Deinstitutionalization and Alternative Care OSMHI: DeI Pilot Project Surakhani District Boarding Sch

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Deinstitutionalizationand Alternative
CareOSMHI De-I Pilot ProjectSurakhani
District Boarding School7

• Acknowledgments
• The authors gratefully acknowledge De-I Pilot
  Projects former and current staff
• Special thanks to the children residing and
  obtaining education at Boarding School7

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Deinstitutionalization Process History Trends

• UNICEF estimates that in 2002 there were
  1,120,800 children in public care in 27 of the
  Central and Eastern Europe, Community of
  Independent States and Baltic countries and
  approximately 605,000 (54) of these were in
  residential facilities (UNICEF Social Monitor,
  2004 Browne et al., 2006).
• Azerbaijan Official Statistic 14.840 children
  are institutionalized (source MoE, 2008) 23.533
  institutionalized , 1.060 deprived of parental
  care (by UNICEF Azerbaijan, 2003)
• DEFINITION OF INSTITUTIONAL CARE The terms
  institution and institutional care refer to
  forms of residential care without a parent or
  guardian for longer than three months catering
  for large numbers of children of 25 or more, or
  small numbers of children between 11 and 24 in a
  building often referred to as achildrens home
  (UNICEF Social Monitor, 2004).

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Deinstitutionalization Process History Trends

• Reasons for placement
• Children may be placed in residential health and
  social care facilities for a wide range of
  reasons
• Biological orphan
• Separation and neglect due to poverty,
  stigmatisation or being an unwanted child
• Incapacity of parents to care due to illness,
  alcohol or drug misuse or imprisonment
• Removal from parental care under child protection
  proceedings in response to abuse, neglect or
  exploitation
• Disability or illness requiring specialist care
  or education
• Conduct disorder and behavioural difficulties
  requiring a specialist school or a secure
  environment
• Conviction of an offence requiring a correctional
  or detention facility
• Immigrant or asylum seeker leading to a detention
  or transit center

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• Impact and Consequences of Institutionalization/In
  stitutional Care on the following areas of
  childs life
• Abandonment
• Social orphans
• No consistent One-to-one care
• Attachment and Identity issues
• Physical and Psychological Wellbeing
• Social Isolation and Emotional deterioration
• Trust and Cooperation
• Social Inclusion/ Life after institution)
• Nelson and Koga, 2004 Johnson et al., 2006
• - poor self-confidence
• lack of empathy and understanding of others
• indiscriminate affection toward adults, lack of
  understanding of appropriate boundaries
• aggression towards others, cruelty to animals
  negative and anti-social behaviours
• autistic tendencies, stereotypical behaviours,
  self-stimulation and self harming
• poor cognitive development, academic
  underachievement
• poor moral development (difficulty in
  understanding right and wrong)
• problems with relationships in childhood and
  adulthood
• delinquent behaviour in adolescence and young
  adulthood

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InstitutionsConditions and Quality of Care

• Institutions are often hidden and isolated from
  the community. As a result, there is a lack of
  knowledge in general about what goes on inside.
  Often, poor practice within institutions can go
  unnoticed for years, since children do not have
  access to trusted adults outside the institution
  in whom they might confide about what is
  happening to them.
• The groups of children living in institutions are
  usually subject to discrimination from the wider
  community. Often institutions house children who
  are poor, from minority ethnic groups, have a
  disability, are born outside wedlock, are from
  asylum seeking/immigrant communities or are in
  conflict with the law. These children are usually
  considered less important by society and
  therefore there is less inclination on the part
  of the general public to get involved and to
  ensure that the children are being cared for
  adequately.
• In large institutions with mixed gender and mixed
  age range, younger or smaller children are at
  risk of being physically and sexually abused by
  older children. Such abuses are not uncommon,
  since the older children have also suffered as a
  result of institutionalization and may not
  understand that their behavior is wrong.
• Violence and Abuse such as
• Slapping, hitting with objects, pulling hair,
  burning with cigarettes, sleep deprivation, food
  deprivation, prolonged periods of exhausting and
  painful exercise, involving children in extremely
  heavy work , humiliating children in front of
  others
• Source UNICEF Romania, 2002

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OSMHI Community for All Azerbaijan - De-I
Pilot Project

• Community for all Azerbaijan De-I Pilot
  project to be implemented within 2008-2012 will
  be a model for the discharge of all children from
  boarding schools and for the concurrent
  development of community-based services in
  Azerbaijan to replace institutional care.
• The major purpose of the given project is to
  implement the de-institutionalization (DI) of
  children from the Internat School (Residential
  School) 7, Baku, Surakhani. Therefore, an
  appropriate Memorandum of Understanding signed
  between Open Society Mental Health Initiative and
  the Ministry of Education of Azerbaijan Republic.
  
• The given Memorandum between the Parties is
  signed for developing legislation on Family Based
  Alternatives and National Child Rights Inspection
  System and ensuring the monitoring and
  supervision of community service provision within
  Pilot Project.

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Projects Priority
• Goal(s)
• To contribute to the reform of national child
  welfare system and programs (de-institutionalizati
  on, community based services) in Azerbaijan which
  is expected to improve the lives of children and
  their families in the long perspective.
• Objective(s)
• 1. To contribute to the development of national
  legislation on service provision
• 2. To create quality alternative care services
  responding to the best interests of children in
  need and their families. These alternative care
  services may include but not limited to
• Day Care and Education Services
• Parental Trainings
• Community Based Rehabilitation Services
• Small Group Homes.
• 3. To develop national service provision
  certification system (social work, psycho social
  counseling, case management, rehabilitation,
  special educators, etc.)
• Piloting locations Surakhani district, Sumgayit,
  Baku, Garadag district, Guba, Ismayilli.

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Projects framework and phases 2008-2009
  (beginning)
• Memorandum of Understanding between OSMHI and MoE
• Recruitment of Implementation Team
  multidisciplinary Implementation Team (IT) for
  conducting De-I related activities at Surakhanis
  Boarding School7
• Study Tour with participation of some of IT
  members, MoE officials and other relevant
  organizations to comprehensive community-based
  services for children in Romania and to learn the
  experience in sphere of DI
• Initial assessment of families
• Initial assessment of children
• Moratorium on admissions of children to Internat
  7.

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Initial results of conducted assessment
• Children
• Age range children residents are between 5 to 19
  years old, most of children are between 9 and 14
  years old.
• Reasons for institutionalisation 58 of children
  were placed in the institution because of
  poverty, 28 because of special educational
  needs, 4 because of child protection issues, 3
  because they failed in mainstream education, 3
  because of a disability and 3 because of other
  reasons.
• Family background 29 of children assessed have
  both parents, 53 come from a single parent
  household, 9 come from a single parent living
  with a close relative household, 6 come from a
  household where the parent remarried and 3 lived
  with relatives (extended family).

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Initial results of conducted assessment
• Families
• Living conditions only 7 families have living
  conditions, which were assessed as suitable, and
  do not require improvement. The rest of the
  families assessed require accommodation and
  living conditions improvements ranging from
  securing accommodation, to reconstruction,
  renovation, clarification of legal status as
  owners or tenants, access to utilities, household
  items and furniture.
• Contact with children Out of 62 children who
  spend most of their time in the institution 34
  children are visited often, at least once in two
  weeks, 28 children are visited occasionally
  (couple of times a year).
• Other type of support required 48 families
  require support to improve their parenting skills
  and social relationships with extended family and
  their community. All families require support to
  access medical services, support towards
  integrated education and access to welfare
  services.

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Next phases and framework of the project
• Recommendations based on conducted activities
• Re-assessment of children regarding their Mental
  Health Status
• Preparation of Individual Folio for every
  child/young person to be examined by newly
  created Interdisciplinary Commission
• Recommendation for placement and service
  provision for selected group of 10th grade
  children
• Piloting of Individual Care Plans for 10 selected
  children
• Contribution into the State De-I Program in terms
  of standards development (Individual forms,
  training modules, questionnaires, etc)
• Piloting of Monitoring and Service provision for
  3 children naturally reunified with their
  biological families
• Piloting of Supervision and Monitoring
  models/standards for further placement of
  children

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OSMHI Community for All Azerbaijan- De-I Pilot
Project

• Next phases and framework of the project
• Recommendations based on conducted activities
• Prevention Services
• Gate-keeping
• Day-Care Centers
• Family Support Services
• Crisis intervention both for children and for the
  families
• Primary Health Care
• Recourse networks and information sharing
• Counselling Services
• Development of new professions- Specialized
  Social Workers/Occupational Therapists/Special
  Educators etc