One names handicap the limitation of the possibilities of interaction of an individual caused by a deficiency which causes an incapacity, permanent or supposed final and which it even leads to a social or physical moral handicap.

It expresses a deficiency with respect to an environment, that it is in term of Accessibilité, of expression, comprehension or apprehension. It thus acts more than one social concept and of a medical concept .

New definition given by the French law of the bearing February 11th, 2005 on the chance and equal rights, the participation and the citizenship of the handicapped people: “A handicap Constitutes, within the meaning of the present law, any limitation of activity or restriction of participation in the life in society undergone in its environment by a person because of a substantial, durable or final deterioration of one or more functions physical, sensory, mental, cognitive or psychic, of a polyhandicap or an invalidating disorder of health. ”

Typology of the handicap

The word handicap comes from the English expression hand in course , which means “the hand in the cap”. It was about a game of chance, the players laid out their bets in a hat. The expression is transformed into word and is applied to the sporting field at the 18th century.

Historically, the handicap was defined in opposition to the disease. The patient was sick as long as his problem could be dealt with médicalement, it considered handicapped had once become incurable.

Into 1980, the Britannique Philip Wood radically transformed the vision of the handicap by defining it as a disadvantage whose a person is victim to achieve a normal social role because of her deficiency (lesion temporary or final) or of her incapacity (reduction partial or total of the capacity to achieve an activity).

This definition was criticized thereafter to put too ahead the functional aspect of the handicap and not enough its social aspect. It is true that the social problems of the handicap always butted against an ambiguity: everyone can at a time given to live a situation of handicap, however the handicapped people are well a minority brought to defend its rights as a social group.

With the publication of the international Classification of operation, handicap and health (CIF, CIH-2), WHO introduced a new typology of the handicap which takes more into account the environmental factors. The handicap can be defined there as the meeting of a deficiency with a situation of the daily life. These two components are subjected to the influence of problems of Santé (Maladie S, wounds, lesions) and of contextual factors (personal Environnement and factors).

Deficiencies

Loss of substance or final or provisional deterioration, of a structure or psychological, physiological or anatomical function. This term in the French translation is more total than disorder, which does not include a loss of substance. DREANO GUY Guides specialist education, DUMOD, 2002 (2nd edition)

Deficiencies are problems of the body, variations compared to the normal situation. One distinguishes the lesions from the anatomical structures and the limitations of the organic and psychic functions.

A deficiency can be objective or supposed, because of deteriorations of the regard of its own capacities (fear of making).

One can note that a deficiency can be the consequence (the Symptôme) of a disease, but itself is not the disease. For example a loss of the Audition can be the consequence of a pathology (Otite, Encéphalite S, Oreillons…) or of a traumatism or of a genetic anomaly or that of ageing.

If deficiencies always have an organic or psychic cause, they recover a field wider than the concept of disorder or disease. That means that suffering individual of a deficiency should not inevitably be regarded as a patient.

Situations of life

One distinguishes the activities, which indicate the execution of a task and the participations which indicate the fact of taking part in a situation of the daily life. The situations of life thus consist in implementing at the same time know-how and knowledge-being. A situation of handicap is the whole of the difficulties encountered by an individual to react to a situation of life because of its deficiencies. To measure these difficulties one differentiates the concept of performance from that of capacity. The performance measures the response of an individual to a situation of life in its real environment, whereas the capacity measures the aptitude of an individual to answer this same situation in a standardized environment.

All these measurements are dynamic: they vary at the same time according to the evolution of deficiencies of the patient and his trainings.

It should be noted that all the difficulties encountered by a person do not return inevitably to the concept of handicap which is here defined. For example, the answer to be brought to a person victim racial discrimination is not of a socio-medical nature but of a purely legal nature.

Health issue

It is a rather broad expression gathering the diseases and the wounds but also the mental health disorders, the congenital or genetic anomalies, even the effects of the age, the Grossesse, lifestyle (alcohol, overweight, etc). They can involve deficiencies or be added again to the effects of a deficiency. For example the impact of a driving deficiency on the possibilities of displacement could be worsened by a ponderal overload.

Certain health issues do not have any relationship with the concept of handicap either that they are asymptomatic (Hypertension, Séropositivité) or that they are dealt with and compensated médicalement (diabetes).

Contextual factors

The contextual factors are induced by the medium of life of a person. They indicate all the aspects of the world in which an individual evolves/moves and which has an influence on the situations of life with which he is confronted.

Environment

They is at the same time the technical assistances and prostheses or the material environment of the person and the attitude of her close relations and his entourage. It is also the attitude of the institutions and the whole of the company on deficiencies of the person.

Personal factors

They relate to all the aspects of a personality which do not arise from the field of health. That can be education, the age, the culture, the social origin or the educational level not example. It is also the drive resulting from the readjustment.

An important aspect is subjectivity i.e. the psychic repercussion of the appearance and the evolution of the handicap: how the person feels her handicap, up to which point it feels different, excludes, decreased. This psychological dimension was in particular taken into account in work of Claude Hamonet.

Classification

  • physical: engine and sensory or relational.
  • mental: intellectual and relational handicaps durable.
  • associated or multi handicaps: office plurality of several handicaps.
  • polyhandicap: office plurality of handicaps driving, intellectual and of the communication.

Medical

According to the date of which has occurred of the handicap, one can classify:
  • the handicap of the child of perinatal origin enters 22 weeks of amenorrhoea and 8 days post-native (30 to 60%)
  • the handicap of antenatal origin (chromosomal or genetic, the infectious embryofœtopathies of occurred early (20 to 35%)
  • the handicap of postnatal origin (infectious, tumoral or traumatic) (5 to 10%)

Definition of the medical origin

Antenatal

  • Genetic
  • Chromosomal
  • Embryofœtopathies (Cytomegalovirus, Toxoplasmose, Rubella, Herpes…)
  • cerebral Anomaly (hydrocéphalie, microcephalus…)
  • multiple congenital Anomaly with or without backwardness
  • Hemorrhage and cerebral vascular accidents anténatals
  • So higher than 34 weeks of amenorrhoea: abnormal cerebral imagery (leucomalacie perish-ventricular…) and absence of perished event/néonatal
Perished or néonatale at 34 weeks of amenorrhoea and less
Probable
  • Hemorrhage of rank III or IV of origin perished/néonatale identified
  • Edema/cerebral suffering related to a shock or suffering néonatale (visceral insufficiency and reanimation)
  • Bactériémie and central infection of the nervous system of origin perished/néonatale identified
  • normal initial cerebral Imagery then appearance of the images (leucomalacie perish-ventricular and/or intra-ventricular hemorrhage) which do not answer the criteria anténatals
Probable
  • Apgar low lower 3 to 5 minutes or 5 to 10 minutes, or lower pH 6,9
  • Ventilation assisted of more than 7 days or pneumothorax
Perished or néonatale after 34 weeks of amenorrhoea
  • Hemorrhage or AVC of origin perished/néonatale identified
  • Edema/cerebral suffering related to a shock or suffering néonatale (visceral insufficiency and reanimation)
  • Bactériémie and central infection of the nervous system of origin perished/néonatale identified
  • ischemic hypoxic Encephalopathy (Apgar lower 5 to 1 or 5 minutes, reanimation/ventilation, convulsions before the third day)

Various types of handicap

There thus exist handicaps which have a physiological origin:

  • mental Handicaps

This terminology relates to the major handicaps rather, the related light handicaps will be rather indicated by handicap Neuropsychologique.
    • mental and intellectual Deficiencies
    • Autism

  • Neuropsychological Handicap of origin

But also of the handicaps without somatic significance:

  • cognitive Handicap (Illiteracy, language, culture…)
  • social Handicaps

And others whose statute is more ambiguous:

  • Turbid of the communication
  • Turbid of the training

One polyhandicapé is not only one person presenting an accumulation of physical handicaps and mental. It presents also a great dependence and requires a constant assistance for all the acts of the daily newspapers: Syndrome of Rett, etc

Integration of the handicapped people

Principle generals and measurements in place

The French law 2005-102 of February 11th, 2005 has vocation to improve this integration by a whole series of measure in the course of implementation.

The idea is, in the name of the principle of equality, to recognize that the right to the Compensation of the handicap results from a duty sociétal, and not of any logical of commiseration even of charity. In other words it is a question of restoring some " equality of the chances".

  • With the national plan, one will note inter alia requirements increased in terms of accessibility of urban spaces and various provisions aiming at raising the barriers of access to employment.

On the financial plan, this effort resulted in the installation of the National bank of solidarity for autonomy (CNSA). This one manages in particular the sums collected because of suppression of bank holiday (Pentecost). Part of these sums, intended for the handicapped people, are then redistributed at the general advices. To however note that an important part of the funds is used also to organize the response of the French company to the major challenge which is the Vieillissement of its population.

In practice in France

Département house of the handicapped people

  • With the local plan, the general advice is seen reinforced in its role of architect and organizer of the policy of Compensation of the handicap.

On him the organization of the Département house of the handicapped people rests. This one must function like an one-stop shopping bound for the handicapped person, and replaces in particular the various structures to which were to address the handicapped people before: CCPE, CCSE, CDES, Cotorep… It must also prepare a departmental Diagram of the handicap, in particular aiming to structure and supervise different the services from accompaniment offering of the services to the handicapped people.

Transport

In France, according to an investigation of IFOP carried out in July 2004 , more than 82% of the lines of bus are inaccessible to the handicapped people, 30% of the post offices and 23% of the town halls. The half of the cinemas, the restaurants and bakeries are also inaccessible to the handicapped people.

Work

In 2006, more than 30% of the population of the handicapped people able to work is with unemployment - even if there exist fortunately Exemples of integration of people handicapped with the work world.

Sport and leisures

The integration of the people in situation of handicap is done in the sporting milieu specialized within the framework of two federations:

  • the FFSA (French federation of Sport Adapted) which addresses to the public carriers of intellectual handicap
  • the FFH (French federation Handisport) which addresses to the public carriers of driving and sensory handicap

In addition, of the sections handisport or adapted sport can exist within the clubs " valides" for an integration in ordinary medium more marked.

Accompaniment of the handicapped people

It should initially be stressed that the accompaniment of the handicapped person does not have anything systematic. The majority of the handicapped people are autonomous, but some of them cannot live decently without the assistance of a third.

In a general way, the handicapped person tends more and more to being the organizer of her accompaniment. In the future it should be the employer of its guides more and more (more frequently called assistant (E) of life). In France, the French health insurance system of Health insurance (CPAM) allots a monthly allowance for that.

This vision is opposed to that of a great dependence with respect to the outside, whose prototype was the " a long time; catch in charge" in specialized establishment. This movement joined that of Désinstitutionnalisation.

It is a question of going now worms of the personalized services.

This in 2 manners which are not incompatible: the maintenance in residence and the stay or domiciliation in adapted establishment.

The maintenance in residence in France

It is a question of creating various services making it possible the handicapped person to live in ordinary medium in spite of its handicap.

It is first of all advisable to insist on the crucial role played by the medical community and ancillary medical, liberal or hospital. For certain handicaps, this accompaniment can be enough.

For the very young children, it will be initially about a support brought by SME and CAMSP.

For the children, this mission is shared with the State education (CLIS, UPI, IME, IMPro, SESSAD,), and, in certain cases, with the services of pédopsychiatrie (CMP, CMPP,…)

For the adults, other services exist, like the services for the autonomous life (SVA) (from now on generally integrated in the Département house of the handicapped people), SSIAD, SAAD, SPASAD, SAMSAH… It is necessary as to note the important answer as the family Accueil can constitute.

Stay and domiciliation in establishment adapted in France

It is the more traditional solution of the social and medico-social establishments. These establishments take part in the public service of the social action and medico-social (Olivier POINSOT, " Private institutions and public service of the social action and médico-sociale" , General Review of the Territorial collectivities n° 37, Nov. - DEC. 2005, p. 415-431; Olivier POINSOT, " The social action and medico-social, an industrial and commercial public service? " , The Legal Week ED. At 2005, n° 1358) and contributes to the implementation of the public health policy laid down by the law n° 2004-806 of August 9th, 2004.

Some of these structures have sometimes bad press.

Initially because the " découverte" regular of Maltraitance throws the opprobrium on these " institutions".

Then parce the collective lifestyle which is imposed there de facto runs up against the contemporary aspiration against individualism. He points out institutions caricatures like the boarding school or asylum (with the pejorative direction). It should be added that within this framework, the handicapped person is to attend much more other handicapped people that the average of the population, which is not indifferent within the framework of the Backwardness or psychic in particular.

Lastly, the person handicapped there is confronted with a team of professionals " sachant" , which can listen to their opinion of experts sometimes more that of the person (that one calls today generally " résidant" or " jeune" when that is justified). Within this framework, it is not always able to be strictly speaking the organizing one of its accompaniment.

Let us add that these structures are expensive (usually more 100€ per day and anybody accommodated).

The Loi n°2002-2 of January 2nd, 2002 renovating the social action and medico-social instituted a whole battery of reforms likely to improve operation of these institutions: Project of establishment, the Council of the social life, Contract of stay, Charter of the rights and freedoms of the accommodated person, Autoévaluation, external evaluation, Booklet of reception.

Moreover of the systematic programs of inspection are currently implemented by DDASS.

These establishments are not therefore in lose speed, bus of the new places are programmed. On the other hand they must evolve/move on the services which they offer. It is necessary for them to adopt an approach customer and to set up a step quality. He also belongs to them to set up flexible solutions of temporary reception or day.

These requirements with tendency consumerist and entrepreneurial shock a priori a big number of the workers who exert there; they however condition the future of these establishments.

The majority of those are associative with nonlucrative goal. Many are managed by associations parents. Some are managed by mutual insurance companies. There exists also a network of public corporations - sometimes managed by Hospitals.

Certain structures are turned towards adapted work: they are the Establishments and Services Assistance by Work (ESAT), (ex CAT Center of Assistance by Work). They are medico-social structures which make the balance between the requirements of the production and the capacities of the workers, who all are of the handicapped people.

With the ESAT are often leant Foyers of lodging, which are structures of lodging offering in addition an psycho-educational accompaniment to the residents.

When the people are not ready to work, they can be accommodated in a Foyer of Life (sometimes called occupational Foyer).

The people suffering from more serious handicaps can be accommodated in Maison of reception specialized, in theory built to accommodate the polyhandicapées people. The establishments for polyhandicapés children are also in research, for most dynamic, of specialized educational approaches supporting the development and the autonomisation, such as the rooms Snoezelen, or conductive education.

The Foyer of reception medicalized is a structure rather similar to the specialized House of reception, but whose role is tallied less and more complex financing.

To finish, it should be noted that a good political comprehension of the differences between establishments requires the knowledge of the Financement of the social establishments and méd ''' ico-social.

Sources

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