who have equal rights; that they are an object of social services is a secondary issue. This is a revolution that shifts the view of disability from one that focuses on the individual's inferiority or the individual's problem to one that calls circumstances and society into question, wishing their certain social existence.
B. Health and Medical Care
In institutions for children with severe motor and intellectual disabilities, that is the special hospitals for persons with severe motor and intellectual disabilities, SMID, medical care, education, and the necessities for everyday life are provided uniformly and systematically. Recently, as those who initially resided in such institutions as children have grown up and become adults, medical care, education, and the necessities for everyday life continue to be provided so that they can live there comfortably and fully.
For the past decade, the extensive experience gained in institutions for children with severe motor and intellectual disabilities has created scientific knowledge and technology that surpasses any that has been seen in the world. Recently, based on this, the possibility has been examined that children with severe motor and intellectual disabilities could stay at home and live in their own community. As a concrete beginning, day services have been tried. Day services for children with severe motor and intellectual disabilities living at home have been carried out as a national program since 1996, following a several years' trial of an experimental model.
Because of the remarkable progress of medical science and the full development of programs for children with severe physical and mental disabilities, a measure for children who are considered "children with ultra-severe physical and mental disabilities" has been sought as a new task. In other words, this refers to the problems of those children who have more serious disabilities and need more special care in their daily life, compared to other children with physical and mental disabilities. Recently in the United States, increasing affention has been paid to children with physical and mental disabilities who are called medically fragile children or children with medically intensive needs. So far as I know, these terms refer to children whose disabilities are milder but have a wider range than those who in Japan are called children with ultra-severe physical and mental disabilities.
In Japan, since April 1996, children with ultra-severe physical and mental disabilities are charged a special medical fee for their medical treatment only when they are placed in institutions. It is realized that this opens a new way for treating them.
Among the reasons that children are born with mental and physical disabilities, the percentage caused by genetic factors is not so large. But it is apparently incorrect to think that almost no disabilities are due to genetic causes. Not only environment but also genetic factors are extremely important for all living beings. Disability that happens to be due entirely to some genetic mechanism is not very frequent, but that kind of disability is also not rare. Recently, the nature of genetic diseases due to some mutation has been clarified. Also, the number of kinds of disabilities has been increasing as people's environment and style of life change. It is very important for us, as human beings, to elucidate the causal mechanism.
Today, mental health care service agencies and public health centers have an important role in the early detection of children's developmental disabilities. Successful early detection depends on knowledge of the various types and degrees of disability, and on how widespread the system of doing medical examinations of babies and children is. Many public health centers contribute to the care and education of children with disabilities through accepting out-patients and having public health nurses do home visits.
Providing dental care for children and adults with disabilities used to be a major problem. Today, this problem is gradually being solved through the efforts of the national dentists' association as well as of individual dentists and dental hygienists. Meanwhile, for quite a long time, dentists have been trained in how to treat the mouth functions (especially eating and swallowing) of children and adults with disabilities,and this training has been considered very important by the persons concerned. In September 1995, many people participated in a conference on the rehabilitation of eating and swallowing functions, showing again how important this subject is to those involved in the care of children and adults with disabilities.
In Japan, the importance of living at home and in the community is stressed as the way that social
