Which are the problem areas in the deinstitutionalization?

2 May, 2012

18 April 2012

Sofia, Bulgaria

Problem areas in the deinstitutionalization and development

of social services for children and families policy and practice in Bulgaria

The National Network for Children (NNC) which is a network of over 100 Bulgarian NGOs working with children and families participates in the deinstitutionalization policy consultation process from the very beginning. During the last years, we – the non-governmental organizations, work actively as create good practices, share with readiness the accumulated experience and have always been available for participation in discussions, working meetings and consultations in support of the government actions in this sphere.

We are deeply concerned about the way the state policy is implemented in the following three areas:

1) The deinstitutionalization projects and the negative trends in these projects: а) The infant homes project; b) Foster care; c) „Childhood for all” and small group home/family-type placement centre;

2) The funding of the social services: the lack of reinvestment of the funds from the closed homes and capacities in the new services. The delegation of the services;

3) The capacity of the system for social assistance and in particular the child protection departments (CPD).

During the last two and a half years from the management of this government, we have firmly supported the policy as a responsible and foreseeable partner. From 2009 to 2012 we have provided at least 30 letters, statements and opinions on the issues of deinstitutionalization and social services development in the structures of the Ministry of Labour and Social Policy (MLSP), the Agency for Social Assistance (ASA) and the State Agency for Child Protection (SACP) and at the same time we have received not more than 10 official responses to our written enquiries on the issues raised. We have participated in a range of working meetings for which we spent a lot of energy, efforts and time and have repeatedly stated our concern about the planning of the projects and the changes in the legislation in the child welfare sphere. However, it’s a fact that the problems become more and more and we couldn’t keep silent or bypass any longer the above mentioned three problem areas in the activities of the MLSP and the operational programme “Development of human resources”.

The commitments undertaken by the state institutions are implemented too slowly, the actions undertaken are not linked with concrete results, neither with the lessons learned from the realized projects, nor with an assessment of the effectiveness of the commitments. Furthermore, during the last few months we observe lack of political will about carrying out reforms and we even witness processes with negative effect upon children and families.

We are deeply concerned by the fact that often representatives of the state and the government make un-backed general conclusions in the public domain with regard to non-governmental organizations (NGOs) and derogate state structures such as the civil organizations. This has effect upon the democratic state in which these organizations are corrective and partner to which we object. If there are offenders to the law, let them be explicitly named no matter if they are local or national authorities or non-governmental organizations. However, we are against the manipulation of the public opinion that the non-governmental organizations are guilty for all problems in the country, consumers, etc.

Stating all of this, we undertake actions with which we will introduce personally to the prime minister Mr. Boiko Borisov and the deputy prime minister Mr. Tzvetan Tzvetanov. We start working on a public campaign for putting pressure on the state institutions on behalf of the European Commission, UNICEF and the UN Committee on the Right of the Child and other stakeholders.

Below are the main arguments for our concern in the above mentioned three problem areas with regard to the concrete policies and practices:

1. The deinstitutionalization projects

Project „I have a family too”, implemented by the Agency for Social Assistance

The main deficit in the implementation of the project is the incorrect planning of its aims and expected results. If as of September 2011 the children placed in foster care are approximately 800 and the project aims further 600, then this sums to a total of 1400 children. If we compare this with the number of children admitted only in the infant homes in 2011, which is 2508, then it turns out that the envisaged aims and objectives won’t meet the need of care even only for the abandoned babies. Furthermore, the project envisages that these 600 children will be placed in 500 foster families. At the same time, there are 86 co-ordinators, 86 accountants, 28 regional co-ordinators and additional approximately 20 people at national level who will implement the project. If we include the number of the hired social workers for the foster care teams, then it turns out that for every foster family, there will be a person hired from the project. This is not only extremely inefficient but also shows that this is not a project for development of foster care but for reduction of unemployment. All this, put in the context of a moratorium of placement of children from 0-3 years old in institutions and residential social services, means that the ASA should put significantly more realistic aims in the implementation of the project “I have a family too”.

The project “I have a family too” and its supporting documentation and guidelines didn’t clarify the role of NGO – service provider. Despite the insistence in the monitoring committee of the operational programme “Development of human resources” (OPDHR) for NGOs to be written as partners in the project, this wasn’t done by the political management of the MLSP. After the announcement of the original intention of the ASA for a possibility to distribute responsibilities and resources between municipality and NGO if the service is provided through a centre for community support or by an association, at the end this wasn’t done. Traditionally, foster care in the country was and is developed by non-governmental organizations and at the moment in practice they are excluded from this process. This service was introduced to Bulgaria following long-term efforts of the civil sector in partnership with the state institutions and the experience of a range of organizations was ignored and undervalued by the political management of the MLSP.

The approach for social services provision in the sphere of foster care on behalf of the local authority is disputable mainly because of the lack of experience and appropriate resources for most of the municipal administrations to work as a provider of such services. This is a heavy task with which the Bulgarian municipalities can hardly manage on their own and the way the service is provided can be ruined.

There are also a number of concerns in relation to the potential development of the project. They are mostly related to the training of the teams, the lack of sufficient time for that, the lack of funds for on-going training and supervision and the insufficient envisaged costs for the project implementation.

The implementation of the project with these parameters won’t lead to the desired results. On the contrary, the isolation of the competent players in the face of NGOs and the lack of sufficient funds for training, supervision and support to the teams risk developing low quality which could lead even to abuse upon the children placed. A potential failure of this project could mean a collapse of the entire deinstitutionalization policy and inefficient use of the European structural funds which Bulgaria is considered as a good example in the European Union.

Recommendations:

Encouraging the collaboration between the local authorities and the non-governmental organizations in the provision of foster care within the project “I have a family too”.
Reviewing the financial conditions of the project so that there’s sufficient financial resource envisaged for training and supervision of the teams, their management as well as the running costs related to the project activities.
Initiating amendments in the legislative framework for the introduction of a special regime for contracting professional foster carers as the specifics of their work doesn’t meet the requirements of the Labor Code mostly with regard to working time and the leaves.
Development and implementation of a financial standard for foster care and delegation of the whole process to NGO who to professionalize in the service provision.
Increasing the understanding of the municipal administrations and the ASA structures about minimum and quality standards in the provision of foster care.

„Childhood for all” project, implemented by the State Agency for Child Protection

There are several problems which the delegated social services for integrated living in the community face currently. The budget for running the services for children with disabilities is entirely insufficient and risks the quality of care for the children placed in small group homes/family-type placement centres. The first monitoring report about the Action plan for deinstitutionalization progress states that the quality of services has increased since the ratio staff-children has increased in favor of the children in the new services. It also says that the ratio in small group homes for children with disabilities is 1:4. The practice of “Cedar” foundation which manages 6 small group homes with delegated by the state budget shows that in some cases the ratio reaches 1:9 or 1:10. The organization manages to maintain a ratio of 1:4 with 15 additional staff members who are funded with own contribution from the foundation.

The monitoring report states that 149 small group homes are envisaged to be built with a capacity of 12 children per home and a possibility for 2 additional emergency placements. We are convinced that “community-based services which are with high quality and respond to their (of the service users) individual needs”[2] can’t be provided with such conditions. Such a capacity in combination with the insufficient funding creates real opportunities to replace the large-scale institutions with small ones.

The relationship with the educational services, mainstream and helping schools should be regulated as soon as possible. Otherwise, even if in a small scale, these children will continue their lives in line with the institutional model.

The action plan and the “Childhood for all” project lack special mentioning and meeting the needs of the children and youngsters with difficult behavior. There’s a lack of strategy, trained professionals and planned measures for dealing with such children and youngsters and ensuring their social inclusion. There’s no culture of understanding and acceptance of these children and young people. It turns out that the only alternative is the institutionalization which not only doesn’t resolve the problem but is a violation of their main human rights.

Recommendations:

Increasing the budget for residential service for children with disabilities running in order to reach an actual 1:4 staff to children ration;
Reviewing the small group home/family-type placement centres capacity and reduction to minimum 8 in line with good European practices;

Planning and implementation of appropriate services for children with difficult behavior.

„DIRECTION: family” project, implemented by the Ministry of Health

The ministry of health (MH) has its own concept for deinstitutionalization of the infant homes. On this basis is developed a pilot project for restructuring of 8 infant homes which should lead to a sustainable model for lasting deinstitutionalization of the children from 0 – 3. The MH together with the Ministry of Regional Development (MRD) will implement this within two projects: about infrastructure of the services and for development with a standard, name and functioning of innovative services. The first (10 million leva) started at the end of July 2011 and the second (Ist component for planning of the services, 2 million leva, 32 months) started at the end of October. The actual service development (IInd component 14,5 million leva) will start where there’s preparation and readiness for that.

In 2011, a preliminary and purely preparatory stage of the project began which is related to the infrastructure changes in the institutions and with the administrative-functional organization of the soft measures. The real work for taking the children out from the infant homes within the pilot project remains delayed in time as it depends on the existence of new services.

At the same time, the services for prevention of abandonment of children up to 3 years in the country are still underdeveloped. 2508 children entered infant homes in 2011 (which is with 299 children more than the previous year) as 63.6% of them are up to a year[3]. In 2011 there still aren’t standard procedures for all neonatology wards for prevention of abandonment of children with disabilities. There isn’t even correct data about the services for prevention of abandonment in country. The question “How many services for prevention of abandonment are running in the country at the end of June 2011?” is answered by the ASA with the following: „The mother receives financial support and is consulted about the social services provided in the community. One of the possibilities is a placement in the social service “Mother and baby”.

At this stage it’s not clear if the projects aimed at closure of the pilot infant homes the non-governmental organizations will be identified as service-providers for the new social-health services. It’s only pointed out that the services will be provided by the Municipalities. As a whole, the central state institutions put in a privileged position the municipalities over the non-governmental organizations service providers in the preparation of the mechanisms and the projects for deinstitutionalization. This fact often creates tension at local level and leads to loss of valuable resources.

Apart from the pilot 8 infant homes which are part of the MH project attention should be paid to the successful practices of a pilot closure of an infant home with the collaboration of a NGO. The infant home in Teteven was closed with the help of “Equilibrium” and “Hope and homes for children” organisations. “For our children” foundation actively works for prevention of placement of babies developing foster care and support to parents in the infant home “Sveta Sofia” in Sofia. A pilot closure of a big infant home is currently undertaken in Shumen where with the support of UNICEF are working SAPI and “Child and space” association. There are services at the maternity ward level, services supporting families and foster care for babies. For less than a year the number of children in the home is reduced almost half (from 107 to 60). This reduction is achieved before the development of new services only through the improvement of the co-ordination between state, municipal and NGO structures.

Recommendations:

The Ministry of health should improve the organization of the work of the project and take into consideration the good practices implemented in infant homes from various non-governmental organizations.
To develop a mechanism for the non-governmental organizations to participate more actively in the project so that the necessary sustainability and quality of the community-based services is secured.

2. Funding of the social services: the lack of reinvestment of funds from the closed institutions and capacities in the new services. Delegation of the services. Operational programme “Development of human resources” (OPDHR)

„The saved” finances

The saved finances from the reduced capacities or closure of schools and specialized institutions are lost in the general budget and are not invested in children’s policies. There’s a lack of a mechanism for transferring these finances from the institutions towards the community-based services. The opening of state delegated community-based social services is extremely slow and for a year and a half (2010- 06.2011) it amounts to 4 861 006 leva with which are served 957 children and adults in the community out of which 644 places are for direct work in the community. It’s necessary to speed up the process of delegation and opening of new services which to contribute to prevention of abandonment and support the reintegration of children in the community. In addition, we suggest that a comprehensive financial analysis for “the savings of financial resources” in the child welfare system is carried out. The data shows that with the closure and reduction of capacities of specialized institutions there’s a difference of 9 069 929 leva for the period 2009 and 2010. When the sum for the delegated social services (4 861 006) is taken out from this sum, it turns out that almost 4 208 923 leva are lost / saved in the state budget and these funds are not invested back in the state delegated services for children and families. If this is analyzed from the period in 2003, then it could turns out that the saved finances from closure of capacities of institutions haven’t been invested in social services and the sum could be a huge loss for the vulnerable groups of children.

Recommendations:

Preparation of a financial analyses for the saved finances from the reduced capacities of the institutions;
Preparation of a mechanism for transferring the funds from the institutions to the social services in the community.

Delegation of services

Bulgaria started the development of alternative services for children with a loan from the World Bank which was accompanied with a number of legislative reforms 11 years ago. The indisputable success of this process was that the non-governmental organizations which were providing services funded by different donors were included as service providers. The possibility for NGOs to become service providers with delegated from the state funds was given as a good practice example to the countries from Central and Eastern Europe. However, recently there’s a trend in the opposite direction. The programmes and projects of the Agency for Social Assistance and the Ministry of Labor and Social Policy obligate more and more activities to the municipalities and the NGOs are excluded from the service provision.

The signals which the National Network for Children receives from the whole country show that the ASA employees informally encourage municipalities to stop delegating services to NGOs. This creates bigger and bigger tension at local level and the good practice is to become history. Such an unreasonable approach leads to dropping the quality and most probably there will be an exodus of specialists in which professional development a lot of investments were made. From all 10 complexes for social services only 5 are managed by non-governmental organizations. There isn’t an analysis how these services are managed both financially and methodologically on behalf of NGOs as well as municipalities.

The debate who is better provider – the municipalities or NGOs don’t lead to a beneficial way out of the situation as the ASA hasn’t developed a mechanism for monitoring the quality of social services for children and families. These debates only lead to confrontation between the service providers. The regulation of the social services for children and families market should be done as soon as possible as there’s a waste of state funds without guarantee for the necessary quality.

Recommendations:

Development of a mechanism for monitoring of the social services for children and families quality which is oriented towards the results and allows comparison of the work of different service providers. Licensing of all providers and certification of the providers according to the quality of the services they provide.
Introduction of a mechanism for prevention of “savings” from the services for children and distribution of the transitional rests.
Engagement of the experienced players in the face of non-governmental organizations in the provision of social services for children and families.

Operational programme “Development of human resources” (OPDHR)

There aren’t operations under the OPDHR Няма операции по ОПРЧР which to fund NGOs for implementation of their activities for children and families at risk. From 107 million euro provided from the European structural funds in the area of deinstitutionalization, there isn’t a single lev allocated to civil organizations that have closed homes and have taken children from the damaging institutions.

Until now, there are 4 institutions closed with the main role and participation of Bulgarian non-governmental organizations.

Recommendations:

Preparation of a mechanism which allows civil organizations not only to participate in the Monitoring Committee of OPDHR but also development of operations and application guidelines;
Review of the legislation and preparation of suggestions for changes with the view to simplify the mechanisms and more effective use of financial resources under the OPDHR;
Removing the condition for binding the administrative costs and their percentage proportion from the realized budget. As a whole, the requirements for administrative costs should be reviewed as they cause loss to the administration and the entire implementation of the projects.

3. Capacity of the “Social assistance” system and in particular the Child protection departments (CPD).

The social assistance system in the country is in crisis. It’s necessary to approve a minimum common understanding about the essence of social work with children, its values and develop standards on this basis.

The data about overload of social workers undoubtedly show the urgent need from introduction of social work standards and strengthening the capacity of the Child protection departments in the country. The public status of the profession is low, the remuneration – extremely insufficient, there’s lack of adequate forms of support to the teams such as regular supervision and trainings which increases the risk of professional burn-out of the workers.

Despite the start of the project for strengthening the capacity of the ASA, at the end of the year there still aren’t standards about social work in terms of workload and number of cases per social worker. The social workers continue working with a huge overload and extreme shortage of all types of resources. The data is 124 signals per social worker for 2010 and 112 cases for 2008.

Recommendations:

The development of standards for social work with children should become urgent task which shouldn’t be delayed any more. There should be a working group which stepping on the basis of the already done proposals to develop a concept for national consultation and approval;
Increasing the capacity of CPD though increasing the number of social workers, securing better remuneration and introduction of forms for support an trainings to the teams;
Civil organizations, which traditionally run trainings and supervision to CPD and social work specialists, should be included in the process of development and testing of standards;
The professional standard (the competences which the social workers should possess) should be introduced to all educational institutions which prepare specialists in this sphere so that they could meet the criteria.

[1] On April 17^th the National Network for Children conducted a meeting with Totyu Mladenov, the minister of labour and social policy of Bulgaria. The current statement was presented at this meeting posing acutely the question for the problematic areas in the deinstitutionalization process and in the development of the social services for children and families in the country. The chair of the State Agency for Child protection – Mr. Kalin Kamenov and the deputy executive director of the Agency for Social Assistance – Ms. Darinka Yankova also were at the meeting .

[2] Action plan for implementation of the national strategy “Vision for deinstitutionalisation of Republic of Bulgaria”, Chapter III, Scope

[3] National statistical institute, Homes for medico-social care in 2011.

Photo: flickr/Abee5