Table 1: Typology of institutions TYPE OF SERVICE SIZE AGE GROUP TYPE OF LEVEL OF SUPPORT PROVIDED TYPICAL OF AGE OF Instituts médico-éducatifs (IME) educational Institute Mostly day centres (67,4%) Others are residential places (3-20 years old) disability Various support provided, depending on the residents’ needs (over 95%) security Over two years 10-50 years Instituts thérapeutiques, éducatifs et pédagogiques (ITEP) Medical, educational and teaching institutes Mostly residential centres (55,5%) places (3-20 years) old Mental health problem Various support provided, depending on the residents’ needs (over 95%) security Over two years 10-50 years 100 100 profit profit
Établissements pour déficients moteurs Establishments for people with physical disabilities More than half of these are day centres (54%) places (3-20 years old) Physical disability Various support provided, depending on the residents’ needs (over 95%) security Over two years 10-50 Instituts pour déficients visuels et auditifs Institutes for people with visual and hearing impairment Half of these are day centres (49,5%) and 42,5% are residential. places (3-20 years old) Sensory disability Various support provided, depending on the residents’ needs (over 95%) security Over two years 10-50 Instituts d’éducation sensorielle pour enfants sourds/aveugles Sensory education Institutions for deaf/blind children Mostly day centres (64,5%) places Sensory disability Various support provided, depending on the residents’ needs (over 95%) security Mixed of (41% stay up to two years; 12,4% 10-50 profit profit profit
stay three years) Centres (CMPP) Centre Consultation centres, not residential places Mental health problem Less than ten hours a week (over 95%) security Mixed of Over 50 years Centres d’action médico-sociale précoce (CAMSP) Centre for medical-social action at an early stage Consultation centres Over places (0-6 years old) Mixed Day-time support provided Mixed security Mixed of 10-50 Services d’éducation spéciale et de soins à domicile (SESSAD) Services for special education and home care Mostly at home or at school (90%). 0,5% of the places are residential Over places Mixed Less than ten hours a week Mixed security Mixed of 10-50 profit
Établissements et services d’aide par le travail (ESAT) Establishments and services providing care through employment (previously called CAT) Not residential places Adults Mixed Various support provided, depending on the residents’ needs (over 95%) Mixed of Over 50 years Foyers occupationnels et foyers de vie pour adultes handicapés Foster care for people with disabilities Mostly residential (69%) 11-30 places Adults Mixed Various support provided, depending on the residents’ needs for Mixed and private Mixed of 10-50 Foyers d’hébergement pour adultes handicapés Shelter for people with disabilities places Adults group not specified Only night and weekend support provided for Mixed and private Mixed of Over 50 years Maisons d’accueil spécialisé (MAS) Specialised reception centres Residential institutions places Adults Mixed Various support provided, depending on the residents’ needs for security (95%) Mixed of 10-50 years profit
Maisons d’accueil spécialisées (MAS) pour personnes handicapées vieillissantes Nursing home for elderly people with disabilities Residential institutions 11-30 places Older people group not specified 24-hour support provided for security (95%) Mixed of 10-50 years Foyers d’accueil médicalisé pour adultes handicapés (FAM) Foster nursing care for people with disabilities Mostly residential institutions (75,1%) places Adults Mixed 24-hour support provided for Mixed local and security Mixed of 10-50 years Établissements expérimentaux pour adultes handicapés Experimental establishments for adults with disabilities Mostly day centres (37,5%) and provision of home care (30,4%) 11-30 places Adults Mixed Various support provided, depending on the residents’ needs for security Mixed of 10-50 years Services d’accompagnement à la vie sociale (SAVS) et services d’accompagnement pour adultes handicapés places Adults Mixed Less than ten hours a week provided for Local Mixed of 10-50 years
reference with URL if available authority, national statistical office academia, NGO data services for older people, services for children, large residential homes etc. France, DREES (2013) 'Services and institutions for children and adolescents with disabilities. Results of the survey implemented in 2010. Working document' ('Etablissements et services pour enfants et adolescents handicapés. Résultats de l’enquête en 2010. Document de travail'), Séries Directorate of Research, Studies, Evaluation and Statistics (La Direction de la recherche, des études, de l’évaluation et des statistiques, DREES*) Government ministry 2010 31 December 2010 Survey with questionnaire sent by registered post. The response rate is 98% of the institutions and services targeted by the survey, that is to say institutions and services in charge of children with disabilities located in National (11,248 services and Services and institutions for children and adolescents with disabilities (all types of disabilities, mental, physical, etc.)
des adultes handicapés dans les établissements et services en 2010'), Etudes et Résultats, n°833, available at: The response rate is 97% of the institutions and services targeted by the survey, that is to say institutions and services in charge of adults with disabilities located in mainland France and the overseas departments. mental, physical, etc.) France, DREES (2013) ''), Etudes et Résultats, n°832, available at: DREES* 2010 31 December 2010 Survey with questionnaire sent by registered post (this study is based on the in 2010 – National Services and institutions for children with disabilities (all types of disabilities, mental, physical, etc.) sociaux
practice. Special report (Faire face à l'avancée en âge des personnes adultes handicapées : Impacts sur les dispositifs et les pratiques professionnelles. Rapport spécial), Les Cahiers de l’Actif, n°454-455. sociologists, dealing with this issue: elderly people with disabilities). France, Actif (2014) Food services, nutrition, eating habits: specificities of people in Social and Medical-Social Institutions. Special report (Restauration, diététique, comportements alimentaires : spécificités des Actif (NGO) not available Information not available Qualitative (This special edition provides contributions from officials, doctors, dealing with this issue: eating habits of people with disabilities). National Services and institutions in charge of people with disabilities
France, Regional Health Agency of d’Azur (2012) Overview of medical-social support for children with disabilities in Vaucluse. Report (État des lieux de l’offre pour les enfants en situation de handicap dans le Vaucluse. Rapport). Regional Health Agency (Agence régionale de santé, ARS) of d’Azur 2012 2012 data Local of Services and institutions for children with disabilities France, Regional Centre for children, adolescents and adults with special needs (2014) Background and needs in the next three years of children with disabilities in Vaucluse, including those covered under the Creton Regional Centre for children, adolescents and adults with special needs (Centre Régional pour les Enfants, les Adolescents et les Adultes Inadaptés, CREAI) 2013 2012-2013 (31 December) Survey with questionnaire sent to institutions. Almost all institutions returned the completed questionnaire. In addition some qualitative Local of Services and institutions for children with disabilities sociale
amendment. Report (Profil et besoins à trois ans des enfants en situation de handicap dans le Vaucluse, dont les jeunes relevant de l’amendement Creton. Rapport), available at: information was collected by emails and phone calls to find out more about problematic situations of some children. France, ANCREAI, Alcimed, Ipso (2013) Overview of actions and the dynamics of key actors dealing with people with rare disabilities by interregional area in France. Official Report (Etat des lieux approfondi des interventions et des dynamiques d’acteurs relatives National Association of CREAI (ANCREAI), Alcimed and Ipso Facto (consulting firms) 2012 Study period from April 2012 to November 2012 data, interviews with key actors (ten per Region), including institutions, NGOs, professionals. National Services and institutions for people with rare disabilities
controlled and transmitted it to the DREES. Nearly all institutions and services responded). France, CREAI of PACA (2013) Overview and developments of institutions and services for people with disabilities in the PACA Region. Report (Etat des lieux et evolutions dans les établissements et services medico handicap de la region PACA. Rapport), available at: CREAI of PACA, DREES 2010 2006-2010 data, (Idem) Local (Region of PACA) Institutions and services for people with disabilities France, IGAS (2011) Care for General Inspectorate of Social Affairs (Inspection 2011 2011 data, National Institutions and services
people with mental disabilities. Report (La prise en charge du handicap psychique. Rapport), available at: générale des affaires sociales, IGAS) meetings with NGOs, heads of institutions, etc. for people with mental health problems or intellectual disabilities France, Médialis (2012) Survey 2012: actual functioning of SAMSAH and SAVS. Analyses and comments (Etude 2012 : réalité du fonctionnement des SAMSAH et SAVS. Analyses et commentaires), available at: Médialis (company) 2012 The survey participants responded between 25 May and 25 September 2012 Survey 150 responded to one questionnaire elaborated by Médialis in collaboration with professionals. Questions provide information about the date of creation, the people who National Institutions and services for people with mental disabilities
attend the services, the staff, the partnerships, the funding. France, CREAI (2013) Institutional environments and care for autism. Practices for receiving people with pervasive development disorder within the medical social organisation (Environnements institutionnels et prise en charge de l'autisme. Les pratiques d'accueil des personnes avec TED face à l'organisation médico-sociale), Bulletin CREAI Bourgogne 2013 2011 Survey, visits to institutions and interviews with professionals (36) in institutions: people with administrative functions, psychologists, nurses, educators. It took place in the four Departments of Local Institutions and services for people with mental disabilities
d’information, n° 334, 2013, available at: . France, Regional Health Agency of Bretagne (2013) Medical-social care of young people with disabilities in Britany (Prise en charge des jeunes handicaps en Bretagne), Les études de l’ARS Bretagne, n°3, available at: Regional Health Agency of Bretagne 2012 2010 data Local Institutions and services for young people with disabilities France, Delhon, L. (2014) Violence in ITEP: creativity of professionals (Violences en ITEP: la créativité des professionnels), Lien Academic researcher 2013 2013 Applied research (article based upon interviews No Institutions and services for children with mental disabilities
social, l’actualité autrement, n°1137. No web link available. with professionals) France, National Agency for Support to Performance of Health and Establishments (Agence nationale d’appui à la performance des établissements de santé et ANAP) (2013) The Sector, Understanding for better action (Le secteur comprendre pour agir mieux), available at: National Agency for Support to Performance of Health and Medical-Social Establishments (Agence nationale d’appui à la performance des établissements de santé et medico-sociaux, ANAP) 2013 Information not available data and about the management of institutions and services dealing with people with disabilities. National Institutions and services for people with disabilities France, National Action and Resource National Action and Resource Centre (Centre 2010 July 2010 data National Institutions and services
For an overview of the survey with web links to documents connected to the surveys conducted in 2001, 2006 and 2010: France, DREES, Survey of institutions and services for children and adults with disabilities (ES ‘disability’), 9 July 2013, available at: . Overview of community-based services for persons with disabilities (2015) NB: A national database of social and medical social institutions and services has been put in place. It is accessible online: (last update 19/03/2015). Table 3: community-based services for persons with disabilities Type of community-based service Please provide the name of the type of service in the national language and a translation into English Yes/ No Please indicate if this type of service is available in your country Profile of the users age (children, adults or older persons) type of disability (physical disability, intellectual disability, Explanatory information For each type of service, please provide a short description of: the type and level (i.e. 24 hour, daytime, weekends, etc.) of support the service provides; Extent to which support is For each type of service, please provide information about the extent to which users control the support provided. Can individuals using the service: If data are available, please specify number of services operating in the country and the number of users
Please indicate if the types of services presented below are given a different name in your country psycho-social disability, deaf or hard of hearing, blind) location of the service (i.e. city, town, rural areas); who is eligible for the service who is typically the provider and funder of services (i.e. national government, local government, municipality, NGO, private company, etc.)? recruit and manage staff providing support; determine the activities for which support is needed; determine how the budget for services and supports is used; choose types of equipment and adaptations to meet their needs? Please provide a full reference for this data, including information about the period covered by the data. Please indicate, if data is available, if there has been decrease / increase in the last five years Direct payments / personal budget (cash payment enabling service users to employ YES Allowance for the compensation of disability (Prestation de compensation Adults and older persons with disabilities (normally reserved for individuals under 60 but 5 types of services covered, including human support (aide humaine) notably for essential acts of daily life, technical support (wheelchair, hearing aid Active role recognised by law to the person supported. Users have control, with direct payments (e.g. over recruitment of a person to assist them or of a All local services operate with these type of allowances. Beneficiaries
action and families, and is available online (see reference) YES Allowance for personal independence (Allocation Personnelle d’Autonomie, APA) Potentially including the Supplement for independent life (Majoration pour la Vie Autonome, MVA) Elderly persons with disabilities over 60 years. (or without disabilities also) All types of impairments For the MVA: persons living in an independent home. Allowance to cover various forms of support in favour of personal independence. Similar range of services as for the PCH; Amount is variable. MVA allowance intended to support the person with the costs of independent housing (current amount isn104.77 Euros per month). Available across the country Provided by the General Council (Conseil Général) – co-funding from the National The person can choose the helpers he/she employs or services (obligation to declare these) A professional evaluation is carried out to evaluate the loss of independence of the person and design a support plan with relevant measures for which the allowance will be allocated (home helper, delivery of meals, home modifications etc.) Number of beneficiaries of the APA: 1 222 290 beneficiaries in Dec. 2012, including 730 712 using it for home use (others in institutions) (on the increase, e.g. 1 148 171 in total in 2009)
disability (Fonds départemental de compensation du handicap) to cover remaining costs. (beds, sanitary material). Various practices and financing of the funds locally (can be supported by the Sanitary and Social action commission of the health insurance system (Commission d’Action Sanitaire et Sociale de la Caisse Primaire d’Assurance Maladie) refund for equipment paid may also be possible. The committee managing the fund locally evaluates the application. NB: As this is additional to aid provided for in law, procedures and practices can vary from one department to another. Personal assistance (typically purchased through earmarked cash allocations, the purpose of which is to pay for any assistance needed) YES See above Human support in the context of the CPH / APA / AEEH Persons with disabilities eligible for assistance See above concerning the CPH Assistance financed fully or partially. The personal assistance can come through direct employment of a person, use of a service accredited or authorised by the Department. Persons can thus sometimes directly recruit and pay for the See above concerning CPH
and benefiting from interventions of SAMSAH and SAVS services (see below) benefiting from SAMSAH or SAVS services In-home (home help, home care service) (home help consists of assistance with household tasks, such as shopping, cleaning, cooking, etc. Home-care services include assistance with daily routine tasks such as getting up, dressing, bathing and washing or taking medicines) YES Social life support services (Services à la vie sociale, SAVS) Support services for adults with disabilities (Services pour adultes Adults (largest age group according to a 2012 survey) All types of impairment Some are specialised Various in home services (cleaning, laundry, preparation of meals, grocery shopping, hygiene, social activities) + medical support in SAMSAHs (mobilizing social workers, psychologists and integration officers in SAVs, a multidisciplinary team including a doctor in SAMSAHs). In home support, less than 10 hours/week (timing defined in the decision) Varying types of support (permanent, temporary, sequential) will depend on the decision of the relevant Commission (commission des droits et de l’autonomie des personnes handicapées, CDAPH). Services should be aimed at contributing to the realization of the personal project (projet de vie) of persons and the development of their social, educational or professional links. Participation of the Number of structures registered in the FINESS database (2015): SAVS: 975 SAMSAH:334 SAVS:1214 SAMSAH: 54 (according to action-social website) For 2010: Equipment rate of 1.3 for
handicapés, SAMSAH) Available across the country Provided by services funded by the local council (Conseil Général in Départements), with a contribution from the National Solidarity Fund for Independence, CNSA). In SAMSAH, medical expenses are covered by the health insurance system (CPAM), and the rest of the support is covered by the Conseil Général, as for SAVS. person in the definition of that project is foreseen in the Code of social action and families General note: for all social and institutions and services, the law provides for the signing of a contract on stay (contrat de séjour) or an individual support plan (document individuel de prise en charge) which should detail the list and the nature of services offered and their anticipated costs. 1000 persons aged 20 to 59 Beneficiaries: 46 804 persons benefiting by Dec. 2010 (including both SAVSs and SAMSAHs). Another report mentions 44 297 places in in 2013 Home services (Services de soins infirmiers à Concerning adults Interventions at home including health-related support for SSIAD (which can be 7/7, Interventions by SAAD: they are based on an individual evaluation as well, and the definition Number of structures registered in
domicile- SSIAD) (to become - services polyvalents de soins et d'aide à domicile, SPASAD) Services d’Aide et à Domicile (SAAD) Note: additional support (e.g. allowances for services can be provided by municipalities) - under 60 and living with a disability (and persons over 60 living with an illness, lot of independence, or chronical diseases) usually daytime) and broader forms of support for SAAD (for acts of daily life) Available across the country. SAAD charge their services, based on a fixed rate (for an hour of in-home service) which can be set locally by the Department (for SAAD which are authorised (autorisés), others are free to set their own initial rate. . Beneficiaries can for instance use their APA (see above) to cover these costs. For SIAAD, funding depends on regional health agencies, which also set the rate. Funding is channelled of a contract/document concerning the support to be provided (document individuel de prise en charge) Note: Article 4 of the Charter on the rights and freedoms of the person supported (Charte des droits et des libertés de la personne accueillie), relevant for these types of service, states the principle of free choice and consent to the services offered, and of participation. Support should be individualised (article 2). Interventions by SSIAD are based on medical prescriptions. Needs the FINESS database (2015): SSIAD: 2079 SPASAD: 92 SAAD: 1422).
through the medical insurance funds (caisses d’assurance maladie). Service does not involve costs for beneficiaries are determined on an individual basis. Service d’éducation spéciale et de soins à domicile (SESSAD) (83.1 % of services provided in daily environment (milieu ordinaire/lieu de vie) Children/young persons aged 0 to 20 All types of impairment Some services specialised by type of impairment (distinct from SESSAD but sometimes grouped under): Specialisation: SSAD (for those with multiple disabilities, e.g. mental and physical), Services include educational and therapeutic support, counselling also the family and next of kin with a view to fostering independence and support schooling. Available across the country Financed by the social security system (Assurance maladie) Services should be individualised (96% of children aged 6 to 16 benefiting from the SESSAD services are attending normal schools) – personalised support, by a multidisciplinary team with the objective of maintaining them in their usual environment. $ Number of structures (on the increase) registered in the FINESS database (2015): 1650. 1451 services and 44 770 children benefiting from support in SESSAD by Dec. 2010.
provision of home care (30.4%) Available across the country Generally operated by non-profit organisations, funded by the local council (Conseil general, in Départements). offered and their anticipated costs. Day-care services (Services d’accueil de jour) Adults with disabilities (over 20). All types of impairment. Support for one day or more during the week, to develop or maintain the independence and social integration of persons with disabilities; Provided on a specific site, or sometimes within organisations with residents (Foyers de vie, foyer d’accueil médicalisé etc.) Available across the country Usually financed by a participation of the beneficiary and General note: for all social and institutions and services, the law provides for the signing of a contract on stay (contrat de séjour) or an individual support plan (document individuel de prise en charge) which should detail the list and the nature of services offered and their anticipated costs. Number of structures registered in the FINESS database: 94
complementary support from the local council (Conseil Général) Foyers Adults with disabilities with some degree of personal independence but not in a capacity to have a professional activity All types of impairment Providing day-time activities (recreational and educational), with social activities. Available across the country Mostly operated by the non-profit sector and financed by participation of beneficiaries and complementary support from the local council (Conseil Général). In some cases, public establishments. Centres ‘foyers occupationnels’ which offer day support and activities. These organisations usually Idem as above concerning day-care services Number of structures registered in the FINESS database: 160 (foyers
provide a number of activities for residents (arts, sports, ergotherapy etc.). A distinct type of institution (foyer de vie), generally includes residence (internat). Available across the country Funded by payments from beneficiaries, with complementary financing by the local council (Conseil general) Experimental institutions for children with disabilities expérimentaux pour enfants handicapés) Children, mostly aged 0 to 20, sometimes up to 25. All types of impairment (institution specialised according to Available across the country Financed Children are orientated towards experimental institutions, IMEs and ITEPSs by the CDAPH. A personalised schooling plan needs to be elaborated (Plan personalise de scolarisation). Number of structures registered in the FINESS database (2015): Experimental institutions for children
the type of impairment) Within these social or medico-social institutions, modalities of support and services offered should be individualised. with disabilities 93 institutes (Instituts- - IME) Children All types of impairment (including intellectual and psychological disabilities - movement, senses, behaviour) Organisations providing for education and support of children. Mostly day centres, 67.4% (accueil de jour). IME are specialised depending on the form of disabilities Available across the country Financed by the social security system (Assurance maladie) Number of structures: registered in the FINESS database (2015): 1262 Therapeutic, educational and pedagogical institutions (Instituts Children with psychological difficulties, behavioural problems, affecting their (Day centres, 40.5%) Support of children to favour family, social and professional integration, Number of structures: registered in the FINESS
NB: Measures foreseen also by the 2015 draft bill on the adaptation of society to aging, i.e. provide for corresponding financial support/option of temporary housing of the person supported if the carer requires a break (specifications will be adopted by decree) the local authorities (e.g. Conseil Général in Departments) Foster care (where children are placed in the domestic environment of a YES Specialised Familial Children All types of impairment Services to provide children and adolescents with psychological, educational and affective environment Foster families need to be accredited. Number of organisations registered in the FINESS
family that is not their own) support centre (Centre d’accueil familial spécialisé, CAFS) which cannot be found in their own environment. Sometimes attached to other services/institutions (such as IME) database (2015): 72 NB: upcoming study expected on family support (accueil familial), which seemingly remains not so developed Exists also for adults: Accueil familial d’adultes handicapés Adults All types of impairment Alternative mode of support between stay and institutions, also for temporary stays. Signature of a contract (contrat d’accueil familial). The charter of rights and freedoms of the person supported applies (see also A.3, p.22 on control by beneficiaries) No data available Informal support YES Both children and adults (Informal) (Informal) (Informal, no data)
(help provided by another person close to the user - family members, relatives and friends - without any official forms of support) No yet any clear legal definition but some is available, and some prospects with the 2015 draft bill on the adaptation of society to aging. Foreseen by the 2015 draft bill on the adaptation of society to aging: a definition of the notion of close helper (proche aidant) but for elderly persons (art.35). Actions also foreseen in the
Crisis intervention and emergency services (various activities aimed at supporting an individual or a family to overcome a difficult situation, for example,: individual and family counselling, crisis resolution teams (usually rapid support for people living in the community who are experiencing a mental health crisis) and emergency foster care where children are at risk of neglect or abuse) YES Mobile intervention teams (Equipes mobiles d’intervention) NGO support service (including hotline) Children and adults with disabilities, including autism and pervasive behavioural disorders (troubles envahissants du comportement) persons with mental disabilities Different types of initiatives, including services coordinated by psychiatric hospitals. Available across the country (but limited number of initiatives) Including funding by the ministry of social affairs/ regional health agencies. N/A No overview
Befriending (service provided by trained volunteers to help overcome isolation and enable full involvement in the community and social life) YES Multiple initiatives (not restricted to persons with disabilities but likely to benefit them). NGO services providing support persons (parrainnage) National action against social of elderly persons Broader programmes concerning adults in employment or elderly persons but likely to benefit also adults with disabilities All types of impairment Volunteers supporting adults in their daily life, social inclusion, and sometimes access to development. Available across the country Volunteer/NGO services Network involving NGOs and institutions, with teams of volunteers (‘équipes citoyennes’) to support elderly persons who are isolated Various documents can frame the form of befriending/support, formalising joint commitments and expectations. Based on voluntary engagement. No data available project Children (sometimes with disabilities) The system of local mentoring/support (‘parrainage de proximité’) allows a volunteer adult to support a child in his/her personal This type of mentoring/support can be formalised by a convention. A charter was also produced in 2008 to frame the role of volunteer adults No data available
(Parrainage de proximité) Including NGO-run projects development by being available for activities on a regular basis and educational and affectional support. Adults can benefit from support. A guide has also been produced by the Ministry of Social Affairs. (recalling the importance for respect of the choice of the child etc.)