Kerala government releases draft guidelines for private therapy centres
January 31, 2019
Therapy centres in Kerala must provide comprehensive quality care for children with disabilities at affordable costs. That is the core essence of the draft guidelines released by the Kerala Social Security Mission (KSSM) earlier this week.
The guidelines, which are up on the KSSM website come after an intervention by the Kerala High Court, which was hearing a petition on the need to set up a system to regulate private therapy centres in the state.
The petition was filed by TogetherWeCan (TWC), a group of parents of children with disabilities and special educators, who came together to highlight the malpractices prevalent at many centres.
The draft guidelines, put together after consultations with government agencies, therapists' as well as NGOs, have been welcomed by parents. Smrithy Rajesh, parent to a child with autism said, "Given that there were no rules at all and no management, these guidelines set a good framework".
Among the key concerns raised was to ensure that a certain minimum standard of quality care is maintained at all centres and made available at affordable rates. To ensure thus, the guidelines propose setting up government empanelled model therapy centres and district level monitoring committees.
Though it is only one step closer to a more safe, accountable, transparent, inclusive and ethical system of working with children with disabilities, it is undoubtedly a giant leap and the first of its kind in India. From where we had nothing we now will soon have something in place. - Seema Lal, Co-founder, TogetherWeCan
This Is just the start and a meeting of key stakeholders will be held on 2 February to review these guidelines. Among the concerns some experts have raised is that there is way too much control placed in the hands of the medical lobby.
"All the services that are to be given to a child must be in a way that the child's rights are protected", says Sreejith Namboodri, of the Indian Association of Physiotherapists, Kerala chapter. 'Instead, we fear the guidelines place control in the hands of the medical lobby".
Not all disabilities have been represented either, as Padma Pillai, a parent points out. "The guidelines should cover all disabilities exhaustively and that has not been done. There is no clarity about the kind of committees that will be formed and what role the government will play in monitoring, which is important when there are private players involved".
The meeting this weekend will be critical to iron out these and some other issues raised by the TWC, namely:
- Every district-level monitoring committee should have one parent group representative along with experts. This is missing.
- That details of a complaint redressal forum with name, number and email of the main person in every district be displayed as well, along with display of the qualifications of all therapists and visiting consultants.
- Instead of making disability certificate mandatory, along with a referral via a medical doctor, the freedom to refer to a therapy centre should rest with anyone, including schools and preschools.
- "It may also be too early for a child between 1-2 years of age to be labelled with a disability certificate", points out Lal. "Most early intervention can prevent a permanent diagnosis too. Therapy could also be for corrective measures".
- Periodic reassessments and reviews be done in a transdisciplinary manner with inputs taken from all those working with the child.
There are some other provisions relating to use of equipment as well as autism diagnosis, which will be raised at the meeting.
As a first step this is certainly a progressive move, one that has come after much sweat and tears, but still a long way away from a rehabilitation-based model that is based on empowering families and children, points out Ruchika Sethi Thakkar, parent to a child with a intellectual disability.
"The key concerns have been addressed broadly and it is very commendable as it is the fructification of efforts made by parents but there is a shift towards the medical model of disability away from societal. Bringing the psychiatry department to exercise final judgement is a major concern".
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