The emphasis on individuality, its development and activity, so characteristic of the present time, is naturally also being transferred into the field of social services. The traditional system of treatment and care is gradually being replaced by individualized support. An essential part of this process is finding suitable approaches to people with disabilities and ways of working that would support their own activity.
The concept of activation became more widespread with the new Social Services Act, which defines it as one of the activities provided in social services. According to Mgr. Hanuše, head of the Department of Social Services and Social Inclusion at MPSV, who was involved in the preparation of the law, there is no precise definition of what activation activities are—its authors intended to create only a framework that providers could fill according to their own understanding; generally, however, it means a set of activities aimed at initiating activity that leads to social inclusion or learning strategies for coping with the difficulties associated with disability.
The legal definition is therefore quite broad. I believe this advantage is not sufficiently used in practice. On providers’ websites and in students’ theses, activation is mentioned mostly in connection with leisure activities. Especially in residential facilities, specialized experts are employed who create various activation programmes for clients. In some places these are occupational therapists and educators in leisure time, elsewhere actual activation workers. The range of activities for clients is extremely wide—from sport and music to crafts and brain jogging, up to art therapy and ecotherapy. In short, these are managed socio-cultural activities that unquestionably have significance and effectiveness. However, they are “high-threshold” and require at least a certain level of motivation, attention and social skills from clients. Therefore, they are usually available only to people with milder types of impairment. Yet nowhere in the law is it stated that any group of clients should be excluded from activation activities, whether because of age or degree of disadvantage. Clients with combined disabilities or permanently bedridden clients have the same right to attention and stimulation from their surroundings as others. They need a different approach and a different type of activities than those mentioned above.
Not all providers have staff trained in suitable techniques for working with these clients (for example, basic stimulation); nor is pretherapy yet applied everywhere. Where staff are at a loss, a special educator or psychologist steps in. The intent of the law’s authors, however, surely was not to delegate activation activities to experts who are least numerically represented in the facility. All service staff can activate clients (including the director and cooks); experts should primarily be initiators, trainers and guarantors. Let us look at what else, besides leisure activities, could be concealed under the term activation.
Starting from the concept itself, activity comes to mind, that is, action or active engagement. A biological starting point for defining its content may be that among all animals, the human being has advanced farthest in its (evolutionary) development. This was enabled, among other things, by the brain being used very effectively and by creating a specific form of communication. Given how greatly our knowledge in the fields of neurology and neurobiology has expanded in recent years, we know more about how the human brain works and therefore better understand how to develop it. For brain development, its activity is necessary and it holds that the more a person uses the brain, the more the brain develops. At the core is the formation of new connections—synapses—between individual brain cells. If a person uses the brain in an unusual way, either new connections are created between brain cells or existing connections—even damaged ones—are strengthened. This does not mean that a person must compose symphonies or solve complex mathematical problems; creative thinking is sufficient. From a physiological perspective, activation is therefore any situation in which the brain is forced to process either new stimuli, or familiar ones in a different way. Research shows that a brain that works only in the same schemes and does not develop is, for example, much more vulnerable to dementia. From a psychological perspective, activation is associated with the human need to perceive, know and control oneself and one’s environment.
From the above it follows that activity, in turn activation, is always associated with new, unusual stimuli. In most clients, the ability to secure a sufficient amount of stimuli from their surroundings is weakened, so these stimuli need to be offered or mediated to them. The type and intensity of stimuli must therefore be appropriate to the client’s condition. Just as individual needs of each client must be assessed, we must also realistically assess their capacities. While weaving baskets and a trip to a castle can be activation for a relatively independent client, for a person with advanced dementia, a foot massage can be an equally powerful experience.
The word activation can easily create the impression that its content should mainly be various sophisticated activities, such as educational, recreational, therapeutic and rehabilitation programmes. These surely belong to it, but it would be a pity to limit one’s understanding of activation only to them. According to sociologists, activities of this kind occupy about 12% of an ordinary European’s time. In the remaining time we study, work, and take care of ourselves and the household. A client’s day filled mostly with prepared activation programmes, with good intentions, therefore has a different structure from the day of a typical person.
Here two questions arise: how to activate outside prepared activities, and where to keep taking those new stimuli from? The answer is not complicated. If we treat activation as any activity whose result is clients’ activity, the possibilities of what can be done within activation expand considerably, and so do the opportunities for all staff to become involved. I would recommend starting from natural situations that normally occur and arise ad hoc—from self-care to a chance encounter in the corridor. Focusing on everyday and ordinary things brings situations that can be handled in a non-conventional way and thus provide new stimuli to which a client can respond. Naturally, it is not about the outcome as such, but about the interaction process itself. Specific examples of how such an approach can work in practice, I would like to offer in a follow-up article in next issue of the journal Sociální služby.
Professional journal Social Services - August / September 2011 More information can be found on the websites http://www.socialnisluzby.eu a http://www.apsscr.cz.