HEALTH AND EDUCATION PROBLEMS OF CHILDREN AND YOUTH WITH DISABILITIES IN LATVIA

Since Latvia has acceded to the European Union, the issue of equal opportunities of education for all has become topical: the legislation is harmonized, the attitude towards children with special needs is changed in education from segregation and social isolation of disabled persons to integration and inclusion. The authors of the article identify the existing problems related to the health and education of disabled children and youth, explain the terminology existing in the country, analyze statistical data of recent years regarding the number of disabled people and describe the opportunities offered by the country to the target audience of the article on all levels of education.


Introduction
In any democratic society a person is considered to be a unique value, who lives, learns or works among other people: everyone shall be provided the most appropriate way of participation in various social activities in order to let each individual feel belonging and understood.
Respecting a person as a value under current conditions in the European states the society puts forward new tasks for the development of education because the education acquired by any person is signifi cant.It is an important precondition infl uencing the life quality of each person.Complete and successful inclusion into the social life and labour market is impossible without appropriate education.
In Latvia the issues related to the provision of education to children and youth with special needs are considered in the context of internationally adopted documents: in 1990 a program "Education for All" was launched, when in Jomtien within the framework of an international conference the declaration "On Education for All" was adopted and an action plan for the coming ten years to facilitate development and access to basic education was developed.In 1994 the World Conference on special education took place in Salamanca, Spain.In 2000 in Dakar, Senegal the World Education Forum was organized to reach the aim by 2015.
In order to ensure successful implementation this commitment is also included into the UNO Millennium Development Objectives (Rouzs, 2006).Basing on the conclusions of the European Council made in Lisbon in March, 2000, the same year the European Council in Nice decided that cooperation in the areas of policy envisaged to fi ght against social exclusion shall be linked by the Open Coordination Method (OCM) combining actions plans of individual states and initiatives facilitating cooperation of the Commission.
Latvia has started moving towards inclusive education.In the narrow sense it is education for children with special needs or functional disturbances, but in the broad sense inclusive education is education for everyone, for everyone is given an opportunity to acquire education according to his/her abilities and needs regardless his/her physical qualities, material status and many other reasons.It is envisaged by the Education Law -every person has a right to acquire education regardless his/her material and social status, race, nationality, ethnicity, gender, religion and political views, health condition, occupation and residence (Izglītības likums, 1998).
Thus, in order to provide equal opportunities and facilitate integration of disabled children and youth into society a coordinated and embracing policy in all spheres of social life is needed, especially in: • health (prevention, health education, diagnostics, treatment, medical rehabilitation); • education (including training the persons involved in the integration process of the disabled people); • employment (vocational orientation, vocational training, and provision of employment); • social integration (social assistance and care, accessible environment); • information and legal protection, etc. (Koncepcija "Vienādas tiesības visiem").

Research object: Provision of education for children and youth with special needs on various levels of education.
Aim: To identify obstacles to successful inclusion resulting from the analysis of the health condition and offered opportunities for the children and youth with special needs in Latvia. Methods: • analysis of normative documents on the education opportunities for pupils with special needs and opportunities of career development support and professional rehabilitation for disabled people; • analysis of statistical data about the health condition of children and youth; • SWOT analysis of opportunities to acquire basic education for pupils with special needs.

Defi nitions of disabled people and terminology used in Latvia
According to the information provided by I. Balodis, president of Disabled People and their Friends Union "Apeirons" (Latvia) talking about this social group in the legislation of Latvia there are used two notions "disabled person" and "disability".
In compliance with Section 4 of LR Law "On Medical and Social Protection of Disabled Persons" a disabled person is a person who due to the disturbances of the organ system functions caused by a disease, trauma or inborn defect needs additional medical and social assistance and to whom disability is determined according to the procedure envisaged by this law and other normative acts (LR likums.Par invalīdu medicīnisko un sociālo aizsardzību).
Disability is permanent or intransitive limitation of physical abilities of a human body unrelated to age changes, which impose diffi culties for a person to integrate into society, completely deprives of or partially restricts person's ability to work and take care of himself/ herself (Section 5 of LR Law "On Medical and Social Protection of Disabled Persons").
However, exploring the world experience and the terminology existing in other states it can be concluded that this term is not used there at all.One of the reasons is as follows -when translating from English the root of the word "invalid" indicates uselessness or unfi tness; however, in Latvia this term is deeply-rooted, but lately many other terms have been observed, for example: 1. a person with disability -a term used by NGOs as it includes all groups of disability and indicates a person and his/her disability; 2. persons with handicaps -persons with disturbances of physic health, social behaviour, etc.; 3. persons with special needs -persons with development disturbances, which are diagnosed: persons with mental development disturbances, persons with vision and hearing disturbances, persons with language and speech disturbances, persons with mental health disturbances, persons with support and movement system disturbances).
The application of terms in Latvia depends on the branch, where it is used, for example: in the legislation on education a term "children with special needs" is used, but in the legislation on medicine and social work terms "disabled children" or "youth with disabilities" are used; thus, in the article we a use several terms to denote the target audience.

Situation analysis in Latvia
The issues of health, education and preparation for the labour market among children and youth with disabilities shall be considered in the long-term.A successful solution is possible under conditions when purposeful and systematic work has already been started in and succession is observed in this process.The topicality of the issue in the long-run is also confi rmed by the statistics on various disturbances among children, including the number of disabled children.
According to health examinations children and youth are divided into three health groups.Group I includes children and teenagers who have no chronic diseases and whose development is without pathology, physical development corresponds to the age; group II includes children with threats of having chronic diseases, functional disturbances, and even implicit neuro-psychic development retardation; group III includes children having chronic diseases, inborn pathologies of organs and systems, functional pathologies.From 2005 to 2008 the most frequent reasons for children's primary disability were psychic and behavioural disturbances, but since 2009 -inborn deformities and malformations, out of them 25.7% -inborn blood circulation diseases.Overall, in 2009 primary disability was conferred to 853 children -94.6% out of the total number of children sent to the primary disability expertise.
In 2010 primary expertise was performed to 1273 children under 16, the primary status of a disabled child was conferred to 684 children -96.2% out of the total number of children sent to the primary disability expertise to confer a status of a disabled child (out of 711): in the age group 0-6 years -387 children, 7-16 years -297 children.Distribution (%) by age groups is depicted in Figure 2.   The General Education Law and its amendments regulate the educational system in Latvia, including also special education of children and youth with special needs who can learn at any school in compliance with Section 49 of the General Education Law.It determines that in special education there are created opportunities and conditions for pupils with special needs to acquire education corresponding to the health condition, abilities and development level at any educational establishment, at the same time providing pedagogically psychological and medical correction, preparation for work and life in society (Vispārējās izglītības likums).
Currently, pupils with special needs acquire education at special educational establishments (partially segregated environment), special classes of mainstream schools (integrative environment) and mainstream classes (inclusive environment).
The number of pupils in Latvia has been decreasing for several years; however, the proportion of pupils acquiring special programmes decreases less.The statistical data prove that in Latvia in the school year 2010/2011 8435 pupils or 3.8 % from the total number of pupils had special education programmes.Unfortunately, during the last decade a tendency of proportional increase in the number of these students was observed (see Fig. 3).It shall not be ignored in establishing the educational policy.
In the school year 2010/2011 in Latvia there were 821 general education establishments, including 62 special schools.Almost 200 general education establishments had licensed special education programmes.

HEALTH AND EDUCATION PROBLEMS OF CHILDREN AND YOUTH WITH DISABILITIES IN LATVIA
Svetlana Ušča, Ivans Korņiļjevs, Velta Ļubkin In all special basic education programmes the teaching and upbringing process is related to systematic treatment and recovery measures, daily special correction and rehabilitation work because many pupils with special needs besides the primary disturbance often have one or several secondary disturbances or various diseases.Pupils with multiple development disturbances have specifi c problems: memory, language, attention, communication, etc. (Vīgante, 2007).
Within the framework of the doctoral thesis "Development of Communicative Competence among Teenagers with Language Disorders at Basic School" (Ušča, 2011), the author conducted a research related to the educational opportunity offered to children and youth with special needs in Latvia -analysis of advantages and disadvantages of mainstream schools and boarding schools (see Table 1).
As a result of the analysis, it can be concluded that choosing a school by parents and competent authorities, fi rstly, one shall think about a child -which environment is the most suitable for him/her, where s/he will receive complex assistance to develop better taking into consideration his/her special needs.
Experience proves that inclusion of children with special needs into mainstream schools does not always give a benefi t of reaching the maximum result a child is capable of.
The researches conducted in the USA prove that peers better accept in school environment those children who have very severe disturbances because their inadequate behaviour is justifi ed by the kind of disturbance.However, the less severe are the disturbances and the more a child is similar to others, the less is his/her different behaviour justifi ed (Bērziņa, 2010).
The results of this research and the researches of other countries prove that children having slight mental development disturbances, who graduate from mainstream basic schools, have low life quality and it is diffi cult for them to integrate into society.However, after graduation from basic school children and youth with special needs move to the next stage of their life -necessity to prepare for professional life and integrate into the labour market.

Opportunities for career development among disabled persons in Latvia
Article 9 of the European Social Charter (06.12.2001) determines that each person has a right to use "a service which will assist all persons, including the handicapped, to solve problems related to occupational choice and progress, with due regard to the individual's characteristics and their relation to occupational opportunity", thus each EU Member state shall provide career counselling to all population free of charge.Currently in Latvia basing on the EU policy documents and foreign experience by the Cabinet Order No. 214 of 29.03.2006 a conception "Improving Career Development Support System" (hereinafter -Conception) has been approved.The aim of the conception is improving the career guidance support system, to perform coordinated measures to develop normative acts and action policy in order to increase the competitiveness of the labour force and employment rate on the one hand, and provide support to individuals to identify and implement their personal aims and interests on the other hand.Introduction of such system and measures gives an opportunity to individuals, including disabled persons, to broaden their knowledge, to choose the most appropriate and suitable way of education, motivates for studies and achieving good results as well as facilitates integration into the labour market.

Opportunities for professional rehabilitation among disabled youth and analysis of results
Currently, the responsibility for the introduction of the career guidance support system (CGSS) in Latvia on the political level is shared by the Ministry of Welfare: Employment State Agency (ESA), Social Integration State Agency (SISA) and Ministry of Education and Science: LR State Education Development Agency (SEDA).
"Support for Unemployed Persons and Persons Seeking Employment Law" determines the competence of the ministries mentioned above in the development of CGSS (Section 5): • The Ministry of Welfare shall develop State policy for the reduction of unemployment, participate in the development of employment policy and the improvement of the career development support system, as well as co-ordinate the development of proposals for active employment measures and the organization, fi nancing and implementation of preventative measures for unemployment reduction.
• The Ministry of Welfare in co-operation with the Ministry of Education and Science shall ensure the occupational training, retraining and in-service training of unemployed persons, the acquisition of non-formal education of unemployed persons and persons seeking employment, the retraining, in-service training and further education of persons employed by merchants and self-employed, training programmes for involving adults in lifelong education, training programmes for employed persons subject to the risk of unemployment, as well as the organization of career consultations (www.likumi.lv).
Employment State Agency basically implements the policy for reducing the unemployment rate in the state by organizing and enacting active employment measures.Since September, 2007 the agency has taken over the functions of PCGSA (Professional Career Guidance State Agency): offers group and individual consultations regarding career guidance, identifi cation of professional suitability, provides information on the issues related to job seeking and workplace preservation both to young people and adults, as well as performs psychological evaluation of the unemployed persons' training skills.
In compliance with Cabinet Regulations No. 239 "Bylaw of Social Integration State Agency" of 01.04.2008 -the Social Integration State Agency (SISA) is a state institution under supervision of the Ministry of Welfare aimed at facilitating social integration of disabled persons and persons with functional disturbances and providing disabled persons and persons with functional disturbances an opportunity to receive vocational rehabilitation and acquire the fi rst level vocational higher education (college education).
SISA is established to improve the life quality (welfare indicator, which includes physical and mental health, free time and spending it, work and link with society, a right to make decisions independently and implement them, material provision) for disabled persons by providing professional, social and medical rehabilitation services.
SISA has the following functions: • to provid e vocational rehabilitation services -measures ensuring renewal or development of professional knowledge and skills or mastering a new profession according to the kind and severity of person's functional disturbances, and prior education and qualifi cation; • to provide vocational rehabilitation services -measures oriented towards renewal and development of social functioning skills; • to provide medical rehabilitation and physical medicine services; • to implement vocational basic education, vocational secondary education and fi rst level professional higher education as well as professional further education programmes; • to evaluate disabled persons' professional suitability according to their interests, abilities, prior education and health condition; • to provide consultations to employers regarding adaptation of work environment, etc. (Valsts aģentūras "Sociālās integrācijas centrs" darbības stratēģijas [Action Strategies of State Agency "Social Integration Centre"], 2008).
SISA is competent to provide professional rehabilitation services to disabled young persons, and one of them is identifi cation of professional suitability for integration of disabled youth into the labour market.In 2010 professional suitability was tested among 458 persons, including 252 females and 206 males.An extended professional suitability course was taken by 272 persons, in support points professional suitability was tested for 186 persons (SIVA.

gada publiskais pārskats).
SISA had recommended 352 persons for receiving vocational rehabilitation services.Acquisition of educational programmes at Jurmala Vocational Secondary School is recommended to 259 persons, out of them 5 persons had a professional suitability testing course in 2009 and used an extended professional suitability testing course in 2010.93 persons were recommended for studies in college, out of them 2 persons had a professional suitability testing course in 2009 and used an extended professional suitability testing course in 2010.114 persons were not recommended to acquire vocational education (1 person had a professional suitability testing course in 2009 and used an extended professional suitability testing course in 2010), 36 persons have not used an extended professional suitability testing course yet.The professional rehabilitation service is refused to 78 persons due to their health condition, very weak abilities and knowledge (see Fig. 4).Out of all applicants professional suitability testing was performed among 25 (5%) persons having the 1 st disability group, 178 (39%) persons having the 2 nd disability group, 252 (55%) persons having the 3 rd disability group and 3 (1%) disabled children.
Testing of professional suitability was also performed in the support points established in the regions of Latvia in Cesis, Barkava, Viesite, Jelgava, Cirava, Rezekne, Daugavpils, Kuldiga and Jurmala.

HEALTH AND EDUCATION PROBLEMS OF CHILDREN AND YOUTH WITH DISABILITIES IN LATVIA
Svetlana Ušča, Ivans Korņiļjevs, Velta Ļubkin In 2010 1455 disabled persons studied in support points.According to the results of professional suitability testing in Daugavpils, Rezekne and Jelgava Support Points trainings in the further and professional development programme "Computer Use" was organized, providing training for 77 disabled persons to gain the qualifi cation of an information input operator.
The support points (SP) inform and consult disabled persons about the services offered by SISA in the fi eld of vocational and social rehabilitation; 905 individual consultations about requalifi cation and further education for disabled persons, opportunities to receive vocational rehabilitation services, situation in the regional labour market and other issues have been provided.Within 117 informative group consultations 526 disabled persons have been informed.In cooperation with employers 38 potential workplaces have been identifi ed and 72 disabled persons have been placed there to work or have practice.
Within the research the questionnaires fi lled in by the clients in SISA SP in Rezekne, results of practical and actual work have been summarized.The analysis from 2007 to the end of 2010 was done and refl ected in a monograph (Korņiļjevs, 2011).
Table 2 depicts the proportion of disability and number of disabled persons (comparison of SISA SP in Rezekne clients with the overall situation in the state).The total number of SISA SP Rezekne clients or the number of respondents in Rezekne region (Rezekne, Rezekne district and Ludza, Ludza district according to SISA territorial distribution) are 670 disabled persons from the age of 16 till retirement age (see Table 3).Out of them 321 participants have already undergone primary professional testing (PPT) in SISA SP Rezekne and 87 persons -extended professional suitability testing in SISA Jurmala.
Conducting a research, the data about the education and age of SISA SP Rezekne clients have been analyzed (see Table 3).Analyzing the obtained data it is seen that among SISA SP Rezekne clients in the youth group under 20 a majority of persons (17) have basic education, 13 -secondary education and 8 -incomplete basic school.
The research shows that out of 670 SISA SP Rezekne clients only 38 persons under 20 have requested assistance in the support point.Despite the legislation facilitating an inclusive policy, activities of various organizations and implementation of various projects there are many problems in the fi eld of disabled children and youth with special needs, especially in the education and employment fi eld of disabled persons, which cause obstacles to their successful inclusion into the society and labour market.
Successful implementation of an inclusive education policy depends on everyone's understanding and activity, thus participation of all parties -teachers, parents, employers, social workers, each member of society -is needed.

Conclusions
The legislation of Latvia provides an inclusive attitude towards education of pupils with special needs, career guidance and vocational rehabilitation of disabled young people; however, at the current stage the implementation of the inclusive policy has several obstacles: • Lack of understanding in the society about persons with special needs: the educational system offers training, but parents do not want pupils with special needs to learn beside their children, employers do not wish to hire a specialist with disability, etc.
• Physical environment: not all educational establishments are accessible for children and youth with special needs, especially if they have movement disorders: there is a lack of approaches, ascents, lifts, etc.The issue about access to interest education and culture and sports events is not settled.The issue of transportation is also topical because persons with movement disorders often cannot get to the educational establishment or workplace.
• Threats of mechanical inclusion: in mainstream schools pupils with special needs sometimes are kept just because of the number of pupils.There is a lack of trained teachers, insuffi cient support staff -a support team (psychologist, special pedagogue, speech therapist,

HEALTH AND EDUCATION PROBLEMS OF CHILDREN AND YOUTH WITH DISABILITIES IN LATVIA
Svetlana Ušča, Ivans Korņiļjevs, Velta Ļubkin teacher's assistant), an assistant.Under such conditions of mechanical inclusion the school cannot provide complex pedagogical, corrective and rehabilitation assistance; as a result pupils with special needs suffer intellectually, emotionally and physically.
• Teachers' readiness to work in inclusive environment: Many teachers lack knowledge and experience how to work with children with special needs.It is the worst situation if a teacher blames a child and his/her parents if the child cannot learn something being unable or unwilling to see the problem.
• Insuffi cient methodological provision: there is a lack of appropriate teaching and technical aids, a majority of concepts are taken over from Russia and Western countries without systemically considered adaptation.There is a lack of experience about organizing teaching and learning in integrative and inclusive environment.

Figure 1 .
Figure 1.Distribution of newborns, children and teenagers according to health groups (%)

Figure 2 .
Figure 2. Distribution of disabled children by age groups (%)

Figure 3 .
Figure 3. Number of pupils in special schools and classes (%)

Figure 4 .
Figure 4. Distribution of recommendations among applicants for professional suitability testing (number of persons)

Table 1
SWOT analysis of two options for acquiring basic education (Ušča, 2010)

Table 2
Proportion of disability and number of disabled persons (comparison of SISA SP in Rezekne clients with the overall situation in the state)

Table 3
Correlation between education and age of SISA SP Rezekne clients