabilitation Department i n 1944  and 1947,  Outpatients i n Montreal.  and a Rehabilitation Clinieiifor  Ontario opened i t s widely-known  inpatient Rehabilitation Centre at Malton i n 1947, started an outpatient  and  centre for injured workmen i n  Alberta  1952.  Most ofthe p r o v i n c i a l boards were empowered to make additional s p e c i f i c expenditures on r e h a b i l i t a t i o n , mainly f o r vocational services, to return as many i n d u s t r i a l casualties to work as possible. Widespread sympathy for the handicapped c h i l d  was  reflected i n the extension of crippled children's societies to other provinces.  In the larger c i t i e s , general and  chil-  dren's hospitals set up special f a c i l i t i e s to improve the treatment of children with orthopedic d i s a b i l i t i e s .  At  the  - 65 same t i m e , many o f the p r o v i n c i a l and l o c a l e d u c a t i o n a l a u t h o r i t i e s e x e r c i s e d g r e a t e r concern about the e d u c a t i o n of handicapped c h i l d r e n , and s p e c i a l c l a s s e s f o r d i f f e r e n t d i s a b i l i t i e s were o r g a n i z e d w i t h i n the r e g u l a r p u b l i c s c h o o l s systems.  P a r e n t s ' groups a l s o sprang up i n many p a r t s of the  c o u n t r y t o o r g a n i z e s e p a r a t e treatment and e d u c a t i o n a l day c e n t r e s f o r c e r e b r a l p a l s i e d and m e n t a l l y r e t a r d e d c h i l d r e n . Some o f the most s i g n i f i c a n t movements were sparked a t t h e community l e v e l . f o r coordinated  S o c i a l agencies became aware of the need  s e r v i c e s f o r a l l types of d i s a b i l i t y .  One  t h e f i r s t i n s t a n c e s o f c o - o p e r a t i v e community a c t i o n was  of  the  f o r m a t i o n o f t h e Vancouver C o u n c i l f o r Guidance o f Handicapped i n 1943;  the o n l y o r g a n i z a t i o n o f the k i n d which has  had a continuous e x i s t e n c e s i n c e t h a t d a t e .  S i m i l a r planning  a c t i v i t i e s were i n i t i a t e d l a t e r i n such c i t i e s as M o n t r e a l , Toronto, H a m i l t o n , Windsor and Edmonton among o t h e r s .  Physical  r e h a b i l i t a t i o n c e n t r e s , f o r c i v i l i a n s began t o be e s t a b l i s h e d . A number o f c e n t r e s were o r g a n i z e d , under v o l u n t a r y a u s p i c e s where a program o f assessment, m e d i c a l s e r v i c e s , p h y s i c a l and o c c u p a t i o n a l t h e r a p y , v o c a t i o n a l guidance, and o t h e r r e h a b i l i t a t i o n s e r v i c e s were made a v a i l a b l e t o p h y s i c a l l y d i s a b l e d p e r sons.  O u t s t a n d i n g examples were the G.P.  Strong R e h a b i l i t a -  t i o n Centre i n Vancouver and the R e h a b i l i t a t i o n I n s t i t u t e o f M o n t r e a l b o t h opened i n  1949.  Teaching h o s p i t a l s , the m e d i c a l s c h o o l s and p r o f e s s i o n a l a s s o c i a t i o n s , t o o , became i n c r e a s i n g l y aware of the development and t r a i n i n g o f m e d i c a l r e h a b i l i t a t i o n s e r v i c e s .  There was  - 66 a l s o a t r e n d towards t h e growth o f l o c a l s e l f - h e l p o r g a n i z a t i o n s formed by t h e d i s a b l e d themselves as f o r example t h e Canadian P a r a p l e g i c A s s o c i a t i o n .  These were m a i n l y concerned  w i t h s o c i a l and v o c a t i o n a l a c t i v i t i e s e s p e c i a l l y w i t h s h e l t e r e d workshops. P r o v i n c i a l governments began t o support c e r t a i n v o l u n t a r y a c t i v i t i e s f i n a n c i a l l y , and some p r o v i n c e s  initiated  r e h a b i l i t a t i o n s e r v i c e s d i r e c t l y f o r c e r t a i n d i s a b i l i t y groups such as p o l i o m y e l i t i c s , t h e c e r e b r a l p a l s i e d and t h e m e n t a l l y ill.  Saskatchewan was t h e f i r s t p r o v i n c e t o i n t r o d u c e a  p r o v i n c e - w i d e g e n e r a l v o c a t i o n a l r e h a b i l i t a t i o n program f o r i  a d u l t c i v i l i a n s i n 1946. I n 1948,  t h e F e d e r a l Government i n t r o d u c e d  the National  H e a l t h Grants Program which s t i m u l a t e d t h e development o f numerous p r o j e c t s and t h e expansion o f v o l u n t a r y and p r o v i n c i a l s e r v i c e s t h a t q u a l i f i e d f o r an a s s i s t a n c e t h r o u g h v a r i o u s h e a l t h grants administered H e a l t h and W e l f a r e .  by t h e Department o f N a t i o n a l  S e v e r a l g r a n t s , such as those f o r t u b e r -  c u l o s i s , m e n t a l h e a l t h and c r i p p l e d c h i l d r e n , made s p e c i f i c p r o v i s i o n f o r r e h a b i l i t a t i o n measures on a s h a r e a b l e W i t h i n a s h o r t t i m e , f e d e r a l and p r o v i n c i a l h e a l t h  basis. grants  became an i n f l u e n t i a l f a c t o r i n t h e development and expansion o f r e h a b i l i t a t i o n s e r v i c e s and f a c i l i t i e s .  I n Vancouver, t h e  g r a n t s enabled a S e i z u r e C l i n i c t o be e s t a b l i s h e d a t Vancouver G e n e r a l H o s p i t a l which was l a t e r t a k e n over by t h e h o s p i t a l i t self.  Grants a l s o made p o s s i b l e a d e m o n s t r a t i o n p r o j e c t by  t h e Vancouver F a m i l y W e l f a r e Bureau o f t h e v a l u e o f Homemaker S e r v i c e s where t h e mother was i n c a p a c i t a t e d f o r an extended  - 67 period. T h i s agency a l r e a d y had a s u p e r v i s e d Homemaker S e r v i c e , but was v e r y much aware o f t h e need f o r such a s e r v i c e o f t e n extended beyond a few months which tended t o t h e maximum l e n g t h o f time t h e agency might be a b l e t o p r o v i d e t h e s e r vice. Developments D u r i n g t h e 1950's A h i g h l i g h t of t h i s decade was t h e Canadian  Sickness  Survey c a r r i e d out i n 1950-1951 i n some 10,000 households throughout Canada.  I n t h e words o f t h e H a l l Report  I t showed t h e a p p a l l i n g s o c i a l , economic c o s t t o Canada o f i l l h e a l t h , p r o v i n g t h a t t h e f a m i l y and n a t i o n pay h e a v i l y i n terms o f l o s t p r o d u c t i o n f o r f a i l u r e t o make a v a i l a b l e t o a l l Canadian c i t i z e n s t h e standard o f h e a l t h s e r v i c e we know how t o p r o v i d e . Nor i s i t o n l y i n l o s s o f p r o d u c t i o n t h a t we pay. Many o f our s o - c a l l e d 'welfare e x p e n d i t u r e s ' a r e t h e end r e s u l t o f i l l n e s s , d i s a b i l i t y and premature d e a t h . Not a l l o f t h e s e e x p e n d i t u r e s a r e a v a i l a b l e o f course but c l e a r l y many o f them a r e . l The  s u r v e y i n d i c a t e d t h a t 7.4 % o f t h e p o p u l a t i o n  s u f f e r from some degree o f permanent d i s a b i l i t y , and about 3 i" were s e v e r e l y o r t o t a l l y d i s a b l e d .  These f i g u r e s d i d n o t  i n c l u d e mental i l l n e s s o r d e f i c i e n c y as c a t e g o r i e s n o r d i d they include residents of i n s t i t u t i o n s , m i l i t a r y e s t a b l i s h ments and I n d i a n r e s e r v a t i o n s .  There would need t o be con-  R o y a l Commission on H e a l t h S e r v i c e s , 1964, V o l . 1, Queen's P r i n t e r , Ottawa, 1964, pp. 5-6.  - 68 s i d e r a b l e upward r e v i s i o n t o make them a t a l l comprehensive. One r e s u l t o f the s u r v e y was the r e i n f o r c e m e n t o f t h e view o f workers i n the r e h a b i l i t a t i o n f i e l d t h a t  services  were i n c o m p l e t e and u n c o o r d i n a t e d . F o r a l o n g t i m e , attempts by p r e s s u r e groups  and  o t h e r i n d i v i d u a l s i n the f i e l d of r e h a b i l i t a t i o n t o urge t h e f e d e r a l government t o assume a more v i t a l r o l e i n the f i e l d d i d not seem t o meet w i t h much s u c c e s s .  However, i n  1951, t h e f e d e r a l government announced t h a t i t would  convene  a n a t i o n a l conference on the r e h a b i l i t a t i o n of the p h y s i c a l l y handicapped t o c o n s i d e r s o l u t i o n s  t o the problem.  This  proved t o be one o f the most f r u i t f u l development i n Canadian rehabilitation.  Over 200 d e l e g a t e s and o b s e r v e r s from t h e  t h r e e l e v e l s o f governments as w e l l as from major v o l u n t a r y s o c i e t i e s concerned w i t h t h e d i s a b l e d  met i n T o r o n t o .  Re-  commendations made a t t h i s conference "became i n f l u e n t i a l f a c t o r s i n more-co-ordinated development and expansion o f comprehensive  services  to c i v i l i a n disabled  and brought  about  formal, j o i n t , federal-provincial p a r t i c i p a t i o n i n r e h a b i l i t a t i o n i n Canada."  1  Three important developments following year.  took place i n the  I n 1952, t h e f e d e r a l government a p p o i n t e d a  Roeher, A., "Progress and Needs of R e h a b i l i t a t i o n i n Canada" R e h a b i l i t a t i o n and World Peace. P r o c e e d i n g s o f t h e 8 t h World Congress of t h e I n t e r n a t i o n a l S o c i e t y f o r the W e l f a r e o f C r i p p l e s , New York, I960, p. 62.  - 69  -  N a t i o n a l A d v i s o r y Committee on the R e h a b i l i t a t i o n of  Disabled  Persons w i t h n a t i o n - w i d e r e p r e s e n t a t i v e s from f e d e r a l ments, p r o v i n c i a l governments, o r g a n i z e d  labour,  depart-  employers,  u n i v e r s i t i e s , the m e d i c a l p r o f e s s i o n and v o l u n t a r y h e a l t h  and  welfare agencies,  t o s e r v e as a forum f o r the exchange of  ideas  and  I t also established a C i v i l i a n Rehabilitation  information.  Branch i n the N a t i o n a l Department of Labour and a p p o i n t e d , as head of t h i s new  department, a n a t i o n a l co-  o r d i n a t o r of R e h a b i l i t a t i o n t o c o - o r d i n a t e a c t i v i t i e s a t t h e f e d e r a l l e v e l and to co-ordinate I n 1953 provinces  i t also  rehabilitation  t o a s s i s t the  provinces  and d e v e l o p t h e i r r e h a b i l i t a t i o n programs. matching g r a n t s were a l s o made a v a i l a b l e t o  s i g n i n g a r e h a b i l i t a t i o n c o - o r d i n a t i o n agreement.  I n commenting on t h e s e developments a Canadian o b s e r v e r has remarked " T h i s a s s i s t a n c e was  predicated  t o meet the p r i m a r y needs i n d e v e l o p i n g  on the p r i n c i p l e t h a t an o v e r - a l l r e h a b i l i t a -  t i o n s e r v i c e would r e q u i r e c o n s i d e r a b l e p r e l i m i n a r y  planning,  experience,  t e c h n i c a l equipment and a l a r g e number o f t r a i n e d  personnel.  The  f e d e r a l support was,  o f t e c h n i c a l , a d v i s o r y and  t h e r e f o r e , i n the n a t u r e  f i n a n c i a l help."" " 1  I n the same y e a r , the f e d e r a l government a l s o  increased  the a v a i l a b l e funds f o r m e d i c a l r e h a b i l i t a t i o n by a d d i n g a M e d i c a l R e h a b i l i t a t i o n Grant t o the N a t i o n a l H e a l t h Program t o support s e r v i c e s f o r d i s a b l e d persons not a s s i s t e d under  Roeher, A., "Progress and Needs of R e h a b i l i t a t i o n i n Canada", op. c i t . , p. 63.  - 70 other Health Grants.  T h i s g r a n t made a v a i l a b l e on m i l l i o n  d o l l a r s a n n u a l l y f o r approved p r o j e c t s f o r t h e purchase o f r e h a b i l i t a t i o n p e r s o n n e l on a non-matching b a s i s , and f o r t h e e x t e n s i o n o f r e h a b i l i t a t i o n s e r v i c e s on a matching b a s i s . Every p r o v i n c e now has i n o p e r a t i o n a means o f c o ordinating rehabilitation a c t i v i t i e s .  Between 1953 and 1955  n i n e p r o v i n c e s have a p p o i n t e d a C o - o r d i n a t o r o f R e h a b i l i t a t i o n , whose r o l e i s t o c o - o r d i n a t e p u b l i c and p r i v a t e e f f o r t s i n t h e p r o v i n c e on b e h a l f o f d i s a b l e d i n d i v i d u a l s . A n o t h e r forward s t e p was t h e e x t e n s i o n i n 1953 o f t h e f e d e r a l - p r o v i n c i a l v o c a t i o n a l t r a i n i n g scheme (Schedule R ' ) , f  a d m i n i s t e r e d by t h e Department o f Labour, t o i n c l u d e v o c a t i o n a l t r a i n i n g o f d i s a b l e d persons.  The S p e c i a l Placement S e c t i o n  o f t h e N a t i o n a l Employment S e r v i c e was a l s o expanded i n t h e same y e a r . I n 1955, another j o i n t f e d e r a l - p r o v i n c i a l program was i n a u g u r a t e d through t h e D i s a b l e d Persons A l l o w a n c e s .  People  who were permanently and t o t a l l y d i s a b l e d were g r a n t e d a l l o w ances on a means t e s t b a s i s .  The A c t a l s o made p r o v i s i o n f o r  the r e h a b i l i t a t i o n assessment o f a p p l i c a n t s who might b e n e f i t from such s e r v i c e s , "thus a c t i n g as a d e v i c e f o r c a s e - f i n d i n g and r e f e r r a l t o r e h a b i l i t a t i o n services.""*" At t h e 1960-61 s e s s i o n o f P a r l i a m e n t , these  efforts  t o develop a comprehensive and c o - o r d i n a t e d program o f r e h a b i l i t a t i o n f o r d i s a b l e d persons were g i v e n f u r t h e r s t a t u t o r y  Roeher, A., "Progress and Needs o f R e h a b i l i t a t i o n i n Canada" o p . c i t . , p. 63.  -  71  -  r e c o g n i t i o n w i t h the passing of the V o c a t i o n a l R e h a b i l i t a t i o n o f D i s a b l e d Persons A c t .  This Act s p e c i f i e s the r e s p o n s i b i l -  i t i e s o f t h e F e d e r a l Government i n t h i s a r e a ;fof r e h a b i l i t a t i o n and p r o v i d e s f o r agreements w i t h t h e p r o v i n c e s thus ena b l i n g them t o proceed even f u r t h e r i n t h e i r c o - o r d i n a t i o n e f f o r t s t o meet the needs of d i s a b l e d persons.  The F e d e r a l  Government, t h r o u g h i t s agreements, w i l l share w i t h t h e p r o v i n c e s the c o s t i n c u r e d i n p r o v i d i n g comprehensive v o c a t i o n a l r e h a b i l i t a t i o n s e r v i c e s t o d i s a b l e d persons who need them.  The A c t a l s o p r o v i d e s f o r c o - o r d i n a t i o n o f F e d e r a l  a c t i v i t i e s i n the f i e l d of r e h a b i l i t a t i o n , research i n vocat i o n a l r e h a b i l i t a t i o n a t t h e f e d e r a l l e v e l and i n c o - o p e r a t i o n w i t h t h e p r o v i n c e s and t h e p u b l i c a t i o n o f i n f o r m a t i o n . These a c t i v i t i e s a r e undertaken through t h e o f f i c e of the N a t i o n a l Co-ordinator i n the C i v i l i a n R e h a b i l i t a t i o n Branch o f t h e Department o f l a b o u r . The N a t i o n a l C o - o r d i n a t o r and h i s s t a f f cooperate c l o s e l y w i t h t h e p r o v i n c e s and w i t h t h e P r o v i n c i a l  Oo-ordinators  and stand ready t o a d v i s e and a s s i s t i n the development o f programs requested  by t h e p r o v i n c e s .  Development and improve-  ment o f r e h a b i l i t a t i o n s t a f f and s e r v i c e s i s encouraged i n many ways: t h r o u g h c o n s u l t a t i o n , c o n f e r e n c e s , by continuous  workshops and  exchange o f i n f o r m a t i o n and e x p e r i e n c e s  within  t h e p r o v i n c e s and between t h e v a r i o u s p r o v i n c e s and the F e d e r a l Government.  - 72 Developments i n the 1960's I n the decade of the s i x t i e s , r e h a b i l i t a t i o n p r o gramming appears t o date t o have c o n t i n u e d a l o n g the same l i n e s as i n the  fifties.  However, a t the b e g i n n i n g o f the decade, a Canadian o b s e r v e r made t h i s comment about the g e n e r a l s t a t e o f our rehabilitation services: As a g e n e r a l c o n c l u s i o n , i t can be s t a t e d t h a t the b a s i c f o u n d a t i o n f o r sound r e h a b i l i t a t i o n programming has been e s t a b l i s h e d but comprehensive s e r v i c e s a r e s t i l l e i t h e r una v a i l a b l e o r inadequate f o r the g r e a t e r number o f Canadians whose d i s a b i l i t i e s c o u l d be prevented or r e h a b i l i t a t e d . T h i s optimum s t a g e o f development w i l l not be r e a l i z e d u n t i l r e h a b i l i t a t i o n p r i n c i p l e s , processes and p r a c t i c e s a r e i n t r i n s i c a s p e c t s o f r e g u l a r h e a l t h , e d u c a t i o n and s o c i a l s e r v i c e s of t h e community. The momentum of c u r r e n t a c t i v i t i e s suggests t h a t these g o a l s w i l l be reached w i t h i n the next g e n e r a t i o n . 1 The w r i t e r s o f t h i s study would be i n s u b s t a n t i a l agreement w i t h t h i s o b s e r v a t i o n , w i t h the e x c e p t i o n o f the l a s t sentence.  An a l t e r n a t i v e v i e w p o i n t , which i s e x p l o r e d "  i n t h i s s t u d y i s t h a t t h e s e g o a l s cannot be reached n e x t g e n e r a t i o n o r indeed a t a l l w i t h o u t two  i n the  important  p r e l i m i n a r i e s - f i r s t a c a r e f u l r e v i e w and a n a l y s i s o f our p r e s e n t r e h a b i l i t a t i o n p o l i c i e s and programs as a p r e r e q u i s i t e t o n e c e s s a r y r e d e s i g n i n g and s e c o n d l y , a w i l l i n g n e s s t o cons i d e r some r a t h e r r a d i c a l r e v i s i o n s o f p o l i c y .  Roeher, A., "Progress and Needs of R e h a b i l i t a t i o n i n Canada", op. c i t . , pp. 72-73.  BIBLIOGRAPHY (Chapters I, I I , I I I )  Books A l l a n , S e o t t , R e h a b i l i t a t i o n : A Community Challenge. John Wiley & Sons Inc., New York, 1958. B a r t l e i t , H a r r i e t t , M., S o c i a l Work P r a c t i c e i n the H e a l t h F i e l d . N.A.S.W. New York, U.S.A. Garrett,  James & l e v i n e , Edna (ed.), P s y c h o l o g i c a l P r a c t i c e s with the P h y s i c a l l y D i s a b l e d . Columbia U n i v e r s i t y Press, New York, 1962.  Green, Mary, W., (ed.) Proceedings of the Workship: P r a c t i c e of S o c i a l Work i n R e h a b i l i t a t i o n , U n i v e r s i t y o f Chicago, 111., June, I960. Hamilton, Kenneth, C o u n s e l l i n g the Handicapped i n R e h a b i l i t a t i o n . Ronald P r e s s , New York, 1950. Laycock, Samuel, R., S p e c i a l E d u c a t i o n i n Canada. W.J. Gage L t d . , Toronto, Canada, 1963. Morse, David, "Way Back t o Working L i f e " P l a n n i n g f o r V i c t o r y over Disablement. Proceedings o f the 7 t h World Congress of the I n t e r n a t i o n a l S o c i e t y f o r the Welfare of C r i p p l e s . London, 1957. Roeher, A l l a n , "Progress and Needs of R e h a b i l i t a t i o n i n Canada" R e h a b i l i t a t i o n and World Peace. Proceedings o f the 8th World Congress of the I n t e r n a t i o n a l S o c i e t y f o r the Welfare of C r i p p l e s . New York, I960. Rusk, Howard, L i v i n g w i t h a D i s a b i l i t y : A t Home - At Work - At P l a y . The B l a k i s t o n Co. L t d . , Garden C i t y , New York, 1953. Rusk, Howard, R e h a b i l i t a t i o n Medicine. The C.V. Mosby Co. S t . L o u i s , 1958. Thompson, N e l l i e , Z., The Role of the Workshop i n R e h a b i l i t a t i o n , (ed.) A Report o f the N a t i o n a l I n s t i t u t e on the Role of the Workshop i n R e h a b i l i t a t i o n , Bedford, Penn. Wash., D.C., A p r i l , 1958.  - 74 W r i g h t , B e a t r i c e , A. ( e d . ) , P s y c h o l o g y and R e h a b i l i t a t i o n . P r o c e e d i n g s o f an I n s t i t u t e on t h e R o l e s o f Psychology and P s y c h o l o g i s t s i n R e h a b i l i t a t i o n , P r i n c e t o n N.J., Feb., 1858, Washington, D.C., I960. Publications Canada Canadian M e n t a l H e a l t h A s s o c i a t i o n , B r i e f t o t h e R o y a l Commission on H e a l t h S e r v i c e s . Toronto. 1962. Department o f Labour, C i v i l i a n R e h a b i l i t a t i o n , Canada, R e h a b i l i t a t i o n i n Canada. Summer, 1962, Queen's P r i n t e r and C o n t r o l l e r o f S t a t i o n e r y , Ottawa, 1962. Department o f N a t i o n a l H e a l t h and W e l f a r e , Research and S t a t i s t i c s D i v i s i o n . R e h a b i l i t a t i o n S e r v i c e s i n Canada. P a r t I : G e n e r a l Review, Ottawa, I960. Department o f N a t i o n a l H e a l t h and W e l f a r e , Research and S t a t i s t i c s D i v i s i o n . R e h a b i l i t a t i o n S e r v i c e s i n Canada. P a r t I I : P r o v i n c i a l and L o c a l Programs, Ottawa, 1959. United States American P u b l i c H e a l t h A s s o c i a t i o n I n c . , S e r v i c e s f o r H a n d i capped C h i l d r e n : A Guide t o G e n e r a l P r i n c i p l e s and P r a c t i c e s f o r P u b l i c H e a l t h P e r s o n n e l , New Y o r k , 1955. American A s s o c i a t i o n o f M e d i c a l S o c i a l Workers: S o c i a l Work P r a c t i c e i n M e d i c a l Care and R e h a b i l i t a t i o n S e t t i n g s : Monograph I : The E v o l v i n g Concept o f R e h a b i l i t a t i o n . Washington, D.C., 1955. American A s s o c i a t i o n o f M e d i c a l S o c i a l Workers: S o c i a l Work P r a c t i c e i n M e d i c a l Care and R e h a b i l i t a t i o n S e t t i n g s : Monograph I I : Teamwork: P h i l o s o p h y and P r i n c i p l e s . Wash., D.C., 1955. American A s s o c i a t i o n o f M e d i c a l S o c i a l Workers: I n s t i t u t e P r o c e e d i n g s : Teamwork i n t h e M e d i c a l S e t t i n g . Oct., 1953, M o n t r e a l , Canada. R o y a l Commission on H e a l t h S e r v i c e s . P r i n t e r , Ottawa, 1964.  1964, V o l . 1, Queen's  U.S. Department o f H e a l t h , E d u c a t i o n and W e l f a r e : V o c a t i o n a l R e h a b i l i t a t i o n A d m i n i s t r a t i o n . McGowan, John F. ( e d . ) , An I n t r o d u c t i o n t o t h e V o c a t i o n a l R e h a b i l i t a t i o n P r o c e s s . U.S. Government P r i n t i n g O f f i c e , Wash., D.C., U.S.A., I960.  - 75  -  U.S.  Department of H e a l t h , E d u c a t i o n and W e l f a r e : O f f i c e o f V o c a t i o n a l R e h a b i l i t a t i o n . The Placement P r o c e s s i n V o c a t i o n a l R e h a b i l i t a t i o n C o u n s e l i n g . Thomason, Bruce and B a r r e t t , A l b e r t M., (ed.) U.S. Government P r i n t i n g O f f i c e , Wash., U.S.A. I960 R e h a b i l i t a t i o n S e r v i c e S e r i e s #545.  U.S.  Department o f H e a l t h , E d u c a t i o n and W e l f a r e : O f f i c e o f V o c a t i o n a l R e h a b i l i t a t i o n . P r o c e e d i n g s on the I n s t i t u t e on R e h a b i l i t a t i o n Centre P l a n n i n g . Chicago, 111. Feb.March, 1957. U.S. Government P r i n t i n g O f f i c e , Wash., U.S.A., R e h a b i l i t a t i o n S e r v i c e S e r i e s #420.  U.S.  Department of H e a l t h , E d u c a t i o n and W e l f a r e : O f f i c e o f V o c a t i o n a l R e h a b i l i t a t i o n . P a r r e t t , James F. (ed.), P s y c h o l o g i c a l A s p e c t s of P h y s i c a l D i s a b i l i t y . U.S. Government P r i n t i n g O f f i c e , Wash., U.S.A., R e h a b i l i t a t i o n Service Series #210.  United Nations I n t e r n a t i o n a l Labour O f f i c e , V o c a t i o n a l R e h a b i l i t a t i o n of the D i s a b l e d . Report IV (1) I n t e r n a t i o n a l Labour Conference, Geneva, 1954. I n t e r n a t i o n a l Labour O f f i c e , V o c a t i o n a l R e h a b i l i t a t i o n of the D i s a b l e d . Report IV (2) I n t e r n a t i o n a l Labour Conf e r e n c e , Geneva, 1955. World H e a l t h O r g a n i z a t i o n , E x p e r t Committee on M e d i c a l R e h a b i l i t a t i o n . Geneva, 1958. T e c h n i c a l Report Series #158. Britain M i n i s t e r of Labour and N a t i o n a l S e r v i c e t o P a r l i a m e n t , Report of the Committee of I n q u i r y on The R e h a b i l i t a t i o n T r a i n i n g and R e s e t t l e m e n t of D i s a b l e d P e r s o n s . Her M a j e s t y ' s S t a t i o n a r y O f f i c e , London, 1956. Others Gorthy, W i l l i s : D a r l i n g , R o b e r t ; Tsu P a i , L u c i l l e and O b r i e n , Jay, V o c a t i o n a l E v a l u a t i o n by Work Sample T e c h n i c and i t s Dependence upon M e d i c a l C o n t r i b u t i o n s . New York, 1959.  - 76 -  I n s t i t u t e f o r t h e C r i p p l e d and D i s a b l e d . R e h a b i l i t a t i o n o f M e n t a l P a t i e n t s i n a Comprehensive R e h a b i l i t a t i o n C e n t r e . New York, I960. I n s t i t u t e f o r t h e C r i p p l e d and D i s a b l e d . R e h a b i l i t a t i o n Trends: M i d c e n t u r y t o 1956, New York, 19567 Raimy, V i c t o r ( e d . ) , C o o r d i n a t e d T r a i n i n g i n R e h a b i l i t a t i o n . Report o f t h e Western I n s t i t u t e on C o o r d i n a t i o n o f T r a i n i n g i n R e h a b i l i t a t i o n , March, 1959, B o u l d e r , C o l o r a d o , 1959. T u l a n e , U n i v e r s i t y , S c h o o l o f S o c i a l Work, Newer Concepts o f M e n t a l R e t a r d a t i o n i n M e d i c a l Care Programs f o r C h i l d r e n . New O r l e a n s , LA. 1957. Journals Benney, C e l i a , "The R o l e o f t h e Caseworker i n R e h a b i l i t a t i o n " S o c i a l Casework. V o l . 36, #3 March 1955, pp. 118-121. S t i t e s , Mary, " P s y c h o l o g i c a l D i a g n o s i s i n V o c a t i o n a l R e h a b i l i t a t i o n S e r v i c e s " S o c i a l Casework, V o l . 39, #1 Jan., 58, pp. 12-21.  S t i t t , P a u l i n e George, "The C o - o p e r a t i o n o f t h e D i s a b l e d i n t h e i r R e h a b i l i t a t i o n " S o c i a l Casework, V o l . 33, #4 A p r i l 52, pp. 153-160.  W a l l a c e , H e l e n , "The R o l e o f t h e S o c i a l Worker i n t h e R e h a b i l i t a t i o n o f t h e Handicapped" S o c i a l Casework, V o l . 38, #1 J a n u a r y 57, pp. 9-15. Papers B r a e e l a n d , F r a n c i s J r . , The R o l e o f P s y c h i a t r i s t i n R e h a b i l i t a t i o n , R e p r i n t from t h e J o u r n a l o f American M e d i c a l A s s o c i a t i o n , Sept., 1957. B r i c k e r , June, P l a n n i n g f o r R e h a b i l i t a t i o n S e r v i c e s , R e p r i n t from t h e J o u r n a l o f Home Economics, Nov., 1958. G i l m o u r , S.M., The Employers' R e s p o n s i b i l i t y i n t h e R e h a b i l i t a t i o n o f t h e D i s a b l e d , R e p r i n t from Conquering P h y s i c a l Handicaps: P r o c e e d i n g s o f t h e P a n - P a c i f i c R e h a b i l i t a t i o n Conference, 1958, Sydney, A u s t r a l i a .  - 77  -  Martin, Paul, The Honourable, Minister of Health and Welfare, Health Grants, excerpt from Hansard p. 4680 under •Supply' May, 1953. Sims, V a l e r i a A., The Development of Vocational Rehabilitation i n Canada. Obtained from the o f f i c e of the National Co-ordinator of C i v i l i a n Rehabilitation, Ottawa, 1961.  SECTION::, I I THE ROLE OF THE FEDERAL GOVERNMENT IN REHABILITATION  CHAPTER THE  LEGISLATIVE BASE FOR  IV-1  REHABILITATION SERVICES IN CANADA  Canada's Commitment t o Implement Comprehensive R e h a b i l i t a t i o n S e r v i c e s  I t i s perhaps a p p r o p r i a t e t o b e g i n a c o n s i d e r a t i o n of the base f o r r e h a b i l i t a t i o n i n Canada from the v i e w p o i n t  t h a t Canada s i g n e d  the c o n s t i t u t i o n of the World H e a l t h O r g a n i z a t i o n , and has s u b s c r i b e d t o the f o l l o w i n g p r i n c i p l e e n u n c i a t e d  legislative  accordingly  i n the preamble to i t s  charter:"The enjoyment of the h i g h e s t a t t a i n a b l e standards of h e a l t h i s one of the fundamental r i g h t s of every human b e i n g w i t h o u t d i s t i n c t i o n of r a c e , r e l i g i o n , p o l i t i c a l b e l i e f , economic or s o c i a l c o n d i t i o n . The h e a l t h of a l l peoples i s fundamental t o the attainment of peace and s e c u r i t y and i s dependent upon the f u l l e s t c o o p e r a t i o n of i n d i v i d u a l s and S t a t e s . " (1)  I t s h o u l d be remembered t h a t the U n i t e d Nations d e f i n i t i o n of h e a l t h has  always been a comprehensive one,  c u r a t i v e and  encompassing the p r e v e n t i v e , d i a g n o s t i c ,  r e h a b i l i a t i v e phases.  Canada, then i s on r e c o r d at the i n t e r n a t i o n a l l e v e l as h e r s e l f to implement the p r i n c i p l e s she has Nations  Charter.  s u b s c r i b e d to i n the  In a modern s o c i e t y , implementation  out government a c t i o n at the l e g i s l a t i v e  In Canada, as was  1  United  i s impossible with-  level.  seen i n Chapter I I I , r e h a b i l i t a t i o n s e r v i c e s grew  up a t many d i f f e r e n t times under d i f f e r e n t a u s p i c e s  The  pledging  t o meet d i f f e r e n t needs  World H e a l t h O r g a n i z a t i o n , C o n s t i t u t i o n , Geneva,. O r g a n i z a t i o n , 1960, p. 1  IV-2  for different to  the  groups.  T h i s i s not  i s made an  Because of  ment p o l i c y  The  the  policy.  insurmountable o b s t a c l e  i n the  rehabilitation field  constitutional  Constitutional The  a number of  rehabilitation  q u e s t i o n then a r i s e s  be  said  c h a l l e n g e s and  circumstances p e c u l i a r  as  done u n l e s s  The  i n r e h a b i l i t a t i o n may  c o n s i d e r e d adequate to the  today.  of  However, i t cannot be  o b j e c t i v e of n a t i o n a l  what Canada's p o l i c y be  an  development o f a comprehensive scheme of s e r v i c e s ,  c o u n t r i e s have shown.  may  necessarily  to be  how  a  Division  consideration  of Power i n Canada of 1867,  often referred  t o as  "Canada's  constitution",  p r o v i d e s f o r a d i v i s i o n of j u r i s d i c t i o n between the  and  governments.  h e l d r e s p o n s i b l e f o r the " W e l f a r e " as w e l l as in rehabilitation.  Under t h a t d i v i s i o n , the  areas which today have become known as  f o r E d u c a t i o n , a l l of which are As  time went by,  federal  a i d t o the the  government.  Role of It  the  increasingly  from the  In the  field  provinces  assistance  of  rehabilitation  Rehabilitation r o l e o f the  federal  government i n rehab-  early years following Confederation.  visualized  and  i n v o l v e d , to some e x t e n t ,  defined i t s r o l e .  however, must s u f f i c e f o r purposes of t h i s s t u d y . government has  "Health,"  i t became i m p o s s i b l e f o r the  of ways.  F e d e r a l Government i n  i s p o s s i b l e to t r a c e the  ilitation  generally  S u c c e s s i v e Canadian governments have extended  provinces i n a v a r i e t y  government has  federal  p r o v i n c e s are  to meet t h e i r f i n a n c i a l r e s p o n s i b i l i t i e s i n these areas w i t h o u t from the  govern-  d i v i s i o n of powers.  B r i t i s h North America Act  provincial  society  review of  preceded by  to  far i t  needs o f Canadian  to Canada, any  must be  and  as  i t s role  A b r i e f summary,  In essence, the  i n r e h a b i l i t a t i o n as  a fourfold  federal task:-  IV-3  (1)  To p r o v i d e s p e c i a l c o n c e s s i o n s to the d i s a b l e d legislation.  (2)  To take d i r e c t r e s p o n s i b i l i t y f o r the r e h a b i l i t a t i o n of c e r t a i n s p e c i f i c groups o f c i t i z e n s .  (3)  To extend f i n a n c i a l a i d t o the p r o v i n c e s through a v a r i e t y c o s t s h a r i n g d e v i c e s and d i r e c t grants i n a i d .  (4)  To a c t i n a c o o r d i n a t i n g r o l e , o f f e r i n g a s s i s t a n c e , a d v i c e and c o n s u l t a t i o n s e r v i c e s and a c t i n g as a c l e a r i n g house f o r i n f o r m a t i on.  In g e n e r a l ,  i n the  i t might be s a i d the f e d e r a l government has  i n system of what i t has to examine how  f u n c t i o n s w i l l now  be  acted  c a l l e d "Cooperative f e d e r a l i s m . "  t h i s system a c t u a l l y works i n p r a c t i c e .  general  of  as  "enabler"  I t i s important  Each of the  reviewed.  C o n c e s s i o n s t o the D i s a b l e d  i n the General L e g i s l a t i o n  From v e r y e a r l y i n Canadian h i s t o r y , the f e d e r a l government provided  i n d i r e c t f i n a n c i a l a i d to the d i s a b l e d  cessions  to them i n the g e n e r a l  of Canada, f o r i n s t a n c e , and  regulations  Customs and  legislation.  a considerable  In the  taxation  number o f s e c t i o n s  tax on a r t i c l e s used by  has  through c e r t a i n con-  e x i s t which o f f e r to the d i s a b l e d  excise  four  structure  of  statutes  c e r t a i n tax  reliefs.  the d i s a b l e d are waived as i s  s a l e s tax on goods produced i n workshops f o r the b l i n d , on a r t i c l e s by h o s p i t a l s f o r the b e n e f i t of the d i s a b l e d ,  and  organizations  There are a l s o c e r t a i n tax  e x i s t i n g to h e l p  the d i s a b l e d .  c o n c e s s i o n s i n r e l a t i o n to e s t a t e The  printed  by  duties.  Canadian R e h a b i l i t a t i o n C o u n c i l  f o r the d i s a b l e d has  commissioned a study on Canadian l e g i s l a t i o n as (1)  on m a t e r i a l s  used  i t a f f e c t s the  recently disabled.^  P e r s o n a l communication from the N a t i o n a l E x e c u t i v e D i r e c t o r , Mr. K e i t h Armstrong, i n a l e t t e r to Mrs. Mary Tadych, D i r e c t o r o f t h i s study, 24th November, 1964. The C o u n c i l Study w i l l be under the d i r e c t i o n of P r o f e s s o r A.M. L i n d e n of Osgoode H a l l , T o r o n t o .  IV-4 Such a study has its  been l o n g overdue, because, as the C o u n c i l s t a t e d i n  B r i e f to the Royal Commission on  Taxation:-  " L i t t l e thought seems to have been g i v e n t o the n a t i o n a l T a x a t i o n p o l i c y i n r e l a t i o n to the d i s abled. The l e g i s l a t i o n i s a patchwork. I t has grown up b i t b y ^ b i t over the y e a r s . There i s no meaningful o v e r a l l p o l i c y . . . T h e r e a r e only f r a g ments o f a p o l i c y . T h i s p o l i c y seems t o be t h a t 'The government w i l l h e l p some of the d i s a b l e d i n some ways some o f the t i m e ' . . . . C a r e f u l c o n s i d e r a t i o n must be g i v e n t o t h i s problem. A n a t i o n a l p o l i c y must be c r e a t e d . Then l e g i s l a t i v e draughtsman must do a s y s t e m a t i c r e v i s i o n of the p e r t i n e n t l e g i s l a t i o n i n i t s image. P r o v i s i o n must be made f o r c o n t i n u a l and easy r e v i s i o n " , The  C o u n c i l advocated t h a t t h i s r e v i s i o n be  "simplicity,  c o n s i s t e n c y and f a i r n e s s . "  i n the i n t e r e s t s of  (2)  I t i s assumed f o r purposes of t h i s study a p o l i c y of general concessions  that there i s merit  of t h i s k i n d , and  made, i n the words o f the C o u n c i l ' s b r i e f  t h a t they  " i n such a way  can  in  be  as t o promote  s e l f s u f f i c i e n c y , r a t h e r than t o make the i n d i v i d u a l dependent upon (3) government l a r g e s s e . " However, as the C o u n c i l ' s study w i l l be an e x t e n s i v e l i t t l e point i n devoting  a full  a t i o n of the e f f e c t s of p r e s e n t ual disabled citizen.  chapter  one,  i n t h i s p r e s e n t study  federal policy  Ibid,  p.8  3  Ibid,  p.8  to a  i n t h i s a r e a on the  I t i s an a r e a which r e q u i r e s d e t a i l e d study  1 Canadian R e h a b i l i t a t i o n C o u n c i l f o r the D i s a b l e d B r i e f to the Royal Commission on T a x a t i o n , pp.12-13 2  t h e r e seemed considerindividand  IV-5  c l a r i f i c a t i o n p r i o r t o any v a l i d c o n s i d e r a t i o n o f changes i n n a t i o n a l policies, sections  F o r t h i s reason, the r e a d e r i s r e f e r r e d t o the v a r i o u s of t h e C o u n c i l ' s  study as they become a v a i l a b l e . ^  1 The C o u n c i l p l a n s t o have h e a l t h l e g i s l a t i o n and e d u c a t i o n a l l e g i s l a t i o n ( as they a f f e c t the d i s a b l e d ) , reviewed as w e l l .  CHAPTER V FEDERAL RESPONSIBILITY FOR THE REHABILITATION OF SPECIFIC CITIZEN GROUPS  A c c o r d i n g t o the B r i t i s h North America A c t , and subsequent the f e d e r a l government agreed groups  of c i t i z e n s ,  Ironically, was  and t h i s extended  the assumption  t o demonstrate  t o take d i r e c t r e s p o n s i b i l i t y  of f e d e r a l r e s p o n s i b i l i t y  direct responsibility  The groups  for certain  to t h e i r r e h a b i l i t a t i o n needs.  the best and the worst  p o l i c i e s and p r a c t i c e s .  amendments,  f o r these  in rehabilitation  groups  principles,  f o r which the f e d e r a l government has  are M a r i n e r s , I n d i a n s , Eskimos,  V e t e r a n s , and  Blind  People.  Mariners As we  are i n c r e a s i n g l y a p p r o a c h i n g the "One  W o r l d " o f Wendell  W i l k i e ' s dream, i t f o l l o w s t h a t a l l the c o u n t r i e s o f the w o r l d have a special responsibility still  t o m a r i n e r s , I n s p i t e o f a i r t r a n s p o r t , they are  the key people i n e n a b l i n g us t o enjoy the goods of the w o r l d .  a r e exposed  to many h e a l t h h a z a r d s , e s p e c i a l l y a c c i d e n t s , and o f t e n  from r e s i d u a l d i s a b i l i t i e s  f a r more s e v e r e than n e c e s s a r y because  not t r a n s p o r t e d to n e c e s s a r y care i n time or they have t o because  They suffer  they a r e of  economic n e c e s s i t y , r e t u r n to s h i p duty w h i l e they c o u l d s t i l l b e n e f i t  from  r e m e d i a l measures. While  the Canadian  government has a r e a s o n a b l y good r e c o r d i n the c a r e  of t h i s group, much remains  t o be done which cannot be accomplished by  government o f one country a c t i n g a l o n e . economic dependency found i n t h i s group an i l l n e s s or a c c i d e n t , t h e i r way  Much o f the d i s a b i l i t y i s because  the  consequent  once they have s u f f e r e d  o f l i f e makes i t extremely d i f f i c u l t  to  V-2 b r i n g the f u l l b e n e f i t s o f modern r e h a b i l i t a t i o n p r a c t i c e s t o bear on particular  problems.  T h i s group  their  i s often overlooked i n r e h a b i l i t a t i o n  studies.  Indians and  Eskimos  The i n t e n t o f the f e d e r a l A c t s which gave the r e s p o n s i b i l i t y groups  t o the c e n t r a l  plight  o f the f i r s t  is  government was  f o r these  t o ensure them " p r o t e c t i o n " .  n a t i v e born Canadians  under t h i s  one o f the worst b l o t s i n Canadian h i s t o r y .  The  "protective" policy  That they a r e prime  can-  d i d a t e s f o r our r e h a b i l i t a t i o n programmes f o r " s o c i a l l y d i s a d v a n t a g e d groups" i s a t e l l i n g comment on the p o l i c i e s t h a t enabled them to become " d i s a d v a n t a g e d " c i t i z e n s on the country o f t h e i r It  i s h e a r t e n i n g to note evidences of a reawakening  conscience i n r e l a t i o n improved groups  o f the  Canadian  to these two groups, which has a l r e a d y l e d t o  rehabilitation policies.  H e a l t h and W e l f a r e s e r v i c e s f o r these  a r e found i n a number o f d i f f e r e n t  government departments,  tends towards f r a g m e n t a t i o n o f r e h a b i l i t a t i o n It  origin.  i s to be hoped t h a t f u t u r e p o l i c y  and  this  services.  towards these groups w i l l  find  e x p r e s s i o n i n the implementation o f the "Royal Commission On H e a l t h S e r v i c e s " recommendation t o the e f f e c t  that:-  " A d m i n i s t r a t i o n of H e a l t h S e r v i c e s f o r these groups s h o u l d be e n t r u s t e d to the p r o v i n c e s and h e a l t h s e r v i c e s p r o v i d e d i n the same manner and of the same q u a l i t y as those enjoyed by o t h e r  "Canadians."  (D  1 The Royal Commission on H e a l t h S e r v i c e s , V o l . 1, p.21  V-3  Veterans F o l l o w i n g the two w o r l d wars, the Canadian government  introduced  an e x c e l l e n t system of r e h a b i l i t a t i o n s e r v i c e s f o r v e t e r a n s . be t r u e t o say  t h a t t h i s Canadian developed programme c o u l d s t i l l  as an i n t e r n a t i o n a l model on which t o p a t t e r n any of r e h a b i l i t a t i o n . the  I t would  Unfortunately,  i t was  stand  comprehensive system  l i m i t e d t o a s p e c i f i c group i n  population. The  i n t e n t of the f e d e r a l l e g i s l a t i o n i n t h i s a r e a was  the best p o s s i b l e r e h a b i l i t a t i o n o f d i s a b l e d v e t e r a n s , so w e l l t h a t , i n e f f e c t ,  s i n c e been argued t h a t g r a t i t u d e t o war  r a i s i n g them t o the s t a t u s of a h i g h e r higher  this i t did  the r e h a b i l i t a t i o n s e r v i c e s p r o v i d e d  exceeded both i n q u a l i t y and q u a n t i t y those p r o v i d e d I t has  and  t o promote  to other  veterans  to  veterans  citizens.  s h o u l d not  c l a s s c i t i z e n with r i g h t s to a  c l a s s of r e h a b i l i t a t i o n s e r v i c e s than i s a v a i l a b l e to the  population.  I t has  even been suggested t h a t c e r t a i n a s p e c t s  of  general the  V e t e r a n ' s R e h a b i l i t a t i o n s e r v i c e s l o c a t e d i n the V e t e r a n ' s A f f a i r s ment need no The of 1962  longer  Depart-  exist.  Royal Commission on Government O r g a n i z a t i o n recommended t h a t v e t e r a n ' s  ( the G l a s s c o  Commission)  h o s p i t a l s s h o u l d be i n t e g r a t e d i n the  t o t a l Canadian h o s p i t a l programme, w i t h b e t t e r o v e r a l l use  o f the  to the b e n e f i t of the average Canadian c i t i z e n as w e l l as the  The  include  facilities  veteran.  Blind The  f e d e r a l government has  wards the B l i n d .  a l s o undertaken c e r t a i n r e s p o n s i b i l i t i e s  to-  Under the B l i n d Persons A c t , the government a u t h o r i z e s  the  payment lof allowances t o B l i n d people.  T h i s programme i s a good example of  the " c a t e g o r i c a l " or " p i e c e m e a l " approach  t o r e h a b i l i t a t i o n which has been  c h a r a c t e r i s t i c of Canadian r e h a b i l i t a t i o n p o l i c y f o r so l o n g . t o be no s p e c i a l r e a s o n why  There seems  the b l i n d , r a t h e r than any o t h e r group s h o u l d  be s i n g l e d out f o r a c t i o n of t h i s k i n d a t the f e d e r a l l e v e l , when no o t h e r group  of the d i s a b l e d has had  s p e c i a l l e g i s l a t i o n passed f o r them.  only answer seems t o be t h a t t h i s was could r e a d i l y  i d e n t i f y and  The  a group w i t h which the p u b l i c c o n s c i e n c e  sympathize.  A maximum monthly allowance o f $75.00 i s a v a i l a b l e t o i h o s e b l i n d people who  meet the requirements  of a means t e s t and who  b l i n d w i t h i n the meaning o f the a c t .  are c e r t i f i e d  The Allowance i s a d m i n i s t e r e d through  a p r o v i n c i a l board, s i m i l a r t o the Old Age A s s i s t a n c e Board, the same Board.  or a c t u a l l y  Viewed as an income maintenance programme, t h i s  is often insufficient  as  allowance  t o meet the f i n a n c i a l needs o f the r e c i p i e n t .  In  some p r o v i n c e s , m e d i c a l and h o s p i t a l b e n e f i t s a r e i n c l u d e d , i t i s t r u e , as w e l l as p r o v i s i o n f o r supplementary  monetary a i d , but t h e r e i s no u n i f o r m i t y .  Other needs of the B l i n d may  through the Canadian  be met  National Institute  f o r the B l i n d , a p r i v a t e agency, which assumes r e s p o n s i b i l i t y such needs as t r a i n i n g i n s p e c i a l s k i l l s ,  j o b placement  and  f o r meeting  recreation.  Yet i n a number o f r e s p e c t s , the b l i n d get more c o n c e s s i o n s from both f e d e r a l and p r o v i n c i a l governments than do o t h e r d i s a b l e d groups.  While  t h e r e i s no d i f f e r e n c e i n the amount o f t h e i r p e n s i o n as compared t o o t h e r groups,  (such as Old Age A s s i s t a n c e and D i s a b l e d Persons A l l o w a n c e ) , the  means t e s t  i s more l i b e r a l f o r the b l i n d  other d i s a b i l i t i e s .  than f o r p e o p l e s u f f e r i n g  from  A s i n g l e b l i n d p e n s i o n e r can earn up t o $1,500 per  y e a r , w h i l e a person w i t h another d i s a b i l i t y  i s limited  t o $1,260, and  a  m a r r i e d b l i n d p e r s o n can earn up t o $2,580, as compared w i t h $2,220 f o r o t h e r  V-5  groups.  A l s o , f o r a b l i n d person, an e x t r a allowance i s made i f t h e r e  i s a dependent c h i l d , but t h i s i s not g i v e n i n the case o f a p e r s o n w i t h another type o f d i s a b i l i t y . it  While these c o n c e s s i o n s may  i s a l s o t r u e t h a t persons w i t h o t h e r d i s a b i l i t i e s may  and may  be l i t t l e  have e x t r a expenses  need the a i d of another p e r s o n as a b l i n d person may  The only f a i r way  enough,  need a g u i d e .  i s t o extend t o the d i s a b l e d p e r s o n whatever k i n d o f a i d  he needs t o p r o v i d e f o r h i m s e l f or t o meet those needs which he possibly provide f o r himself.  cannot  F l a t r a t e allowances by themselves  cannot  do  this. At the f e d e r a l l e v e l ,  the government reimburses the p r o v i n c e s f o r 757.  of t h e i r B l i n d Persons Allowance  E x p e n d i t u r e , w h i l e i t reimburses  50% of t h e i r e x p e n d i t u r e s on o t h e r d i s a b i l i t y p e n s i o n s . example o f h i s t o r i c a l anomalies  them o n l y  T h i s i s y e t another  p r e s e n t i n the c u r r e n t p a t t e r n i n g o f s e r v i c e s .  CHAPTER VI-1 FEDERAL POLICIES IN FINANCIAL AID TO THE PROVINCES A f u l l review of a l l the measures by which the f e d e r a l government has  extended  a i d t o the p r o v i n c e s i n the r e h a b i l i t a t i o n f i e l d would  o u t s i d e the scope of t h i s s t u d y .  Two  be  of the p r i n c i p a l types of a i d  w i l l be s e l e c t e d as c h a r a c t e r i s t i c of the Canadian p a t t e r n , an a n a l y s i s of  t h e i r e f f e c t on the p r e s e n t p a t t e r n i n g of s e r v i c e s w i l l be made.  These are the F e d e r a l H e a l t h Grant Programme and  the a s s i s t a n c e a v a i l -  a b l e t o the p r o v i n c e s under the H o s p i t a l and D i a g n o s t i c S e r v i c e s A c t .  N a t i o n a l H e a l t h Grants  Programme  The p r i n c i p l e of g r a n t s i n a i d t o p r o v i n c e s t o a s s i s t them i n c a r r y i n g out t h e i r r e s p o n s i b i l i t i e s has  proved  t o be one  i n the h e a l t h and r e h a b i l i t a t i o n  of the most p r o d u c t i v e ways i n which the  government can t r a n s f e r f i n a n c i a l r e s o u r c e s t o the p r o v i n c e s . the N a t i o n a l H e a l t h Grants  Programme a v a i l a b l e through  N a t i o n a l H e a l t h and W e l f a r e has the p r o v i n c e s .  In the f i r s t  i n e x i s t e n c e , and and W e l f a r e 1953  he  i n 1953,  a s s i s t e d approved  field  federal Since  1948,  the Department of  p r o j e c t s submitted  by  f i v e y e a r s of the programme, t e n grants were  Mr.  announced t h r e e new  P a u l M a r t i n , then M i n i s t e r of N a t i o n a l H e a l t h grants.  Speaking  i n P a r l i a m e n t on May  1,  said:The house knows the government's b a s i c h e a l t h o b j e c t i v e , of c o u r s e , t o b r i n g the b e s t of h e a l t h c a r e w i t h i n reach of every Canadian. A few days from now we w i l l reach the f i f t h a n n i v e r s a r y of the n a t i o n a l h e a l t h program, the symbol and c e n t r e o f r e c e n t h e a l t h p r o g r e s s i n t h i s c o u n t r y . When the l a t e prime m i n i s t e r , the R i g h t Hon. W i l l i a m Lyon Mackenzie K i n g , i n t r o d u c e d t h i s program i n 1948, he p l a c e d i t i n proper pers p e c t i v e i n r e l a t i o n t o the government's l a r g e r and b a s i c aim of s e c u r i n g f o r the people of Canada a n a t i o n a l minimum of s o c i a l s e c u r i t y and human w e l f a r e . In so d o i n g he p o i n t e d out t h a t the new f e d e r a l grants r e p r e s e n t e d " f i r s t s t a g e s i n the development of a comprehensive h e a l t h i n s u r a n c e p l a n f o r a l l Canada".  VI-2  Nothing c o u l d b e t t e r mark the success of t h i s program over i t s f i r s t f i v e y e a r s than the government's d e c i s i o n , which I have the honour of announcing today, to move forward on t h r e e e n t i r e l y new h e a l t h f r o n t s . The house w i l l be asked t o approve the a d d i t i o n of t h r e e important f e d e r a l health T h i s i s one  of the few  r e f e r e n c e s t o a Canadian " n a t i o n a l minimum" o f  s e r v i c e s , below which no Canadian i s t o be allowed  to f a l l ,  whether t h i s  has been a c h i e v e d , or whether i t ever can be a c h i e v e d under the p r e s e n t d i s t r i b u t i o n of powers i s open to debate. be made l a t e r  i n the study, as i t i s one  s i a l a s p e c t s of Canadian s o c i a l p o l i c y  Further reference to t h i s of the most c r u c i a l and  will  controver-  today. (2)  S i n c e t h a t time, the grants have been f u r t h e r extended. i n c l u d e g r a n t s f o r P u b l i c H e a l t h , T u b e r c u l o s i s C o n t r o l , Mental C h i l d and M a t e r n a l H e a l t h . Grant, which a l l o w s funds and s e r v i c e s ,  There i s a s p e c i f i c M e d i c a l  i n c l u d i n g t r a i n i n g o f p e r s o n n e l and  s e r v i c e s , where i t must be matched.  been used.  i n v a r y i n g degrees.  I t has  been e s t i m a t e d  The q u e s t i o n a r i s e s as t o why for  1 May  reason  t h a t has  Rehabilitation  also for research. f o r expansion  of  A f t e r s i x y e a r s a l l the p r o v i n c e s But a l l of the money a v a i l a b l e has  not  t h a t about 70% of the grants are used.  t h i s s h o u l d be so.  r e c e i v i n g the grant a r e too One  Health,  f o r m e d i c a l r e h a b i l i t a t i o n f a c i l i t i e s equipment  Much of the a i d i s on a non-matching b a s i s , except  participated,  They  Is i t t h a t the c o n d i t i o n s  restricting?  been suggested  i s t h a t the r i c h e r p r o v i n c e s have  E x c e r p t from "Hansard". p\ 4680 under 1 s t , 1953. .  "Supply"  2 F o r a summary of the p a t t e r n of these grants t o date, the r e a d e r i s r e f e r r e d to the Royal Commission on H e a l t h S e r v i c e s Queen's P r i n t e r , Ottawa, 1964, V o l . 1 , p.405  VI-3  already  developed many o f the f a c i l i t i e s  q u a l i f y under t h e g r a n t s . full  Therefore  amount, as t h e poorer p r o v i n c e s  general  are s t i l l  matching  tend t o do, where many o f these Another view i s t h a t some  t o o poor t o meet t h e i r share o f the c o s t even w i t h a  grant.  Edward Dunlop, i n a paper g i v e n  i n Toronto i n 1958, i n which he drew  upon m a t e r i a l he had p r e p a r e d f o r t h e N a t i o n a l A d v i s o r y R e h a b i l i t a t i o n of Disabled grants  programme.  could  they do not a v a i l themselves of the  s e r v i c e s do n o t e x i s t t o the same e x t e n t . provinces  and s e r v i c e s f o r which they  Persons, made t r e n c h a n t  He s t a t e d  Committee on t h e  a n a l y s i s o f the f e d e r a l  that:-  E r o v i n c i a l governments a r e p u r s u i n g l i m i t e d o b j e c t i v e s , u s i n g a v a i l a b l e f e d e r a l funds f o r i s o l a t e d a c t i v i t i e s — the p r o v i s i o n o f some item o f equipment f o r a h o s p i t a l h e r e , p r o v i d i n g a b u r s a r y t o a p h y s i o t h e r a p y student t h e r e , or meeting t h e s a l a r y o f a t e c h n i c i a n somewhere e l s e . Such may be v a l u a b l e i n themselves, but do l i t t l e t o c r e a t e an e f f e c t i v e r e h a b i l i t a t i o n program a v a i l a b l e t o t h e d i s a b l e d g e n e r a l l y . . . . Each e x p e n d i t u r e under t h e M e d i c a l Rehabi l i t a t i o n Grants Order depends upon t h e a p p r o v a l o f a s p e c i f i c p r o j e c t by the M i n i s t e r o f N a t i o n a l H e a l t h and Welfare. So l o n g as t h e M i n i s t e r ' s t o t a l a u t h o r i z a t i o n s do not exceed t h e d o l l a r amounts p r o v i d e d f o r a p r o v i n c e f o r the y e a r , h i s power t o approve o r r e j e c t i s almost u n l i m i t e d . Today he can approve a p r o j e c t t o send t h e d i s a b l e d i n a r o c k e t t o the moon; tomorrow he can d e c l i n e t h e purchase o f t h e i r space s u i t s . I t i s sometimes suggested t h a t t h i s system has t h e m e r i t o f f l e x i b i l i t y . I t i s f r e q u e n t l y d i f f i c u l t however, t o d i s t i n g u i s h between what may be regarded as r e a s o n a b l e f l e x i b i l i t y on the one hand and i n c o n s i s t e n c y , l a c k of p o l i c y or c a p r i c e on t h e other....The c u r r e n t measures a r e v a r i o u s l y a d m i n i s t e r e d by f o u r or f i v e s e p a r a t e d i v i s i o n s o f a t l e a s t two government departments. The i n e v i t a b l e consequences o f t h i s d i s p e r s i o n o f m i n i s t e r i a l and d e p a r t m e n t a l a u t h o r i t y a r e a d i m i n i s h e d sense o f r e s p o n s i b i l i t y , remoteness o f l e a d e r s h i p , d i f f i c u l t y o f a d m i n i s t r a t i o n and c o n f u s i o n i n r e l a t i o n s w i t h p r o v i n c i a l governments....' '' 1  1 The Paper was e n t i t l e d " R e h a b i l i t a t i o n f o r the D i s a b l e d i n Canada: A Plan for National Action". I t s p u b l i c a t i o n was made p o s s i b l e by t h e Canadian A r t h r i t i s and Rheumatism S o c i e t y . E x t r a c t i s from pp.20-21  Vl-4  Dunlop then went on government w i l l  t o say  a s s i s t the  t h a t the  purposes f o r which the  p r o v i n c e s are  i n r e l a t i o n to v o c a t i o n a l t r a i n i n g . the v o l u n t a r y agencies are rehabilitation  H o s p i t a l and  As  not  clearly defined,  a result,  D i a g n o s t i c Services Act,  a r e s u l t of which h o s p i t a l  treatment h o s p i t a l s  ill.  I t does not  s a n i t o r i a or n u r s i n g homes. act  as  or  federal  except on  i n c l u d e mental h o s p i t a l s ,  of  standard for  the  tuberculosis  These r e s t r i c t i o n s impose s e r v i o u s  this s t i l l  further  as  the  limit-  In addition,  province includes r e h a b i l i t a t i o n centres,  schemes and  l i m i t s the use  share o f c o s t s i n t h i s programme i s 50%,.  equipment.  is available t h e r e are  I t might be  through the  limitations  with here. o f the  1  to care a t  in hospitals  include sharing i n c a p i t a l costs, interest  one  government  of  it  and this  a g e n e r a l r e h a b i l i t a t i v e measure.  The not  i n the  federal  a g e n e r a l r e h a b i l i t a t i v e measure.  i s o p t i o n a l whether the  as  i n planning  i n s u r a n c e i s extended to about 99%  ward l e v e l i n " a c t i v e  act  and  programme through which a l l  However, t h i s i s l i m i t e d  facilities  provinces  1957  Canadian p o p u l a t i o n .  the  except  services.^  p r o v i n c e s have entered i n t o agreements w i t h the  a t i o n s on  the  d e p r i v e d of i n f o r m a t i o n e s s e n t i a l  This i s a j o i n t f e d e r a l - p r o v i n c i a l  chronically  federal  Ibid,  The  non  on  argued t h a t a i d  but  l o a n s , or  i t does  depreciation  i n c a p i t a l development  H o s p i t a l C o n s t r u c t i o n Grants l e g i s l a t i o n ,  i n t h i s l e g i s l a t i o n a l s o , which w i l l not  be  but dealt  s h a r i n g of c a p i t a l c o s t s , except i n l i m i t e d ways, i s  most r e s t r i c t i n g f e a t u r e s of much Canadian l e g i s l a t i o n t h a t  p.p.20-21  has  VI-5  to do w i t h the i t may  be an  facilities.  c r e a t i o n of r e h a b i l i t a t i o n .  insurmountable o b s t a c l e  In the p o o r e r  provinces,  to the c r e a t i o n of the  I t might be noted t h a t B r i t i s h and  American  on the whole makes much b e t t e r p r o v i s i o n f o r the s h a r i n g  necessary  legislation of meeting  of c a p i t a l costs. Canadian o b s e r v e r s have s p e c u l a t e d p a r t i c u l a r a c t has t o any  greater  While use treatment and t a i n s t h a t the  the development of r e h a b i l i t a t i o n s e r v i c e s  degree. i s made of p u b l i c h o s p i t a l s f o r m e d i c a l assessment, p h y s i c a l r e s t o r a t i o n of d i s a b l e d p e r s o n s , Roeher maingenerous government s u b s i d i e s  t o develop f u l l y p a r t i a l l y due  aided  as to the e v i d e n c e t h a t t h i s  fail  t h e i r p h y s i c a l medicine u n i t s .  t o induce h o s p i t a l s He  feels this is  to the f a c t t h a t p u b l i c , p r o f e s s i o n a l and  administrative (1)  persons do not  r e a l i z e what can be done f o r the handicapped.  On the o t h e r hand, the H a l l Commission p o i n t s out t h a t "We have found i t d i f f i c u l t t o d i s t i n g u i s h c l e a r l y between treatment and r e h a b i l i t a t i o n . . . . F o r i n s t a n c e any h o s p i t a l u n i t s d e s i g n e d as c o n v a l e s c e n t , g e r i a t r i c or c h r o n i c or o r t h o p a e d i c w i l l have a s t r o n g element of r e h a b i l i t a t i o n s e r v i c e , whereas on the o t h e r hand beds earmarked " r e h a b i l i t a t i o n " may w e l l be used f o r acute or c h r o n i c treatment IT1, The  three  s p e c i f i c a c t s which the f e d e r a l government passed  that  r e l a t e s p e c i f i c a l l y t o the needs of d i s a b l e d w i l l be reviewed next. These are the D i s a b l e d i l i t a t i o n of D i s a b l e d  Persons Allowances A c t , Persons Act  and  the V o c a t i o n a l  p a r t of the T e c h n i c a l  1  Roeher, o p . c i t . p . 7 0  2  Royal Commission on H e a l t h S e r v i c e s ,  o p . c i t . Vol.1,  Rehaband  p.636  VI-6  Vocational Training  Assistance Act.  These w i l l be a n a l y s e d from t h e  v i e w p o i n t o f t h e i r e f f e c t i v e n e s s i n r e l a t i o n t o the needs they were s e t up t o meet and t h e i r p l a c e i n the o v e r a l l p a t t e r n i n g o f  services.  SECTION I I I CRITIQUE OF THE SPECIFIC FEDERAL ACTS RELATING TO REHABILITATION  PART I I I  CRITIQUE OF SPECIFIC FEDERAL ACTS RELATING TO REHABILITATION  i  TABLE OF CONTENTS Page Chapter VII C r i t i q u e of the Disabled Persons Act, 1955 Purpose of the Act. A r e h a b i l i t a t i o n measure. Age requirement. Residence clause. "Total and permanent d i s a b i l i t y " . Other categorical allowances. T r a n s f e r a b i l i t y of allowance. Maximum allowable incomes. S o c i a l assistance. No r i g h t of appeal.  2  Chapter VIII Critique of the Vocational R e h a b i l i t a t i o n of Disabled Persons Act, 1961 A. Vocational R e h a b i l i t a t i o n Act: Agreements. Objectives of Act. Employment as a l i m i t e d goal. J u s t i f i c a t i o n f o r r e h a b i l i t a t i o n costs. Cost sharing arrangements. Coordination. Purchase of services. Role of voluntary agencies. Advisory C o u n c i l . B.  The Individual i ) Schedule 1, i i ) Schedule 2, i i i ) Schedule 3, i v ) Schedule 4, v) Schedule 5,  Schedules: Assessment and Counselling. Services and Processes of Restoration, The Training, Employment Placement, Training of S t a f f .  C. Other Considerations of the Act: Expenses of s t a f f . C l i e n t contribution. Non-shareable c o s t s . Variations of p r o v i n c i a l spending. F i n a n c i a l status before and a f t e r r e h a b i l i t a t i o n . Movement i n occupation because of rehabi l i t a t i o n . The type of people r e h a b i l i t a t e d .  1  16  19  Chapter IX C r i t i q u e of the Technical and Vocational Training Act, I960. A. The Training Act: Technical and vocational t r a i n i n g . Purpose of Act. Coordination. National Advisory Council, Cost sharing.  2  B.  5  The Programs; i ) Program 1 , Vocational High School Training (V.H.S.) i i ) Program 2, Technician Training (T) i i i ) Program 3, Trade and Other Occupational Training (T.O.) i v ) Program U, T r a i n i n g i n Cooperation with Industry (T.I.) v ) Program 5 , Training of Unemployed (M.) v i ) Program 6 , Training of the Disabled (R) v i i ) Program 7 , Technical and Vocational Teacher Training (T.T.) v i i i ) Program 8, Training Programs f o r Federal Departments and Agencies (G) i x ) Program 9, Student Aid (S.A.) x) General Provisions under the Agreement  ii  G. General Conclusions; I n c l u s i v e n e s s of program. Three s p e c i f i c c r i t i c i s m s . Appeals* Rural a c c e s s i b i l i t y . Need t o i n c o r p o r a t e c l i e n t needs i n t o r e h a b i l i t a t i o n goals*  2  CHAPTER  VII  CRITIQUE OF THE DISABLED PERSONS ACT,  1955  The Disabled Persons Act Is ». . .designed t o  provide  allowances f o r t o t a l l y and permanently d i s a b l e d persons unable t o make use of the r e h a b i l i t a t i o n s e r v i c e s already e s t a b l i s h e d . " S e c t i o n 3, s u b s e c t i o n ( I ) of the Act enables f e d e r a l p r o v i n c i a l agreements whereby the f e d e r a l government w i l l share f i f t y percent of the cost of allowances paid by the  province  t o the d i s a b l e d , p r o v i d i n g the maximum allowance paid to any i n d i v i d u a l does not exceed seventy-five d o l l a r s per month. The Act makes no p r o v i s i o n f o r r e h a b i l i t a t i o n , nor does i t provide f o r any other needs a d i s a b l e d person might have.  Even i f I t i s considered  s o l e l y as an income-maintenance  s e r v i c e , the question a r i s e s as t o i t s adequacy.  I t i s not  even s u f f i c i e n t to meet the b a s i c p h y s i c a l needs of the ordinary person, l e t alone the d i s a b l e d person who  o f t e n , even  at the p h y s i c a l l e v e l , has needs i n a d d i t i o n to those of the ordinary person.  I n e f f e c t t h i s means the allowance o f t e n  has to be supplemented through " s o c i a l a s s i s t a n c e " aids at the p r o v i n c i a l or municipal  level.  Stanley F. Bodlak, D i s a b i l i t y Allowances: The New Dominion-Provincial P r o v i s i o n s and Their S o c i a l Welfare I m p l i c a t i o n s . Master of S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, Vancouver, B.C., 1957» P. 34-. 1  3  To be more comprehensive  the allowance paid should  be based on a c t u a l need rather than on the e x i s t i n g "means test".  The means t e s t demands that the r e c i p i e n t show proof  of i n d i v i d u a l f i n a n c i a l needy but then c o n t r a r i w i s e , the a c t u a l money, paid t o the d i s a b l e d person does not a c t u a l l y meet the "needs" he has been compelled t o show he has not the means t o meet.  I f the allowance i s t o be a f i x e d pension  then there should be no need t o prove indigency nor the n e c e s s i t y t o make annual r e i n s p e c t i o n s o f the r e c i p i e n t ' s f i n a n c i a l condition.  Perhaps more f e a s i b l e would be an  adoption of the more advantageous  "needs t e s t e d " p l a n whereby  a c t u a l income i s compared t o a c t u a l need and p r o v i s i o n s are made f o r the remaining d e f i c i e n c y * The s e c t i o n o f the Act having a d m i n i s t r a t i v e i m p l i c a t i o n s , and one that i s c o n t r o v e r s i a l , i s s e c t i o n 3, s u b s e c t i o n (2)s Payments t o a province pursuant to t h i s s e c t i o n s h a l l be made only i n respect of a r e c i p i e n t who (a) at the date o f the proposed commencement o f allowance payments t o him ( i ) has attained the age o f eighteen y e a r s , and ( i i ) has resided i n Canada f o r t e n years immediately preceding that date, or i f he has not so r e s i d e d , has been present i n Canada p r i o r t o those t e n years f o r an aggregate period equal t o twice the aggregate period o f absences from Canada during those t e n years; (b) i s t o t a l l y and permanently d i s a b l e d as prescribed by the r e g u l a t i o n s ; (c) i s not i n r e c e i p t of an allowance under the B l i n d Persons Act or assistance under the Old Age Assistance Act or an allowance under the War Veterans Allowance A c t ,  4  or a pension under the Old Age S e c u r i t y A c t ; (d) i s not i n r e c e i p t of money or assistance from any province or m u n i c i p a l i t y by way of mothers allowance; (e) i s not a p a t i e n t i n a t u b e r c u l o s i s sanatorium or mental i n s t i t u t i o n ; ( f ) i s not a p a t i e n t o r r e s i d e n t i n a h o s p i t a l , nursing home, i n f i r m a r y , home f o r the aged, an i n s t i t u t i o n f o r the care of i n c u r a b l e s , or a p r i v a t e , c h a r i t a b l e or p u b l i c i n s t i t u t i o n , except as prescribed i n the r e g u l a t i o n s , and (g) i s (1) an unmarried person, and h i s income, I n c l u s i v e of allowance, i s not more than eleven hundred and f o r t y d o l l a r s a year, ( i i ) married and l i v i n g w i t h h i s spouse, and the t o t a l income, i n c l u s i v e o f allowance, o f the r e c i p i e n t and h i s spouse i s not more than nineteen hundred and eighty d o l l a r s a year, or ( i i i ) married and l i v i n g w i t h h i s spouse who i s b l i n d w i t h i n the meaning o f the B l i n d Persons A c t , and the t o t a l income, i n c l u s i v e o f allowance, o f the r e c i p i e n t and h i s spouse i s not more than twentythree hundred and f o r t y d o l l a r s a year. While the b i l l was introduced i n Parliament before passing i n 1955, considerable p r o v i n c i a l disagreement r e s u l t e d over the age requirement.  Some provinces advocated a lower age  c o n d i t i o n f o r e l i g i b i l i t y , hoping i t would narrow the gap i n s e r v i c e s extended t o c h i l d r e n and those a v a i l a b l e t o a d u l t s . P r e s e n t l y the r e g u l a t i o n s a l l o w f o r p r o v i n c i a l d i s c r e t i o n i n s e t t i n g an age l i m i t higher than eighteen, but not lower. Act i s p r i m a r i l y an economic measure and the minimum age  The  5 s t i p u l a t i o n i s made so t h a t a i d i s p a i d o n l y to a d u l t s ; below the q u a l i f y i n g age are considered as dependents should seek resources  those  and  through t h e i r parents o r g u a r d i a n s .  T h i s seems l o g i c a l , but are not the t o t a l l y and permanently d i s a b l e d u s u a l l y dependent  also,  regardless  I n r e v i e w i n g the scope o f t h i s have t o say t o be f a i r t h a t  it  o f t h e i r age?  programme one would  i s not intended t o cover those  below e i g h t e e n years o f age and those w i t h l e s s severe disabilities,  who would not thereby q u a l i f y as t o t a l l y and  permanently d i s a b l e d , yet who would not be e l i g i b l e  for  v o c a t i o n a l s e r v i c e s on the grounds t h a t t h e r e would not be "reasonable prospeet" o f t h e i j b ' r ? being able t o f i n d and h o l d a job. I f one values  t h i s view, t h e n i t  is  also  necessary  to p o i n t out that these two g e n e r a l groups are at nowhere s p e c i f i c a l l y the d i s a b l e d . that  is  covered i n l e g i s l a t i o n p e r t a i n i n g  a v a i l a b l e t o these groups through the  t h a t there are some v e r y s e r i o u s  services  be r e f e r r e d to the many p r i v a t e agencies t h a t children's d i s a b i l i t i e s .  disabilities.  i s at once  gaps.  Those who do not q u a l i f y because of age,  organizations  to  A c l o s e l o o k at the amount and k i n d o f a i d  p r e s e n t l y a v a i l a b l e t o the g e n e r a l p o p u l a t i o n , i t evident  present  can o f t e n  cater  The gap here however,  to  i s that  are s e l e c t i v e and may not be i n c l u s i v e of The o l d e r group, i f they are i n c a p a b l e o f  such all  6 earning their subsistance may apply for S o c i a l Assistance (known as S o c i a l Aid i n some provinces), a programme administered  on a needs test basis, which w i l l be discussed  later. The ten year Canadian residence clause permits movement within a province and i n t e r - p r o v i n c i a l movements which are bound by reimbursement clauses. necessitates suspension.  Movement outside the country  The intra-national movement conditions  enable determination of who has the f i n a n c i a l r e s p o n s i b i l i t y . The residence clause receives more appropriate c r i t i c i s m when viewed along two d i f f e r e n t l i n e s .  F i r s t , the person who  absents himself from Canada does not immediately  acquire new  citizenship and therefore would not l i k e l y qualify under the receiving country's programs.  As long as a person retains  Canadian c i t i z e n s h i p he should remain e l i g i b l e for her benefits. Secondly, past experiences indicate that residence laws do not make an appreciable difference on the movement of recipients of public assistance.  An exception to t h i s might be the  greater stimulation of transient s o c i a l assistance recipients toward a more lenient and generous l o c a l i t y .  The contention  that residence laws are necessary to prevent the disabled from flocking po provinces with less r e s t r i c t i o n s has never been proven. Seen from the residence viewpoint  of Canadians outside  Canada, t h i s not being permitted, i t seems as i f i n t h i s age of  7 i n t e r n a t i o n a l communication and t r a n s p o r t a t i o n , provisions  should he regarded as a n t i q u a t e d .  such  Individually,  i t p e n a l i z e s the d i s a b l e d Canadian who has r e l a t i v e s another country ( o f t e n i n the U . S . A . ) who are w i l l i n g  in to  o f f e r him accommodation, p e r s o n a l comfort and companionship, a l l v i t a l human i n g r e d i e n t s  i n l i v i n g which he must f o r e g o  he wishes t o remain e l i g i b l e The R e g u l a t i o n s ,  for his  allowance.  s e c t i o n 2, s u b s e c t i o n  what i s meant by t o t a l and permanent  if  (2), p r e s c r i b e  disability.  . . . a person s h a l l be deemed t o be t o t a l l y and permanently d i s a b l e d when s u f f e r i n g from a major p h y s i o l o g i c a l , a n a t o m i c a l or p s y c h o l o g i c a l impairment v e r i f i e d by o b j e c t i v e m e d i c a l f i n d i n g s which i s l i k e l y t o continue i n d e f i n i t e l y without s u b s t a n t i a l improvement a n d , as a r e s u l t t h e r e o f , such person i s severely l i m i t e d i n a c t i v i t i e s pertaining to normal l i v i n g . Notwithstanding attempts at o b j e c t i v e  disability  assessment,  a r b i t r a r y d e c i s i o n s vary from p r o v i n c e to p r o v i n c e . such as  "major. .  "substantial  •  impairment", " l i k e l y t o  Terms  continue",  improvement" and "severely l i m i t e d i n • • • normal  l i v i n g " do not e a s i l y  y i e l d to s t a n d a r d i z a t i o n .  Criteria  for  g r e a t e r u n i f o r m i t y i n d e f i n i t i o n should be p r o v i d e d . Determining d i s a b i l i t y r e s t s not o n l y w i t h m e d i c a l findings.  The measurement  be i n c l u d e d .  of s o c i a l impairment should a l s o  T h i s i s done t o some degree i n the s o c i a l  worker's  s o c i a l h i s t o r y o f the a p p l i c a n t , even i f t h i s i s not demanded  8 by l e g i s l a t i o n .  Improvement i n t h i s a r e a might be made i f  t h e r e was l e g i s l a t i v e s o c i a l evaluations  encouragement  to have the m e d i c a l and  performed by doctors and s o c i a l workers  who were r e q u i r e d to become f a m i l i a r w i t h the programme and the r e h a b i l i t a t i o n s e r v i c e s p r o v i d e d .  There are  still  c o n s i d e r a b l e v a r i a t i o n s among m e d i c a l p e r s o n n e l and s o c i a l work p e r s o n n e l as to what c o n s t i t u t e s  " t o t a l and permanent"  d i s a b i l i t y w i t h i n the meaning o f the A c t . The emphasis on d i s a b i l i t y i s m i s g u i d e d . o f the A c t might v a l i d l y be that i t encourages w i t h the d i s a b l i n g c h a r a c t e r i s t i c s person's  remaining a b i l i t i e s .  One c r i t i c i s m  too much concern  and not enough on the  T h e o r y , but not  necessarily  p r a c t i c e , on r e h a b i l i t a t i o n today s t r e s s e s the importance o f focussing  on "what the c l i e n t has remaining" t h a t  his l i f e .  There i s  a l s o the c o n s i d e r a t i o n o f the  psychological effect  can enhance possible  on a p e r s o n c a l l e d on to prove he  is  t o t a l l y and permanently d i s a b l e d . B r . Leonard Marsh s t a t e s that u s i n g standards o f  total  i and permanent d i s a b i l i t y does serve a purpose.. where i t  is useful  is  i n i n d u s t r y where d i s a b i l i t y may be  considered as a debt or where compensation i s a remuneration, but as a s o c i a l measure i t It  The a r e a  possible  is inappropriate.  i s f r e q u e n t l y questioned whether the demand f o r  D r . L . C . Marsh, " S o c i a l S e c u r i t y P l a n n i n g i n Canada", I n t e r n a t i o n a l Labour Review. V o l . 47 pp. 591 - 6 l 6 . 1  9  permanent and t o t a l d i s a b i l i t y f o s t e r s or creates convictions of d i s a b i l i t y where they should not e x i s t ,  An applicant may  e a s i l y a l t e r h i s s e l f - c o n c e p t i o n i f r e c e i p t of an allowance demands i t . M o d i f i c a t i o n o f t h i s extreme c o n d i t i o n would narrow the gap wherein many people f a l l —  these are the  people who are r e j e c t e d from d i s a b i l i t y allowance and yet do not q u a l i f y f o r r e h a b i l i t a t i o n .  Mr. Bodlak, i n h i s t h e s i s on  t h i s t o p i c , provides i n t e r e s t i n g s t a t i s t i c s which i n d i c a t e among other t h i n g s , the l a c k of communication between personnel concerned i n e s t a b l i s h i n g d i s a b i l i t y and those concerned w i t h rehabilitation.* ' 1  (See Table I ) .  TABLE I P r o v i n c i a l Percentage of Rejected A p p l i c a t i o n s A^ril_l^_1955-t-0_Iar_ch_31-,_lt56  Province B r i t i s h Columbia Newfoundland Quebec Ontario Prince Edward Island Nova S c o t i a Saskatchewan Alberta New Brunswick Manitoba Total Source:  Accepted 725 659  13,064 1,854 270 979 793 1,185 830 730  21,097  Bodlak, Master T h e s i s .  Bodlak, O P . c i t . p. 82.  Rejected 247  326 9,719 1,545 227  1,249 1,026 1,584 1,508  1,429  18,860  Percent Declined 25.4 33.0  42.2  45.4 45.6 56.0 56.4 57.2 64.5 65.9  1G  A t o t a l of 39»957 persons considered themselves s u f f i c i e n t l y disabled to apply, whereas only 52.8 percent were accepted.  What happened to the 47.2 percent that were r e j e c t e d ?  Even admitting that a l l the r e j e c t e d applicants would probably not b e n e f i t from r e h a b i l i t a t i o n , they should at l e a s t a l l have been r e f e r r e d and t h e i r p o t e n t i a l explored.  Although  Mr. Bodlak made h i s study s h o r t l y a f t e r the l e g i s l a t i o n was introduced, t h i s " s t a t i s t i c " has continued t o be a meaningful figure i n reports.  A separate study could be made t o f i n d  out who are the people whose e l i g i b i l i t y f o r Disabled Persons Allowance has been denied, yet who seem not e l i g i b l e f o r any of the r e h a b i l i t a t i o n s e r v i c e s . Receipt of other s p e c i f i c allowances d i s q u a l i f i e s the d i s a b l e d from b e n e f i t s under the Disabled Persons A c t .  1  These are termed c a t e g o r i c a l allowances and they a l l provide b e t t e r and have more comprehensive  coverage than t h i s Act.  In a d d i t i o n t o a s i m i l a r maximum allowance the other a c t s , f o r example the B l i n d Persons A c t , e i t h e r permit a greater maximum allowable income or make some p r o v i s i o n f o r h o s p i t a l and/or medical coverage.  Some programs do not r e q u i r e a t e s t  of f i n a n c i a l e l i g i b i l i t y , others Include supplementary allowances o f t e n paid according t o need.  The Disabled Persons  Act has the l e a s t l i b e r a l p r o v i s i o n s yet the most r i g i d These are B l i n d Persons Allowance, Old Age A s s i s t a n c e , Old Age S e c u r i t y , War Veterans Allowance, and varying p r o v i n c i a l Mothers Allowances. x  11  qualifications. Despite e f f o r t s made at a t t a i n i n g as much commonness i n p r o v i s i o n as p o s s i b l e f o r a r e c i p i e n t o f any c a t e g o r i c a l allowance there i s considerable d i v e r s i t y . Much can be a t t r i b u t e d t o the f a c t that the programs developed i n i s o l a t i o n and according t o p o l i t i c a l convenience r a t h e r than s o c i a l need. As campaigning platforms they may have great p u b l i c appeal although the v o t e r i s o f t e n uninformed of the i n j u s t i c e s and i n e f f i c i e n c i e s of t h i s " c a t e g o r i c a l " approach t o the problem. C e r t a i n l y some needs are being met through such l e g i s l a t i v e a c t i o n , but i f the programs do not serve the e x i s t i n g demands and are l a c k i n g i n s u f f i c i e n t scope t o cover the needs they were s e t up t o meet, they should be reviewed, adjusted, o r revoked t o make room f o r b e t t e r measures. Residence i n c e r t a i n i n s t i t u t i o n s , homes, and h o s p i t a l s i s another d i s q u a l i f y i n g f a c t o r .  The r e c i p i e n t of an allowance  may continue t o receive the allowance up t o f o u r months o f the year i n a p r i v a t e or p u b l i c h o s p i t a l , and may r e t a i n e l i g i b i l i t y i n d e f i n i t e l y , as approved by the province, i f he i s i n the h o s p i t a l f o r treatment of h i s d i s a b i l i t y .  1  If  such residence i s provided f r e e of charge t o the patient some adjustment i n the allowance may be i n order. However, many p r i v a t e homes and i n s t i t u t i o n s not only charge h i g h maintenance Canada, Department of N a t i o n a l Health and Welfare, Research and S t a t i s t i c s D i v i s i o n , R e h a b i l i t a t i o n Services i n Canada. Part I . H e a l t h Care S e r i e s , N o . 8 O t t a w a , March, I960.  12  r a t e s , but o f t e n a d d i t i o n a l fees are asked because the disabled person may r e q u i r e e x t r a personal care.  There are  numerous instances where a d i s a b l e d person already i n r e c e i p t o f the allowance, and because of i t , regains some form of independency from h i s f a m i l y .  Should he d e s i r e t o  move t o a nursing home t h i s allowance would be suspended, thereby r e t u r n i n g the c l i e n t t o h i s former dependent p o s i t i o n . The maximum allowable income, along w i t h i n the allowance i t s e l f , has been Increased since 1955.  increases  s e v e r a l times  Although i t i s c o n t r o v e r s i a l as t o whether the  t o t a l maximum allowable Income i s s u f f i c i e n t f o r maintenance, the r e a l weakness o f the Act l i e s i n the f a c t that no c o n s i d e r a t i o n i s made of the i n d i v i d u a l ' s p a r t i c u l a r l i v i n g expenses nor o f the n a t i o n a l cost o f l i v i n g index. of d i f f e r i n g f i n a n c i a l status o f the disabled's  Because  parents,  r e l a t i v e s o r guardians ( u s u a l l y they themselves own l i t t l e or no p r o p e r t y ) , the allowance granted may serve one r e c i p i e n t w e l l while another p o o r l y .  They may r e c e i v e the same r a t e o f  allowance, yet the s e r v i c e i s not e g a l i t a r i a n . The present means t e s t and maximum allowable income i n v i t e s the r e c i p i e n t t o earn only a nominal annual Income so as not t o jeopardize h i s allowance.  This may be a r e a l  d i s i n c e n t i v e to r e h a b i l i t a t i o n and earning.  Another problem  created by t h i s l e g i s l a t i o n i s that o f accurately c a l c u l a t i n g Income.  Annual r e i n s p e c t i o n s involve h i g h a d m i n i s t r a t i v e  13  costs whereas the allowance, once granted, seldom changes because of annual f i n a n c i a l reviews.  An advantage of these  r e i n s p e c t i o n s i s that some patterned contaet i s kept w i t h the d i s a b l e d . Since more i n s i s t e n c e may be placed on the monetary c o n d i t i o n than e x p l o r i n g the c l i e n t ' s p o t e n t i a l , t h i s "check" should be performed by personnel who are " r e h a b i l i t a t i o n " o r i e n t e d . A more f e a s i b l e arrangement than the means t e s t , e s p e c i a l l y i f the d i s a b i l i t y allowance i s not d e s i r a b l e as an o u t r i g h t pension, would be t o encourage earning by the c l i e n t under a " s l i d i n g s c a l e " where he could s t i l l b e n e f i t from the allowance, at the same time he has greater income by working.  At no time would h i s earnings induce him  to consider unemployment i n preference t o purposeful employment. Human needs are c o n s t a n t l y changing.  So too should  l e g i s l a t i o n be amended t o incorporate these changing demands. Since the passing of the Act t e n years ago, only very i n s i g n i f i c a n t a l t e r a t i o n s have been made.  L i t t l e e f f o r t has  been devoted t o issues that are not monetary i n nature. P h y s i c a l d i s a b i l i t y may not only impose greater f i n a n c i a l difficulty  because of low earning c a p a c i t y , but t h i s r e f l e c t s  a l s o i n the i n d i v i d u a l ' s s o c i a l and psychic f u n c t i o n i n g .  The  Disabled Persons Act i s l i m i t e d and inadequate i n t h i s regard. C a t e g o r i z a t i o n and i n f l e x i b i l i t y of the Act do not recognize that: . . • each p h y s i c a l l y handicapped person i s an i n d i v i d u a l problem of v o c a t i o n a l (personal  14 and s o c i a l ) maladjustment* Yet he has never been regarded as an i n d i v i d u a l but rather..as a c l a s s , a permanently dependent class. I n r e l a t i n g d i s a b i l i t y allowances t o r e h a b i l i t a t i o n , Miss Whitton b e l i e v e s that a comprehensive  s o c i a l assistance  program may serve as an Immediate remedy u n t i l b e t t e r 2 p r o v i s i o n s can be e s t a b l i s h e d .  The problem of d i s a b i l i t y  cannot be met by increased pensions or allowances alone, but so f a r t h i s Act has been a base f o r n e i t h e r a  comprehensive  assistance scheme nor a r e h a b i l i t a t i o n program f o r the group i t i s Intended t o cover.  Nor has the l e g i s l a t u r e accepted  the suggestions of the Canadian Welfare C o u n c i l .  The C o u n c i l  recommends that a l l p u b l i c assistance measures f o r the d i s a b l e d be l i n k e d w i t h some form of r e h a b i l i t a t i o n .  Without  t h i s l i a i s o n the d i s a b l e d person has no hope of Improving h i s p o s i t i o n and may r e s o r t t o maximizing h i s helplessness i n order to o b t a i n as much f i n a n c i a l help as p o s s i b l e . When the Disabled Persons Allowance grant proves I n s u f f i c i e n t t o meet the needs of a d i s a b l e d person, v a r i o u s forms of s o c i a l assistance can be used to bridge the gap. Those are the programs at the p r o v i n c i a l and m u n i c i p a l l e v e l s which are the modern counterpart of the o l d " r e l i e f " g i v i n g Henry K e s s l e r , R e h a b i l i t a t i o n of the P h y s i c a l l y Handicapped. New York, Columbia U n i v e r s i t y Press, 1947, 1  p.23.  C. Whitton, The Dawn of Ampler L i f e . Toronto. Macmillan Company of Canada L i m i t e d , 1943, p. 33. 2  15 programs of former years and which are s t i l l hedged about in many places within the shades of the old Poor Law and the status of "pauper". S o c i a l assistance programs are developed to meet short term f i n a n c i a l need.  They are not a provision for the  chronically handicapped, but are directed toward persons who encounter temporary f i n a n c i a l need.  Their rates are predicated  on the often erroneous assumption that the c r i s i s i s short term only and they provide assistance at a subsistence only.  level  While i t i s true that i n some places, s o c i a l assistance  programs are administered  less.harshly and can be instruments  of r e h a b i l i t a t i o n when s k i l l f u l l y developed and used, i t i s equally true that i n many places they are neither viewed nor administered  i n t h i s l i g h t , with consequent detrimental e f f e c t s  on the r e c i p i e n t s . Also, there are immense variations across Canada i n philosophy  and practice i n these programs and there  are s t i l l municipalities which grant aid of this kind according to t h e i r "grace and favour" and do not grant a basic minimum allowance to a l l t h e i r needy as of r i g h t . These kinds of aid then are the only forms of assistance available to those disabled people f o r whom the Disabled Persons Allowance i s inadequate to meet their basic human needs and to those people who are not disabled according to the Act, are not helped by existing r e h a b i l i t a t i o n agencies, and yet are not s e l f supporting.  Not only i s t h i s kind of aid often  15 o f f o r m e r y e a r s .and w h i c h CUP© s t i l l h e d g e d  programs  i n many p l a c e s  w i t h i n the  the  "pauper".  status  of  shades  Social assistance term f i n a n c i a l need,  encounter  temporary  on the often  t e r m o n l y and they only.  Ihile  it  are  hut are directed  provide assistance  true  administered  that  on the r e c i p i e n t s *  light ftlso,  they  to their  "grace  allowance  there  are  those  Allowance  inadequate  those  a n d <3o  to a l l t h e i r needy  available t o is  people  are not s e l f  as o f  people  t o meet  supporting.  short  social  level  assistance instruments  and used,  it  is nor  sid of this  not  grant  across  kind  a basic  there  according lalnlmuc)  right• o n l y forms o f  assistance  f o r whom t h e D i s a b l e d  their basic  human needs to the  rehabilitation agencies, Hot o n l y  effects  i n these programs and  who a r e n o t d i s a b l e d a c c o r d i n g  are not helped by existing  is  are n e i t h e r viewed  aid then are the  disabled  predicated  immense v a r i a t i o n s  which grant  and f a v o u r "  T h o s e k i n d s of  «*ho  w i t h consequent detrimental  v  Canada i n philosophy''' and p r a c t i c e are s t i l l municipalities  are  h a r s h l y and c a n he  i n many p l a c e s  in this  the  a subsistence  r e h a b i l i t a t i o n when s k i l l f u l l y d e v e l o p e d  equally  to  at  short  persons  the c r i s i s  i n some p l a c e s ,  programs are administered l e s s of  toward  Their rates  assumption that  is true that  t o meet  not a p r o v i s i o n f o r  financial need.  erroneous  o l d Poor Law and  prograras a r e developed  they  chronically handicapped,  of the  about  is this  kind  Persons and  Act, and  of aid  yet often  16 inadequate  f o r the needs o f the d i s a b l e d person, but the  nature o f i t s e l i g i b i l i t y requirements  and the manner i n  which i t i s administered o f t e n offend against the b a s i c p r i n c i p l e s o f human d i g n i t y *  Disabled people have enough t o  contend w i t h without the a d d i t i o n a l s t r e s s o f being subjected to h u m i l i a t i n g experiences at the hands o f those a u t h o r i t i e s who have been set up as p u b l i c servants t o extend a i d and r e h a b i l i t i a t i o n whenever p o s s i b l e t o the d i s a b l e d i n the name o f the community* F i n a l l y , the Act ignores a b a s i c r i g h t o f the c l i e n t . This i s the r i g h t o f appeal. consulting the c l i e n t .  A l l d e c i s i o n s are made without  I f he i s d i s s a t i s f i e d with the  d e c i s i o n s made, he has n e i t h e r f r e e l e g a l advice nor the opportunity t o appeal.  A r e j e c t e d a p p l i c a n t may, a f t e r an  undetermined time i n t e r v a l , reapply.  Despite the unmet  intermediate need between the a p p l i c a t i o n s , the subsequent a p p l i c a t i o n i s again assessed by the same personnel that refused the i n i t i a l a p p l i c a t i o n . As has been seen, the Disabled Persons Act i s , at the most, only an a i d to some d i s a b l e d persons.  I t i s not a  preventive measure and has no c o r r e c t i v e f a c i l i t i e s . The Act i s o f t e n administered by " l o c a l " a u t h o r i t i e s , e i t h e r p r o v i n c i a l or m u n i c i p a l .  While there i s nothing t o  prevent the administering a u t h o r i t i e s from t a k i n g a broad view of the A c t , and administering i t not s o l e l y as an income-  17 maintenance program i n v o l v i n g determination of the e l i g i b i l i t y of the d i s a b l e d person f o r a cash grant, but a l s o as an opportunity to b r i n g t o the c l i e n t what K a r l de Schweinitz has c a l l e d i n many of h i s w r i t i n g s , the " c l i n i c a l s e r v i c e s , " which Involve i n d i v i d u a l diagnosis and treatment (both medical and s o c i a l ) .  I t i s r e g r e t t a b l e that f o r a number of reasons  not always to do with a shortage of s o c i a l work s t a f f , the s e r v i c e brought to the c l i e n t under t h i s Act i s o f t e n l i t t l e more than determination of e l i g i b i l i t y f o r the allowance.  This  Act could be used as a responsive instrument f o r determining and meeting what have been c a l l e d "the non-cash needs" of the d i s a b l e d person.  1  CHAPTER  VIII  CRITIQUE GF THE VOCATIONAL REHABILITATION OF DISABLED  PERSONS  ACT, 1961  An e v a l u a t i o n of the Acts which c o n s t i t u t e the t o t a l r e h a b i l i t a t i o n program at the f e d e r a l l e v e l i n the area o f v o c a t i o n a l r e h a b i l i t a t i o n w i l l a l s o be an i n d i c a t i o n of what a i d i s a v a i l a b l e t o d i s a b l e d people seeking t o enter employment. A l l the issues r a i s e d by these Acts cannot p o s s i b l y r e c e i v e adequate a t t e n t i o n i n t h i s study, though perhaps the study may serve t o heighten awareness o f the issues and perhaps a l s o s t i m u l a t e hypotheses f o r subsequent s t u d i e s . One of the i m p l i c a t i o n s o f the Federal government's both assuming the leadership r o l e and providing f i n a n c i a l a i d would be that i t could and should act as a standard s e t t i n g body without i n f r i n g i n g on the b a s i c r i g h t s o f the provinces. I n the area of v o c a t i o n a l r e h a b i l i t a t i o n , the exercise o f t h i s f u n c t i o n by the Federal government i s c l e a r l y demonstrated. While the provinces  g e n e r a l l y accepted that some  u n i f o r m i t y and c o o r d i n a t i o n i n r e h a b i l i t a t i o n was d e s i r a b l e , they nevertheless wish t o approach t h e i r own problems i n t h e i r own p a r t i c u l a r way, but look t o the f e d e r a l government f o r f i n a n c i a l a i d i n doing so. A.  A V o c a t i o n a l R e h a b i l i t a t i o n Act Under the f e d e r a l Acts r e l a t i n g t o V o c a t i o n a l  2 R e h a b i l i t a t i o n s e r v i c e s , f e d e r a l a i d has been l a r g e l y c o n d i t i o n a l upon the provinces entering i n t o agreements w i t h the provinces to share the costs of c e r t a i n s e r v i c e s . These agreements are s u b s t a n t i a l l y the same f o r each province. The way  i n which the programs under the agreements  were announced was i n t e r e s t i n g i n the l i g h t of Canadian history*  There was an announcement that the agreement was  a v a i l a b l e f o r signature*  P o s s i b l y the shades of the  unsuccessful Dominion-Provincial Conferences of 1945-46 were s t i l l haunting the Federal government.  While i t may  be  speculated that the Federal government consulted experts w i t h i n the provinces, there i s s a i d to be no evidence that a l l the provinces were included i n the c o n s u l t a t i o n s . As a consequence, the r e s u l t i n g agreements may not have been e q u a l l y s u i t a b l e f o r the needs of a l l provinces. The o b j e c t i v e s of the Act are: (1)  t o enable the F e d e r a l Government to enter i n t o agreements w i t h the provinces t o share f i f t y percent of costs incurred by the provinces i n p r o v i d i n g a comprehensive program of s e r v i c e s f o r the v o c a t i o n a l r e h a b i l i t a t i o n of d i s a b l e d persons; (2)  t o provide f o r the c o - o r d i n a t i o n of f e d e r a l a c t i v i t i e s i n the f i e l d of v o c a t i o n a l rehabilitation; (3)  t o enable research t o be undertaken and published i n respect of v o c a t i o n a l r e h a b i l i t a t i o n of d i s a b l e d persons; and (4)  t o e s t a b l i s h a N a t i o n a l Advisory C o u n c i l on the R e h a b i l i t a t i o n of Disabled Persons t o advise the Government and to provide a forum of o p i n i o n on the f i e l d of r e h a b i l i t a t i o n i n Canada.  3  To r e a l i z e these o b j e c t i v e s the f e d e r a l government had t o exercise some c o n t r o l over p r o v i n c i a l functions and organize a h i e r a r c h i a l j u d i c i a l and a d m i n i s t r a t i v e s t r u c t u r e .  Table  I I depicts how l i n e s o f a u t h o r i t y move downward, (which a u t h o r i t y i s p o s s i b l e only because o f the Acts and signed Agreement,) and how the l i n e s of s e r v i c e move from the l o c a l l e v e l upward.  I n t h i s way l o c a l and p r o v i n c i a l resources  are combined w i t h those of other provinces  t o f orm a n a t i o n a l t  aggregate, which, i n t u r n , receives s t a n d a r d i z a t i o n , support i n operation, b e n e f i t s from research, and c o n s u l t a t i o n from the t o t a l o r g a n i z a t i o n . I t i s apparent that the Act and the Agreement are geared s o l e l y toward employment.  The purpose o f t h i s  r e h a b i l i t a t i o n i s t o place the formerly disabled person i n t o the economic market.  This i s evident i n the way i n which the  Act defines two terms. 2. (d) "disabled person" means a person who because o f p h y s i c a l or mental impairment i s incapable of pursuing r e g u l a r l y any s u b s t a n t i a l l y g a i n f u l occupation; and (e)  " v o c a t i o n a l r e h a b i l i t a t i o n " means any process o f r e s t o r a t i o n , t r a i n i n g and employment placement, i n c l u d i n g s e r v i c e s r e l a t e d t h e r e t o , the object o f which i s t o enable a person t o become capable o f pursuing r e g u l a r l y a s u b s t a n t i a l l y g a i n f u l occupation. This i n s i s t e n c e on employment would have more meaning i f a l l those who were disabled could be so r e h a b i l i t a t e d and, i f those so r e h a b i l i t a t e d could compete ; s u c c e s s f u l l y w i t h the  4  TABLE I I  O r g a n i z a t i o n Chart - C i v i l i a n R e h a b i l i t a t i o n Program  National Advisory Council  Minister of Labour  Minister of N a t i o n a l Health and Welfare  National Employment Service  T  Int er-d apartmental Committee  Canadian Vocational Training  National Co-ordinator, Civilian Rehabilitation  Nat'l Medical R e h a b i l i t a t i o n and D i s a b i l - H l t h i t y Advisory Service Grants!  f Provincial. Advisory Bodies  Provincial Coordinators  Disabled Persons Allowances  N a t i o n a l Employment S e r v i c e Training Voluntary Agencies H o s p i t a l s and Health Services Other Community Resources  Source:  United Nations Study on L e g i s l a t i v e and A d m i n i s t r a t i v e Aspects of R e h a b i l i t a t i o n Programmes i n Selected Countries — N a t i o n a l Coordinator.  5  non-disabled unemployed.  Canada has d i f f i c u l t y  employing  a l l her able-bodied labour f o r c e ; s p e c i a l placement cannot t o t a l l y remove an employer's preference i n h i r i n g others rather than the d i s a b l e d . R e h a b i l i t a t i o n should be a v a i l a b l e f o r those d i s a b l e d persons who are w i l l i n g and able t o b e n e f i t from i t , but making employment p o t e n t i a l a c o n d i t i o n of acceptance i n t o the program r e s t r i c t s the s e r v i c e t o only a percentage of the d i s a b l e d persons.  This would be acceptable  i f other Acts covered those d i s a b l e d people who w i l l not be able to meet the g o a l of employment, but i n Canada no such acts e x i s t and the s e r v i c e s a v a i l a b l e under general l e g i s l a t i o n and p r i v a t e agency auspices are not s u f f i c i e n t t o meet the needs of t h i s comparatively l a r g e group. Cybernetic expansion and Increased human replacement by automation w i l l reduce the d a i l y working hours and a l s o the demand f o r employment.  Instead of e x c l u s i v e l y s e l e c t i n g  and r e h a b i l i t a t i n g the p o t e n t i a l l y employable d i s a b l e d where he w i l l c o n t r i b u t e t o the labour supply, the program might be a l t e r e d t o include the unemployables and t r a i n them t o appreciate p u r s u i t s other than the s t r i c t l y commercial type. Many of the d i s a b l e d who w i l l never be able t o compete on the labour market could s t i l l be " u s e f u l l y " occupied i n areas of l i t e r a t u r e , music, and so on.  This would include many of  those p r e s e n t l y considering themselves useless because they have been r e j e c t e d by both Disabled Persons and V o c a t i o n a l  6  Rehabilitation*  Furthermore, while a t t a i n i n g a sense o f  worthiness, they might be performing i n a f i e l d that t r u l y i n t e r e s t s them and no competition i s necessary i n order t o r e t a i n the job*  The n a t i o n a l ideology o f equal r i g h t s t o  employment extends beyond t h i s t o include the r i g h t t o "the pursuit o f happiness", or at l e a s t o f s e l f development* Such an approach t o r e h a b i l i t a t i o n would recognize t h i s human value*  When automation changes the p a t t e r n i n g of our use o f  "work" time and " l e i s u r e " time, and the a c t i v i t i e s appropriate to each, some o f the d i s t i n c t i o n s we c u r r e n t l y make between the two w i l l l o s e t h e i r meaning. One of the goals o f the Agreement i s t o remove the disadvantages s u f f e r e d by the d i s a b l e d  person,  Surely this  should not be r e s t r i c t e d t o employment disadvantages but should Include a l l l i v i n g disadvantages.  This r e h a b i l i t a t i o n  program could be more comprehensive and v a l i d i f i t were t o consider a l s o the " r e h a b i l i t a t i o n " o f persons who could b e n e f i t , even i f only t o a degree, from improvement o r r e s t o r a t i o n o f c a p a c i t i e s h e l p i n g them enjoy such d i v e r s i o n a r y and s e l f expressive a c t i v i t i e s as hobbies, s e l f - c a r e , a more a c t i v e s o c i a l l i f e , and pursuing many o f the a c t i v i t i e s that are a part o f normal contemporary l i f e *  These are personal values  and, being so, have perhaps greater meaning t o the d i s a b l e d who are deprived o f them. This program could be extended t o include those d i s a b l e d  7  who could reach only l i m i t e d goals because they may a c t u a l l y be handicapped i n r e l a t i o n t o the ''ideal" goal o f employment. To the d i s a b l e d person, h i s own r e h a b i l i t a t i o n goal i s a l l important even i f i t i s , as c i t e d e a r l i e r , l i m i t e d . r e h a b i l i t a t i o n goal should always be i n d i v i d u a l l y set  The according  t o the p a r t i c u l a r c a p a c i t i e s . Each d i s a b l e d person has the r i g h t t o help through government and p r i v a t e agency a i d i n a r r i v i n g at what i s the best r e h a b i l i t a t i o n goal f o r him. The determining  e l i g i b i l i t y f a c t o r would then not be  the p o t e n t i a l f o r earning a s u b s t a n t i a l wage and "to contribute to Canada" through income t a x a t i o n .  While those who are able  would s t i l l continue under the current t r a i n i n g f a c i l i t i e s , an expanded and more i n c l u s i v e s e r v i c e would include a l a r g e r segment of the disabled p o p u l a t i o n .  Dunlop describes the  p l i g h t of many d i s a b l e d persons: There are tens o f thousands o f d i s a b l e d Canadians l i v i n g i n despair and f r u s t r a t i o n , who can n e i t h e r f i n d nor keep work, who are unable t o lead happy and u s e f u l l i v e s . These are the people who could be restored through r e h a b i l i t a t i o n — the people f o r whom _ r e h a b i l i t a t i o n s e r v i c e s are not now a v a i l a b l e . R e h a b i l i t a t i o n other than, but i n a d d i t i o n t o , v o c a t i o n a l i s needed.  The eventual f i n a n c i a l r e t u r n o f the r e h a b i l i t a t e d  person i s not a proper c o n d i t i o n o f r e c e i v i n g the help — many Edward Dunlop, " R e h a b i l i t a t i o n f o r the Disabled i n Canada", Toronto, September, 1958. W r i t i n g based on working papers prepared f o r the n a t i o n a l Advisory Committee on the R e h a b i l i t a t i o n o f Disabled Persons. 1  8  h e l p i n g s e r v i c e s cannot p o s s i b l y serve the p u b l i c w e l l when s t r u c t u r e d on the premise that they must r e t u r n at l e a s t as much t o the economy as was spent on the b e n e f i c i a r i e s of the program.  Some s e r v i c e s do not y i e l d the monetary r e t u r n that  i s necessary t o sponsor the s e r v i c e .  The r e t u r n s i n human  values cannot be so e a s i l y measured, but are nonetheless r e a l and v a l i d . Even on the s t r i c t l y f i n a n c i a l l e v e l , there i s s t a t i s t i c a l evidence supporting the low cost o f r e h a b i l i t a t i o n . Non-vocational r e h a b i l i t a t i o n as an economical measure does not lend i t s e l f e a s i l y t o s t a t i s t i c a l evidence, but such Involvement may reduce l a t e r costs of p u b l i c a s s i s t a n c e , p s y c h i a t r i c and medical care.  Speaking on v o c a t i o n a l  r e h a b i l i t a t i o n , the Royal Commission of H e a l t h Services o f 1964 reported a study of n e a r l y 10,000 r e h a b i l i t a t e d persons, done by the C i v i l i a n R e h a b i l i t a t i o n Branch of the Department of Labour.  The f i n d i n g s were* On the basis o f what i t would have cost t o m a i n t a i n those r e h a b i l i t a t e d i n 1961-62, and on the assumption that those r e h a b i l i t a t e d i n e a r l i e r years earned at l e a s t as much as those r e h a b i l i t a t e d i n 1961-62, i t i s estimated that i n that year the savings i n maintenance expenditures approached $60 m i l l i o n , while the earnings of those employed amounted t o over $180 m i l l i o n . 1  H a l l Report, "Royal Commission o f H e a l t h S e r v i c e s " , v o l . 1 , Ottawa, Queen's P r i n t e r , 1964, p. 515.  9 Figures f o r Saskatchewan, l i s t e d i n conduction w i t h those above, i n d i c a t e d that i t cost $54,580 annually t o support 71 people who, a f t e r r e h a b i l i t a t i o n , each earned an average o f about $2,000 a year.  The r a t e at which the r e h a b i l i t a t e d  persons contributes t o the n a t i o n a l economy by way of taxes soon pays f o r the cost o f t h e i r r e h a b i l i t a t i o n and, at the same time, reduces p u b l i c assistance expenditures.  Dunlop ' 1  gives comparable f i g u r e s on V o c a t i o n a l R e h a b i l i t a t i o n costs and returns i n the United S t a t e s . Table I I I provides i n f o r m a t i o n on e a r l i e r years and compares costs o f support before r e h a b i l i t a t i o n t o annual earnings a f t e r r e h a b i l i t a t i o n .  TABLE I I I  n  1  Sources  Number of Dependents  686  315  610  683 1,055 745 1,174 941 1,462 1,614 1,044 1,669 1,079 1,818 1,186 9,789 6,364  372 429 5a 570 590 628 3,425  826 877 1,146 1,276 1,300 1,400 7,435  450,532 984,460 1,232,040 923,240 954,304 902,919 1,118,891 6,530,386  Annual Earnings After Rehabilitation  Females  1,001  Estimated Annual Cost For Support  Males  Up t o March 31, 1957 1957 - 1958 , 1958 - 1959 1959 - I960 1960 - 1961 1961 - 1962 1962 - 1963 Total  Number of Cases  Period  R e h a b i l i t a t i o n Gases and Cost of Support Compared t o Incomes  1,750,753 1,860,165 2,219,380 2,683,403 2,730,502 3,198,547 3,401,979 17,844,729.  Canada, Department of Labour, Annual Report,Queen's P r i n t e r , Ottawa, 1963, p.54.  Dunlop, o n . c i t .  p.4.  10 F e d e r a l - p r o v i n c i a l agreements have a d u r a t i o n o f s i x years.  They may  be amended or e a r l i e r terminated  by mutual  consent of the p a r t i e s and w i t h the approval of the Governor i n Council. with  This combines the q u a l i t i e s of program s t a b i l i t y  flexibility  t o adapt r e a d i l y t o new and immediate needs.  The f e d e r a l government w i l l share costs incurred by a province i n providing a r e h a b i l i t a t i o n s e r v i c e which i n c l u d e s : (4) (a) assessment and c o u n s e l l i n g s e r v i c e s f o r d i s a b l e d persons; (b) s e r v i c e s and processes of r e s t o r a t i o n , t r a i n i n g and employment placement designed t o enable a d i s a b l e d person to dispense w i t h the necessity f o r i n s t i t u t i o n a l care or the n e c e s s i t y f o r the r e g u l a r home s e r v i c e of an attendant; (c)  providing f o r u t i l i z i n g voluntary organizations on a c t i v i t i e s i n the province v o c a t i o n a l r e h a b i l i t a t i o n of  the s e r v i c e s of that are c a r r y i n g i n the f i e l d of d i s a b l e d persons;  (d)  the t r a i n i n g of persons as counsellors or administrators t o carry out programs f o r the v o c a t i o n a l r e h a b i l i t a t i o n of d i s a b l e d persons; (e)  the c o o r d i n a t i o n of a l l a c t i v i t i e s i n the province r e l a t i n g t o v o c a t i o n a l r e h a b i l i t a t i o n of disabled persons; and (f)  such other s e r v i c e s and processes of r e s t o r a t i o n , t r a i n i n g and employment placement i n respect of d i s a b l e d persons as are s p e c i f i e d i n the agreement. R e l a t i n g these p r o v i s i o n s t o the e a r l i e r part of t h i s study wherein a comprehensive program i s o u t l i n e d , one may  observe  t h a t , generous though the p r o v i s i o n s are on some respects,  11 t h i s does not meet the t o t a l r e h a b i l i t a t i o n need of d i s a b l e d people, even from the v o c a t i o n a l aspects.  No e x p l i c i t  p r o v i s i o n i s made t o incorporate new s e r v i c e s and t o expand e x i s t i n g ones.  The Act i s c o n s t r i c t i n g because i t does not  allow cost-sharing f o r s e r v i c e s that are not already i n existence and provinces therefore r e c e i v e no help i n the development of new programs nor w i t h many kinds o f needed facilities.  Since s e r v i c e s may soon become obsolete i n a  r a p i d l y changing world, changes I n programs must be allowed f o r and p r o v i s i o n s made t o include the development o f new resources  f o r the d i s a b l e d .  Otherwise the s e r v i c e becomes  inappropriate because i t lags behind the changes i n s o c i e t y . At present the p r o v i n c i a l coordinator may "purchase" any necessary s e r v i c e which e x i s t s i f i t i s t o b e n e f i t the c l i e n t i n reaching h i s v o c a t i o n a l g o a l .  However, i f the  resource, though necessary, does not e x i s t , f o r example, use of a s h e l t e r e d work shop f o r t e s t i n g work t o l e r a n c e , he i s powerless under the A c t t o f a c i l i t a t e i n any way the inauguration o f such a s e r v i c e . Both the Act and Agreement request the provinces t o define t h e i r programs by o u t l i n i n g the s e r v i c e s , the process and by submitting annual reports and s t a t i s t i c s .  The f e d e r a l  a u t h o r i t i e s are thus w e l l informed o f what happens on l o c a l a d m i n i s t r a t i v e l e v e l s and t h i s i s a l s o a means where suggestions f o r improvements may be made. Two-way communication i s v i t a l  12  i f the necessary changes are to be incorporated and i f they are to be appropriate to the s i t u a t i o n . Sections 5 and 6 state that the Minister "may" undertake f e d e r a l coordination, do research alone or i n conjunction with a province, and assemble material f o r publication.  In a l l these areas the Act does not make clear  what the Federal government  " w i l l " do as opposed to what i t  "may" do. Nor i s i t clear what s p e c i f i c a l l y i s expected of the provinces.  This vagueness does not make f o r a stable  base f o r future planning. of r e h a b i l i t a t i o n would  P r o v i n c i a l a c t i v i t y i n the f i e l d probably have greater security i f the  provinces had some assurance of c e r t a i n mandatory rather than optional f e d e r a l support. To make maximum u t i l i z a t i o n of e x i s t i n g resources the Agreement, which makes p r o v i n c i a l coordination a condition of federal p a r t i c i p a t i o n , i s the means by which t h i s i s done. Provinces have a P r o v i n c i a l Coordinator  or Director of  Vocational R e h a b i l i t a t i o n whose duties are tos 7 (a) e s t a b l i s h appropriate means of seeking out disabled persons. . . . (b) encourage the provision of adequate remedial and educational services f o r disabled children and to ensure continuity for services on t h e i r reaching adolescence. . (c) encourage voluntary agencies to define their r o l e . . . . (d) e s t a b l i s h a committee of representatives of those departments of the p r o v i n c i a l government concerned. . .(with r e h a b i l i t a t i o n ) ;  13  and t o create on a p r o v i n c i a l and l o c a l b a s i s , advisory c o u c i l s or committees where deemed appropriate. Acceptance of these s t i p u l a t i o n s brings together the need and the f a c i l i t y a v a i l a b l e t o t r e a t the need, but says nothing about the means of accomplishing these ends. The f i r s t step i n seeking out d i s a b l e d persons i s f o r doctors to report d i s a b i l i t y at b i r t h . s o r t are"kept w i t h o p t i o n a l d i v e r s i t y .  Records of t h i s  K e s s l e r , making  recommendations f o r the American S t a t e s , suggests t h i s as both a method of e a r l y i n t e r v e n t i o n and a preventative measure. Perhaps we can take a cue from one of the most c o n s t r u c t i v e pieces of l e g i s l a t i o n i n t h i s regard. I r e f e r t o the compulsory r e g i s t r a t i o n of deformed c h i l d r e n at b i r t h . I t provides p u b l i c r e s p o n s i b i l i t y f o r the d e t e c t i o n of the deformity at an e a r l y date . when so much more can be done t o c o r r e c t i t . He a l s o advocates that records be kept throughout the disabled's lifetime.  Awareness and timing of I n t e r v e n t i o n would be  f a c i l i t a t e d ; there would be greater assurance of a c o n t i n u i t y of s e r v i c e so that appropriate i n t e r v e n t i o n , made at s p e c i f i c stages of the i n d i v i d u a l ' s development, would be most e f f e c t i v e . Case f i n d i n g i n the i n d i v i d u a l ' s l a t e r l i f e could be more complete w i t h improved r e f e r r a l arrangements.  There i s very  l i t t l e communication between a u t h o r i t i e s administering Disabled Henry H. K e s s l e r , R e h a b i l i t a t i o n of the P h y s i c a l l y Handicapped. New York, Columbia U n i v e r s i t y P r e s s , 1947, p. x  236.  14 Persons Allowance and r e h a b i l i t a t i o n o f f i c i a l s .  Assuredly,  many p o t e n t i a l r e h a b i l i t a t i o n clients are l o s t i n the s h u f f l i n g of them from one d i s c i p l i n e to another. The Act expounds the p r i n c i p l e that services may  be  purchased from private agencies on behalf of- the disabled person.  This emphasizes the f e d e r a l view that the appropriate  d i v i s i o n of r e s p o n s i b i l i t y i n Canadian r e h a b i l i t a t i o n i s the t r i n i t y of Federal-Provincial-Voluntary source.  There i s  s t i l l strong conviction i n Canada, as i n many other countries, that the day of the private agencies  is by no means done.  Both  successive f e d e r a l governments and the Royal Commission on Health Services see the voluntary agencies a v i t a l role i n r e h a b i l i t a t i o n .  combining to play  This is seen as necessary  even  i f the government implements a comprehensive program, as has been the experience  i n countries l i k e B r i t a i n and Sweden.  It i s most d i f f i c u l t to provide extensive services to a l l persons and f o r a l l d i s a b i l i t i e s . agencies  There are many voluntary  serving selected groups and, because they are already  established, recognition of them w i l l avoid overlapping. there are some d i s a b i l i t i e s that are so  Also,  Infrequent or affect  only a very few people that i t does not warrant an elaborate governmental organization.  The c l i e n t might receive an  adequate, perhaps a more personal, service from a private agency and the government may  find i t more economical to  purchase rather than provide for this intermittent need.  15  R e h a b i l i t a t i o n cannot be I s o l a t e d from h e a l t h , welfare and education.  That the provinces have a committee  of r e p r e s e n t a t i v e s of various d i s c i p l i n e s i s imperative. Advisory c o u n c i l s , t o o , play an important p a r t .  Information  supplied by these groups i s not only p e r t i n e n t but serves as a public voice. The Act s p e c i f i e s the composition o f a N a t i o n a l Advisory Council.  Four members are t o be employees o f Her Majesty;  representing the Department of N a t i o n a l Health and Welfare, the Department o f Veterans A f f a i r s , the Department o f Labour, and the Unemployment Insurance Commission.  Apart from t h i s ,  the i d e n t i t y o f the other members i s not w e l l s p e c i f i e d except that t e n s h a l l be chose upon the j o i n t recommendation of the M i n i s t e r of Labour and the M i n i s t e r of N a t i o n a l Health and Welfare.  The t e n provinces s h a l l each have a member.  one member i s t o serve as chairman.  Finally,  It i s a fair distribution  that the various departments and the t e n provinces be represented, but i t i s a l s o important that p u b l i c s e r v i c e s other than those mentioned and the medical p r o f e s s i o n , v o l u n t a r y agencies, r e l i g i o u s , and other groups be represented, and t h i s granted t o them by l e g i s l a t i o n .  Lay people, and most o f a l l , the  handicapped themselves should be i n c l u d e d . While the provinces may be considered accountable t o the M i n i s t e r s o f Labour and N a t i o n a l H e a l t h and Welfare (the l a t t e r , i n t u r n , are r e s p o n s i b l e t o Parliament) by having t o  16 submit r e p o r t s , accounts and s t a t i s t i c s they do have some degree of autonomy*  The f e d e r a l government, w i t h i n l i m i t a t i o n s ,  w i l l permit provinces t o d i r e c t t h e i r spending as they see fit*  P r i o r approval o f plans are u s u a l l y demanded, but cost-  sharing expenditures are submitted f o r reimbursement the a c t u a l spending has taken place*  after  I n some instances there  i s a c e i l i n g t o f e d e r a l f i n a n c i a l p a r t i c i p a t i o n , but p r o v i n c i a l freedom i s seen i n cases where, once the program i s accepted, the F e d e r a l government seems t o do l i t t l e more than pay the province i t s share o f the c o s t s .  I n the development o r  i n i t i a t i o n of p a r t i c u l a r areas the province seems t o have to take the f i r s t s t e p s , but then may not do l e s s than i s demanded by f e d e r a l standards. B.  The I n d i v i d u a l Schedules Forming part of the Agreement (and which becomes as  binding as any other part of the Agreement) are Schedules that set  out the s e r v i c e s , the methods, and the arrangements  under  which the provinces administer the s e r v i c e t o the p u b l i c . Schedule I l i s t s the conditions of assessment and c o u n c e l l i n g s e r v i c e s t o the c l i e n t .  Previous chapters o f  t h i s study e x p l a i n the v a r i o u s components of a comprehensive r e h a b i l i t a t i o n s e r v i c e and, when compared t o the p r o v i s i o n s under t h i s Schedule, i n d i c a t e s that an i d e a l program i s much more i n c l u s i v e than that which i s o u t l i n e d i n the Agreement. The goal toward which the e x i s t i n g assessment and c o u n s e l l i n g  17 s e r v i c e s are geared i s employment, whereas the c l i e n t has many other needs that are important to him.  Social services,  p s y c h o l o g i c a l h e l p , and r e h a b i l i t a t i o n f a c i l i t i e s are a  few  of those which now receive i n s u f f i c i e n t a t t e n t i o n . Assessments should take i n t o c o n s i d e r a t i o n c l i e n t values and the c l i e n t as a person rather than evaluating i n r e l a t i o n to h i s capacity t o reach goals which may i r r a t i o n a l , mechanical, and u n r e a l t o him.  him  seem  More r e c e n t l y  there has been increased awareness i n placement considerations of recognizing the " t r a i n e e ' s " l i f e experiences,  cultural  and r e l i g i o u s background, preferences, and of those things that have meaning to that p a r t i c u l a r person.  At the same  time there i s understanding of the person's p h y s i c a l and mental l i m i t a t i o n s . S e r v i c e s and Processes of R e s t o r a t i o n are d e a l t w i t h In Schedule 2.  Here again, the i n s t r u c t i o n s are vague,  s t a t i n g only that reimbursement t o the provinces s h a l l be made at the r a t e set out i n the Agreement f o r remedial r e s t o r a t i v e treatment and r e l a t e d s e r v i c e s .  or  Once more the  c o n f l i c t of n a t i o n a l standards and p r o v i n c i a l d i s c r e t i o n arises.  I f the s p e c i f i c processes are not o u t l i n e d i n the  Agreement and Schedules then, even on the l e v e l of p r o v i n c i a l f u n c t i o n s , there i s no guarantee that a c l i e n t w i l l r e c e i v e as comprehensive a s e r v i c e as i s needed or as a s i m i l a r l y disabled person i n another province.  18  Schedule 3 says that t r a i n i n g of the d i s a b l e d maybe provided under the terms of the T e c h n i c a l and V o c a t i o n a l T r a i n i n g A s s i s t a n c e Act or other t r a i n i n g , i n c l u d i n g u n i v e r s i t y courses i f approved by the M i n i s t e r * Some of the prominent t r a i n i n g o p p o r t u n i t i e s a v a i l a b l e w i l l be discussed i n subsequent sections* Employment placement s e r v i c e s (Schedule 4) are provided through the N a t i o n a l Employment S e r v i c e s *  This n e c e s s i t a t e s  close cooperation and good communication between p r o v i n c i a l r e h a b i l i t a t i o n o f f i c e s and f e d e r a l employment o f f i c e s .  The  Act and Agreement s t a t e that s e r v i c e s extended by the N a t i o n a l Employment O f f i c e be coordinated on the f e d e r a l l e v e l ; there i s a l s o c o o r d i n a t i o n by the provinces*  Nowhere i s there  reference t o how the p r o v i n c i a l agencies; should cooperate w i t h the n a t i o n a l o f f i c e s *  This remains confusing because i t  involves two l e v e l s of government and there must be a bridge between these two*  Using follow-up as an example, does the  t r a i n e e ' s p r o v i n c i a l worker or the f e d e r a l placement o f f i c e r r e t a i n contact w i t h the c l i e n t ?  Does the N a t i o n a l Employment  personnel share r e s p o n s i b i l i t y or assume f u l l c o n t r o l \ a f t e r assessment and t r a i n i n g ends?  What part does each p l a y while  r e h a b i l i t a t i o n i s i n process?  Greater c l a r i t y i s needed as  to who  i s a l l o c a t e d r e s p o n s i b i l i t y to do what and when. Included i n Schedule 5 i s the t r a i n i n g of s t a f f t h a t  c a r r i e s out the process of r e h a b i l i t a t i o n .  More mention w i l l  19 be made o f t h i s when the T r a i n i n g Act i s reviewed.  Possible  s t a f f t r a i n i n g v a r i e s from short courses t o academie degrees. Not a l l s t a f f can be p r o f e s s i o n a l l y t r a i n e d , nor need they perhaps be, and the range of t r a i n i n g i s quite appropriate t o the d i v e r s i t y o f functions c a r r i e d out by the s t a f f .  Quality  of the s t a f f w i l l r e f l e c t on the t r a i n i n g received by the disabled person and should therefore be taken i n t o account i n planning the t r a i n i n g curriculum. C. Other Considerations  o f the Act  Costs that the f e d e r a l government w i l l share w i t h provinces  includes  s a l a r i e s and t r a v e l l i n g expenses o f s t a f f  and personnel involved i n r e h a b i l i t a t i o n as w e l l as other a d m i n i s t r a t i v e expenses approved by the M i n i s t e r ; expenses o f disabled persons such as t o o l s and c l o t h i n g , t r a i n i n g , t r a n s p o r t a t i o n and maintenance; costs o f t r a i n i n g s t a f f ; costs of research; approved p u b l i c i t y ; medical f e e s ; and s e r v i c e s that are not f r e e of charge t o the p u b l i c . For s e r v i c e s other than c o u n s e l l i n g , guidance or assessment, the i n d i v i d u a l ' s a b i l i t y t o contribute i s taken into consideration.  There i s no consensus as t o what c r i t e r i a  to use i n c l i e n t p a r t i c i p a t i o n and c l i e n t c o n t r i b u t i o n s may vary without any set minimum rate at which he would not be expected t o reduce h i s personal a s s e t s .  Some provinces  aid  the t r a i n e e i n e s t a b l i s h i n g h i m s e l f , but the t r a i n e e i s not  20 c e r t a i n o f s u f f i c i e n t c a p i t a l resources t o i n i t i a t e a p r i v a t e business a f t e r h i s r e h a b i l i t a t i o n .  S e c u r i t y i s a major  p s y c h o l o g i c a l f a c t o r inducing the c l i e n t t o r e h a b i l i t a t i o n . Apart from c a p i t a l funds, i f the t r a i n e e i s indigent h i s needs may be met. This does not n e c e s s a r i l y include the maintenance of h i s f a m i l y while he i s t r a i n i n g .  Particularly  i f the head of the household i s t a k i n g t r a i n i n g , s e r v i c e s should be extended t o h i s dependents as w e l l , and t h i s  should  not be at the subsistence l e v e l of s o c i a l assistance standards as i s the case i n some provinces. The Agreement does not enable cost sharing f o r s e v e r a l things even though they are b a s i c t o the o v e r a l l program. I n the Appendix of the Agreement i s stated that 10. Except as otherwise s p e c i f i c a l l y provided f o r i n t h i s Agreement, shareable costs do not include p r o v i n c i a l expenditures incurred f o r any o f the f o l l o w i n g items: (a) a c q u i s i t i o n s o f lands and b u i l d i n g s ; (b) purchase or r e n t a l o f o f f i c e equipment and supplies; (c) a l t e r a t i o n s , r e p a i r s or r e n t a l s f o r o f f i c e accommodation; (d) damage or compensation r e s u l t i n g from i n j u r y t o persons except the cost o f f i r s t aid; (e) l e g a l , advisory o r c o n s u l t i n g fees and s a l a r i e s ; and • ( f ) overhead expenses added t o the cost o f m a t e r i a l s s u p p l i e d by the Province or any m u n i c i p a l i t y from e x i s t i n g s t o r e s .  21 The Federal government proposes to help the provinces improve and provide r e h a b i l i t a t i o n s e r v i c e s but, i n f a c t , only aids i n those areas that have already been i n i t i a t e d by the province. One of the r e c u r r i n g themes i n t h i s study has been the frequency w i t h which the Federal government, i n r e h a b i l i t a t i o n l e g i s l a t i o n , throws the onus back on the provinces and  the  voluntary agencies f o r I n i t i a t i n g the s e r v i c e s and meeting many, and sometimes a l l , of the c a p i t a l costs i n v o l v e d .  The f e d e r a l  p o s i t i o n seems to be that i f the provinces and p r i v a t e agencies w i l l develop a s e r v i c e and play the major r o l e i n i t s o p e r a t i o n then the Federal government w i l l support i t .  The r o l e played  by the f e d e r a l a u t h o r i t i e s i s perhaps not f u l l y r e a l i z e d by the average c i t i z e n .  The e a r l i e r mentioned r e h a b i l i t a t i o n  " t r i n i t y " makes a t r i p l e demand on the c i t i z e n .  He i s  required t o contribute t o f e d e r a l and p r o v i n c i a l taxes while expected t o make a generous donation t o p r i v a t e agency programs. A p o s s i b l e f o u r t h demand might be made by the m u n i c i p a l i t y , which may  f o s t e r a r e h a b i l i t a t i o n p r o j e c t of i t s own.  Allowing f o r d i f f e r i n g rates of cost sharing, i f the Federal government d e s i r e s t o h e l p the provinces, e s p e c i a l l y as i t has n a t i o n a l a u t h o r i t y , i t should extend i t s a i d t o a l l those elements that make up the general program and to h e l p i n supplying those elements that the provinces l a c k . i n i t i a l establishment  In  and subsequent expansion the provinces  receive l e a s t support, yet these are the areas of most  22 Importance i n providing adequate s e r v i c e s t o the d i s a b l e d person and are most expensive t o the  province.  Combining the N a t i o n a l Department of Labour's  1963  s t a t i s t i c s of payments made t o the provinces w i t h the  196l  population Census (see Table IV) gives some i n d i c a t i o n of the r a t e at which each province u t i l i z e s f e d e r a l monies. v a r i a t i o n s between p r o v i n c i a l expenditures may  The  depict that the  Act and Agreement do not a f f e c t each province s i m i l a r l y . may  There  be many reasons why one province spends more, per c a p i t a ,  than another.  A r e a l problem remains:  that i s to f i n d a  s o l u t i o n between n a t i o n a l u n i f o r m i t y at a "basic minimum l e v e l " and meeting s p e c i a l p r o v i n c i a l demands at the same time. Table may  The  a l s o be i n t e r p r e t e d as some provinces r e q u i r i n g a  d i f f e r e n t k i n d of help that has so f a r been extended by the f e d e r a l government.  I n d i c a t i v e , however, i s that each province's  r e h a b i l i t a t i o n expenditure i s at a d i f f e r e n t pace. A comparison of the f i n a n c i a l and occupational status of the disabled before r e h a b i l i t a t i o n and that of t h e i r  new  status f o l l o w i n g r e h a b i l i t a t i o n w i l l be one way of evaluating what the program has done f o r those persons who have been accepted. status.  Table V shows a marked change i n the f i n a n c i a l This means that the program does enable f i n a n c i a l  independence f o r many d i s a b l e d people.  P r i o r to r e h a b i l i t a t i o n  the m a j o r i t y were dependent on r e l a t i v e s and p u b l i c a s s i s t a n c e , a f t e r r e h a b i l i t a t i o n the l a r g e s t group earned between $1000 and  23  TABLE IV Payments t o Provinces and P r o v i n c i a l Populations Federal Payment x  Province Newfoundland P r i n c e Edward Island Nova S c o t i a New Brunswick Ontario Manitoba Saskatchewan Alberta B r i t i s h Columbia Total  i  Source:  -  s SEX  - . .  ':  Provincial P o p u l a t i o n xx  10,596.78 3,142.18 23,737.97 52,290.88 75,890.62 84,232.17 47,597.23 21,940.08 13,717.13  457,853 104,629 737,007 597,936 6,236,092 921,686 925,181 1,331,944 1,629,082  333,145.04  12,946,410  Canada, Department of Labour, Annual Report, 1962-63. 1961 Canadian Census  "TABLE V F i n a n c i a l Status Before and A f t e r R e h a b i l i t a t i o n Groups  At Acceptance 1962 1963 T o t a l  Dependent on R e l a t i v e s 718 P u b l i c A s s i s t ' c e 437 D i s a b i l i t y & other A l l . 42 Earnings: under 500 8 501 - 1000 52 1000 - 2000 122 2000 - 3000 80 3000 - over 30 Old Age Sec.Savings,etc 87 Unemployment Insurance 93 No Information M  Totals Source:  1669  756 480 35 1 35 101 65 33 116 187 5 1809  1474 917 77 9  8?  223 145 63 203 280 5  3478  After Rehabilitation 1962 1963 Total  63 198 445 650 221  36 189 499 657 247  99 387 944 1307 468  1577  1628  3205  Canada, Department o f Labour, Annual Reports, 1962- 1963.  24 $3000 per year* possible*  The s e l e c t i v i t y of t r a i n e e s makes t h i s  Should s e r v i c e s be extended t o include the d i s a b l e d  who do not have t h i s good employment prognosis, these s t a t i s t i c s might be r a d i c a l l y d i f f e r e n t .  What might not be  s t a t i s t i c a l l y i n d i c a t e d then, because i t would be more d i f f i c u l t to measure, would be the r e t u r n s i n human s a t i s f a c t i o n and happiness• Table VI i n d i c a t e s movement i n c o c c u p a t i o n a l status because of r e h a b i l i t a t i o n .  T h i s might be a b e t t e r y a r d - s t i c k  f o r measuring Improvement i n " h a b i l l t a t i o n " of some c l i e n t s . Outstanding i s the movement from No Occupation (and U n s k i l l e d Occupation) t o Sales and C l e r i c a l and the S e r i c e Occupation group.  The discrepancy i n the t o t a l number  of persons before  r e h a b i l i t a t i o n and that a f t e r i s accounted f o r by the f a c t that r e h a b i l i t a t i o n may not have been s u c c e s s f u l f o r a l l those who were accepted.  Here, as I n r e h a b i l i t a t i o n workshops,  good t e s t of program scope i s the rate of f a i l u r e .  1  a  I f there  i s l i t t l e f a i l u r e then the program i s l i k e l y very s e l e c t i v e and does not accept "high r i s k " cases — help the most.  those u s u a l l y r e q u i r i n g  Despite the success of r e h a b i l i t a t i o n , i t s t i l l  does not meet the requirements of a comprehensive  program  because i t extends s e r v i c e s only to a s m a l l segment of the disabled group, r a t h e r than being u n i v e r s a l i n coverage. A l i c e E l a r t , R e h a b i l i t a t i o n Coordinator, P r o v i n c i a l Mental H o s p i t a l , Essondale, B.C. Speaking on "A Comprehensive Workshop The Goodwill Approach", at:tbe Annual Meeting of Vancouver D i v i s i o n f o r Guidance of the Handicapped, March 29, 1965* 1  25  TABLE V I Occupation Before and A f t e r R e h a b i l i t a t i o n  Occupation Before  1961 1962 !l963 T o t a l  Occupation After 1961 1962 1963  Total  i  P r o f l and Managerial  49  63  51  163  P r o f ' l and Managerial  85  121  114  320  Sales and Clerical  222  170  208  600  Sales and Clerical  410  395  457  1262  Service Occupations  279  177  150  606  Service 364 Occupations  266  299  929  AgrL, Fishery 134 Forestry,etc.  129  118  381  A g r i . Fishery 64 Forestry,etc.  80  68  212  S k i l l e d Oc- 103 cupation  145  158  406  S k i l l e d Oc- 114 cupat i o n  235  201  550  S e m i - s k i l l e d 123 Occupation  88  118  329  Semi-skilled 131 Occupation  123  154  408  307  317  332  956  Unskilled Labour  214  233  246  693  113  117  230  Housewife and 1 Homemaker  126  124  250  465  560  90  151  241  2  2  f  Unskilled Labour  Housewife and x Homemaker No Previous Occupation Retired Total  K  397 K  1422  S e l f Care  x  4 5097  Not l i s t e d f o r those years.  Source:  Canada, Department of Labour, Annual Reports.  4865  26  TABLE V I I D i s a b i l i t y Groups By Age, Sex and L o c a t i o n  Group  1960-61  Under 20 20-29 30 - 39 40 - 49 50 - 59 Over 60  186 616 331 231 129 139  197 663 344 225 144 96  328 228 177 125  638 1980 1003 784 450 360  Total  1632  1669  1814  5215  Male_ Female Dependents  1044 570 1276  1079 590 1300  1186 628 1400  3309 1788 3976  Total  2890  2969  3214  9073  1009 605  1055 614  1179 635  3243 1854  1614  1669  1814  5097  Urban Rural Total Sources  1961-62  1962-63 255  Total  Canada, Department of Labour, Annual Reports. The 5097 d i s a b l e d persons who were accepted f o r  r e h a b i l i t a t i o n during the three years i s c e r t a i n l y only a s m a l l p o r t i o n o f the people who are d i s a b l e d .  Not only i s  there need t o re-examine what needs and how many, or few, people are served, but the kinds of people p r e s e n t l y served  27 offers d i r e c t i o n f o r the future and should therefore be studied. Table VII shows that those people who were given a service f e l l primarily between the ages 20 and 4G. This i s the most p o t e n t i a l labour force and perhaps i n d i c a t i v e only of the program scope rather than of public conditions. S i m i l a r l y , almost twice as many males as females and nearly twice as many urban as r u r a l persons were e l i g i b l e .  Only t o  a degree i s t h i s representative of d i s a b i l i t y d i s t r i b u t i o n , but i f so, then program focus should n a t u r a l l y adjust accordingly and gear r e h a b i l i t a t i o n services where greatest need exists*  On the other hand, t h i s could be Interpreted as  the program having a l i m i t e d purpose and r e s t r i c t e d t r a i n i n g facilities*  I f the l a t t e r i s correct, i t i s time that  r e h a b i l i t a t i o n be revised to consider u n i v e r s a l coverage.  1  CHAPTER  IX  CRITIQUE OF THE TECHNICAL AND VOCATIONAL TRAINING ACT, i960  This A c t , l i k e the V o c a t i o n a l R e h a b i l i t a t i o n o f Disabled Persons A c t , places great import on " g a i n f u l employment" as i t s end and purpose.  U n l i k e i t s counterpart,  i t does not devote i t s e l f e n t i r e l y t o the p h y s i c a l l y d i s a b l e d . I t serves the unemployed, those employed who wish to advance and improve t h e i r p o s i t i o n s , and other s e c t i o n s of the "healthy" population.  I t can therefore be used f o r the r e h a b i l i t a t i o n  of many kinds of people, i n c l u d i n g the s o c i a l l y  disadvantaged.  The Agreement of the Act defines p r o v i n c i a l a c t i v i t y much b e t t e r , w i t h greater c l a r i t y and d i r e c t i o n , than the V o c a t i o n a l R e h a b i l i t a t i o n of the Disabled Persons Agreement.  The s e r v i c e s  o f f e r e d are more comprehensive, with p r o v i s i o n s f o r trainees more adequate. As w i t h the previous two A c t s , t h i s Act and Agreement w i l l be evaluated conjunctively as they complement and overlap one another.  Again, the approach w i l l be a c r i t i c i s m o f i t s  weaknesses, but t h i s does not make the whole program  inadequate.  Despite the f a c t that more negative than p o s i t i v e c r i t i c i s m s may be recorded, t h i s Act i s perhaps Canada's best F e d e r a l P r o v i n c i a l piece of l e g i s l a t i o n .  I t s i n c l u s i v e n e s s extends  2 not only t o the p h y s i c a l l y and v o c a t i o n a l l y d i s a b l e d , but t o those who have no overt handicap and i t recognizes the s o c i a l l y and p s y c h i c a l l y d i s t r e s s e d person, the unemployed and the poorly employed.  The V o c a t i o n a l R e h a b i l i t a t i o n of Disabled  Persons Act allows f o r the s e r v i c e s necessary f o r r e h a b i l i t a t i o n ; t h i s Act enables the actual t r a i n i n g . A»  The T r a i n i n g Act I n the Agreement, s e c t i o n I , s u b s e c t i o n ( b ) , by  t e c h n i c a l and v o c a t i o n a l t r a i n i n g i s meant . . . any form of i n s t r u c t i o n , the purpose of which i s to prepare a person f o r g a i n f u l employment i n any primary or secondary industry or i n any s e r v i c e occupation or t o increase h i s s k i l l or p r o f i c i e n c y t h e r e i n , and without r e s t r i c t i n g the g e n e r a l i t y of the f o r e g o i n g , includes i n s t r u c t i o n f o r that purpose i n r e l a t i o n t o any of the f o l l o w i n g i n d u s t r i e s or occupations: a g r i c u l t u r e , f o r e s t r y , f i s h i n g , mining, commerce, c o n s t r u c t i o n , manufacturing or communications, or g e n e r a l l y , any primary or secondary i n d u s t r y or s e r v i c e occupation r e q u i r i n g an understanding of the p r i n c i p l e s of science or technology and the a p p l i c a t i o n t h e r e o f , except where such i n s t r u c t i o n i s designed f o r u n i v e r s i t y c r e d i t . This i s , quite a p p r o p r i a t e l y , general and t h e r e f o r e allows f o r p r o v i n c i a l d i s c r e t i o n i n developing along l i n e s of demand. The t r a i n i n g o f f e r e d i s l i m i t e d to a degree and applies only t o a c e r t a i n type of l i v e l i h o o d *  While choice w i t h i n t h i s  confine i s l i b e r a l , i t excludes many people who could take t r a i n i n g i n courses other than these.  I n one sense, the  3 provisions made f o r t r a i n i n g are indeed good.  In another  sense, because we have l i t t l e other supplementary r e h a b i l i t a t i o n l e g i s l a t i o n , the t o t a l opportunities available to the Canadian c i t i z e n are very l i m i t e d , especially as education for the many types of workers needed i n the health f i e l d  is s t i l l  met primarily, i f not exclusively, out of p r o v i n c i a l education budgets.  Other forms of r e h a b i l i t a t i o n , even i n the vocational  f i e l d , must be developed before Canada can claim to have a t r u l y comprehensive range of r e h a b i l i t a t i o n opportunities open to a l l who can q u a l i f y for them without prohibitive cost to the i n d i v i d u a l or the province. The Agreement spells out the major purpose.  It i s ,  f i r s t , to enable f e d e r a l - p r o v i n c i a l cost sharing according to some uniform standard.  Second, to meet the need f o r  trained workers i n our increasing and dynamic technological society.  Third, to aid the economy by increasing  and knowledge on the labour force.  skills  Fourth, to meet the  need of newly trained and retrained workers.  F i f t h , to aid  and encourage industry which i s an important element of our economy and which, i n turn, contributes toward development of manpower s k i l l s .  Sixth, to a s s i s t i n the development  and operation of programs f o r the t r a i n i n g of manpower. A subsequent mention of the s p e c i f i c Programs w i l l show that these goals are being r e a l i z e d .  Even so, the  achievement of the proposed goals i s i n s u f f i c i e n t i f these  4 goals are l i m i t e d i n scope.  Thus, even though a program  f u l f i l l s i t s i n t e n t , i t can s t i l l be l a c k i n g as a good p u b l i c service. C o o r d i n a t i o n occurs on p r o v i n c i a l and f e d e r a l l e v e l s s e p a r a t e l y as w e l l as p r o v i n c i a l - f e d e r a l j o i n t l y .  I t operates  on a base comparable t o "cooperative Federalism" where a c t i v i t i e s are shared and delegated r a t h e r than proceeding according t o a s t r i c t s e p a r a t i o n of powers.  Governments have  found t h i s acceptable and workable as long as there Is no confusion o f r e s i d u a l powers and r e s p o n s i b i l i t i e s . Superior to the V o c a t i o n a l R e h a b i l i t a t i o n of Disabled Persons A c t , the N a t i o n a l Advisory C o u n c i l , s e c t i o n 9 of t h i s Act,  represents equally employers and employees w i t h other  i n t e r e s t e d s e c t i o n s of the community. P r o v i n c i a l advisory or c o n s u l t i v e committees are mandatory.  Representation  permits a f a i r d i s t r i b u t i o n of l a b o u r , education, s o c i a l s e r v i c e s , c i v i l i a n , and other i n t e r e s t e d  groups.  T r a i n i n g f o r which the f e d e r a l government w i l l accept cost-sharing and the v a r y i n g rates of the sharing are set f o r t h i n s e c t i o n 3 of the A c t , but are made much c l e a r e r i n the iAgreement w i t h i t s attached Schedules and Appendixes. Any cost that i s not s p e c i f i e d under these subsections f a l l under s e c t i o n 3,  may  p r o v i d i n g i t i s not an expenditure f o r  which the f e d e r a l government has o u t l i n e d as not being a cost-sharing item.  5 B.  The Programs (i)  Program I,  Vocational High School Training (V.H.S.)  Courses given as part of the high school education i n Ttfxieh the greater part of time i s devoted  to preparing  the student f o r employment through t e c h n i c a l , commercial and other vocational subjects are part of the program.  The  annual f e d e r a l contribution does not exceed three m i l l i o n dollars with allotments of t h i r t y thousand plus an extra adjustment based on the percentage of persons between the ages 15-19  i s paid to each province.  In no instance i s the  federal share more than 50$ of t o t a l costs up to this maximum. The money i s used at p r o v i n c i a l v o l i t i o n but not for c a p i t a l expenditures.  I n i t i a l l y , provinces must submit f o r approval  the l i s t of schools and courses that w i l l play a part i n the training.  Excluded are courses that may  be termed as general  subjects or those that do not contribute toward the students future employment.  The same c r i t i c i s m s of limited scope  apply here. (ii)  Program 2, Technician Training (T) It i s possible under t h i s  cost-sharing scheme to  take t r a i n i n g at a post-High School stage i n the f i e l d s of science or technology and other related f i e l d s with emphasis on the a p p l i c a t i o n of such t r a i n i n g .  This does extend to  t r a i n i n g designed f o r u n i v e r s i t y c r e d i t . of t r a i n i n g may be long-term  The time and type  (three years), part-time, or  $ by correspondence and may be preceded by advanced t h e o r e t i c a l and p r a c t i c a l t r a i n i n g .  The t r a i n i n g p o s s i b l e can h a r d l y be  d i s t i n g u i s h e d from r e g u l a r u n i v e r s i t y classes and there i s a l a c k of overt c r i t e r i a as t o who can r e c e i v e u n i v e r s i t y c r e d i t under the program and who,  even i f i n d i g e n t , i s  expected t o sponsor h i s own education.  Why  university  education i s included under t h i s s e c t i o n and not under others seems to be a matter of p r i v i l e g e .  I t i s somewhat of a  r a d i c a l advancement t o o f f e r a u n i v e r s i t y type of education w i t h i n r e h a b i l i t a t i o n programs.  While t h i s i s t o be  e l i g i b i l i t y requirements should be more e x p l i c i t .  advocated,  In this  area i t i s not easy to separate a r i g h t from a p r i v i l e g e i n education and why the r e g u l a r student pays h i s fees while the student of t h i s program has these e x t r a advantages without there being d e f i n i t i o n of who  i s to be  accepted.  In previous years the scope of t r a i n i n g on e d u c a t i o n a l and p r o f e s s i o n a l l e v e l s v a r i e d g r e a t l y from one Schedule to another.  Since May, 1963,  the Second Meeting of the N a t i o n a l  Advisory C o u n c i l on R e h a b i l i t a t i o n of the D i s a b l e d , the provinces may,  at t h e i r own d i s c r e t i o n , provide any type of  t r a i n i n g that i s considered f e a s i b l e .  1  This permission  places the provinces i n a p o s i t i o n where they have t o decide what range of academic t r a i n i n g f o r the d i s a b l e d i s j u s t i f i e d . Canada, N a t i o n a l Advisory C o u n c i l on R e h a b i l i t a t i o n of Disabled Persons, Second Meeting, Appendix C, N a t i o n a l Coordinator's Report, May 13-14-, 1963, p. 1. 1  7  The d i f f i c u l t question remains as whether some types of d i s a b i l i t i e s are favored and whether the d i s a b l e d r e c e i v e better o p p o r t u n i t i e s than the student who assumes r e s p o n s i b i l i t y f o r f i n a n c i n g h i s own (iii)  education.  2  Program 3, Trade and Other Occupational  Training(T.O.)  Cost-sharing of 50$ supports pre-employment t r a i n i n g , upgrading or r e t r a i n i n g f o r persons over the s c h o o l age  who  have l e f t before elementary s c h o o l but r e q u i r e such t r a i n i n g t o develop or increase t h e i r competence.  The e f f e c t of t h i s  type of t r a i n i n g acts as an e q u a l i z e r between the educated and the uneducated employee.  That person who discontinues  h i s education when i n grade school o f t e n ends up as a "common labourer".  Modern trends I n industry and commerce demand  specialized  training.  Through t r a i n i n g the employee can  Increase not only h i s wage but h i s standard of l i v i n g  and  thus b e t t e r meet the increased costs of a contemporary comfortable  life.  As i s seen I n Table V I I I t h i s program i s Important i f the amount spent Is any i n d i c a t i o n of the people served. There are thousands of employees who are w i l l i n g and able t o improve t h e i r competencej t h i s program enables them t o realize their potential.  The n a t i o n as w e l l as the i n d i v i d u a l  b e n e f i t s from t h i s t r a i n i n g . * W r i t e r ' s notes of meeting with P r o v i n c i a l Coordinator of R e h a b i l i t a t i o n , B r i t i s h Columbia, March, 1965.  TABLE V I I I Federal Payments and Program Breakdown  Program  1961 - 62  1962 - 63  V o c a t i o n a l High School Training  1,927,453.03  1,901,569.88  Technician Training  3,351,895.85  5,766.622.60  Trade and Other Occupational T r a i n i n g  5,415,028.83  7,446,179.61  29,398.51  52,732.84  3,451,554.41  6,760,901.90  T r a i n i n g o f the Disabled  363,716.39  582,837.00  T e c h n i c a l and V o c a t i o n a l Teacher T r a i n i n g  212,595.69  191,332.75  26,711.43  41,258.09  301,953.75  299,719.74  1,969,588.64  2,160,484.84  T r a i n i n g i n Cooperation With Industry Training of Unemployed  T r a i n i n g Programs f o r Federal Departments Student Aid Apprentice Training Source:  Canada, Department o f Labour, Annual Beports.  9  (iv)  Program 4,  T r a i n i n g i n Cooperation w i t h Industry  (T.I.)  T r a i n i n g i n t h i s f i e l d i s undertaken and developed c o n j o i n t l y by the province and a p a r t i c u l a r i n d u s t r y .  The  f e d e r a l government shares $0% of costs of the approved programs and, since February 1964, 75% of approved programs. This includes a p p r e n t i c e s h i p , supervisory and management. employee may  An  receive t r a i n i n g i f , f o r some reason, he cannot  o b t a i n such from an e s t a b l i s h e d shcool or other i n s t i t u t i o n . The t r a i n i n g a p p l i e s d i r e c t l y t o the employee's work p o s i t i o n - and.thus the theory and s k i l l s acquired have maximum p r a c t i c a l value.  "Training on the job" o p p o r t u n i t i e s are a very  important source f o r d i s a b l e d people, who o f t e n could not be placed i f some such plan were not a v a i l a b l e . T r a i n i n g i s , however, not uniformly a v a i l a b l e t o a l l employees even though they may  be i n s i m i l a r employment.  Much r e s t s on the employer, who may  consider personal g a i n as  a c o n d i t i o n t o employee advancement.  There i s nothing t o  prevent an employer from r e f u s i n g t o p a r t i c i p a t e i f he receives no great r e t u r n from entering i n t o an agreement with the province.  Since cooperation of the employer determines whether  t h i s program w i l l be used, the d e c i s i o n r e s t s i n the wrong hands as employee's d e c i s i o n to t r a i n i s contingent upon the p r i o r d e c i s i o n of h i s employer.  The employee has no c l a i m  to u n f a i r treatment, he can only r e s i g n from h i s work though i t i s not e a s i l y done a f t e r roots have been e s t a b l i s h e d .  1G E i t h e r because the combination of a l l other programs i s quite i n c l u s i v e , or because employers are not w i l l i n g t o involve themselves, t h i s resource has not been too a c t i v e . Table V I I shows that spending under t h i s program has remained second lowest. Program 5,  (v)  T r a i n i n g of Unemployed  (M)  The f e d e r a l government contributes 75% of costs f o r t r a i n i n g of the unemployed, and 90% of costs of allowances paid to unemployed persons while i n t r a i n i n g .  The  higher  r a t e of c o n t r i b u t i o n i s not s u r p r i s i n g when considering that had not these persons accepted t r a i n i n g they might remain on p u b l i c assistance or unemployment insurance, both of which i n v i t e s i m i l a r p u b l i c spending.  The N a t i o n a l Employment  Service recommends the t r a i n e e but the f i n a l s e l e c t i o n includes the d e c i s i o n s of p r o v i n c i a l r e h a b i l i t a t i o n o f f i c i a l s . Hours and content of t r a i n i n g programs vary.  The p r o v i n c i a l  advisory committee, representing employers, labour,  and  f e d e r a l and p r o v i n c i a l governments, w i l l advise on the kind of t r a i n i n g needed, the nature and length of the courses offered• Apart from the issue of whether the unemployed employable has employment p r i o r i t y over the unemployed d i s a b l e d , the employable can be returned t o work f a s t e r and w i t h l e s s cost.  The stigma attached t o the i d l e able-bodied  person  may not be as great an i n c e n t i v e t o employment as t r a i n i n g  11 which w i l l make h i s labour more productive, perhaps more i n t e r e s t i n g , under improved c o n d i t i o n s , and y i e l d a humane l i v i n g wage. Training-on-the-job  may  be arranged f o r t r a i n e e s .  The employer s t i p u l a t e s the conditions of t r a i n i n g and submits regular reports t o the province.  E s p e c i a l l y f o r people  who,  f o r any reason, cannot take the time or a f f o r d the money t o discontinue work t o accept t r a i n i n g , t h i s o f f e r s an e x c e l l e n t opportunity.  Arrangements are u s u a l l y made t o maintain  the  employee's wage while h i s t r a i n i n g continues, w i t h the employer c o n t r i b u t i o n s on a percentage or s c a l e b a s i s • R e l a t i n g t h i s to s i m i l a r arrangements f o r the d i s a b l e d person, t r a i n i n g - o n - t h e - j o b precautions errors mentioned by  need be taken against  Linden.  Thus, although i n some circumstances the type of l e g i s l a t i o n ( t o compel! employers t o h i r e a percent of disabled persons on s t a f f ) may be required i n order t o secure some work f o r d i s a b l e d people who could not otherwise be employed, i t should be used s p a r i n g l y and c a r e f u l l y . I t Is recognized that where a d i s a b l e d person i s unable to compete with other workers i n a given t a s k , i t might be p r e f e r a b l e t o pay him a smaller hourly wage and keep him working than ( s i c ) t o r e q u i r e equal pay which would n e c e s s i t a t e h i s d i s m i s s a l . However, i t must be made c l e a r that d i s a b l e d people mut not be e x p l o i t e d merely because they are handicapped where they are able t o do the job s a t i s f a c t o r i l y . Where v a r i a t i o n from minimum wages are necessary i t should be done only w i t h safeguards f o r the d i s a b l e d person.l A, M. Linden, "Labour L e g i s l a t i o n and the Disabled *, M a t e r i a l submitted t o the Canadian R e h a b i l i t a t i o n C o u n c i l f o r the D i s a b l e d , p. 7. 1  12 While disagreeing with the enforced employment of the d i s a b l e d , the handicapped or untrained person should always be protected from e x p l o i t a t i o n *  I t i s recommended that persons, whether  i n t r a i n i n g or employed, when s t i l l p a r t i a l l y d i s a b l e d , be assured of a minimum wage.  This minimum should be the same  as that of the general wage s t r u c t u r e , and under c e r t a i n circumstances  where i t i s lower i n the case of a severe  d i s a b i l i t y , there should be c a r e f u l safeguards exploitation.  against  This i s a question that recurs w i t h i n c r e a s i n g  fervor i n r e h a b i l i t a t i o n c i r c l e s .  I t i s s t i l l debated and  never appears to have been s e t t l e d to the point where i t i s possible t o say there i s a m a j o r i t y or a m i n o r i t y o p i n i o n for  or against i t .  Part of the d i f f i c u l t y i s that some d i s a b l e d  people want to work and are w i l l i n g t o accept lower rates than the minimum wage because they are conscious of the f a c t that t h e i r production, or at l e a s t t h e i r a g i l e pace, i s slower i n comparison to the non-disabled worker performing the same Job. Under t h i s program a minimum wage i s assured, w i t h employers being reimbursed on a " s l i d i n g - s c a l e " rate which is separately negotiated i n each instance depending on the l i m i t a t i o n of the employee.^ (vi)  Program 6, T r a i n i n g of the Disabled  (R)  This program, s p e c i f i c a l l y , l i n k s the Technical and ^ G. A. Roeher, "Progress and Needs of R e h a b i l i t a t i o n i n Canada", R e h a b i l i t a t i o n and World Peace, (ed.) E . J . T a y l o r , New York, I n t e r n a t i o n a l S o c i e t y f o r R e h a b i l i t a t i o n of the D i s a b l e d , 8th World Congress, I960, p. 67.  13  V o c a t i o n a l T r a i n i n g Assistance Act with the p h y s i c a l l y disabled person and therefore with the V o c a t i o n a l R e h a b i l i t a t i o n o f Disabled Persons A c t .  I t o u t l i n e s the terms and conditions  under which d i s a b l e d persons receive the v o c a t i o n a l t r a i n i n g . The p h y s i c a l l y handicapped person may receive assessment c o u n s e l l i n g , and p h y s i c a l r e h a b i l i t a t i o n under the V o c a t i o n a l R e h a b i l i t a t i o n o f Disabled Persons Act, but the a c t u a l v o c a t i o n a l t r a i n i n g f o r most people f a l l s under t h i s program. Here the two Acts complement one another. Placement of the r e h a b i l i t a t e d person i n s u i t a b l e employment i s the r e s p o n s i b i l i t y o f the S p e c i a l Placement S e c t i o n o f the N a t i o n a l Employment S e r v i c e .  This department  operates under the a u t h o r i t y of the Unemployment Insurance A c t , Part 11, 1955.  1  The work of the S p e c i a l Placement S e c t i o n i s  c l o s e l y co-related with r e h a b i l i t a t i o n agencies and, though p o l i c i e s may vary from province t o province w i t h regard t o c r i t e r i a o f a c t u a l placement, the s e r v i c e i s a v i t a l part o f rehabilitation. The f e d e r a l government shares 50% of the cost o f t r a i n i n g for those s e l e c t e d by the p r o v i n c i a l s e l e c t i o n committee. Without p r i o r approval, t r a i n i n g may not exceed two years but w i t h i n t h i s period i t may take next t o any form, i n c l u d i n g training-on-the-job.  Such t r a i n i n g i s subject t o the same  The N a t i o n a l Coordinator's submission f o r "Study on L e g i s l a t i v e and A d m i n i s t r a t i v e Aspects of R e h a b i l i t a t i o n o f the Disabled i n Selected Countries", New York, United Nations, 1964. 1  14 comments as i n the previous s e c t i o n . There seems t o be some discrepancy between t r a i n i n g of the unemployed and t r a i n i n g of the d i s a b l e d . f i r s t category the f e d e r a l government accepts of 7%  I n the  cost-sharing  and 90$ o f expenditures whereas, and perhaps f o r  s i m i l a r t r a i n i n g , only 50% of p r o v i n c i a l expenditures f o r the disabled.  Nor does the d i f f e r e n c e i n f e d e r a l rates account  e n t i r e l y f o r the large d i f f e r e n c e i n the t o t a l money spent annually on these two programs.  (See Table V I I I ) .  The f i r s t  of these two arguments i n d i c a t e s that the unemployed r e c e i v e more support than the d i s a b l e d and the f e d e r a l government does not concentrate s u f f i c i e n t l y on d i s a b i l i t i e s .  The  second argument of t o t a l annual expenditures i n d i c a t e s that the provinces  are f a l l i n g i n t o the same e r r o r .  I f there are  more d i s a b l e d people i n Canada than unemployed, i t would be assumed t h a t , r e c e i v i n g equal r e h a b i l i t a t i o n o p p o r t u n i t i e s , the expenditures f o r t r a i n i n g of the d i s a b l e d would be higher than f o r the unemployed.  Furthermore, because of the  d i s a b i l i t y , per c a p i t a t r a i n i n g costs f o r t h i s group would be much higher than f o r the unemployed. (vii)  Program 7 j T e c h n i c a l and V o c a t i o n a l Teacher T r a i n i n g (T.T.)  I t f o l l o w s that i f adequate t r a i n i n g s e r v i c e s are d e s i r a b l e , there must be p r o v i s i o n made to t r a i n the s t a f f that provides the s e r v i c e .  Each province  and t r a i n i n g  15  i n s t i t u t i o n decides what q u a l i t y of s e r v i c e w i l l be extended t o the t r a i n e e by s e t t i n g standards of i n s t r u c t i o n and determining the q u a l i f i c a t i o n s of the teaching s t a f f .  The  schedule makes p o s s i b l e the r e a l i z a t i o n of these d i f f e r e n t and numerous p r o v i n c i a l t r a i n i n g courses. (viii)  Program 8,  T r a i n i n g Programs f o r Federal  Departments and Agencies  (G)  T r a i n i n g f o r members of the Armed S e r v i c e s or f o r t r a i n i n g f o r employment i n a f e d e r a l government department w i l l be paid f o r up t o 100% of the t o t a l cost of that t r a i n i n g . Those j o i n i n g the Armed Forces i n Canada do so v o l u n t a r i l y , they can make i t t h e i r career and r e c e i v e j u s t wages.  If  they r e q u i r e v o c a t i o n a l or other r e h a b i l i t a t i o n t r a i n i n g , there i s no reason f o r them t o have any advantage over any other c i v i l i a n (ix)  person.  Program 9, Student A i d (S.A.) P r o v i n c i a l a i d to a s s i s t u n i v e r s i t y students and  nurses may be given as a grant, a l o a n , or a combination of both, and the f e d e r a l government w i l l reimburse 50% of these costs.  The amount of and purpose f o r t h i s a s s i s t a n c e i s  determined by the province. I t i s not c l e a r how t h i s program i s t o operate i n conjunction w i t h the f u n c t i o n s of the Department of Education. A l s o confusing i s what c r i t e r i a  i s used t o determine who  may  16 receive t h i s a i d . There must be a d i v i d i n g l i n e between the e l i g i b l e and the i n e l i g i b l e and there i s danger of unfairness t o those grouped near t h i s marginal l i n e . (x)  General P r o v i s i o n s under the Agreement Arrangements, separate and i n a d d i t i o n t o the  Schedules, may be entered i n t o i n order t o i n i t i a t e correspondence  courses i n t e c h n i c a l and v o c a t i o n a l areas.  P r o v i n c e s , however, must make such courses a v a i l a b l e even to non-residents of the province at r a t e s charged i t s own residents• Contrary t o other s t i p u l a t i o n s , under c e r t a i n circumstances the f e d e r a l government w i l l accept cost-sharing for c a p i t a l expenditures and t r a i n i n g f a c i l i t i e s .  This i s an  encouraging p o s i t i v e step which aids i n t r a i n i n g f a c i l i t i e s i n c l u d i n g b u i l d i n g s , p h y s i c a l equipment, machinery and other p h y s i c a l needs f o r t r a i n i n g .  C a p i t a l expenses cover costs  of approved c o n s t r u c t i o n , pruchase, a d d i t i o n or a l t e r a t i o n of b u i l d i n g s o r p h y s i c a l p l a n t , but excludes purchase of l a n d , t a x e s , l e g a l f e e s , f a c i l i t i e s f o r I n d u s t r i a l Arts c l a s s e s , and costs r e s u l t i n g from damage t o property. A l l p r o j e c t s of t h i s nature where cost-sharing may occur r e q u i r e s the p r i o r approval o f the M i n i s t e r .  The M i n i s t e r may r e j e c t  any p r o j e c t and there i s no appeal.  On the other hand, he  cannot impose any changes on the p r o j e c t s presented f o r approval*  E s p e c i a l l y i n t h i s respect, t h i s Agreement i s much  17 more adapted to expanding r e h a b i l i t a t i o n s e r v i c e s than i t s counterpart under V o c a t i o n a l R e h a b i l i t a t i o n of Disabled  Persons.  S e v e r a l minor, but no l e s s important, s e c t i o n s d e a l with the N a t i o n a l Advisory C o u n c i l which i s to advise i n matters p e r t a i n i n g t o t r a i n i n g Canada's manpower.  The  Council's  c o n s u l t a t i v e a c t i v i t y can be of value i n d i r e c t i n g the r e h a b i l i t a t i o n and t r a i n i n g programs.  This e f f o r t , combined  w i t h c o o r d i n a t i o n , can i n f l u e n c e the q u a l i t y of r e h a b i l i t a t i o n through a n a l y s i s of courses taught, study of needs, p r o v i d i n g information, and g i v i n g advice. Provinces agree t o p u b l i c i z e t h e i r t r a i n i n g programs. An awareness of a p u b l i c s e r c i c e i s not only a determinant of i t s use but, being a p u b l i c s e r v i c e , i t i s a r i g h t to be informed.  Needed i s s p e c i f i c information of the d i f f e r e n t  kinds of t r a i n i n g a v a i l a b l e so that the p o t e n t i a l c l i e n t  can  s e l e c t by comparison and that which i s most appropriate t o h i s own p a r t i c u l a r case.  This p u b l i c i t y must make mention of  the r o l e played by the f e d e r a l government.  This i s presumably  so that the c l i e n t , as tax payer, w i l l know that the f e d e r a l government i s Interested enough to spend money i n t h i s area. The f e d e r a l government a l s o provides occupational t r a i n i n g i n f o r m a t i o n to be d i s t r i b u t e d throughout secondary schools and other t r a i n i n g i n s t i t u t i o n s .  E a r l i e r information  may supply c o n t i n u i t y of v o c a t i o n a l p r e p a r a t i o n u n t i l v o c a t i o n a l "establishment" i s a t t a i n e d and perhaps i n t h i s  way,  18  at an e a r l i e r age, help curb " d r i f t i n g " i n t o "dead-end" jobs. C.  General Conclusions In some instances the Agreement i s e x p l i c i t as t o what  costs w i l l be shared, but no mention i s made whether maintenance of the c l i e n t includes that of h i s f a m i l y and dependence. i f the t r a i n i n g f a c i l i t i e s are comprehensive  Even  f o r the  v o c a t i o n a l l y handicapped person, he cannot accept t h i s t r a i n i n g i f t h i s means l e a v i n g behind a d e s t i t u t e f a m i l y . The t o t a l p r o v i s i o n s p o s s i b l e under the Acts mentioned comprise a reasonably good range of v o c a t i o n a l t r a i n i n g and some p h y s i c a l r e h a b i l i t a t i o n .  However, they do not provide  f o r meeting the general need f o r developing new s e r v i c e s or expanding e x i s t i n g ones.  P r o v i n c i a l governments tend t o  regard assured f i n a n c i a l p a r t i c i p a t i o n by the f e d e r a l government as a c o n d i t i o n precedent t o e s t a b l i s h i n g new t r a i n i n g and r e h a b i l i t a t i o n f a c i l i t i e s , when these are the very areas i n which the f e d e r a l government o f f e r s l e a s t a s s i s t a n c e . This expectation and p o s s i b l y r e l i a n c e on the part of the p r o v i n c i a l governments when support i s not forthcoming, hinders new developments and expansion o f s e r v i c e s so that the l a g between s e r v i c e and needs may tend t o i n c r e a s e . Dunlop has three major c r i t i c i s m s o f these A c t s , which are summaries of what has already been pointed out while s p e c i f i c s e c t i o n s o f the Acts were reviewed.  1  Edward Dunlop, " R e h a b i l i t a t i o n f o r the Disabled i n Canada", Toronto, September 1958. W r i t i n g based on working papers prepared f o r the N a t i o n a l Advisory Committee on the R e h a b i l i t a t i o n of Disabled Persons, p. 19. 1  19 1  P r o v i n c i a l governments have no assurance that f e d e r a l support w i l l continue at the same r a t e , nor have they any assurance they w i l l receive adequate help i n development o f new programs. 2  I n many instances the conditions o f cost sharing i s vague and there i s no c l e a r - c u t s t a t u t o r y a u t h o r i t y d e l i n e a t i n g the s p e c i f i c s e r v i c e s , the costs that are shareable, nor the conditions under which they w i l l be shared. 3  There i s not only d i v i d e d a d m i n i s t r a t i v e r e s p o n s i b i l i t y and a u t h o r i t y on the f e d e r a l l e v e l , but a l s o confusion on the f e d e r a l provincial level.  Since t h i s was w r i t t e n , some changes have been made, e s p e c i a l l y i n o u t l i n i n g short-term cost-sharing and under what conditions they w i l l be shareable.  A t t h e same time much confusion  remains and no conclusive d e c i s i o n s have been made on what government w i l l be responsible f o r each part i n the t o t a l o f rehabilitation. Throughout the review of the Acts and Agreements the observation that the c l i e n t has no recourse from the d e c i s i o n s of o f f i c i a l s responsible f o r the programs has been made.  Since  there i s no o f f i c i a l allowance f o r appeals, t h i s i s a b a s i c l a c k i n a democratic country.  I t i s a p r i n c i p l e of English  law that the c i t i z e n should always have a l e g a l remedyj t h i s the Acts f a i l t o provide.  I n t h i s view, i t could be argued  that the omission i s a v i o l a t i o n of the Canadian B i l l o f R i g h t s . In the i n c r e a s i n g bureaucratic tendencies o f modern s o c i e t i e s , i t i s more than ever necessary that a l e g a l  20 recourse of some kind be provided.  Many suggestions have  been made as to the best way of s t a r t i n g an e f f e c t i v e of appeal«  system  The Scandinavians have r e l i e d on the use of  ombudsmen, while the French, w i t h t h e i r " c o n s e i l " approach are s a i d to have the most e f f e c t i v e recourse system of a l l . This l a c k i n the Canadian system deserves deep c o n s i d e r a t i o n . As seen i n Table V I , r u r a l i n a c c e s s i b i l i t y i s s t i l l a s e r i o u s problem.  While many d i s a b l e d persons may move t o  urban centers t o b e t t e r care f o r themselves, there remain many d i s a b l e d i n the r u r a l areas that are neglected.  These  people must cry out to r e c e i v e r e c o g n i t i o n , yet t h e i r residence should not place an a d d i t i o n a l hinderance i n t h e i r path toward improvement„  More generous p r o v i s i o n s should be made  f o r these people, even i n the form of h a b i l i t a t i o n so that they may remain where they are.  I n t h i s r e s p e c t , homebound  s e r v i c e s and other modes of r e h a b i l i t a t i o n , other than s t r i c t l y employment, would serve a great need. Drawing most of the comments t o t h i s s e c t i o n of the study together, one could s t a t e that Canada has a very good r e h a b i l i t a t i o n program f o r p h y s i c a l treatment and v o c a t i o n a l training.  Considerations f o r i n c l u d i n g the disabled's s o c i a l  and personal needs are being slowly incorporated i n t o the general program, but are s t i l l l a c k i n g i n scope.  A truly  comprehensive r e h a b i l i t a t i o n program would need to have greater awareness of the p a r t i c u l a r needs and values of the  21 individual.  In r e h a b i l i t a t i o n , we can successfully return  to employment many disabled people, but the conditions of acceptance should be the p o s s i b i l i t y of a more meaningful l i f e f o r the disabled rather than only f i n a n c i a l through employment.  independence  22  BIBLIOGRAPHY  Bodlak, S t a n l e y . D i s a b i l i t y Allowance. Master of S o c i a l Work T h e s i s , U n i v e r s i t y of B r i t i s h Columbia, Vancouver,B.C.,1957• Bradbury, W . and Hatcher, F.  Interview w i t h w r i t e r , March 1965.  Canada, Department o f N a t i o n a l Health and Welfare. Research and S t a t i s t i c s D i v i s i o n . R e h a b i l i t a t i o n S e r v i c e s i n Canada. Part I . H e a l t h Care S e r i e s Memorandum No.8, Ottawa, March, I960. Canada, S t a t u t e s . Disabled Persons A c t . 1953*-54, c.55j as amended by 1957, c. 14; 1957-587 c . 5 ; 1962, c.3? 1963, c. 26. Canada, N a t i o n a l Coordinator's Report. N a t i o n a l Advisory C o u n c i l on R e h a b i l i t a t i o n o f Disabled Persons, Second Meeting, Appendix C. 13-14 May 1963. Canada, N a t i o n a l Coordinator's Submission f o r the United Nations' Study on L e g i s l a t i v e and A d m i n i s t r a t i v e Aspects of R e h a b i l i t a t i o n of the Disabled i n Selected C o u n t r i e s . Department of Economic and S o c i a l A f f a i r s , New York, United Nations, 1964. Canada, Royal Commission on Health S e r v i c e s . Ottawa, Queen's P r i n t e r , V o l . 1 1964. Canada, S t a t u t e s . T e c h n i c a l and V o c a t i o n a l T r a i n i n g Assistance A c t . 1960-61, c. 6. Canada, S t a t u t e s . V o c a t i o n a l R e h a b i l i t a t i o n o f Disabled Persons A c t . 1960-61, c. 26.  23  Dunlop, Edward. R e h a b i l i t a t i o n f o r the Disabled i n Canada. Toronto, September 1 9 5 8 . W r i t i n g based on working papers prepared f o r the N a t i o n a l M v i s o r y Committee on the R e h a b i l i t a t i o n of Disabled Persons. E l a r t , A l i c e . Speaking on A Comprehensive Workshop - The Goodwill Approach at Annual Meeting of Vancouver D i v i s i o n f o r Guidance of the Handicapped, 29 March, 1965. K e s s l e r , Henry. R e h a b i l i t a t i o n of the P h y s i c a l l y Handicapped. New York, Columbia U n i v e r s i t y Press, 1947. Linden, A. M. Labour L e g i s l a t i o n and the D i s a b l e d . M a t e r i a l submitted t o the Canadian R e h a b i l i t a t i o n C o u n c i l f o r the Disabled• Marsh, L. C. " S o c i a l S e c u r i t y Planning i n Canada." I n t e r n a t i o n a l Labour Review. V o l . 47. Roeher, G. A. "Progress and Needs of R e h a b i l i t a t i o n i n Canada". R e h a b i l i t a t i o n and World Peace. Ed. E . J . T a y l o r . New York, I n t e r n a t i o n a l S o c i e t y f o r R e h a b i l i t a t i o n of the D i s a b l e d , I960.  SECTION IV  PROFILE OF REHABILITATION SERVICES IN A PROVINCE - BRITISH COLUMBIA  PARTICULAR  i TABLE OF CONTENTS Page B r i t i s h Columbia - Background Factors  2  General P r o v i n c i a l L e g i s l a t i o n as i t a f f e c t s the Disabled  5  The use of the Coordinator of R e h a b i l i t a t i o n of Agreement Act i n B r i t i s h Columbia  5  The Role of the P r o v i n c i a l D i v i s i o n of R e h a b i l i t a t i o n  7  The Role of the P r o v i n c i a l Coordinator  $  Experiments i n Coordination i n i t i a t e d by the Coordinator's O f f i c e  10  Establishment  12  Observations  of Local Community R e h a b i l i t a t i o n Councils on the use of these Coordinating Devices  17  The Disabled Persons Allowance Act as interpreted i n B r i t i s h Columbia  19  The Vocational R e h a b i l i t a t i o n of the Disabled Act  27  The Technical and Vocational Training Act Use of the Hospital Insurance and Diagnostic Services Act  33  Use of Federal Grants  33  P r o v i n c i a l Services f o r S p e c i f i c Categories  39  Mentally 111  40  Services t o Children  45  Role of the Voluntary Agency  55  G.F.  55  Strong R e h a b i l i t a t i o n Centre  Canadian A r t h r i t i s and Rheumatism Society  63  Paraplegic Association  68  Poliomyelitis and R e h a b i l i t a t i o n Society  74  G e r i a t r i c and Chronic Services  80  D i v i s i o n f o r the Guidence of the Handicapped of the Community Chest and Council  86  Summary and Conclusions  93  X  1  CHAPTER  X  PROFILE OF A PROVINCE  Patterning of Services i n B r i t i s h Columbia with S p e c i a l Reference to the L e g i s l a t i v e Base As previous sections of the study hav indicated, the function of federal aid i s to assist the provinces to carry out t h e i r r e s p o n s i b i l i t i e s i n the f i e l d s of health, education and welfare, a l l of which areas are concerned  to some degree  with services which come within the r e h a b i l i t a t i o n f i e l d . Many factors enter into a consideration of whether a province has an adequate s o c i a l policy towards the disabled and  how  much continuity or change i n this policy might be detected, depending on which p o l i t i c a l party was  i n power.  This  section attempts to do no more than make a beginning  review  of the effects which the present l e g i s l a t i v e structure f o r the d i v i s i o n of r e s p o n s i b i l i t i e s i n Canada would seem to have on the patterning and provisions of services at the p r o v i n c i a l and l o c a l l e v e l , where they are or should be available to the i n d i v i d u a l Canadian who needs them. Long before the federal government extended aid to the provinces i n these three f i e l d s , each province, under the B r i t i s h North America Act had made i t s own  interpretation  X of i t s r e s p o n s i b i l i t i e s  2  i n these f i e l d s and had developed  i t s own unique pattern of s e r v i c e s . The patterns developed i n B r i t i s h Columbia were influenced by many factors, some of which w i l l be b r i e f l y reviewed. B r i t i s h Columbia -  Some Background Factors  B r i t i s h Columbia i s Canada's westernmost  province,  reaching from the Rockies to the P a c i f i c and from the American broder to the Yukon.  Early i n the development of B r i t i s h  Columbia, more than mountains separated i t from Canada.  Until  1871 the province was a Crown Colony and only reluctantly gave up i t s status i n exchange f o r the promise of a railway which would open up an area which already had seen one gold rush and was yet to see another. In 1871 B r i t i s h Columbia had an estimated population of 36,247.  A l l but between 8,500 and 9,000 of these souls  were Indians.  In the l a s t 1961 census B.C. had a population  of 1,629,082 ( i t i s now estimated at 1,738,000 f o r 1964). Of this number 38,814 are Indian and Eskimo. Most of the population i s squeezed into the south western portion of the province i n the d e l t a of the Fraser River.  Vancouver, the third largest c i t y i n Canada and the  only large Canadian port on the P a c i f i c coast, had a metropolitan population of 790,165 i n 1961; V i c t o r i a , the  X-3 the second largest c i t y i n B.C., had 1 5 4 , 1 5 2 .  Vancouver's  population i s 4 8 . 5 $ of the t o t a l with V i c t o r i a 9 . 5 $ of the total.  Together, these urban areas make up almost 60$ of  B r i t i s h Columbia's population.  This i s a d i f f e r e n t  population d i s t r i b u t i o n form than that of i t s two neighbouring provinces of Alberta and Saskatchewan and has had considerable effect on the patterning of services.  Although B r i t i s h  Columbia has an area of 366,255 square miles and the t h i r d largest p r o v i n c i a l area i n Canada, many of these miles represent mountain tops.  I t has been variously estimated  that between less than 10 to 20$ of the land i s usable, although there i s untold mineral wealth, as yet largely undeveloped. of  Certainly much of i t i s vast mountain tracts  forest with the exception of the Great Interior Plateau  with i t s f e r t i l e Okanagan V a l l e y and the Peace River d i s t r i c t further north.  While i t might be over-simplifying, one has  only to leave the Fraser River Valley behind to have a sense of  the primeval spendour that i s s t i l l B r i t i s h Columbia.  And one does not need to go beyond one's front door step to sense the s p i r i t of a f r o n t i e r society with i t s emphasis on individualism, innovation and an isolated approach to situations which seems as c h a r a c t e r i s t i c i n r e h a b i l i t a t i o n as i n other areas of c i v i c r e s p o n s i b i l i t y . secondary  While the growth of  industries i n the province looks impressive from  the l a t e s t s t a t i s t i c s , the main industries are s t i l l the  X-  4  primary ones of l o g g i n g , mining and f i s h i n g , and from the point of view of r e h a b i l i t a t i o n there are s t i l l f a r too  few  a v a i l a b l e jobs that can be c l a s s i f i e d as of a " l i g h t " or "sedentary" nature. B r i t i s h Columbia has a plethora of s e r v i c e s offered by both government and voluntary agencies, most of them located w i t h i n the lower mainland area. there are  In Vancouver alone,  more than eighty agencies i n the Vancouver  Community Chest and C o u n c i l .  General P r o v i n c i a l L e g i s l a t i o n as i t A f f e c t s the  Disabled  There i s need f o r a s p e c i f i c study of the  general  p r o v i n c i a l l e g i s l a t i o n as i t a f f e c t s the d i s a b l e d .  There  has been some concern expressed that p r o v i n c i a l labour l e g i s l a t i o n d i s c r i m i n a t e s against the d i s a b l e d .  A separate  study would seem to be i n d i c a t e d t o i n v e s t i g a t e t h i s area. While the general p r o v i n c i a l t a x a t i o n l e g i s l a t i o n does allow some concessions t o the d i s a b l e d , the p i c t u r e i n t h i s area would appear t o be s i m i l a r t o what the Canadian R e h a b i l i t a t i o n C o u n c i l f o r the Disabled study found to be true at the Federal l e v e l - that the ( p r o v i n c i a l ) "government w i l l help some of the disabled i n some ways some of the time." example of t h i s inconsistency may  be given here.  An  Under the  Motor V e h i c l e Act and the Gasoline Tax A c t , c e r t a i n "categories"  x of disabled,  5  such as paraplegics,  amputees and those confined  to wheelchairs may claim exemption from automobile and gasoline taxation.  However, the exemption does not cover  a l l handicapped people who cannot use public The  transportation.  p r o v i n c i a l government extends aid to the disabled i n  four additional ways.  It u t i l i z e s federal provincial  l e g i s l a t i v e agreements to help provide c e r t a i n services. It takes d i r e c t r e s p o n s i b i l i t y for c e r t a i n services and groups.  It extends f i n a n c i a l aid to some voluntary societies  i n the r e h a b i l i t a t i o n f i e l d and sometimes purchases t h e i r services.  I t delegates c e r t a i n r e s p o n s i b i l i t i e s to the  municipalities  and offers varying kinds of assistance to  them to carry out t h e i r designated r e s p o n s i b i l i t i e s , especially i n r e l a t i o n to what are usually called the "welfare services" some of which, as has been seen, have a d i r e c t bearing on rehabilitation. It i s proposed to select c e r t a i n aspects of these services to examine the prevailing Canadian d i v i s i o n of l e g i s l a t i v e r e s p o n s i b i l i t i e s and how i t affects patterns i n r e h a b i l i t a t i o n services  i n B r i t i s h Columbia.  I t i s appropriate  to begin with the u t i l i z a t i o n and interpretation of federal l e g i s l a t i o n pertaining  to r e h a b i l i t a t i o n by the province.  Use of the Coordination of R e h a b i l i t a t i o n Agreement Act i n B r i t i s h Columbia.  X-6  In 1953  f e d e r a l funds were made a v a i l a b l e to the  provinces through t h i s Act to pay f o r the s e r v i c e s of a p r o v i n c i a l co-ordinator and h i s s t a f f on a f i f t y - f i f t y basis.  I n A p r i l 1954,  B r i t i s h Columbia signed the Co-ordination  of R e h a b i l i t a t i o n Agreement t o q u a l i f y f o r f e d e r a l a s s i s t a n c e . The i n i t i a l agreement, which r a n t o 1958, a s i x year period to March 1964, to 1970.  was signed f o r  and has now been re-signed  Under the terms of t h i s agreement the province  agreed to appoint a P r o v i n c i a l Co-ordinator of R e h a b i l i t a t i o n , to e s t a b l i s h an interdepartmental r e h a b i l i t a t i o n committee and to develop a coordinated p r o v i n c i a l plan which w i l l " c l a r i f y and coordinate the r o l e of a l l aspects of r e h a b i l i t a t i o n , i n c l u d i n g V o c a t i o n a l T r a i n i n g Placement Services as w e l l as the s e r v i c e provided under N a t i o n a l Health Grant Program".^  F e d e r a l - p r o v i n c i a l funds can be used t o  pay f o r s t a f f i n g of the Coordinator's o f f i c e f o r s t a f f t r a i n i n g , for  research and demonstration p r o j e c t s and f o r "expenses  incurred on behalf of d i s a b l e d i n d i v i d u a l s f o r r e h a b i l i t a t i o n s e r v i c e s not otherwise a v a i l a b l e under the V o c a t i o n a l T r a i n i n g Co-ordination Act, Federal Health Grants or l o c a l p resources." R e h a b i l i t a t i o n S e r v i c e s i n Canada. Part 1. General Review Health S e r i e s , No. 8, Research and S t a t i s t i c s D i v i s i o n Dept. of N a t i o n a l Health and Welfare, March I960, p. 30. 1  Loc.cit.  X-7  I n September 1954 the p r o v i n c i a l coordinator was  appointed  and the newly set up D i v i s i o n of R e h a b i l i t a t i o n was attached t o the Health Branch of the P r o v i n c i a l Department of Health Services and H o s p i t a l Insurance. The R e h a b i l i t a t i o n D i v i s i o n i s administered  through  the Bureau of S p e c i a l Preventative and Treatment S e r v i c e s . There i s an A s s i s t a n t P r o v i n c i a l Health O f f i c e r d i r e c t i n g the Bureau who  i s a doctor and who  i s responsible f o r the  broad c o - o r d i n a t i o n of the P r o v i n c i a l Health U n i t s as w e l l as other governmental departments concerned and the work of voluntary h e a l t h agencies, both i n l o c a l and wide f i e l d s .  province-  The Co-ordinator of R e h a b i l i t a t i o n , who i s  under the d i r e c t o r , works c l o s e l y with him t o provide f o r the b r i n g i n g of v o c a t i o n a l services t o the handicapped.  In  a d d i t i o n the R e g i s t r y of Handicapped C h i l d r e n and Adults i s under the a d m i n i s t r a t i o n of the Bureau.  These o f f i c e s are  i n a b u i l d i n g w i t h i n the complex of b u i l d i n g s surrounding Vancouver General H o s p i t a l , and t h e r e f o r e , t h e o r e t i c a l l y at l e a s t , e a s i l y a c c e s s i b l e t o doctors and p u b l i c a l i k e .  The Role of the P r o v i n c i a l D i v i s i o n of R e h a b i l i t a t i o n This i s o f f i c i a l l y defined i n i t s own p o l i c y manual as f o l l o w s : 1.  C o n s u l t a t i o n i n the f i e l d of v o c a t i o n a l rehabilitation to:  X-8  a.  l o c a l r e h a b i l i t a t i o n committees;  b.  p u b l i c and p r i v a t e medical, s o c i a l and v o c a t i o n a l agencies.  2.  A d m i n i s t r a t i o n of r e g u l a t i o n s concerning v o c a t i o n a l r e h a b i l i t a t i o n under the Disabled Persons Act. 3.  Development of standards i n r e h a b i l i t a t i o n s e r v i c e s and f a c i l i t i e s .  4.  Co-ordination of a l l a c t i v i t i e s i n the province r e l a t i n g to v o c a t i o n a l r e h a b i l i t a t i o n of d i s a b l e d persons. 5.  Compilation of reports and s t a t i s t i c s vocational r e h a b i l i t a t i o n .  concerning  6.  Development of educational programs i n rehabi l i t a t i o n f o r p r o f e s s i o n a l community and other groups. The Role of the  Coordinator  A broad d e f i n i t i o n of h i s r o l e i s stated as f o l l o w s : "To act as a consultant on problems of r e h a b i l i t a t i o n of i n d i v i d u a l s and t o coordinate a l l departments and  agencies  p  working i n the r e h a b i l i t a t i o n f i e l d . "  I t i s the  provincial  r e s p o n s i b i l i t y of the co-ordinator t o create a broad co-operative program w i t h the p r o v i n c i a l Departments of S o c i a l Welfare, Education, and the Federal Departments of B r i t i s h Columbia, "Manual f o r V o c a t i o n a l R e h a b i l i t a t i o n i n B r i t i s h Columbia," D i v i s i o n of R e h a b i l i t a t i o n , Health Branch, Department of Health Services and H o s p i t a l Insurance, Vancouver, p. 6. 1  D i r e c t o r y of Health. Welfare and Recreation Services i n M e t r o p o l i t a n Vancouver, prepared and issued by the Community Chest and C o u n c i l of Greater Vancouver, 1958, p. 24. 2  X-9 Health and Labour as well as the National Employment service, i n order to administer the Vocational R e h a b i l i t a t i o n of Disabled Persons Act and the agreement signed.  Co-ordination  on a policy-making l e v e l i s done through an interdepartmental committee which includes the Deputy of Ministers of the Health and S o c i a l Welfare branches, the Department of Education, Department of Labour, the Chairman of the Workmen's Compensation Board and the P r o v i n c i a l Secretary. The Health Branch Program i s primarily geared to the vocational r e h a b i l i t a t i o n of the handicapped;  however, the  disabled can be rendered any service which w i l l result i n improved self-care and thus better s o c i a l functioning.  The  Co-ordinator of Rehabilitation, who provides for the use of services by payment, must give approval before any r e h a b i l i t a t i o n services w i l l be paid f o r . He functions somewhat i n the role of agent on behalf of those disabled people are accepted for s e r v i c e .  Although c l i e n t s may  who  not be seen  by the Co-ordinator, he functions on t h e i r behalf, following up on the treatment processes through reports and carrying through f i n a n c i a l l y u n t i l a case i s closed, either  through  vocational r e h a b i l i t a t i o n , or through achievement of increased self-care and improved functioning. So although the emphasis i s l a i d upon vocational i & a b i l i t a t i o n i n the l e g i s l a t i o n , this has not prevented a broad interpretation of the  C o o r d i n a t o r ' s r o l e w i t h emphasis on h i s power t o a u t h o r i z e "expenses i n c u r r e d on b e h a l f of d i s a b l e d i n d i v i d u a l s not otherwise  available."  Improved f u n c t i o n i n g and  c a p a c i t y f o r independence may the  . . • greater  be of as much importance t o  individual. I n other areas of the province s c r e e n i n g w i l l  i n c r e a s i n g l y be done through  the l o c a l  committees being set up through  rehabilitation  out the p r o v i n c e .  Experiments i n C o o r d i n a t i o n I n i t i a t e d by the P r o v i n c i a l C o o r d i n a t o r I n February  1959,  the C o o r d i n a t o r ' s O f f i c e and  N a t i o n a l Employment S e r v i c e commenced an program t o provide a steady  the  experimental  contact between the l o c a l  and  r e g i o n a l o f f i c e s o f the N a t i o n a l Employment S e r v i c e and Co-ordinator's O f f i c e .  As t h i s r e s u l t e d  i n improved  the  co-  o r d i n a t i o n , a s e n i o r placement o f f i c e r of the N a t i o n a l Employment S e r v i c e ' s S p e c i a l Placement S e c t i o n , was  seconded  to the C o - o r d i n a t o r ' s O f f i c e t o provide c o n s u l t a t i v e s e r v i c e s to both o f f i c e s and t o h e l p i n the improvement o f j o b - p l a c i n g s e r v i c e s f o r those who He  are h a n d i c a p p e d .  r e g u l a r l y handles  1  a l l r e f e r r a l s from the Vancouver  G e n e r a l H o s p i t a l r e g a r d i n g academic up-gradings,  re-training  under the V o c a t i o n a l T r a i n i n g Agreement or those d i s a b l e d  B r i t i s h Columbia, Department of H e a l t h and Unemployment Insurance P u b l i c H e a l t h S e r v i c e s Annual Report, V i c t o r i a , 1961, p. U 112. x  X - l l who are ready f o r job placement. the h o s p i t a l s ' patients who  This a l s o includes any  of  are to be r e f e r r e d t o other  agencies f o r v o c a t i o n a l r e h a b i l i t a t i o n such as the P o l i o m y e l i t i s and R e h a b i l i t a t i o n Foundation or the Canadian Paraplegic Association.  The h o s p i t a l f a c i l i t a t e s the r e f e r r a l  of the d i s a b l e d person through i t s r e h a b i l i t a t i o n conference set up by the h o s p i t a l ' s S o c i a l Service Department. conference meets twice monthly to discuss cases. when p o s s i b l e i s the p a t i e n t ' s doctor.  Present  Present a l s o i s a  representative of the Co-ordinator's O f f i c e , and Supervisor  This  of the Out-Patient Department.  the  I t i s the  r e s p o n s i b i l i t y of the p a t i e n t ' s s o c i a l worker t o have w r i t t e n up the s o c i a l h i s t o r y , obtained  the medical h i s t o r y from the  doctor i n w r i t i n g and, i f r e q u i r e d , a p s y c h i a t r i c and p s y c h o l o g i c a l e v a l u a t i o n from the Department of P s y c h i a t r y i n order t o guage the p a t i e n t ' s motivation, t o l e r a n c e , p o t e n t i a l i n t e l l i g e n c e and i n t e r e s t s . The s o c i a l worker a l s o presents: the case at the conference.  I f the patient i s accepted by  the Co-ordinator's O f f i c e and there s t i l l needs to be f u r t h e r v o c a t i o n a l assessment which cannot be performed by the h o s p i t a l , the C o - o r d i n a t o r s O f f i c e can buy these s e r v i c e s 1  elsewhere.  For instance, there i s the P o l i o m y e l i t i s and  R e h a b i l i t a t i o n Foundation Assessment Centre or the Youth Counselling Services which a l s o give v o c a t i o n a l assessment and c o u n s e l l i n g although t h e i r s e r v i c e s are d i f f i c u l t f o r the  X -  12  p h y s i c a l l y handicapped t o g a i n p h y s i c a l access t o , as they are i n a downtown b u i l d i n g on an u p s t a i r s f l o o r . A close l i a i s o n i s being maintained w i t h various community agencies on a two-fold b a s i s , to o f f e r , i n d i r e c t l y through c o - o r d i n a t i o n , required r e h a b i l i t a t i o n s e r v i c e s to the handicapped  and t o seek out and u t i l i z e the s e r v i c e s  a v a i l a b l e i n order t o help i n d i v i d u a l d i s a b l e d persons  who  seek h e l p through the p r o v i n c i a l r e h a b i l i t a t i o n department.  Demonstration P r o j e c t s i n Establishment of L o c a l Community Rehabilitation Councils. I n i960 a p i l o t study was undertaken by the P r o v i n c i a l R e h a b i l i t a t i o n Consultant of the Co-ordinator*s O f f i c e t o see i f handicapped people and i n d i v i d u a l s i n r e c e i p t of welfare allowances could become s e l f - s u p p o r t i n g .  This  p r o j e c t , shared between the S o c i a l Welfare Branch and the Health Department and supported by N a t i o n a l Health Grant Funds, u t i l i z e d the  l o c a l N a t i o n a l Employment S e r v i c e .  From a t o t a l  of 375 cases 167 were i d e n t i f i e d as having h e a l t h problems; 48 of these people were s e l e c t e d t o demonstrate the p o s s i b i l i t y of r e h a b i l i t a t i v e procedures.  A year l a t e r , i n 1961,  26 of  the 48 cases had e i t h e r been r e h a b i l i t a t e d or were i n the process; the remaining 22 were found u n s u i t a b l e f o r a r e h a b i l i t a t i o n program.1 B r i t i s h Columbia, P u b l i c Health S e r v i c e s , Annual Report of the Department of H e a l t h and Unemployment Insurance, V i c t o r i a , 1961, p. U 113 1  X-13  As a consequence of t h i s study, i n Nanaimo, a f u r t h e r p i l o t demonstration was set up i n C h i l l i w a c k u t i l i z i n g the procedures and methods of the Nanaimo study.  A program  devoted t o s e t t i n g up l o c a l r e h a b i l i t a t i o n teams has been undertaken by a research consultant  o r i g i n a l l y on the t r i a l  project and now seconded t o the C o - o r d i n a t o r s O f f i c e t o f  e f f e c t e d a co-ordinated approach i n the development of a program f o r v o c a t i o n a l r e h a b i l i t a t i o n . The procedures set up were workable.  Three a d d i t i o n a l committees were s e t  up i n other communities using the same procedures, under the c o n s u l t a t i v e s e r v i c e s of the D i v i s i o n of R e h a b i l i t a t i o n i n Vancouver. During 1964 they provided v o c a t i o n a l r e h a b i l i t a t i o n 1  services t o 214 cases and 31 were placed i n employment during the year.  Five new l o c a l r e h a b i l i t a t i o n committees were  established during 1964 throughout the province t o undertake v o c a t i o n a l r e h a b i l i t a t i o n planning; so w i t h a t o t a l of eight l o c a l a c t i v e committees, there were 278 cases under assessment f o r v o c a t i o n a l r e h a b i l i t a t i o n through the l o c a l organizations  Organization  set up.  of the L o c a l R e h a b i l i t a t i o n Committees  A d m i n i s t r a t i v e l y the r e h a b i l i t a t i o n committees on a l o c a l l e v e l w i l l f u n c t i o n w i t h i n the e x i s t i n g Health Unit 1  Unpublished report of Mr. F. Hatcher.  X-14 areas of the P r o v i n c i a l Health Department u t i l i z i n g the resources  of other p r o v i n c i a l government departments on  a l o c a l l e v e l , such ass S o c i a l Welfare, N a t i o n a l Employment S e r v i c e .  Education and the  I n i t s manual, "Vocational  R e h a b i l i t a t i o n i n B r i t i s h Columbia" the p o l i c y i s l a i d down that the Health Unit D i r e c t o r , the D i s t r i c t Supervisor of Welfare and the S p e c i a l Services o f f i c e r or l o c a l manager of N a t i o n a l Employment Service form a committee.  The Health  Unit D i r e c t o r has a d m i n i s t r a t i v e r e s p o n s i b i l i t y f o r the continuing work of the committee on the l o c a l l e v e l .  1  The purpose of the L o c a l R e h a b i l i t a t i o n Committee is to: S e l e c t and screen p o s s i b l e r e h a b i l i t a t i o n cases. E f f e c t the establishment of comprehensive r e h a b i l i t a t i o n assessment and e v a l u a t i o n . Co-ordinate s e r v i c e s i n r e h a b i l i t a t i o n planning, case a c t i v i t y and handling. Determine the requirements f o r v o c a t i o n a l r e h a b i l i t a t i o n and p h y s i c a l r e s t o r a t i o n . Use c o n s u l t a t i v e and s p e c i a l r e h a b i l i t a t i o n s e r v i c e s through the D i v i s i o n of R e h a b i l i t a t i o n . R e f e r r a l s w i l l come from h o s p i t a l s , p r i v a t e doctors, the Medical Health o f f i c e r or h i s s t a f f , the R e g i s t r y , l o c a l S o c i a l WelfareJServices,  l o c a l N a t i o n a l Employment S e r v i c e s ,  B r i t i s h Columbia, Manual f o r V o c a t i o n a l R e h a b i l i t a t i o n i n B r i t i s h Columbia, D i v i s i o n f o r R e h a b i l i t a t i o n , Health Branch, Department of Health Services and H o s p i t a l Insurance, Vancouver, January 1965, p. 2. 1  2  Loc.cit.  community agencies and i n d i v i d u a l s .  I t i s hoped through  these measures t o provide e a r l y r e h a b i l i t a t i o n s e r v i c e s before f i n a n c i a l and emotional resources are so depleted that a person becomes c h r o n i c a l l y emotionally p a r t i c i p a t e  dependent and unable to  i n a r e h a b i l i t a t i o n program.  The L o c a l Committee on R e h a b i l i t a t i o n ,  once a  r e f e r r a l i s made, w i l l decide upon the f e a s i b i l i t y of s e r v i c e a f t e r a m e d i c a l , s o c i a l and v o c a t i o n a l assessment.  When a  person i s accepted the committee can then, on a continuing b a s i s , help the i n d i v i d u a l achieve h i s goal of v o c a t i o n a l r e h a b i l i t a t i o n through a c o n t i n u i t y of p l a n n i n g .  I t i s hoped  that each l o c a l committee w i l l h e l p f i f t e e n handicapped  people  i n a year to achieve employment w i t h another f i f t e e n cases benefitting  from v o c a t i o n a l r e h a b i l i t a t i o n procedures.  The  expectation i s that approximately 225 cases w i l l be helped to employment each year through the a c t i v i t i e s of the l o c a l r e h a b i l i t a t i o n committees.  This may, of course, vary and w i l l  be dependent not only upon the degree of m o t i v a t i o n i n the i n d i v i d u a l but a l s o on the economic s i t u a t i o n and employment possibilities. Another advantage i s that the l o c a l r e h a b i l i t a t i o n c o u n c i l s w i l l be h e l p f u l i n r e t u r n i n g the d i s a b l e d t o t h e i r own communities a f t e r they have been to the r e h a b i l i t a t i o n center or other treatment f a c i l i t i e s o f f e r e d i n the Vancouver area.  The P r o v i n c i a l Co-ordinator i s concerned with the  X numbers of handicapped who  16 stay In the Vancouver area  with few or no s o c i a l contacts, often without t h e i r vocational r e h a b i l i t a t i o n hopes being r e a l i z e d but not without hope that they someday w i l l be. i s o l a t i o n and hopelessness. they should be returned  They often l i v e l i v e s of  The Co-ordinator's  view i s that  i f possible to be cared for by the  people they know and with whom they have d a i l y associations. It i s natural, however, that some people with severe physical handicaps should elect to remain i n Vancouver where there are l i k e companions, more service clubs available, and a milder climate that makes i t less d i f f i c u l t to manoeuver outside i n the  winter.  With Councils established and operating Abbotsford  and Port Alberni since 1963,  the  i n Cranbrook,  Co-ordinator's  Office i s planning to e s t a b l i s h councils i n four new during 1965.  The f i r s t R e h a b i l i t a t i o n F i e l d  who has recently been appointed i s now  areas  Consultant  functioning i n the  central and northern part of Vancouver Island where he w i l l be responsible f o r vocational r e h a b i l i t a t i o n and to the l o c a l committees.  consultation  It i s planned that a second w i l l  be appointed to free the R e h a b i l i t a t i o n Consultant planning further l o c a l committee services i n new the  for  areas of  province. The value of these co-ordination projects at the l o c a l  l e v e l cannot yet be estimated as they are so recent, but t h e i r development augurs  well for the future.  Local r e s p o n s i b i l i t y i s given to l o c a l organizations and units —  a most important  formal procedure has developed  concept.  A predictable and  i n terms of inter-agency  co-ordination with the functions of each agency c l e a r l y defined as to t h e i r responsibilities and authority. To date there has been no effort to co-ordinate the services i n the Vancouver area, an admittedly gargantuan task because of the number of specialized s e r v i c e s .  Instead the Co-ordinator's  Office has picked out usable services within the community for  clients referred to his o f f i c e .  This has often meant  that co-ordination i s not smoothly effected f o r the i n d i v i d u a l concerned.  Yet the task i s not easy because Vancouver i s  such a mosaic of agencies with varying attitudes of cooperation. The P r o v i n c i a l Co-ordinator's Office has decided that the larger areas of Vancouver and V i c t o r i a should be l e f t u n t i l s u f f i c i e n t experience had been gained i n setting up r e h a b i l i t a t i o n co-ordinating committees i n smaller towns and communities, so that workable methods and procedures be originated before attempting organization i n these  can  two  complex urban centres.  Observations on the Coordinating Devices Used As co-ordinating devices are such a notoriously d i f f i c u l t task i n the f i e l d of r e h a b i l i t a t i o n i t i s important  X  - 18  to document and follow up a l l attempts to pioneer i n this s t i l l l a r g e l y unknown f i e l d .  Research should be done as to  the success of the newer devices, such as the l o c a l community councils. The inter-agency "case conference" device as used by the R e h a b i l i t a t i o n department through the Vanoaiver Hospital i s an interesting and useful development.  General  However,  i t should be realized that only a f r a c t i o n of the patients who  could benefit from r e h a b i l i t a t i o n services are referred  by t h e i r doctors to s o c i a l service departments i n hospitals, for a variety of reasons which i t i s not appropriate to enter into here.  The extension of a similar system to the other  hospitals i n