DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 1 DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES

Final report

Joanna Rogers and Volodymyr Kuzminskyi and data collection: Daulet Serikbay

In association with: Partnership for Every Child (P4EC) CEE/CIS Consultancy Group

February 2016

2 The opinion expressed in this publication are those of the authors and do not necessarily reflect the views of UNICEF in Kazakhstan.

People and objects in the photographs used in this publication does not necessarily reflect the content of this report.

The designations employed in this publication and the presentation of the materials do not imply on the part of UNICEF the expression of any opinion whatsoever concerning the legal status of children in Kazakhstan or of any country or territory, or of its authorities, or the delamination of its boundaries. Any information from this publication may be freely reproduced, but proper acknowledgement of the source must be provided.

The publication is not for sale.

United Nations Children’s Fund (UNICEF) in the Republic of Kazakhstan 10- A, Beibitshilik Str. Astana, Republic of Kazakhstan, 010000 Tel: +7 (7172) 32 17 97, 32 29 69, 32 28 78 Fax: +7 (7172) 32 18 03 www.unicef.kz www.unicef.org

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 3 List of tables and figures

Table 3.1 Inquire Framework for the Assignment...... 15 Table 3.2 Summary of Indicators Identified for Use in Assessing Effectiveness of Child and Family Support Services: national, regional and city level...... 16 Table 3.3 Number of Participants in Fieldwork Interviews, Meetings, Consultations and Focus Group Discussions...... 17 Table 3.4 Number of Organizations Taking Part in Various Types of Documentation Activities During Fieldwork...... 18 Table 4.1 Types of Services Provided by NGOs Based in Semey and Oskemen/Ust-Kamenogorsk...... 22 Table 4.2 Number of Children with Disabilities in Kazakhstan Using Residential and Day-care Services, 2009 – 2014...... 26 Table 4.3 Accompaniment Service Data from Oskemen/Ust-Kamenogorsk Child and Family Support Centre, 2008 – 2015...... 33 Table 4.4 Costing of U-K Children and Family Support Centre...... 36 Table 5.1 Summary of Progress and Results for Two Promising Practices...... 51

Figure 4.1 Family Support Services in East Kazakhstan Oblast Identified During Fieldwork...... 20

Figure 4.2 Child Population in East Kazakhstan Oblast, 2014...... 21

Figure 4.3 Results of Reforming the System of Social Services 2009–201...... 25

Figure 4.4 Case Management Processes in Accompaniment Services U-K CFSC...... 32

Figure 5.1 Number of Children Without Parental Care per 100,000 Child Population Aged 0-17 Years

in Kazakhstan and Regions 2010–2014...... 42

Figure 5.2 Number of Children Without Parental Care in Guardianship, Patronat Care and Residential Care in 2014...... 43

Figure 5.3 Number of Children Without Parental Care in Guardianship, Patronat Care and

Residential Care per 100,000 Child Population in 2012...... 44

Figure 5.4 Proportion of Children Without Parental Care per 100,000 Child Population Aged 0-17 Years

in EKO Districts, 2012–2014...... 45

Figure 5.5 Children Without Parental Care Living in Guardianship or Patronat Placement in EKO Districts, 2012–2014...... 46

Figure 5.6 Number of Children in Infant Homes at the End of the Year in Kazakhstan, 2010–2014...... 47

Figure 5.7 Number of Children in Infant Homes at the End of the Year in EKO

and Selected Regions of Kazakhstan, 2010–2014...... 47

Figure 5.8 Number of Children With an Episode of Care in an Infant Home During Each Year (N) = Number of Children

Who Left During the Year Plus the Number Who Remained at the End of the Year...... 48

Figure 5.9 Number of Children Entering an Infant Home Each Year Following Abandonment

or Relinquishment in the Maternity Hospital or From Home, or For Temporary Placement, 2012–October 2015...... 49

Figure 5.10 Number of Children Each Year Exiting an Infant Home for Adoption,

Reintegration or Other Types of Care Placement, 2012–October 2015...... 50

4 Abbreviations

CAM Centre for the Adaptation of Minors (in Russian TsAN - Tsentr Adaptatsii Nesovershenoletnikh) CCRP Committee on Child Rights Protection CMA Commission of Minors’ Affairs and Protection of their Rights EKO East Kazakhstan Oblast MHSD Ministry of Healthcare and Social Development MNE Ministry of National Economy MoE Ministry of Education MSI Medical Social Institution (in Russian MSU – Meditsinskoe Sotsialnoe Uchrezhdenie) NGO Non-government Organization PMPK Psychological Medical Pedagogical Consultation PMSP Primary Medical Sanitary Post or Primary Medical and Health Service (which includes all forms of community-based primary health care provision – polyclinics, hospitals, maternity hospitals, perinatal clinics and health centres) ToR Terms of Reference U-K CFSC Oskemen/Ust-Kamenogorsk Child and Family Support Centre

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 5 Contents

List of tables and figures...... 4 Abbreviations...... 5 Executive summary...... 7 1 Introduction...... 10 2 Objective of the assignment...... 11 3 Methodology...... 14 3.1 Methodological approach...... 14 3.2 Description of the respondents to the inquiry...... 17 3.3 Data limitations...... 18 4 Description of family support service practices identified during fieldwork...... 19 4.1 East Kazakhstan Oblast family support service network...... 19 4.2 Strategy and implementation – two family support centres in Semey and Oskemen/Ust-Kamenogorsk...... 29 5 Progress and results...... 42 6 Lessons learnt and recommendations...... 52 7 Bibliography...... 57 Annex A Case study from other promising practice, adapted from materials provided by service providers....58

6 Executive summary

Introduction This report presents the findings, conclusions and parental care and orphans as potential beneficiaries of recommendations of an exercise to document the services (among children in difficult life situations, children experience of East Kazakhstan Oblast (EKO) in establishing with health problems and victims of violence) but Order family support services. This was not an evaluation, but a No. 165 of 26 March 2015, on Standards in Special Social documentation exercise that included a desk review and field Services, only describes services for children and adults work in Oskemen/Ust-Kamenogorsk and Semey in October with disabilities and their families. 2015. The report defines family support in relation to EKO identified 39 organizations providing family international practice and the Kazakhstan institutional and support services to children and their families during the legislative framework and uses these definitions to identify documentation exercise; 13 of these organizations are NGOs and document promising practices, to make an assessment and 26 are state service providers, including 22 children’s of their effectiveness and to provide recommendations for homes, Centres for the Adaptation of Minors (CAM), shelters, further development of family support services. Youth Houses and other residential care facilities. It was The approach to documenting family support services not possible within the scope of this inquiry to carry out a included: administering a questionnaire to service providers comprehensive survey and it is likely that there are more in order to map the supply side of service provision; state organizations and NGOs providing family support gathering data for eight key indicators from authorities services within EKO. in order to examine the demand side of service provision 11 NGOs completed the supply-side questionnaire and and whether an effect can be seen on the level of demand indicated that they are mainly providing psychological for services; interviews and group consultations with 95 support, information, consultation, social integration respondents in EKO, including focus groups with 17 parents and rehabilitation services to children and adults with and discussions with 54 social workers and other frontline disabilities, and to families with children (including young staff from NGOs and state service providing organizations; children and many children). A few NGOs say that they and visits to service-providing organizations, where service provide crisis intervention, legal advice, social assistance data and case management systems and files were reviewed, or material support and almost none say that they provide observations conducted and case studies documented outreach services in the homes of their service users or that they provide services to children without parental care, with parents in prison or other socially at risk children. Summary of main findings EKO, Semey and Oskemen/Ust-Kamenogorsk city A review of key government policies, legislation and authorities report an extensive network of health, the institutional framework relevant to family support education and police services that may contain some services showed that there is no clear definition of family elements of family support, although it is unclear to what support currently being used in Kazakhstan. The Law on extent these are accessible for children who are most at Special Social Services identifies children at risk of social risk of separation from their families or for children with deprivation or social disadaptation, children without disabilities. Nor is it clear whether these services are

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 7 focused on the goal of supporting families and preventing to state conclusively whether they have had an impact separation. The network of residential facilities providing on reducing levels of child and family separation. It social care or education to children in EKO has created seems likely that that they may be having an impact on ‘family support services’, but these largely operate in strengthening families, as service data shows high levels of name only. Some examples of promising practice have success in preventing separation in both services, but it is been identified, in trying to help families address their less clear whether they are targeting children and families problems or in trying to facilitate foster care placements most at risk of separation. It is also not entirely clear in a chlidren’s home and in one of EKO’s CAM, but these whether these services have explicit objectives to prevent cannot be described as family support services. They children from losing parental care. With better targeting provide only some limited elements of the types of services and strengthened methods, both of these services have the that could be considered family support services, according potential to reduce the number of children losing parental to international definitions used for this assessment. For care. Disaggregated data is required to better monitor example, support in claiming benefits and solving issues effectiveness. of registration, or other aspects of social administration, Focus groups with parents suggest that the NGO Family is provided in the CAM and to a limited extent to some Support Centre in Semey is providing much needed practical families in the children’s home. The children’s home also support with legal issues, social assistance, employment provides some support to children from the children’s home support and crisis intervention. Parents in Oskemen/Ust- who have been placed into foster care or guardianship or Kamenogorsk report that the Accompaniment service has who have returned home, but this support is limited in helped them to feel protected, safe and able to better scope and nature. In both cases, promising practices have care for their children. Parents of children with disabilities been developed and are being provided by staff who have greatly value the highly professional day-care services full-time duties and responsibilities for other tasks within provided by the state run rehabiliation centre for children the facility. Some promising practices were also identified with disabilities in Oskemen/Ust-Kamenogorsk. at Semey NGO Family Support Centre and at some NGOs and state organizations providing services to children Gaps in services include emergency family-based care with disabilities and their families. Overall, two promising and day-care provision for infants and babies whose practices in family support were identified as developed families are experiencing difficulties. and effective enough to help inform further development of similar family support services in EKO and across other regions of Kazakhstan: • The Accompaniment service at the Oskemen/Ust- Kamenogorsk Child and Family Support Centre (U-K CFSC); and • The social worker and psychologist teams attached to Semey Primary Sanitary Medical Posts (PSMP), maternity hospitals, hospitals and other medical services in Semey City. Sections 4.2.1 and 4.2.3 of this report describe the promising practices of these two family support services, present their results, identify areas in need of strengthening and offer an assessment of the effectiveness of services in achieving their objectives in strengthening families and preventing separation. The data that became available in relation to eight indicators and sixteen sub-sets of indicators during fieldwork does not provide sufficiently disaggregated information about the effectiveness of these two promising practices in relation to preventing loss of parental care for their target populations of children. It is not possible

8 Lessons learned, conclusions and recommendations

1. More systematic monitoring and rigorous evaluation effectively targeting specific vulnerable groups. Where is required if promising practices in family support are to funding and resources have been allocated to the PMSP be properly understood, in order to be further developed in Semey and to the Oskemen/Ust-Kamenogorsk Child and and replicated Family Support Centre, promising family support practices This review has identified two promising practices: have emerged. Allocation of additional staff, to develop and implement new services, is essential. The ‘family • PSMP integrated community-based social worker/ support services’ supposedly developing in children’s paediatrician/psychologist teams focused on prevention homes and CAM are not really developing at all, because of infant abandonment or relinquishment; and these functions have been assigned to staff who already • The U-K CFSC Accompaniment Service. have a range of other responsibilities and functions within However, lack of data means that it has not been the institution. Without additional funding and setting possible to identify conclusively the impact of their work on up clear organizational structures, these services will not preventing loss of parental care for children. Both services begin to develop at any effective level. It is possible for require strengthening, but appear to have potential for NGOs to develop family support services of all kinds – as wide dissemination. evidenced by the elements of promising family support practices emerging in disability NGOs and in the Semey There is a need for systematic gathering and monitoring NGO Family Support Service – however, they need steady of disaggregated data for each of the eight groups of and reliable sources of funding in order to be strategic and indicators identified for this review – by district of origin effective in developing these services. NGOs also need to as well as by age and disability – in order to identify more be able to hire professional staff to deliver effective and conclusively, how far populations being served by specific high quality services and to have a space from which to family support services are being prevented from losing operate their services. The costs of office rental, or other parental care. space where day-care or group services are provided, need to be permissible expenses in grants to NGOs if they 2. Family support services delivered by either are to be encouraged to develop family support services. NGOs or state service providers need to be able Mechanisms need to be found to ensure that family support to work across sectoral silos services, whether run by NGOs or state providers, can cover the costs of transport associated with making home visits Government service providers may require strong and and the costs of communicating by telephone with families formally constituted inter-sectoral commissions or bodies who are receiving support.. to support case management and co-ordination of service delivery. NGOs may find it easier to operate flexibly across 4. Capacity building and technical support is education, health, employment and housing than state essential organizations rooted in a particular sector. Capacity building is needed to help local organizations 3. Human and other resources, such as develop and strengthen their methods, based on national transport, office space and communications, are and international promising practices. Strongly evidence- essential for the development of family support based training in methods of supporting families to change behaviours and to meet the needs of their children can be services effective in sowing the seeds for locally adapted social Irrespective of whether services are being developed or work practices, to support families in a way relevant to delivered by an NGO or a state organization, there is a need local situations. Relevant methods include basic social to ensure funding for salaries and transport and for a space work practice, such as case management, and individual to operate from, in order for family support services to assessment based on thorough understanding of children’s emerge in a sustainable way. The Semey NGO Family Support needs and family ability to meet needs, as well as Centre does not have stable funding, but has managed to community social work. Individual and group training and develop some promising practices highly valued by parents, education programmes for parents, therapeutic approaches with funding it has managed to access. Longer-term service to addressing trauma following abuse, neglect or violence, development grants and training could help to ensure more and effective methods for working with families with systematic development of family support services, more

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 9 addictive behaviours could also be relevant. Specialist whose families are experiencing difficulties. These types of training is required to work with potential or existing services need to be developed in a regulated and systematic foster carers and guardians, as well as with children who way to ensure high quality service delivery. Grants to have lost parental care and who have experienced violence, NGOs with carefully crafted terms of reference and calls abuse or neglect by parents, and children who have been for proposals are a good way for regional governments to in long-term institutional care. This training must include stimulate development of such services. knowledge, skills and competencies relevant to early 7. Family support services need to be childhood development, including attachment theory and developed in districts ‘feeding’ children to other important theories relating to child development, residential institutions in Semey, Oskemen/Ust- trauma and resilience. In addition, training for working with children with disabilities is also relevant, encompassing Kamenogorsk and other districts of EKO a bio-psycho-social understanding of disability, the An immediate priority should be to train PMSP teams International Classification of Functioning, and the UN in other districts of EKO using the Semey model. The U-K Convention on the Rights of People with Disabilities.. CFSC Accompaniment Service can also be replicated; the methods, service specifications and case management 5. Service user participation in monitoring approach are sound enough to produce positive results and evaluation is essential to ensure relevance if replicated by organizations with sufficient resources to and effectiveness of services being developed. employ qualified staff trained to deliver services in their Parental participation in focus groups has given districts to children and families most likely to end up important insight into the services needed by families and being referred to residential care. the services that will enable them to care for their children with disabilities at home, namely those that: • Treat them as valued human beings; Вы • Assess their needs and provide flexible packages of support to meet those needs; • Take time and care to assess functioning and are staffed by professionals; and • Include parents in decision-making about health, education and social support provision. • These types of services can be developed through targeted grants for NGOs as well as through the application of standards.

6. Gaps in services include lack of family- based emergency care for babies and infants and lack of day or nursery care for babies and infants whose families are experiencing difficulties Temporary’ placement into residential care for infants and babies is being used in the absence of these services and this practice needs to be challenged and stopped. Emergency foster care and a range of day-care models can be developed instead. Child-minding services can provide cost-effective and high quality day-care while also providing employment opportunities for women (and men) with their own young children at home. NGOs can be encouraged to develop day-care services not only for children with disabilities but for babies and young children

10 Conclusions This review has identified two promising family support practices and elements of other promising practice in a range of settings in EKO. If UNICEF intends to support the further development of the PSMP Integrated Service there is a need to ensure that the service is developed with the understanding that referrals into an infant home must be a measure of last resort and that alternatives exist to providing emergency short-term care for children at risk and to providing day- care services for babies and young children. The further development of family support services in EKO can be achieved by supporting the further development of the U-K CFSC Accompaniment Service and by supporting the EKO Administration to make more strategic use of its grant programme to support the Semey NGO Family Support Centre and the development of other priority NGO services in the two main cities and in more remote districts. This would include capacity building of NGOs as current and future service providers. UNICEF could support this process by ensuring that training and technical assistance is provided to NGOs who are awarded family support service development grants or supporting the EKO Administration to develop mechanisms for providing capacity building and training to NGOs. The U-K CFSC should ideally be supported to conduct a case review and to fine-tune its practice. Ultimately, it cannot start to achieve real impact on the numbers of children without parental care in Oskemen/Ust-Kamenogorsk until a strategic decision is taken by the EKO Administration to extend family support services across every district of the oblast and permit the U-K CFSC to dedicate all its resources and capacity to developing its Accompaniment Service, instead of the 20% of time and resources currently dedicated to this service, and to supporting rayons to develop their own family support and Accompaniment Services. The existing EKO child protection and social services monitoring system needs to be adjusted to be able to capture disaggregated data that can demonstrate the effectiveness of family support services.

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 11 1 Introduction

The development of family support services in East which children and young people were temporarily placed Kazakhstan Oblast (EKO) in the period 2010-2015 has been when picked up from the streets or when removed for their taking place in a policy environment, where regional and own safety from the care of their family. The newly named local authorities have been encouraged, through a range of Centres for the Adaptation of Minors (CAM) were moved from legislative and policy initiatives, to develop family support police jurisdiction to that of local education departments; services and other specialized social services. There are police in uniforms were replaced by staff with socio- several policies and elements of legislation that, taken pedagogical or social work functions, who were also tasked together, represent a government strategy, which is working with establishing ‘child and family support services’. In the towards strengthened family support and community-based same year, the EKO Administration formally established care services, as well as the development of alternative ‘Child and Family Support Services’ on a volunteer basis5 family-based care and deinstitutionalization of children’s at all children’s homes and other types of residential care services. These policies aim to: care facilities. These services were mandated to work on reintegration of children with their birth or extended • Strengthen families and family traditions1; family and to place children into alternative family-based • Provide targeted social assistance to low-income care, where reintegration or kinship care options are not households2; possible. A public campaign, ‘Second Chance’, was launched 6 • Support the emergence of NGOs delivering social to help find relatives or recruit ‘patronat’ carers for children services3; in residential care. • Encourage alternative family placements for At around the same time, the Division of Education children without parental care in residential care4; of the City of Oskemen/Ust-Kamenogorsk, with technical support from UNICEF, established the Oskemen/Ust- • Change police temporary holding centres into Kamenogorsk Family and Child Support Centre and Semey Centres for the Adaptation of Minors; and City government began to develop services focused on • Develop integrated social services and child infants and young children through the City Health Division protection. and the city network of Primary Medical Sanitary Posts (PMSP). Both oblast and city administrations began to UNICEF Kazakhstan has been an active partner to the encourage and support non-governmental organizations to Government in developing and implementing many of provide social services from 2009 onwards, when the Law these programmes and initiatives. This report documents on Special Social Services came into force. child and family support services within this wider context. This report maps the network of services currently Interviews with staff and service managers in East active in EKO, documents family support practices that have Kazakhstan confirm that 2011 was a watershed year in the developed in some of these organizations, and assesses the reform of social support services for children and families. extent to which these services have been and continue to This was the year when the EKO Administration reorganized be effective in supporting families to care for their children its system of police-run temporary holding facilities, in and to prevent child and family separation. 1 National plan of action to strengthen family relations, and moral-ethical and spiritual values, in the Republic of Kazakhstan, 2015-2020 2 Social Development Concept 2030, Government Order No. 396, of 24 April 2014 3 Law on Special Social Services, 2008 4 Note for 2015 on the state social order ‘Creation of Services to Support Families in Difficult Life 5 ‘na obshestvenikh nachalakh’ Situations’ (mimeo, UNICEF Kazakhstan) 6 ‘patronat’ is the term used for foster care in Kazakhstan

10 2 Objective of the assignment

According to the ToR, the main focus of this assignment Definition of family support was to document any promising practices in family UNICEF’s Social Protection Framework (2012) defines support that have been developed in Oskemen/Ust- family support as activities to strengthen and preserve families, Kamenogorsk and Semey, and assess their effectiveness prevent separation of children from parents and ensure early and relevance in meeting the needs of children and intervention in families at risk. In UNICEF’s ‘Family and Parenting families, and ensuring lasting impact on the realization Support’ (2015) the following definitions are offered, based on a of children’s rights. The consultant team was expected to review of policies and programmes around the world: document existing services, and identify gaps, as well as Family support is a set of (service and other) activities potential costings to remedy these gaps. It was anticipated oriented towards improving family functioning and that findings in these areas could inform comparative grounding child-rearing and other familial activities in a analysis through secondary data sources of the system of supportive relationships and resources (both effectiveness of the family support services established formal and informal). in East Kazakhstan and other family support practices in Parenting support is a set of (service and other) activities Kazakhstan and internationally. oriented to improving how parents approach and execute Key research questions specified in the ToR were: their role as parents and to increasing parents’ child-rearing resources (including information, knowledge, skills and 1. What relevance do family support services have to social support) and competencies. the needs of families and children? 2. How effective are family support services in addressing family needs and child rights? The UN Guidelines for the Alternative Care for Children (welcomed by the UN General Assembly in 2009) define two 3. How effective are family support services key principles that should inform any decision-making about compared to other services in Kazakhstan, and alternative care for children: the necessity principle and the international best practice? suitability principle. Decision-makers should be sure that all measures are taken to support families and to ensure that 4. Do the establishment of family support centres children do not leave the care of their families unnecessarily. result in lasting change in favour of children’s Family support can therefore be seen as a way of preventing rights? unnecessary separation of children from their families and 5. How much does it cost to launch and operate a should incorporate a range of measures, including family family support service centre, depending on the strengthening services, day-care and respite care services, and target group/per child, high/low risk etc.)? practical and advisory support. 6. Which services (not covered by family support centers) are still needed for child protection at local level?

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 11 Source: From Theory to Practice, Implementing the Alternative Care Guidelines, Cantwell et al., 2013

12 There is no clear definition of family support in Kazakhstan’s national policy framework, but the briefing note for 2015 relating to the state social order ‘Creation of Family Support Services, For Families in Difficult Life Circumstances’ (mimeo, UNICEF), states a need to ‘create a mechanism for the prevention of family ill-being at an early stage and a system for providing professional psychological support to children and families in a difficult life situation’. The expected result is prevention of separation of children from families experiencing difficulties and facilitation of reintegration of children in state care into their families. During fieldwork carried out as part of this assignment, it became clear that respondents at all levels understand the meaning of family support in different ways. One infant home director in Astana confirms ‘there are different ways of understanding the development of the child in the family’. For the purpose of analysing the data collected during fieldwork, family support services are considered to be: • Services formally created (on a volunteer basis) in children’s homes, internats, and Centres for the Adaptation of Minors (CAM) across Kazakhstan and are called ‘Family Support Services’; • The two family support centres that are the main focus of this review; • Organizations providing non-residential day-care services for children; • Organizations providing non-residential psycho- social or pedagogical-social services for children with disabilities and their parents; and • Organizations providing outreach social work services to families with children who are experiencing difficulties. • Promising practices in family support are considered to be those that: • Are based on professionally delivered comprehensive assessment of children’s needs and the capacity of the family, and of the formal and informal is their contribution to strengthened families, prevention structures in the immediate family environment to meet of separation of children from their families and reduced those needs; reliance on institutional care for children. • Are rooted in a systematic approach to working in partnership with families, to overcome problems, to improve care or the capacity of parents to provide adequate care, and to ensure that children’s needs are being met; and Prevent unnecessary separation of children from parents. The ultimate measure of the effectiveness of these promising practices, as defined in the ToR for this assignment,

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 13 3 Methodology

3.1 Methodological approach This assignment was not intended to be an evaluation, target beneficiaries and the cost of service delivery. The but rather a review aimed at learning lessons from the level of need, or demand, for family support and prevention experiences of establishing family support services in services was assessed using data for key indicators, provided Kazakhstan, to inform further development of family support by local and regional authorities and gathered from the services and to document promising practice in two services files of the EKO Child Protection Unit (the Guardianship and in Oskemen/Ust-Kamenogorsk and Semey. These services Trustreeship Organ) in the Education Department. are viewed by UNICEF as offering promising practices, elements of which can potentially serve as models for further 2. Interviews with key informants, including decision- replication: hence the need to document – both to ascertain makers and specialists from national, oblast and city level the extent to which practices are ‘promising’ and to provide NGOs and government bodies relevant to child protection evidence to support arguments for replication. The aim of and family support. These interviews mainly took the form this documentation assignment is essentially to provide a of group consultations, with two or more respondents form of expert peer review, including comparative analysis participating. Interviews explored further the supply and with other promising practices nationally and internationally demand for services, including requests for data related to as far as possible, to help ensure that family support practices the eight core indicators and their sub-categories. Focus effective in prevention are advocated for replication. groups were also conducted with parents or carers who are users or potential users of family support services. At the outset of the assignment, an inquiry framework – summarised in Table 3.1 – was developed and agreed with 3. Visits to family support services, including interviews, UNICEF. This framework subsequently guided both the desk observation and documentation review. The intention was to review and the fieldwork elements of the inquiry. focus primarily on the two main family support centres that were the subject of this documentation assignment. However, The desk review and fieldwork aimed to triangulate data visits were also made to several other family support services, from several sources and a range of perspectives, to document in both Semey and Oskemen/Ust-Kamenogorsk. existing family support services and to provide an assessment of their relevance, effectiveness and sustainability. Primary Costing data was mainly captured through the supply side data was obtained through interviews with national, oblast questionnaire. and city authorities: social service organization (state and NGO) managers and staff and focus groups, alongside service users, including parents, grandparents and foster carers. Secondary data, including statistical data relating to the child protection system, was gathered from reports provided by UNICEF and their government counterparts: official information from key stakeholders, including the Committee on the Rights of the Child of the Ministry of Education, the EKO Adminstration and from social services providers themselves. The final sample of interviewees and data collected is described below, in section 3.2. The main elements of our methodology included: 1. Supply and demand side system analysis. We administered a supply-side questionnaire to service providers, exploring the types of services they provide, their

14 Table 3.1 Inquire Framework for the Assignment

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 15 The indicators (see Table 3.2) for quantitative data support and prevention services; and analysis were selected following a desk review, based on • The extent to which data for monitoring these two key criteria: indicators is already gathered in a systematic way and • Usefulness in assessing the effectiveness of family could be accessed by the consultant team.

Table 3.2 Summary of Indicators Identified for Use in Assessing Effectiveness of Child and Family Support Services: national, regional and city level

16 The indicators focus on: a) the whole child population; to the whole child population at national and oblast levels, but b) young children (aged 0-3 years); and c) children with not at city level. The eighth indicator was the most problematic, disabilities. The latter two groups comprise children most because no regular monitoring is carried out by the Government vulnerable to loss of parental care. 17 The main focus of the or any other organization in relation to preventative services integrated model of child and family services in Semey was for children at risk of losing parental care. Some disaggregated on the prevention of abandonment or relinquishment of data was available for some of the indicators at national children aged 0-3 years; the two sub-groups – young children and oblast level relating to children with disabilities and to and children with disabilities – are also the central focus of children aged 0-3 years, but was, nevertheless, insufficient government policies on family support and prevention of loss to draw robust conclusions about the extent to which these of parental care.82 groups are receiving relevant and effective services. Data was available for nearly all of the indicators relating 71 See, for example, ‘Children Under Three in Formal Care in Eastern Europe and Central Asia, UNICEF, 2013’ http://www.unicef.org/ceecis/UNICEF_Report_Children_Under_3_2013_ ammended_January_2013_Web.pdf 82 See, for example, the Alternative Report on Implementation of the CRC, 2014 and the Ministry of Health and Social Development competition for best social projects

3.2 Description of the respondents to the inquiry

Table 3.3 summarises the number of respondents of 95 people were consulted, including 17 parents and 54 who contributed to this report through individual or social workers or other frontline staff, from both NGOs and group interviews or consultations, through completing state service providing organizations. questionnaires and/or by providing quantitative data. A total

Table 3.3 Number of Participants in Fieldwork Interviews, Meetings, Consultations and Focus Group Discussions

A total of 16 supply side questionnaires were completed, to identify and document promising practice, including case although not all those who responded provided costing management and case work documentation and case studies. information. Interviews and visits to service providers The final sample of data collected, apart from quantitative generated a range of other types of data, which has been used data, is summarised in Table 3.4

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 17 Table 3.4 Number of Organizations Taking Part in Various Types of Documentation Activities During Fieldwork

129

9 Includes one NGO outside of EKO

3.3 Data limitations

Quantitative data was gathered from a range of noting changes over time, but should not be relied upon sources at national, regional and local level, including as ‘hard’ data. directly from service providers. Many of these sources Qualitative data gathered through interviews and report different figures for the same indicators and the consultations has provided rich material for documenting same years. It is possible that these discrepancies may be family support services in EKO but, in many cases, the result of adjustments made at the time when official managers and staff members of service providing reports were filed and/or when data was aggregated, organizations were present during discussions with at city and oblast levels respectively. However, it seems parents about their work. Similarly, managers from city or more likely this is the result of poorly defined indicators. oblast administration departments were present at some For example, children aged 18 years are included in data meetings with service providers. This is likely to have populations for children aged 0-17 years. Notably, child influenced the way in which participants responded to population data for 0-17 year olds is difficult to determine questions. In cases where researchers noted the presence accurately, as the standard approach to recording child of staff or a manager and felt this may have affected the population data in Kazakhstan includes 18 and 19 year ability of participants to communicate openly and frankly, olds. this has been noted in the report. As a rule, the study has taken data provided by The remainder of this report presents findings from UNICEF, based on national government reports, as the fieldwork, combined with analysis of quantitative data main data source for national/regional data comparisons, gathered before, during and after fieldwork. It is organized alongside data provided by the EKO child protection as follows: department, including population data, for sub-regional comparisons. Nevertheless, indicators presented as ‘per • Section 4 describes family support services 100,000 child population’ for EKO should be treated with identified during fieldwork, including a commentary on caution throughout this report, as the child population practices used by the two main family support centres has been estimated using an average of the 0-15 year identified at the outset of the assignment. The descriptions old population and the 0-19 year old ‘child’ population. are based on a range of data gathered during fieldwork, Data is still useful for comparing districts within EKO and including presentations, documentation reviews, interviews,

18 case studies and observation; parental care; and • Section 5 reviews evidence pertinent to the • Section 6 draws conclusions and offers relevance and effectiveness of identified practices and their recommendations based on findings. impact on the main indicators of children living outside of

4 Description of family support service practices identified during fieldwork

4.1 East Kazakhstan Oblast family support service network

At the outset of documentation, UNICEF provided A note on data on the level of service information about a network of 20 family support services in EKO, based in a range of state and NGO service providing coverage for children with disabilities organizations. In the course of the desk review, it became During fieldwork, no services were identified in four of the clear that these are mainly oblast and local government districts with larger child populations (see Figure 4.2): the children’s homes, boarding schools and other types of Ayagoz, Tarbagatay, Glubokoe and Zharma districts (apart from social care institutions mandated by the EKO government the oblast internat for children with disabilities in Ayagoz). to provide some kind of family support activities. More remote districts also appear to have no services available for children and families. However, EKO Administration reports Most of these services are concentrated in Semey and that there are 11,913 individuals with disabilities or older Oskemen/Ust-Kamenogorsk and many provide services to people receiving services across the oblast, including 7,285 children from the whole oblast. By the end of fieldwork, people receiving services at home. Of these service users, it was agreed with UNICEF that visits would be made to about a third, or 2,260, are children aged 5-18 years. The other examples of these types of services in these two cities, on 4,628 service users are being provided with residential or day- the assumption that they are representative of the types care services and again, around a third, or 1,500, are children. of services developing in other parts of the oblast. The An estimated 3,760 children are therefore receiving services, numbers and locations of these and other family support according to EKO Administration. service providing organizations identified during fieldwork are summarised in Figure 4.1. According to estimates given by respondents, the social rehabilitation centres in Semey and Oskemen/Ust-Kamenogorsk Services included in Figure 4.1 all fall into the definition are providing services to between 400 and 600 children and of family support services set out in Section 2. There are young people under 18 years of age. If EKO Administration other types of services, which some respondents argue estimates are accurate, then a further 3,160 children with are also contributing to the support of families and the disabilities are receiving services in the other districts of the prevention of child and family separation, such as after oblast. It seems likely, however, that the ‘third of service users school activities and ‘courtyard clubs’. However, these have are children’ estimate is either an over-estimate or that there not been included, as they do not fall into the group of family are some clients being double-counted; the overall population support services defined for this assignment. Inclusion of of children with disabilities was only 3,217 in 2014, according a service on the map does not necessarily indicate that it to EKO data on children with disabilities provided to UNICEF, has been identified as having developed promising family which is less than the EKO estimate of the number of child support practices.

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 19 service users. If, however, the official MHSD data for 2014 is of coverage (81%) for children with disabilities in EKO having correct, then 4,639 children with disabilities are registered in access to home-based and day-care services, delivered by both EKO and the EKO101 service delivery estimate shows a high level NGOs and state organizations. 101 www.stat.gov.kz accessed 18 August 2015, based on MHSD data Apart from centres providing services to children with Figure 4.1 Family Support Services in East Kazakhstan Oblast Identified During Fieldwork

20 disabilities, the number of organizations highlighted in Figure of state services providing education and health services to 4.1 represent only part of the overall services in EKO working children and families that may also contain elements of social with children and families. There are almost certainly other work or family support, which have not been counted. NGO service providers and there are certainly other types

Figure 4.2 Child Population in East Kazakhstan Oblast, 2014

Source: Developed by authors, based on data provided by EKO Education Department NGO service providers - children under 3 years of age and families with many children. One NGO reports working with Oralman211 families. service users and types of services provided Fewer NGOs report working with psycho-social factors ПWhen asked to choose from a list of service users, the named by respondents in interviews in Semey and Oskemen/ responses from 11 NGO service providers show that the main Ust-Kamenogorsk as contributing to separation of children: NGO run services available in EKO target children with disabilities parents being in prison, drug and alcohol dependency, and family and their families, as well as adults with disabilities, families with 11 Ethnic Kazakhs who have repatriated to Kazakhstan from other countries, such as China

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 21 violence. Very few NGOs report working with children who have for children with autistic spectrum disorders. They also provide already lost parental care. This does not mean that no NGOs are playgrounds and clubs (such as for art, sport or music). Five NGOs offering these types of services, as this was not a universal survey. report that they deliver habilitation and rehabilitation services for Some of these services are provided by state service providers, children with disabilities. NGOs more rarely provide direct practical such as children’s homes, Youth Houses and CAM, but if more of support, such as transportation, material or financial aid and legal these types of services are needed, then the authorities of EKO, assistance. Only one or two NGOs report providing services in Oskemen/Ust-Kamenogorsk, Semey and the other districts of EKO, the home (of service users) and only a couple of NGOs provide especially those with higher levels of child and family separation, day-care or family reintegration services and not on a regular could increase their supply by stimulating the market, via grant- basis. Information on the services provided by the Oskemen/Ust- giving. In addition, oblast authorities run an annual competition Kamenogorsk City Child and Family Support Centre is not included that awards grants to NGOs for the delivery of special social in Figure 4.1 as it is not an NGO. services targeting gaps in services. All of the NGOs that returned questionnaires are based either As presented in Table 4.1, these NGOs primarily provide in Semey or Oskemen/Ust-Kamenogorsk, but some provide psychological assistance, as well as information, social integration limited services to children and families from rayons immediately and adaptation for children with disabilities, and consulting surrounding the cities: Beskaragay, Glubokoe and Borodulikha. and training or group activities, such as parent/child classes

Table 4.1 Types of Services Provided by NGOs Based in Semey and Oskemen/Ust-Kamenogorsk

Source: Questionnaires completed by 11 EKO NGO service providers

22 Other NGO and state providers of family educational achievement. For this reason, they have not been included in Table 4.1 as service providers working support or related services on family support. The Deputy Akim and Department As already noted, it became clear during interviews that of Education representatives interviewed nevertheless respondents at all levels consider a range of services to perceive these services as directly contributing to a be ‘family support services’, but not all of these could be reduction in the juvenile crime rate and assert that ‘72% of reviewed in any depth for this study as they do not fit within children and young people are engaged in extra-curricular the definition used for the purposes of this inquiry. However, activities’. The extent, to which children who are without an overview is presented here, because these services, in parental care or at risk of losing parental care are benefiting some cases, represent potential resources for the future from these services, including children with disabilities, is development of integrated family support services.семьи. less clear. It seems likely that education services in other parts of the oblast are also offering these types of extra- NGOs curricular activities to children and families and those they The EKO Department of Social Protection, reports123 that represent, to some extent, a resource for further developing 16 NGOs received government grants to deliver services community-based family support services. to 1,075 adults and children in 2015 (840 service users Semey Department of Education also reports156 ‘courtyard are receiving services at home and 235 service users are clubs’ as a community-based service, as well as an extensive receiving day-care services as defined by social services network of socio-pedagogical services in the 65 schools standards No. 165 of 26 March 2015134 ). However, it could not under its jurisdiction, including 93 psychologists. “In the give an exact figure for the number of children in families kindergartens, the psychologist leads work with the child and receiving these services. It estimates that roughly a third in the school, a social pedagogue does so. There is a police of clients are children. Some grant funded organizations inspector in every school… The risk factors that trigger an are included in the summary in Table 4.1, but it is likely that intervention from this team include problems with school some remain unrecorded. Several NGOs approached during attendance, the class teacher raising concerns, and observations fieldwork did not return questionnaires, either because they of changes in individual mood.” It is unclear whether the have ceased to operate or because they do not perceive their integration of psychologists, social pedagogues and police services as relevant to supporting children and families inspectors into schools and kindergartens is an oblast-wide and preventing separation. A full list of the organizations intervention or specific to Semey. It is also not clear whether awarded grant funding was requested from the Department these teams of social pedagogues, police and psychologists but was not received. are delivering family support services or are more focused on goals related to improving school attendance and behaviour and increasing educational achievement. UNICEF confirms State education services that national Ministry of Education and Science Order No. 528, The Department of Education in Oskemen/Ust- of 20 December 2011, established psychological services in 14 Kamenogorsk reports5 an extensive network of 40 all schools, but this order was rescinded by Order No. 458, of community clubs for children and adolescents, serving 11 November 2014. According to UNICEF, the implementation 8,000 children across the city and providing after-school of the order was more evident in EKO than in other regions of education and social activities. A further 700 children and Kazakhstan. This assessment found that this service appears adolescents take part in after-school activities at ‘Young to be more evident in Semey than in Oskemen/U-K. Technician’ clubs and an additional 2,000 children take part in arts and culture activities in schools and culture houses. These services are open to all children and adolescents, State health structures so it is unclear to what extent they are working with Respondents from both cities and from the oblast children who are without parental care or who are at risk administration report that, since 2010, there has been a of losing parental care. These services are managed by the programme of ‘prevention of relinquishment of children at education sector and are largely addressing goals within maternity hospital and, since 2011, every Primary Medical the education system relating to school attendance and Sanitary Point in the oblast has had a team in place, comprising 123 Interview with a representative of EKO Administration, Department of Social Protection, October 2015 a community doctor, social worker and psychologist, tasked with 134 The latest version of social services standards order No. 165, of 26 March 2015, describes 167 four sets of standards for services for children and adults with disabilities delivered at home, in residential identifying socially neglected children in families.’ In some care, day-care and temporary residential care, plus seven types of services: social care; socio-medical; socio- cases, these teams are clearly carrying out some functions that psychological; socio-pedagogical; socio-cultural; socio-economic; and socio-legal 145 Group interview with the Deputy Akim of Oskemen/Ust-Kamenogorsk City and representatives 156 Group interview with representatives of the Semey Committee of Education, October 2015 of the Committee of Education of Oskemen/Ust-Kamenogorsk, October 2015 167 Interview with an EKO Administration representative, October 2015

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 23 Family support services for children with disabilities As described earlier in this report, EKO Administration, are directly linked to supporting and strengthening families;178 along with other regions of Kazakhstan and under in others, their function is either unclear or is perceived as the overall guidance of the Ministry of Health and having a medical or public health focus. According to one Social Development (MHSD), moved forward in 2011, respondent, from EKO Administration, ‘The role of social implementing the Law on Special Social Services (2008) by workers is to prepare patients, for example, to increase their mandating children’s homes, internats, and medical-social confidence in procedures such as vaccinations.’ The PMSP institutions (MSI) for children with disabilities to develop family support services in Semey are described in more ‘family support services’. According to the MHSD, there detail in Section 4.2.3, below, but it is worth noting here that, has been a significant increase in day-care and outreach according to one respondent interviewed, the effectiveness services being delivered by these institutions as part of the of services in Semey is partly the result of training invested concept of social modernization, providing a framework for in PMSP teams, with support from UNICEF: the process of deinstitutionalization taking place across ‘other PMSP in the oblast and in the Republic of the country. The main feature of the reform of services for Kazakhstan as a whole have these staff positions children with disabilities is to gradually replace residential established by health department orders, but they have services with day-care services, services in the home and not been trained.’ with services provided by NGOs, as illustrated in Figure 4.3. As PMSP services have a clear health focus, they have not Available data on the Medical Social Institution (MSI) been included in the service organizations counted in Table and other residential care service users presents a more 4.1. However, there is an argument for including them, as ambiguous picture. The Statistics Committee of the Ministry they represent a significant resource that has a mandate to of National Economy produces annual statistical reports on work on family strengthening and prevention of separation the development of the social services system, based on of children from their families, as well as carrying child MHSD data (see Table 4.2). protection reporting functions. The PMSP integrated family Data shows that the number of children using residential support service in Semey appears to be delivering promising and day-care services189 increased in 2014. The number of practice. children with disabilities and without families using these 189 ‘odinokie bezrodnie’ literally ‘alone without kin’ is the term applied in the reports to both adults 178 Interview with a representative of Semey Health Department, October 2015; and Shabdanova, S., and children, but it is not clear whether this means children who are legally without parental care or if this 2015 (mimeo) means children who have no contact with their family, but may still legally be in the care of their parents

24 Figure 4.3 Results of Reforming the System of Social Services, 2009–2014 Source: MHSD, Government of the Republic of Kazakhstan, Kazakhstan, of the Republic of Government MHSD, Source:

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 25 services fluctuated, but more than doubled between 2009 deinstitutionalization is taking place, and whether the and 2014: from 801, rising to 1,746. For children without increase in service users represents an increase in home- families aged 4-13 years, the use of these services more based and day-care service provision. than tripled in the same period: from 239 in 2009 to 940 When asked about policy goals and impact of the in 2014. carer’s allowance on parents and carers of children with Since 2012, residential institutions for children with disabilities, as introduced in 2011, the MHSD responded: disabilities have been renamed in official reports as …the carer’s allowance was intended to provide ‘organizations providing social services with provision of income to families where at least one adult could not residential care’1910 . These provide care and other services work because of care responsibilities and to pay for to both permanent, long-term residents and to temporary services. The intention now is to increase it and to extend residents, as well as non-residential day-care services. it to adults with disabilities. (Interview with MHSD Without clearly disaggregated data on day-care users representative) and long-term residential care users, it is impossible to clearly identify the extent to which the process of The increase in demand for and use of day-care and 1910 ‘odinokie bezrodnie’ literally ‘alone without kin’ is the term applied in the reports to both adults home-care services reflected in the data provided by the and children, but it is not clear whether this means children who are legally without parental care or if this means children who have no contact with their family, but may still legally be in the care of their parents MHSD, and summarised in Table 4.2, could be linked to Table 4.2 Number of Children With Disabilities in Kazakhstan Using Residential and Day-care Services, 2009 – 2014

Source: Statistics Committee of the Ministry of National Economy of RK, annual reports 2009-2014 ‘On Organizations Providing Special Social Services in Kazakhstan - Series 13’, downloaded 18 August 2015 www.stat.gov.kz to the study dropbox

fewer children being placed in residential care by their wheelchair costs 150,000 and medicines are very expensive. families, partly as a result of the carer’s allowance, but it is (Mother of 11 year old boy with cerebral palsy) not possible to state this conclusively. Parents express a wish to have more control over funds Parents of children with disabilities in Oskemen/Ust- budgeted for their child’s equipment: Kamenogorsk who participated in a focus group discussion The wheelchairs that the social service allocate to indicated that the carers’ allowance is important. However, us are completely inappropriate for my child…we need a one mother expressed her view (and others agreed) that specialized one with fastenings. We adapted the support the allowance needs to be sufficient to respond to different frames they issued to us ourselves. We weren’t issued levels of functioning and the requirements of each child with a chair. We have to buy all this ourselves. Everything for technical aids, medical treatment or other support, to we are given is like a dead weight. If the budget is increase functioning: allocating funds to social services, they could transfer My child does not walk, cannot sit without support and those funds (for example 15,000 Tenge) to the place cannot speak. He has full intellectual functioning… my child where we buy wheelchairs. We can pay the difference and needs a lot of money both for equipment and for treatment. purchase the right one that he needs. (Mother of 11 year The amount that we are given is completely inadequate, old boy with cerebral palsy) especially as I stay at home to care for my child. Only my husband works and we have another child as well. It is very Parents were unanimous in the opinion that it is difficult. We receive 47,000 Tenge. It is very little, when a problematic for carers’ allowances to be discontinued

26 when a child reaches 18 years of age: an issue that the reported that a new day-care service was soon to open at MHSD has indicated it is trying to address2011. A further point a school in Oskemen/Ust-Kamenogorsk. Results from our raised by all parents that is relevant to the development of supply-side survey undertaken for this study confirm that family support services for children with disabilities is the there are day-care services being provided for children with way in which disability assessments are conducted by the disabilities in Oskemen/Ust-Kamenogorsk, by a state MSI Psychological Medical Pedagogical Consultation (PMPK). that mainly serves adults and older people, and that NGOs Parents highlight that the ’15 minute assessment’ results have received grants to provide community-based services in misdiagnosis and consigning children to inappropriate of various kinds to children with disabilities and to their education or developmental services: families. They have a timetable – to review a certain number In one case, an MSI that has been providing day services of people each month for 15 minutes each. How can has indicated that it has established 20 residential places you get to know the child from all sides (and provide for children from the oblast this year and a representative a diagnosis) in 15 minutes? It is simply not possible. of EKO Administration reports that plans are being All children are different: one might be open and discussed for a public-private partnership to build a large communicative, another might be more reserved, but rehabilitation centre for children with disabilities, with a all children are wary at first. … My child was always residential facility to serve the whole oblast. Apart from assessed as fully functioning intellectually until he these exceptions, the policy and vision for more community- turned 5 years old, when they labelled him ‘retarded based, non-residential services for children with disabilities, mental development’ (ZPR). I said, “On what basis are you stated by MHSD, at national level, does seem to be in the assigning this diagnosis to my child?” The assessment of process of being implemented in EKO. Day-care facilities our defectologists, psychologists and pedagogues at the are available within several MSI and NGO services for Children’s Rehabilitation Centre is that the child’s mental children with disabilities which are being funded by oblast abilities are developing in accordance with his age. and city level authorities. The effect of this reform process They said, “There can’t be cerebral palsy without mental on children with disabilities and their families is discussed retardation.” I said, “How’s that? That can’t be? They are later, in the final sections of this report. absolutely different things.” I could not convince them. Then my husband arrived: “You understand that you are condemning the child with this diagnosis? With this Family support services provided by state diagnosis, he will start to enter special education. Why child care organizations not stimulate his intellectual development?” (Mother of A group interview was conducted with representatives of a 5-year-old boy with cerebral palsy) Youth House, a children’s home and a baby home and a further Parents would like to see a disability certification seven service providers were visited by the international procedure that better reflects their child’s abilities and social work consultant during fieldwork, including two family levels of functioning and takes into account the conditions support centres and five children’s social care organizations: in which the assessment is conducted. It is of concern that • Two Centres for the Adaptation of Minors (CAM); children with no mental disabilities, according to their parents, are being labelled as having mental disabilities • One children’s home; after a short assessment outside the home environment. • One helping school for children with special This would seem to suggest a lack of competency among educational needs without parental care; and PMPK specialists. • One infant home. The MHSD views the main challenge ahead as ‘changing Respondents who took part in interviews during visits, or the legal status of institutions so that they can become state who participated in group interview, all confirm, in various enterprises and have more freedom to develop services, ways, that reform has taken place. 2011 was repeatedly and to ensure the professional development of the social mentioned as the year when the reform process really began work services workforce’2112. to gather momentum: In the meantime, the vision set out by respondents at We were moved to education in 2011 and renamed national level is reflected in EKO, where the Administration as a Centre for Adaptation of Minors (we used to be a reports that two out of three EKO medical-social institutions ‘Centre for Temporary Isolation of Minors’) (MSI) are providing day-care services. Some parents We started in 2011, when the ‘Second Chance 2011 Interview with a representative of MHSD, October 2015 2112 Interview with a representative of the Department of Social Services, MHSD, October 2015 Programme’ was launched, to work on finding families

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 27 for care leavers. Now, the emphasis is more on seeking The CAMs, children’s home, helping school and infant international adopters. homes visited serve the whole oblast. In interviews with Several respondents indicated that, although they created staff, and with oblast authorities responsible for children’s a ‘Family Support Service’, this was very much on paper, homes, it was identified that the children within children’s since there were no additional staff posts allocated to this homes come primarily from the Zyryanovsk, Ridder and service and members of staff within the organization either Glubokoe districts. Children from Semey and Oskemen/Ust- continued to carry out functions that were now called ‘family Kamenogorsk are also resident in these services, but most of support services’ or carried out new functions as ‘volunteers’: their families are located far away from the services, which represents a significant barrier to developing family support We started working on these issues in 2011. The family work. This study has nevertheless identified promising support service is made up of the psychologist, social practices even in these constrained circumstances: in one pedagogue and the Director of Education Work. We mainly CAM and one children’s home, as documented in section 4.2. work with people who want to take children under patronat or guardianship. We also work with parents returning from prison, with grandparents, and with parents who come wanting Infant homes to place their children. Apart from the social pedagogue, we do this in addition to our other responsibilities within the Respondents in Semey repeatedly mentioned the ‘Hope’ institution. group at the infant home as an example of how new services are being developed that can support families. This group provides We have always done this: searched for parents and ‘temporary’ care for children aged up to three years whose relatives. We write letters and make phone calls. It is families are experiencing difficulties in caring for them. The difficult to establish contact with the relatives of those reasons for this type of placement vary, to include: who were relinquished at maternity hospital. • Single mothers; We have some cases where we have found relatives • Child disability; [5 out of 135] for our care leavers. • Parental illness (e.g. tuberculosis treatment); To develop new services we would need new staff. • ‘Sorting out housing issues’; In 2011, we began to create the Family Support • Student mothers; and Service. We used to be a shelter. We are a team of five people: the Deputy Director, the social pedagogue who Cases where the Commission for Minor’s Affairs has was working in this way previously, a child psychologist, decided to place a child for child protection reasons because a carer and a nurse. In addition to our other duties at the of neglect, poor living conditions or alcohol abuse in the institution, we work on this, going out as a group and family. making assessments. Representatives from the infant home noted that stays in the ‘Hope’ group can last from two months up to three years, Based on these interviews and discussions, it is clear that depending on the individual situation. Parents who have the health sector has allocated additional funding for staff placed their child in the ‘Hope’ group can visit their child, but posts, in order to develop integrated family support services must obtain medical certificates in order to do so. According in PMSPs around the country. EKO children’s care services, to staff, visits typically take place 2-3 times per week for 2-3 however, have been mandated to work on family support, hours each visit, although some parents visit once a week or less reintegration and foster care services, but without funding frequently. The parents are required to visit at times when the being allocated for additional posts or training or technical children are not sleeping or busy with other routine activities support to ensure that these services can develop in more inside the institution, such as mealtimes, playtime and time than name. A representative of EKO Administration clearly spent on early development classes. Parents have to visit during sees the personnel in children’s homes, boarding schools and the working hours of the institution, which may coincide with other care institutions as having a role to play in developing their own working hours. The infant home does not carry out alternative family care services for children without parental any direct work with families to help them address the problems care, stating: ‘District Akims cannot monitor and control that triggered the placement in the first place. Staff are focused children [in foster care placements], but the children’s homes on providing care to children while they are in the Infant home can. There should be family-type children’s homes if families and this might include ‘conversations’ with parents, to help them are willing to take children.’ Yet, without additional resources understand their children’s care needs, but no formal programme for social workers, transport and training, it will be impossible of family support or parental training. to ensure that this potential is realized.

28 Many respondents in Semey perceive this service as a ‘family On the other hand, data presented in Figure 5.8 and Figure 5.9 support service’ and recommend it to parents. The PMSPs actively2213 suggests that there are many more referrals for short episodes refer children to this service, as does the Family Support Centre of care, and resulting in the child returning to their family. Better in Semey. However, data from infant homes, as illustrated in quality data monitoring could help to clarify whether this type Figure 5.9, below, suggests that referrals have fallen since 2012. of residential care or day-care is the type of service needing to

2213 Interview with representative of Semey Health Committee, October 2015 be developed, and whether preventive family support services being offered to parents before or during placements is effective in addressing problems originally triggering placement.

4.2 Strategy and implementation – two family support centres in Semey and Oskemen/Ust-Kamenogorsk The main strategy UNICEF and its partners at EKO are having problems with behaviour that is affecting their Administration have adopted for developing family support schoolwork or is bringing them into contact with the law. services has been to provide training, funding and technical The Accompaniment Service is understood to be working on support to two Child and Family Support Centres – one in preventing separation of children from parents, but is not Oskemen/Ust-Kamenogorsk which was established by the explicitly targeting these objectives in the documents that City Education Department and the other in Semey, which is describe the service. Clearly defined goals and objectives run by the NGO ‘Public Foundation ‘Family Centre’ and which can help to ensure effective monitoring and communication receives funding from the City of Semey. UNICEF’s role has of results. been to provide technical support and training. UNICEF staff Social patronage is defined in some service emphasize that the aim is for each organization to identify documentation231 as ‘visiting a family at home with needs in its community, and to develop services to address diagnostic, control and adaptive-rehabilitative aims that those needs. This section of the report presents these permit the creation and maintenance of a long-term link services and their results. The effectiveness of services is with the family, the early identification of problematic discussed further in section 5 of the report. situations and the provision of an immediate response’. The goal of the social patronage or Accompaniment 4.2.1 Oskemen/Ust-Kamenogorsk Child and Service could therefore be inferred as ‘problems in families identified and responded to in a timely way’. Family Support Centre If families and problems could be further defined, this Registered by the Akimat of Ust-Kamenogorsk in 2008, could help to ensure a more measurable set of objectives by Order No. 7512 ‘On the Creation of the Centre for the and indicators for the service, making it easier to develop Support of the Family and Childhood of the Akimat of an evidence base of effective practice and enabling more Ust-Kamenogorsk’, the U-K CFSC runs a wide range of effective communication with decision-makers. An example programmes and projects relating to children and families. of a more precisely defined goal and objective might be: The service described here focuses mainly on the service ‘problems in families that can contribute to children being of ‘Accompaniment of Children and Adolescents and their separated and entering state care are identified early Families in Difficult Life Situations’ also known as the ‘Social and resolved to prevent separation’. Problems and factors Patronage Service’ in some project documentation. The contributing to separation and families to be targeted Accompaniment Service is linked to other services also run can then be further specified and defined e.g. families by the U-K CFSC, including a hot line for children, families, in crisis referred by child protection authorities; families and parent training groups, which are also referenced here, experiencing mental health or other health problems; low- as is relevant. income families living in poor housing; and parents with low parenting competency and motivation. Goals and objectives The goals of the Accompaniment service are not Roles, staff profiles clearly stated beyond ‘helping’ and ‘providing support’. The Centre has 26.5 posts, filled by 20 members of The staff clearly understands their work to be focused staff. A group of 13 professionals staff the Accompaniment on supporting families to care for their children, and to Service, including a social work supervisor (methodological support older children and adolescents directly if they 231 Instructions for completing the individual route list, U-K CFSC Centre

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 29 advisor), six social pedagogues, three pedagogue to elaborate standards for the Accompaniment Service, and for psychologists and three pedagogue psychologists for crisis further replication of the Service. services. About 20% of this team’s time is spent directly Functional and quality standards on casework, visiting clients and case management as part The Accompaniment Service fits into the system of special of the Accompaniment Service. Another 20% is spent on social services set out by the Government in Articles 5, 6, 14 group work, such as parent training or training for children and 15 of the Law on Special Social Services No.114-IV (2008) whose parents are problem drinkers. Clients from the as a service ‘of a general nature’ (informational, advisory or Accompaniment Service may participate in these activities, mediatory, as defined by Article 5.4) to children in a difficult but they are open to any parent or child who wants to life situation and their families (as defined by Article 6). Order participate, so the time of staff spent on these services No.165, of 26 March 2015, describes four sets of standards for cannot be considered as part of the Accompaniment services for children and adults with disabilities delivered at Service. The Accompaniment Service should therefore be home, in residential care, day-care and temporary residential considered as being resourced by a fifth of the overall staff care, and seven types of services: social care; socio-medical; and other resources of the organization. socio-psychological; socio-pedagogical; socio-cultural; socio- The main role of the professional staff is to conduct economic; and socio-legal. The U-K CFSC Accompaniment casework and ‘Accompany’ (Curate) each child and family’s Service can be described as delivering socio-psychological, case, to conduct regular reviews, to document each case, and socio-pedagogical, socio-cultural, socio-economic and socio- to take part in supervision sessions and case conferences. legal services to children with disabilities and their families at All visits to clients are conducted in pairs, mainly for safety home, which are required to meet these standards. Otherwise, and support reasons. there are no specific standards for the Accompaniment Service The Supervisor monitors the quality of work carried where delivered to children without disabilities or their families, out by the professional team, takes part in client visits beyond the provisions of the Law On Special Social Services (No. as needed, and conducts supervision sessions and case 114-IV of 2008) namely: conferences. The Supervisor also supports learning and • Services are delivered based on an assessment of staff development through a dedicated weekly day of need; meetings, training sessions and seminars. • The assessment is carried out within a ten day period of The Director provides overall management, leads staff the referral or self-referral for services; and development and supports case management and decision- The decision on whether services will be provided is making as required. • taken within three days of assessment being completed. All staff members have higher education qualifications Other functional standards noted are: relevant to their roles, functions and objectives. The Director • is a psychologist and the Supervisor/Deputy Director is a • The service has an approved method and programme qualified social worker with training that enables her to for casework that is used by all the professionals in the team; carry out monitoring and evaluation functions. • One day each week is set aside for planning meetings, Thirteen members of the current team have participated seminars and structured professional development activities; in seven training events relevant to the work of the • Home visits are always conducted in pairs; and Accompaniment Service, between 2011 and 2015, including • All new staff members undergo orientation and one member of staff who took part in UNICEF integrated induction training, followed by a programme of structured social services training in 2012. professional development. The case management material used by the Indicators used by the supervisor for assessing staff Accompaniment Service was developed on the basis of performance242 include: materials used during training delivered by a UNICEF Range and quality of information gathered during expert when the service was first established, in 2008-9. • assessment – high quality assessments contain information from interviews with the client, official child protection bodies Performance indicators and standards and from observations during direct work with the child. High The Accompaniment Service does not operate to an explicit quality assessments include information not only from and set of standards. The following implicit standards can be inferred about the family but also the environment in which the family from interviews conducted and documentation reviewed during exists – neighbours, relatives and friends; fieldwork and could serve as a useful starting point for staff, 224 Briefing note for meeting with Director ‘Form of Methods and Content of Work with Patronage Families and Accompanied Young People’ by specialists from the Family Support Centre, 8 December 2014 (mimeo)

30 • Goals have been set together with the family, based on based on training programmes, counselling methods and information gathered during assessment; interactive psychological methods adapted by staff since 2008. • Structured individual plans are in place for working For example, a training programme for working with children with the family; whose parents drink was adapted from materials developed by Save the Children Sweden325, either from a training event that a • Effective support is provided using a range of methods, former staff member attended, or found on the Internet – nobody such as counselling, regular and frequent home visits and phone quite knows. A staff member developed training packages for calls, group work with family members, group work in schools, parents (‘Family Sitting Room’ and ‘Lessons in Love’), but these and joint work with the police and school; include references to materials that have been adapted from • Approved methods are used during assessment and elsewhere. Case management methodology has been adapted when working with the family, to increase parental competency from a range of sources and has some distinctive features. The and motivation; plan for working with a child is called an ‘individual route map’, • The cycle of assessment-planning-implementation- setting out a clear expectation of how the plan should effect review is sustained throughout the whole Accompaniment transformation, bringing the family from their current place to a process; transformed future place. Guidance for setting and defining goals • Goals set at the outset are achieved and the for working with families similarly reflects this transformational sustainability of change is monitored and reviewed before aspiration: closing the case; and The goal expresses the ideal representation of the • A negative result is when goals are not achieved. result of the activity. It is necessary to mobilise the inner strength of the family to overcome the difficult Monitoring of service delivery life situation. In order to do this, it is first necessary to • Each new case is registered in a journal. Monthly, analyse the problem. Second of all, it is important to quarterly and yearly reports are generated showing the number consult with specialists and, thirdly, based on structured of active and closed cases, with the outcomes for closed cases conclusions, to identify the goal which will allow an exit recorded as ‘positive’ or ‘negative’, with a brief description of the from the difficult life situation264. result in some cases: ‘The family was supported to arrange their The assessment method is based on identifying whether the documents and changed their housing situation’; or ‘child was family belongs to one of six predefined ‘family portraits’ that removed from the police ‘risk’ register’; and were developed as recommendations in 2009 by the Director • Service delivery is monitored through weekly meetings, at the time (S. Ivanenko). It is not clear what the basis was for supervisions, case conferences and case reviews. the original portraits. They may need to be reviewed in order to move away from labelling and stereotyping families. However, Methods and description of processes guidance provides tailored assessment formats for carrying out Referrals to the Accompaniment Service come from a range reasonably thorough, multi-faceted assessments that look at a of sources, including the Commission for Minors’ Affairs and range of children’s needs at different stages in their lives. The six Protection of their Rights (CMA), where the U-K CFSC participates ‘family portraits’ are: on a regular basis, from city guardianship authorities, from 1. A family with children where a member of the family has schools and from self-referrals. The U-K CFSC has an established a prison record; working relationship with all the schools in the city. Each staff 2. A family where parental rights are being removed or member is assigned ten schools and has responsibility for have been removed; providing training to children and working with class teachers, 3. Teenagers with deviant behaviour; and with the CAM in Oskemen/Ust-Kamenogorsk. The plan for 4. Families with dependencies (alcohol, drugs or other working with the CAM is mainly focused on providing training to addictions); children and young people, but joint casework is also reported as taking place. It is clear from interviews with staff and a review of 5. Foster families; and case files that children who are clients of the U-K CFSC are not 6. Families with low caring potential. all at risk of separation, but there are a significant number where If the social worker knows beforehand which category the family violence, complex social problems and other factors family falls into, then she (at the moment, only women are represent a real risk of separation. working in the U-K CFSC) uses the appropriate assessment The Accompaniment Service has several formally approved format for that category of family. If not, then there is a generic methods or ‘programmes’ for working with children and families, 253 When Mama and Papa Drink, Ekbaum, I., Arnell, A., Save the Children, 2009 (mimeo) 264 Instructions for completing the individual route list, U-K CFSC Centre

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 31 format ‘Social Portrait of the Family’ that includes a range of social pedagogy and psychology) represent a solid practice base assessment dimensions, including: over which the staff team has strong ownership. Consideration • The family’s socio-economic situation; should be given to refining some of the assessment instruments, to focus more on identifying parent and family strengths and • Housing; building upon these, rather than focusing on problematic • Employment’ typologies, such as ‘low parenting potential’ (which could • Internal family relationships; be a mistranslation of parenting ‘competency’ dating back • The child’s relationship with various family members; to the first case management training conducted) or ‘social portraits’. Similarly, it may be beneficial to expand the social • Approaches to parenting and care-giving (ways of work equipment in social workers’ toolboxes beyond the mainly punishment, persuasion, affection, encouragement etc.) social pedagogical and psychological tools currently developed • The number of hours parents spend with their children; although, as a foundation for developing family support work, • The child’s social circle outside the family; and it seems good enough. A more rigorous evaluation is needed • Education and relationships at school. in order to answer the question of whether these are the most There is no single method being used that has a strong effective tools for use with families in Kazakhstan or whether evidence base, where external evaluation or rigorous research there may be better and more effective tools already in use has proven that the method is effective. The whole programme, elsewhere. This review has found that these tools are not bad however (case management materials backed up by several and possibly ‘good’, and that they are certainly being used in training packages based on a range of theories from social work, practice by committed professionals working with some complex cases. Importantly, the heart of the approach is in the right place

Figure 4.4 Case Management Processes in Accompaniment Services U-K CFSC

Source: Developed by authors, based on a review of case documentation and on information received through interviews and discussions with staff and managers at U-K CFSC, October 2015

32 and it is more or less a home-grown approach. analyse how many of their long-term clients have had recurring With the exception of processes for case closure (which crises and how many have had just one or two isolated crises. could not be clearly determined within the scope of this review), This kind of long-term accompaniment may be an effective, and the working processes for the Accompaniment Service are probably cost-effective, way of working with families who are summarised in Figure 4.4. in ‘chronic crisis’, where they may bump along from one crisis to A rapid review of journals used to record the opening of new the next without ever reaching an acute crisis that forces a true cases during visits to the Centre showed that, in many cases, transformational change in behaviour or situation. If the social the average length of Accompaniment or Social Patronage development elements of the approach can be strengthened – has lasted around five years. This is a long-term approach active employment strategies and income maximization – in the that may have some strong benefits, but this will need to be methodology, to address some of the underlying problems that clearly demonstrable if this is to be seen as a convincingly keep families in chronic crisis, then this may be a more effective viable service for set up by local authorities in other parts of way to support children and ensure they are receiving a basic Kazakhstan. According to crisis theory527, acute, transformational level of adequate care, rather than placement in alternative crisis in families can usually be addressed within 3-6 months; as forms of care. Again, an in-depth evaluation would be required acknowledged by the U-K CFSC Supervisor in her Briefing Note to identify more precisely gaps in methods and approaches to the Director286, ‘productive work takes place during the initial being used, including a full case review and, ideally, review of a stages and then is reduced to monitoring via phone, which is control group that did not receive the interventions of the Centre. not an effective way to work’. There is a need to establish a However, the findings of this review suggest that this education- clear set of criteria for moving casework from assessment and linked service, with a heavily psychology and social pedagogy

Table 4.3 Accompaniment Service Data from Oskemen/Ust-Kamenogorsk Child and Family Support Centre, 2008–2015

29

30

29 Number of families receiving Accompaniment Services during the year, cannot be added cumulatively as some cases are carried over from year to year.

30 Number of families receiving Accompaniment Services during the year, cannot be added cumulatively as some cases are carried over from year to year. Source: U-K CFSC, author’s calculations implementation of the plan to review, setting new goals or closure driven casework approach, could have potential if harnessed to of the case. The Accompaniment Service may find it useful to stronger social development and social work methods.

275 See for example Crisis Intervention in Child Abuse and Neglect — U.S. Department of Health Parents who took part in Oskemen/Ust-Kamenogorsk and Human Services Gentry, C. E., 1994 focus groups, and who have received services at the U-K CFSC, 286 Briefing note for meeting with Director ‘Form of Methods and Content of Work with Patronage Families and Accompanied Young People’ by specialists from the Family Support Centre, 8 December 2014 emphasize strongly that the service has made them feel ‘safe’ and (mimeo)

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 33 ‘protected’: that they are no longer alone with their problems. and more transformational. The potential for achieving impact They also highly value the professionalism and experience of in relation to important policy goals, such as reducing levels of staff at the Centre: social orphanhood and closing institutions, is also significant. We ended up with E.V [psychologist at the centre], which is In order to make this case, however, the family support service also fantastic. She has five years’ experience as a psychologist has to show that it is working with children who would, in rehabilitation (E… mother of two boys, one with disabilities, otherwise, enter care. It must show that the interventions are Ust-Kamenogorsk) effective in the long-term as well as the short-term and can Some parents emphasized how important it was that be consistently achieved (for example in 69% of cases, or with specialists visit them at home, as it makes it possible to 40%-90% successful case closure). communicate with the children in a familiar environment and avoids exposing them to the stress of going to an unfamiliar Needs and future development perspectives place. Parents also stressed the importance of support being This promising practice has yet to prove that it is effective. The provided to them, as parents, not only to their child. following steps could help to move it towards even more effective practice and the ability to gather evidence of effectiveness, to help in presenting a case to decision-makers for further development. Results and outcomes 1. Better targeting of services 146 families benefited from the Accompaniment Service The reduction in cases closing ‘for other reasons’ suggests that between 2008 and October 2015, with 134 cases having been targeting has improved as the service has matured, with fewer closed, and with successful outcomes in 69% of instances. Twelve cases not fitting the criteria of the service having been opened. It cases were open at the time of writing. Table 4.3 summarizes is vital to agree with child protection authorities on the parameters service data made available by the Centre. The lowest rate of for family support intervention; thresholds for assessment being successful closure was in the first year of operation, when five triggered; and the most effect way of ensuring that interventions cases were closed (two successfully, 40%) and the highest rate was are targeted early enough, to ensure better sustainability. It is vital in 2014-15, when ten cases were closed (nine successfully, 90%). also to ensure that the service is explicitly targeted towards those If the objective of this work was to improve care in the clearly at risk of separation from their family. From 2008-2013, an family and prevent children from entering state care, and if all average of 38.4 children per year had their parental rights removed these children were really at risk of entering state care, then in Oskemen/Ust-Kamenogorsk. 1. If this service were to concentrate there should have been a commensurate fall in the numbers of fully on its Accompaniment Service, targeting families more closely children from Oskemen/Ust-Kamenogorsk entering state care and continuing to have a 69% success rate, it could reach all of these in this period. families and still have capacity to work on reintegrating children If, however, the objective of this work was to improve school already in care, while recruiting, training and supporting foster carers attendance and achievement, reduce offending behaviour or and guardians. reduce suicides among teenagers, then these good results 2. It should further develop some elements of the may not have had any impact on the overall policy goals of assessment method, to focus more on children’s needs, strengthening families and enabling them to care for their family strengths and community resources and revise the children, so that fewer children end up in the care of the state. social portraits approach. This does not mean that this type of family support service cannot have an impact on preventing entry into care; it simply To address the danger of stereotyping in the social portraits means that the service has to be directed to the right families, approach, a more systematic assessment approach could be applied, where there is a real risk of separation, for this impact to be focusing on the needs of the child, the ability of parents to meet these meaningful. The U-K CFSC is under great pressure to prove needs, and the potential of formal and informal support systems in its worth and its worth is often measured in numbers: how the immediate family environment to mitigate weaknesses and many people have you served? The pressure is huge to carry reinforce strengths. out large public events in order to be able to ‘reach’ 30,000 3. Strengthen ‘assistive-therapeutic’ interventions to children or to hold group events in schools, to reach 8,000 build more links to social protection, employment and children with training on civic engagement and behaviour health every year. Next to these numbers, the intensive, individual work of the family support service, squashed into one day Links between the U-K CFSC, schools and guardianship per week, seems insignificant. The impact on the lives of the authorities, including the CAM, are strong and seem to be working children and families concerned, however, is infinitely deeper reasonably effectively. Strengthening links with some city services

34 focused on social assistance, housing, employment and health could lead to overreliance on contact via the office telephone. These ensure that practical issues, including supporting parents with costs would be reasonably low, but could help ensure a more mental health problems, could be addressed in a more co-ordinated mobile, safer and more effective service for children and families, and effective way. This could, for example, take the form of a case as staff would be able to spend more of their time interacting conferencing mechanism or establishing bilateral collaboration on a with children and families in their own homes. case-by-case basis, as needed. 6. Fine-tune data management and monitoring 4. Full case review and analysis instruments to focus more on child outcomes Full case review and analysis could help to consolidate results Current data management and monitoring instruments – journals to date, and gather evidence in a systematic way, for presentation and monthly reports – focus on numbers of types of beneficiaries. by the CFSC and, particularly, by the Accompaniment Service, to the The Accompaniment Service is monitored per family rather than per decision-makers responsible for allocating funding. If the CFSC can child. While this is helpful for management purposes, more could be use service data to show that the service is working with children done to monitor the characteristics of families, for example: who would otherwise end up in care, then there will be less pressure • Needs of children; to engage in other activities with larger numbers of beneficiaries Challenges parents face in meeting needs and problems at and more room to strengthen the quality of the Accompaniment • the point of referral; Service, targeting services and deepening casework and therapeutic interventions. Case management data might be interrogated with • Sources of referral; the following types of questions: • Interventions themselves – level of input by social workers, • From where did referrals originate and what was the and other types of input; and chance of the child being separated from his or her family at the • Outcomes in the short, medium and long-term, for children point of referral to the service? and for other family members. • Are there any factors increasing the risk of child and family 7. Focus more than 20% of organizational capacity on separation at the point of referral, such as the child’s age, parental the child and family support service behaviour, parents’ own family experiences, the child’s behaviour, The U-K CFSC team is competent, professional and able to carry child functional abilities, unemployment or under employment, low- out a range of tasks. It is currently responsible for implementing: the income, parental mental health problems, violence in the family, UNICEF/Oskemen/Ust-Kamenogorsk City partnership for the Child alcohol or other dependencies, or lack of extended family support? Friendly City programme; a project aiming to prevent suicide among • Are there any protective factors that can be identified, such young people; a programme on educating children in schools on civic as older siblings, other caring adults or motivation of parents? responsibility; and a youth employment programme. This tendency • Which critical interventions made a difference, such as to load the U-K CFSC with tasks that are cross-sectoral, or which fall practical support, psycho-pedagogical work with the child or with between sectors, means they have less capacity (time, personnel and the parents, group training, home visits, or regular co-ordination with other resources) to deepen and extend work with children at risk child protection authorities? of separation. A strategic decision is required at management level • What were the outcomes of the intervention for children, to agree on the main focus of the work of the U-K CFSC. If there is parents, and other family members? genuine political will to achieve significant change in terms of social orphanhood, then the U-K CFSC should arguably focus on delivering • How sustainable are the outcomes? Has the family been the Accompaniment Service in a targeted and focused way, in order referred a second or third time to the service? to stop the flow of children into care, facilitate their exit from care • A case review could also help staff to reflect on practice and support the creation of alternative family-based care options and address any problems emerging. where this is not possible. 5. Travel, insurance and communication costs for social workers should be built into the budget Costing of U-K CFSC If social workers can sometimes work on their own, working Our original methodological approach for costing family in pairs only when there is clear danger, then there will be support services was based on the assumption that the family obvious cost savings. Liability insurance would help give social support service in question is a separate organizational structure workers confidence that they are protected in case of accidents or can be clearly separated as a sub-division. In such cases, or problems while they are working with families. Team members we have proposed using three components for costing family currently pay for their own travel and communications. This support services (FSS): setting-up costs of the FSS team; on- arrangement can become a disincentive for home visiting and going operational costs; and the cost of the support package to

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 35 the child and family. services run by the U-K CFSC can only be roughly estimated, using Set-up costs (SC) can be calculated using formula (1) by data available on its overall budget. summing up recruitment costs (RC), the cost of social work gross The cost of the U-K CFSC is presented in Table 4.4. It is simply salary (GS), training costs (TC), equipment and stationary costs calculated as a fifth of the overall budget of the U-K CFSC, since (ESC), transport expenditure (TE) and other costs connected with a fifth of staff time is spent on this service. The cost of a sample management and supervision (coefficient ∆≤ 10% of total cost of CFSC case work interventions is calculated, based on an for setting up FSS). The formula does not take into account office assumption that the cases were served for the full 12 months of costs (e.g. rent) and other running costs (such as communications each year. or Internet/telephone) because, normally, all FSSs use premises If the U-K CFSC Accompaniment Service were to concentrate provided by local authorities. These costs have already been fully on family support, it could close 40-45 cases successfully per included in the local authority budget. year with this funding and at this cost. Oskemen/Ust-Kamenogorsk City has 38.4 parental rights removals per year131 (average per year for 2008-2013) so this service could work with them all and retain capacity to work on foster care training and support, or reintegration for children already in residential care. The U-K CFSC was set up in 2008 as a community centre, As noted above, the U-K CFSC budget omits some costs of to provide a range of services to various clients. Fieldwork has intrinsic importance to the service: transport, communications identified that only 20% of its organizational capacity is focused and accident insurance for staff making home visits. An estimate on child and family support services. Yet, as defined in section 2, for these costs needs to be added to the existing budget in order ‘family support services’ are activities integral to the organization. to understand the full cost of the service. However, it is unlikely to It is very difficult to separate it, as an organizational structure, to be significantly more per closed case than the estimates provided apply our original costing approach. In addition, initial data on here, based on the current budget. recruitment and training costs is available. From the interview, it became clear that transport expenditure is not allocated into

the U-K CFSC budget at all. Therefore, the cost of family support 311 Based on EKO Child Protection Department data for 2008-2013 Table 4.4 Costing of U-K Children and Family Support Centre

36 4.2.2 Semey Family Support Centre Methods and description of processes The Semey Family Support Centre began its activities in Referrals to the service come from a range of sources, 2008 as a volunteer organization and was registered as the including the hotline run by the NGO, self-referrals and Public Foundation ‘Family Centre’ in 2011. The mission of referrals from a range of health and education services in the Centre is to work with families and to consolidate and the city of Semey: schools, kindergartens, maternity hospitals, co-ordinate support from all stakeholders, local authorities, PMSP, other NGOs and social welfare organizations. The NGOs and religious organizations, to stabilize and improve initial phone call or visit is recorded and, in 75% of cases, the situation for families and children. according to estimates by the team, the case ends with the The main objectives of the organization are: provision of one or multiple short consultations, or provision of • Protection of family rights; information and referral to another service. In 25% of referrals, a case is opened and the social worker and psychologist team • Provision of legal, social, psychological and provide an average of one month or more intensive casework consultative services to families; that might include several meetings, phone calls, home visits • Organization of seminars, training, round tables and and co-ordination of services with other service providers. In conferences, aiming to improve the situation of families as a around 5-10% of these cases, casework may last much longer: whole, as well as supporting children, women, young people up to 12 months or more. and the elderly; Casework seems largely to focus on resolving practical • Organization of a hot line, and crisis centres, aimed and legal and administrative issues – registration papers, at prevention of early sexual relationships, suicide, domestic birth certificates, benefits applications, debt management, violence and other problem situations; and school registration – but also providing psychological • Preventive work with families, mothers and children, support, counselling and ‘moral support’. Problems range with the aim of supporting families and promoting healthy from supporting mothers to claim child support payments lifestyles. from absent fathers, through to helping parents negotiate The organization has been funded since its inception the complexities (and expense) of registering their children through a mixture of local authority funding and grants from for school or further education, and more complex problems, foreign donors and, as reflected in the mission and objectives such as helping women (and children) to find their feet after of the organization, delivers a wide range of services to experiencing abuse and domestic violence: multiple target groups. This review has focused on its I borrowed money to buy fuel to heat my home, I have work with individual clients and specifically with children four children and a small baby… now I am in debt and I and families. The Family Centre says that it has provided don’t understand it, how can I owe so much? (O… mother consultations to a steadily growing number of clients: from of five children, Semey) around 200 in 2011 and 2012, to 477 in 2013, and 707 in I myself am from a large family of ten children and I 2014. In the first nine months of 2015, the NGO provided have five children of my own. One has disabilities... the services to 473 clients; it is unclear whether these are Foundation has helped me to get my children ready for counted as families or as individuals, but probably a mixture school, they have explained legal issues to me that I didn’t of both. Similarly, it is difficult to identify the proportion of know… helped me to apply for the housing queue and now families with children among the clients. The NGO estimates I am first in line to rent social housing. They helped me that 70% of its work is directed towards ‘family support’, but with winter fuel. (I… father of five children, Semey) this could include work with families without children as well as those with children. The families who took part in focus groups in Semey express a strong appreciation for the work of the NGO, which is Roles and profiles of staff partly to be expected, as the NGO Director was in the room and The NGO is staffed by a team of one social worker and had herself selected the families who took part. The NGO is four psychologists, four administrators/hotline operators, facing funding difficulties, with one donor not renewing their a Director and three contracted specialists: a lawyer, an grant, so perhaps saw this as an opportunity to advocate for activities co-ordinator and a gynaecologist. The division funding. The narratives of the participants certainly stressed of responsibilities and roles is not completely clear, but how important it is to fund the types of support they have individual work with families is co-ordinated by the social received, but even bearing in mind this bias, their testimonies worker, with a psychologist assigned to each case. are significant as a mark of how important it is for people who are in crisis to encounter a service that treats them with respect and concern and which provides practical advice and

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 37 support to address their problems: material support for winter fuel; or applying for a place on the I had huge problems with my documents, with finding housing register); and psychological and ‘moral support’ (mainly work, and I had two children to take care of, plus my noted by women who have experienced domestic violence or husband’s drinking problem. I didn’t even know how abuse). to feed the family. There simply wasn’t even any food. Families receiving services have experienced shock, but the After that, I came to the Centre and was met by the service seems to be working with motivated and active parents psychologist-girls (many thanks to them, they were a and carers. It is clear that NGO staff are advising mothers to great help) – they do wonderful work…when I came to use the ‘Hope’ group at the infant home, and that they need the Centre I couldn’t even string together two words, I to acquire more knowledge and competencies in relation to was weeping so hard. Now I feel more confident, thanks child developmental needs, as well as case management and to the work of the psychologists…they helped me to other elements of child and family support social work. There feel needed, a self-sufficient person in this society….My is a need to define the goals of the service more clearly. If the problems with documents were sorted out, all the legal goal is to increase family income and support women who have questions were resolved… now I have a job… they helped experienced abuse and domestic violence into employment me to get my children ready for school, my son went into and safe living arrangements, then placing a woman’s children first grade this year, thank you! … My life has completely into residential care could, arguably, be viewed as a positive transformed…I am no longer dependent on my husband. outcome, giving freedom from child care responsibilities and the I have a salary. And, every time, it never mattered when ability to work full time. If, however, the goal is to ensure the I came to them here, they never turned me away. It is a well-being of the children and their full development, and to great organization. When you come here, you feel that prevent family separation and placement of children into care, you are a human being in society. (M --- mother of two then placement of children obviously represents a negative boys, Semey) result. Even weekly boarding or short episodes in residential There is no coherent method or programme of support care can cause enormous stress to parent/child relationships used by the organization. Psychological consultations are a and to child development, especially for younger children. Case form of talking therapy and the casework is undocumented studies written by Semey Family Support Centre staff members beyond initial registration and opening of a file. Our emphasize the positive contribution to child well-being that impression is that it is like an accompaniment service stays in residential care, the CAM or a children’s home, can combined with free legal advice, helping people in crisis provide socialization, behaviour improvements, and acquiring or experiencing problems to overcome administrative and new skills. However, they do not acknowledge the emotional and psychological barriers. While the NGO is clearly working with other developmental needs of children or the need for parents some children on the brink of care, and their families, it is to themselves acquire competencies to improve their child’s more focused on addressing a wide range of issues and social well-being. problems than on preventing separation of children from The Semey Family Support Centre has the potential to families. It did not take part in case management or social develop into a stable family support service, but would benefit work training organized by UNICEF in Semey for the PMSP from a range of capacity building and we would identify the under 3s abandonment prevention project. following as priorities: 1. Management and NGO development – the organization Needs and future development perspectives needs to develop a strategic plan and review its mission, vision and goals. A strategic plan and organizational The Semey Family Support Centre clearly provides a valuable development plan could help to inform decision-making, service to vulnerable women and their children, to fathers and such as on whether to tighten organizational focus, to to other vulnerable people, but it is unclear from interviews or better define its beneficiaries and activities, whether to from focus groups that these families did present risk of child keep a broader focus, reflected more effectively in service separation. According to parents, the two most valued features descriptions, and to ensure stronger communication with of the service are: the legal advice service, that helps them to donors, government partners, beneficiaries and other address legal issues which they would otherwise find daunting agencies. but which would probably not lead to separation of the child (such as arranging guardianship of a grandchild following the 2. Basic social work training – the package of programmes death of a son, with the mother living separately in Russia; and methods that the Oskemen/Ust-Kamenogorsk CFSC coping with the pressures of debt collectors; registering and has developed, and the case management approach being preparing children for school or further education; accessing used by the PMSP in Semey, could be offered to the Semey Family Support NGO. This would strengthen practice and

38 the ability of staff to document their work. Even if there home. An inter-sectoral case management commission also is no need to use a full case management approach for the provides oversight to decision-making. majority of their work, they would benefit from being able The service uses a case management system, developed to better monitor the numbers and types of cases, as well as on the basis of training provided by UNICEF in 2013. presenting problems at the point of referral, and outcomes. Service staff have also been trained in social protection by If the Semey Family Support Centre is to focus on child and the Department of Labour and Social Programmes of Semey family social work linked to child protection, staff members City Administration on the latest developments regarding need to have skills and knowledge relating to child the benefits and social assistance system, and the services protection theories and practice, including a strengths- that can be provided by the city’s social rehabilitation based approach to assessment and case management, and centre. knowldege of children’s developmental needs at different Referrals regarding potential relinquishment or ages. abandonment of infants are received from maternity 3. Parental support – as with basic social work training, hospitals, primary health services, the police and the infant the Semey Family Support Centre would benefit from home. The referral is registered on a ‘signal sheet’ and a strengthening competencies relating to working with preliminary assessment is then made by the social worker. parents, to build parenting capacity and skills. The level of risk to the child is determined during the preliminary assessment: Costing of Semey Family Support Centre • No risk; Data for Semey Family Support Centre costing was not • Low risk - the rights of the child are partially provided during fieldwork. If provided, it will be difficult unobserved; to link the costs of the service to its outcomes or to the • Medium risk - the child is at risk of harm from his number of cases, because of the issues described above or her immediate environment, and his or her needs are not relating to how cases are recorded, opened and closed. It being met; and will be possible to give a cost for the overall service. It is • High risk - the child is at risk of serious harm if he important to note that, at the time of review; the Semey or she remains in the existing environment. Family Support Centre was facing a possible cut in funding from one of its donors and faced an uncertain future. Rent The assessment looks at the needs of the family and a of premises is a major cost for this NGO, but they report that plan is drawn up, for implementation through a process of they are not allowed to pay for rent from their government case management; the social worker co-ordinates actions grants. The costs of service delivery for this NGO will from a range of services, to try and address problems in need to take into account all of its costs, including rent, the family, and to return the child to their family (in the but it may be difficult to compare with the costs of other case of high risk cases where the child has been placed family support services, where no rent is being paid as the temporarily in the care of the infant home) or to prevent premises are being provided by the local authority the child leaving the care of the family in low and medium risk cases. The social worker visits the family every week 4.2.3 Integrated Social Service in Primary Medical during the first three months and, thereafter, on a monthly Sanitary Posts in Semey basis. The plan is reviewed periodically by an inter-sectoral This section provides a brief overview of the Primary commission, and a decision is taken as to whether the plan 132 Medical Sanitary Posts (PMSP) service in Semey , which has should be renewed/extended or closed. been identified as a promising practice. Integrated social services in PMSP in Semey comprise a system of community-based paediatricians working as a Results and progress team, with a home-visiting nurse, a psychologist and a social Early results from the service documented by the service worker. The ‘integrated family support’ part of the service provider suggest that, of 1,118 assessed cases in 2013-2014, is essentially delivered by the psychologist and the social where 113 cases were assessed as high risk, 128 cases of worker. There is one of these teams per 10,000 population. potential child and family separation were prevented. Without In addition, three psychologists are working in the three city knowing how many of the 1,118 assessed cases were low/ maternity hospitals and there is a social worker at the infant medium risk, it is hard to calculate a meaningful success rate. The service provider considers successful prevention cases to include those where the child was placed into the ‘Hope’ group, 321 Based on interviews in Semey and the PMSP report provided by UNICEF, Shabdanova, S., 2015 (mimeo) at the Semey infant home.

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 39 An inter-sectoral commission has been formally established understanding about the potentially damaging impact of group to oversee the case management processes of the PMSP care on children during early childhood. There is a strong integrated family support service. The commission is made up evidence base which demonstrates that placement into group of representatives from health, education, social development, care, even high quality group care, can lead to ‘serious harm’. It police, child protection and NGOs (including the Semey NGO is unclear from the description of the service that decisions to Family Support Centre). During interviews, it was unclear whether make this placement were always made in the best interest of the respondents make a distinction between this commission and child (i.e. whether ‘serious harm’ in the family might have been the Commission on Minors’ Affairs and Protection of their Rights less serious than that in the infant home) or what processes and (CMA). A more focused inquiry is required to understand how this criteria are being used to determine risk of ‘serious harm’. There commission is operating in practice, and the extent to which it is an urgent need to identify ways of creating alternative forms is instrumental in supporting the PSMP in achieving its results. of temporary emergency care for infants that can ensure one- on-one care while helping ensure that the child’s birth parents and family can develop the competencies to provide care going Needs and future development perspectives forward. Removal of the child from the family can lead to the The Semey integrated PMSP service clearly has potential for family adapting its behaviours around the absent child, so that further development. A case review could help to identify the reintegration becomes more difficult and can lead to longer risk factors commonly presented at the point of referral and help term problems in family relationship dynamics and the ability ensure that those most at risk of separation are being referred to provide care. Ongoing monitoring of service data can help to for support. identify the extent to which this service is providing sustainable The regular referral of children to the ‘Hope’ group interventions for babies and infants, while also preventing for temporary placement indicates a concerning lack of unnecessary loss of parental care.

40 A disability NGO in Astana that took part in discussions of Kamenogorsk providing socio-pedagogical and psycho- the first draft of this report mentioned that it is important for social services for children with disabilities, and their children with disabilities, and their parents, to be referred to families, which can been considered to be promising. They NGOs at birth or at the moment of diagnosis. Introducing this are: practice to the integrated PMSP service would strengthen the a. Provided at home or in a day-care setting; response available and help to ensure support can be provided b. Organized in partnership with, or by, parents; to parents while they care for their baby rather than placement of the child outside of the family. c. Include activities that are aimed at maximising functioning of the child and adapted to his or her assessed needs; and 4.2.4 Other types of promising family support d. Appear to have positive assessments from parents. practices One NGO, ‘Shag navstrechu’ is a parent-led organization Information about other services identified as also displaying working with children with autistic spectrum disorders. some elements of promising practice is summarised here with Parents come together to organize daily group events more details and case illustrations provided in Annex A. for their children, supported by a volunteer from the Promising day-care, family support and foster care USA, a specialist in Applied Behavioural Analysis who practices in state service providing organizations can help them to develop individualised behavioural and • Children’s home No. 3 in Semey is trying to support developmental programmes for their children. This NGO children in foster care and foster carers. The social pedagogue has no funding for its work but, nevertheless, has managed also provides practical support to parents returning from prison to develop a programme that helps both children and or in other situations, if they want their child to return to the families (according to the mother who runs it). family. Staff members need training and technical support This type of service, with the right financial and technical in order to ensure more effective foster care services can be support, could help to make evidence-based programmes developed. Their account of trying to ensure that each child for children with autism spectrum disorders available in can adapt to the care of the foster family and that the foster the community to a wider group of children in EKO, and family has access to professional support from children’s home prevent their unnecessary institutionalization in special staff demonstrates a clear understanding of the challenges of needs institutions. delivering effective foster care services, and the lack of resources provided to implement them. Family strengthening services – SOS Children’s • CAM Family Support Service in Semey is carrying out Villages Kazakhstan casework with families using an approach that resembles the SOS Children’s Villages has developed family practices described above, at the Semey NGO Family Support strengthening services in Almaty, Astana and Temirtau cities, Centre. The service is mainly focused on helping with legal and with a case management system based on methodology practical issues, such as housing, documents, claiming benefits provided by the regional headquarters. The results claimed and other social administration tasks. by the NGO indicate a high rate of success in preventing • The Rehabilitation Centre for Children with Disabilities, separation, with only 14 families (of 877) having children in Oskemen/Ust-Kamenogorsk, is providing day-care services separated, among those receiving services over an eight- that include habilitation/rehabilitation services for children year period233. This suggests a success rate of 98.5%, but with disabilities. Two parents who took part in focus groups, it is unclear that the children and families with whom the who are receiving services at this Centre, express a high level of service is working are those at real risk of entering care. satisfaction, which indicates that the service may be effectively The cost of the service is calculated by SOS as 50,436 assessing and responding to the needs of children and families. KZT per year per family being supported, but it is unclear A more rigorous assessment would be needed to clearly establish how this cost has been calculated. It was not possible to if this is the case or not, but the views expressed by parents are review the case management system within the scope of a positive indication. this assignment, but it has been summarized in reports available from SOS Kazakhstan, in Russian and English. NGO services for children with disabilities – flexible, responsive to need, creative Among the NGO services taking part in the supply-side survey, there were several in Semey and Oskemen/Ust- 332 Justification for supporting programmes to prevent social orphanhood and strengthen families in Kazakhstan being implemented by SOS Children’s Villages Kazakhstan, 2015 (mimeo)

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 41 5 Progress and results

One of the questions included in the Terms of Reference integrated family support service) was inadequate for for this review concerns the extent to which promising provision of a meaningful assessment on the issue of impact practices identified by the review ‘meet or exceed the stated or effectiveness. However, quantitative data gathered results for children (e.g. prevention of child abandonment during the course of the review against the eight main and neglect, and reduction of violence and conflict in indicators, set out in section 3, could offer some insight in families) or expectations; and the experience is successful relation to whether these services may be contributing to in achieving a sustainable change favouring children’s changes in patterns of children losing parental care and rights’341. entering formal care in EKO. Some of the data needs to Service data available for the two main promising be treated with caution, as discussed earlier in this report. practices identified (U-K CFSC and the Semey PMSP Child population data for the regions of Kazakhstan, for 341 Terms of Reference for this assignment example, was only available for 2012, but has been used

Figure 5.1 Number of Children Without Parental Care per 100,000 Child Population Aged 0-17 Years in Kazakhstan and Regions, 2010–2014

Source: MoE data provided to UNICEF; author’s calculations; NB no child population data for 2013 and 2014 was provided so the latest available data for 2012 was used in calculating the proportions for 2013 and 2014

42 to calculate rates for 2013 and 2014. Information gathered It is interesting to note that the region with the largest through interviews with parents can also help to provide child population, South Kazakhstan Oblast (SKO), has the another perspective on the relevance and effectiveness lowest rate of children living outside of parental care. of services and practices. Data gathered at micro-level Figure 5.2 shows the actual numbers of children in each in Semey and Oskemen/Ust-Kamenogorsk, where services form of alternative care and it can be seen that SKO has have been developing, is set within the wider context of one of the highest proportions of children without parental national and regional trends. care living in guardianship care, compared to most of the other regions; EKO is second only to Karaganda Oblast as Comparative analysis of child protection a region with a high number of children in residential care, and family support data 2010-2014 – East compared to other types of care. Kazakhstan and other regions of Kazakhstan When examined as a proportion of the child population, A higher proportion of the child population in EKO is as in Figure 5.3, however, it can be seen that EKO had a living outside of parental care than the national average smaller proportion of its child population in residential proportion, or than the proportion in many other regions care in 2012 (the latest year for which child population of the country. Figure 5.1 illustrates that EKO follows the data is available) than Karaganda, Kostanay and North national trend in displaying an overall reduction in the Kazakhstan oblasts. proportion of children in the child population living outside of parental care.

Figure 5.2 Number of Children Without Parental Care in Guardianship, Patronat Care and Residential Care in 2014

Source: MoE data provided to UNICEF

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 43 Comparative analysis of child protection and serving a local population. family support data 2010-2014 – districts of East It is worth noting the significant reduction in the Kazakhstan Oblast proportion of children without parental care in the child The data for EKO provided by the Department of population of Ridder city, compared to the EKO average Education shows that districts where there are children’s and the steady, but less steep, reduction in Oskemen/ homes, or other kinds of residential institutions for children Ust-Kamenogorsk. There is a special education school in without parental care, have a much higher proportion of Ridder for children with disabilities, and this fall could children without parental care in the child population (see be a reflection of national policies on carers’ allowances Figure 5.4). Most of the children’s homes and boarding and increased availability of day-care services in EKO, schools in Oskemen/Ust-Kamenogorsk and Semey are mentioned above, meaning that parents are more able serving the whole region and not just the local population. to care for their child at home and make education This makes it difficult to disaggregate from this data the arrangements nearer to home. There could, however, be impact that local family support services in Semey and data errors or data reclassification, administrative reforms Oskemen/Ust-Kamenogorsk are having, as they are mainly or other interpretations of the dramatic reduction in Ridder

Figure 5.3 Number of Children Without Parental Care in Guardianship, Patronat Care and Residential Care per 100,000 Child Population in 2012

Source: MoE data provided to UNICEF; author’s calculations

44 Figure 5.4 Proportion of Children Without Parental Care per 100,000 Child Population Aged 0-17 Years in EKO Districts, 2012–2014

Source: Child Protection Unit, EKO Education Committee; author’s calculations of the proportion of the child population without parental others showing a reduction? Why has the rate in Ayagoz care and this phenomenon requires further exploration. dropped to almost zero? It can be seen, however, that Given the difficulty of disaggregating data for Semey the rate in Oskemen/Ust-Kamenogorsk is not increasing and Oskemen/Ust-Kamenogorsk and the need to try and and even has a tendency to reduction and the rate of examine Oskemen/Ust-Kamenogorsk and Semey separately children without parental care in guardianship or patronat from other districts, Figure 5.5 presents only the data for placement in Semey has fluctuated, but remained at the children without parental care living in guardianship or same level between 2012 and 2014. While this cannot patronat placements as a proxy indicator, on the assumption offer conclusive evidence of the effect that the family that this rate will be more or less unaffected by the presence support centre in Oskemen/Ust-Kamenogorsk is having or absence of children’s residential institutions. on the population of children without parental care, it Without further information, the data is difficult to is arguably a sign that at least some part of the children interpret. Why are some districts without family support with whom the family support centre has been working services showing an increase in family care placements and might otherwise have joined their peers in alternative care without the preventive interventions described above.

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 45 Figure 5.5 Children Without Parental Care Living in Guardianship or Patronat Placement in EKO Districts, 2012–2014

Source: Child Protection Unit, EKO Education Committee; author’s calculations

Infant home data The MHSD indicated in an interview for this study that, at and those who have been removed from the care of their parents. the end of 2014, there were 25 infant homes across the country, The number of children being adopted also fell during the period caring for 1,200 children and that ‘we need now to replace beds 2010-2014, so the overall reduction in numbers of babies in infant with services’. National data shows that the number of children in homes may reflect impact from the programme to prevent infant infant homes at the end of each year has fluctuated between 2010 abandonment. This began in 2011, including assigning social and 2014, with an overall reduction in 2014 compared to 2010, as workers and psychologists to the PMSP, as described above. On the illustrated in Figure 5.6. assumption that this may be the case, it is useful to examine Semey EKO has one of the larger infant home populations, compared infant home, where this programme is perceived by UNICEF and city to the other regions of Kazakhstan, and the number at the end of health authorities as representing particularly promising practice. each year has fluctuated in a similar way to the national average In October 2015, there were 55 children at Semey infant home351. number, with an overall drop to 156 at the end of 2014, compared City health authorities noted during interview that ‘there has clearly to 175 in 2010, as illustrated in Figure 5.7. been an impact, because we regularly had 120 children in the infant More than half of the regions had fewer than 50 infants in this home in 2008, and prior, but now, in 2015, there are only 56-60 type of care at the end of each year during this period, with little children being cared for’. Data provided by the infant home suggests fluctuation. These numbers include children who are placed for that the number of children entering the infant home each year is 351 According to data provided by infant home representatives interviewed during this temporary periods, as well as abandoned and relinquished children study, October 2015

46 Figure 5.6 Number of Children in Infant Homes at the End of the Year in Kazakhstan, 2010–2014

Source: Government of Kazakhstan reports, UNICEF not falling significantly, although it is consistently slightly less than Figure 6.8 illustrates that the number of children who have an the number leaving each year. At the beginning of 2015 (covering episode362 in the care of the infant home is perhaps a more accurate a nine-month period), 59 children had entered the infant home and way of monitoring usage of this service. By adding the number of 64 had left. children remaining at the end of the year to the number who have

362 Meaning children who have spent at least some period of time in the infant home Figure 5.7 Number of Children in Infant Homes at the End of the Year in EKO and Selected Regions of Kazakhstan, 2010–2014

Source: Government of Kazakhstan reports, UNICEF

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 47 left during the year, it is possible to determine how many children A range of respondents in Semey perceive the abandonment have spent at least some time in the care of the infant home, or and relinquishment prevention programme integrated into PMSPs who have had an episode of care, during the year. The increase in as having a positive impact on child relinquishment and as numbers of children with an episode of care in the infant home reducing the numbers of children entering an infant home: between 2012 and 2015, illustrated in Figure 5.8, could indicate We have very few babies now, maybe one every three that the infant home is beginning to be used in different ways – for months, and those are only very disabled children. There shorter stays, for example, prior to adoption or returning to family. is a queue for adoption, with 53 prospective adopters Figure 5.9 presents data received from the infant home on the at the moment (they prefer to adopt healthy babies). In number of children who enter each year and reasons for entry. The 2011, for example, there would have been 4-5 babies infant home distinguishes between children who are ‘abandoned’ per month. (Representative of Semey City Education and ‘relinquished’. In the case of ‘abandonment’, it is assumed that Department) this means there is no ‘permission for adoption’ or relinquishment It is difficult to see these positive results in Figure 5.9. Perhaps paper (‘otkaz’) signed by the mother in the child’s file; in the case this is because the babies being referred to as ‘one every three of ‘relinquishment’, we assume that such a document does exist. months’ are babies born in the maternity wards of Semey itself, Data also distinguishes between children who enter the infant while the 37-47 babies who have been ‘abandoned’ each year (3-4 home from the maternity hospital and those who enter from their per month) actually come mainly from other parts of the oblast. own home. It separately counts the number of children who, at the Data on outcomes for babies in an infant home, summarised in request of parents, are given temporary placements.

Figure 5.8 Number of Children With an Episode of Care in the Infant Home During Each Year (N) = Number of Children Who Left During the Year Plus the Number Who Remained at the End of the Year

Source: Infant home data, October 2015

Figure 5.10, also illustrate the need for clear defining indicators, in ‘relinquished’ but were placed temporarily, while work was carried order to identify the effect of promising family support practices. out with the family. In this case, questions need to be asked about If the majority of babies are entering an infant home because whether placement into an infant home is the best solution, they have been abandoned or relinquished by their parents, as knowing how damaging this type of care can be for babies and illustrated in Figure 5.9, then it is unclear why the main outcome infants, and whether, perhaps, placement into a nursery or day- is returning to their parents, as illustrated in Figure 5.10. It could care service is preferable. The PMSP project report cites slightly be that some of these children were not actually ‘abandoned’ or different figures than the infant home for numbers of children

48 entering and leaving, from 2012 until 30 June 2015. Regardless at national level as a means of guiding reform, goes some way of the exact figures, it is impossible to identify the impact or effect towards paving the way for closure of beds, and replacing them of the programme without disaggregating babies born in Semey with early intervention and family support services, but it could itself from those born in other districts of the oblast. go further. The format for placing a child temporarily, for example, The draft statute for infant homes373, which is being discussed suggests that the minimum length of placement is one year. This seems extraordinarily long given the goal of reducing the length 373 UNICEF, 2015 (mimeo) of time infants spend in institutional care settings.

Figure 5.9 Number of Children Entering an Infant Home Each Year Following Abandonment or Relinquishment in the Maternity Hospital or From Home, or For Temporary Placement, 2012–October 2015

Source: Infant home, Semey, October 2015

Conclusion – progress and results Quantitative data does not provide a great deal of data for children without parental care by age, disability or conclusive evidence about the effectiveness or impact of region of origin. Data is not available, for example, to show family support services developing in Semey and Oskemen/ the district of origin of children who are currently resident Ust-Kamenogorsk on the flow of children into formal care. in children’s and infant homes, in internats and in special This is because it is impossible to review disaggregated schools. If this data were available, it might be possible

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 49 Figure 5.10 Number of Children Each Year Exiting an Infant Home For Adoption, Reintegration or Other Types of Care Placement, 2012–October 2015 )

Source: Infant home, Semey, October 2015

to identify whether family support services are having an impact on the flow of children being separated from their families and entering these forms of care, or alternative family care. The best that can be said from the available evidence is that, in Oskemen/Ust-Kamenogorsk, the rate of children without parental care and living in guardianship or patron placements is neither falling nor increasing among children aged 0-17 years. Also that, in Semey, the flow of children from maternity wards in Semey to infant homes may be reducing, if the numbers of children classified in Figure 5.9 as ‘relinquished in the maternity ward’ are from the maternity wards of Semey and not from other maternity wards around the EKO region. The survey of services shows that most of the NGOs surveyed say they are providing psychological, informational and advisory services to children with disabilities, and to their families and to families with children. Very few NGOs (the Semey NGO Family Support Centre is one such), are providing practical support with day to day problems, such as transport, housing issues,

50 Table 5.1 Summary of Progress and Results for Two Promising Practices

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 51 6 Lessons learned and recommendations

This final section of the report provides analysis on the aspects of the methodology may need strengthening and extent to which the practices that have been developed are it will be important to ensure that the service extends its sustainable and replicable. It provides some comparison links to other dimensions of social protection, employment with promising practices internationally and discusses and health services, as well as building on existing links to ways forward in the further development of child and education and child protection services and organizations. family support services. In both cases, there is not enough conclusive evidence More systematic monitoring and rigorous evaluation is of positive impact on preventing loss of parental care required if promising practices in family support are to be and the flow of children into the system of formal care properly identified and understood, to be further developed in EKO. There is a need for systematic gathering and and replicated. monitoring of disaggregated data for each of the eight This review has identified two promising practices: groups of indicators identified as a basis for this review. PSMP integrated community-based social worker/ If this data were available, then it would be possible to paediatrician/psychologist teams focused on preventing identify more conclusively whether the populations being infant abandonment or relinquishment; and the U-K CFSC served by specific family support services are, in fact, being Accompaniment Service. Both have potential for wide strengthened and children are remaining in the care of dissemination. their families rather than losing parental care. The wording The PSMP integrated service is already being of indicator 3 ‘Number of children aged 0-17 in all forms implemented regionally in EKO and nationally. The key of institutional care at the end of the year’ should be re- lesson learned from this review is that teams need to be worded to capture the district of origin for each child, for trained not only in social work and case management, example ‘Number of children aged 0-17 from each district but in other dimensions of social protection, so they can, in all forms of institutional care at the end of the year’. for example, help families to apply for cash assistance, Services can be delivered by either NGOs or state obtain places in kindergartens for their children, and link service providers – non-governmental organizations may to employment services. There is also a need to ensure have more flexibility in operating across sectoral silos and that teams implementing the service and assessing risk to inter-sectoral commissions may be needed to support case children have stronger understanding of child development, management and co-ordinated delivery of services. so that the referral of children into residential care services The U-K CFSC Accompaniment Service could be delivered only takes place when it is clearly in the best interest of the by either an NGO or a governmental organization. The child and as a last resort, based on full understanding of strong link to education services created as a result of U-K how damaging institutional care can be for early childhood CFSC affiliation to the City Education Department allows development processes. potential for early identification and referral through The U-K CFSC appears to be able to successfully schools and kindergartens, but also means that the service accompany families in very difficult situations and, in 69% is being drawn into education-related tasks. Similarly, of cases, sometimes after quite long intervention, can close PSMP family support services are drawn into addressing cases with positive results. health-related tasks and fulfilling health-related functions, Better monitoring and evaluation is required to assess although strong integration into health structures aids the sustainability of these interventions. Will these families earlier identification of problems and risk situations for be returning for more support? Will their children end up children. NGOs such as the Semey Family Support Centre separated and in care anyway? The carefully thought out may find it easier to operate with a range of stakeholders, casework approach being implemented by the U-K CFSC has across education, health, employment and housing, than clear and strong management and quality control systems with state organizations rooted in a particular sector. in place, and a strong methodological basis in social Government service providers may require strong and pedagogy and psychology, and clearly has potential. Some formally constituted inter-sectoral commissions or bodies

52 and the setting up of clear organizational structures, these services cannot develop to an effective level. It is possible for NGOs to develop family support services of all kinds, as evidenced by elements of promising family support practices emerging among disability NGOs and within the Semey NGO Family Support Service. However, they need steady and reliable sources of funding in order to be strategic and effective in developing these services. NGOs also need to be able to hire professional staff to deliver effective and high quality services and to have space from which to operate their services. Costs of renting office or other spaces from which to deliver day-care or group services need to be permissible expenses in grants to NGOs if they are to be encouraged to develop family support services. Mechanisms need to be found to ensure that family support services, whether run by NGOs or state providers, can cover the transport costs associated with making home visits and the costs of communicating by telephone with families receiving support. Capacity building and technical support is essential. The Semey NGO Family Support Centre has not been involved in any training provided by UNICEF on case management and social work for U-K CFSC and PSMP integrated services in Semey. This was clearly a missed opportunity, but has had the side effect of creating a ‘control experiment’ for testing UNICEF’s approach to supporting the development of services. Capacity building from outside is needed to help local organizations develop and strengthen their methods, based on national and international promising practices. Semey NGO Family Support Centre has weaker methods and results than the other two services, partly because it has not received training. Training in methods with a strong evidence base to support case management and co-ordination of service can be effective in sowing the seeds for locally adapted delivery. social work practices supporting families in a way that is Provision of sufficient human and administrative relevant to local situations. Relevant methods include resources, such as transport, office space and basic social work practice, such as case management, communications, is essential for the development of family and individual strength-based assessment oriented via support services. thorough understanding of children’s needs and family Allocation of additional staff to develop and implement ability to meet needs, as well as community social work. new services is essential. The ‘family support services’ that Individual and group training and education programmes are supposed to be developing in children’s homes and CAM for parents, therapeutic approaches to addressing trauma are not really developing at all because these functions following abuse, neglect or violence and effective methods have been assigned to staff who already have a range of for working with families with addictive behaviours could other responsibilities and functions within the institution. also be relevant. Specialist training is required for working The objective of the family support service, to strengthen with potential or existing foster carers and guardians, with families and prevent separation of children from parents children who have lost parental care and experienced or to facilitate the return of children to their families or to violence, abuse or neglect by parents and with children placement into other types of family care, fundamentally who have been in long-term institutional care. This training conflicts with the objective and mandate of the institution must include knowledge, skills and competencies relevant to provide care to children. Without additional funding to early childhood development, attachment theory and

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 53 other important theories relating to child development, They tend to be aimed at women who are experiencing trauma and resilience. In addition, training for working domestic violence, but there are other groups of parents with children with disabilities should encompass bio- (including fathers, and mothers and fathers together) who psycho-social understanding of disability, the International may need emergency accommodation in a crisis or who may Classification of Functioning and the UN Convention on the simply need day-care provision for their infants or babies. Rights of People with Disabilities. In the absence of these services, ‘temporary’ placement Service user participation in monitoring and evaluation into residential care for infants and babies is being used is essential to ensure relevance and effectiveness of instead; this practice needs to be challenged and stopped. services being developed. Emergency foster care and a range of day-care models Services for children with disabilities and their families can be developed instead. There are examples of effective in Oskemen/Ust-Kamenogorsk were rated very highly by two emergency foster care models in the CEE/CIS region that mothers who took part in focus group discussions. Their can be referenced as good practice to help EKO and other contributions give important insights into the services regions of Kazakhstan to develop this type of service as families need and the services that will enable them to care an alternative to infant home placements. Child-minding for their children at home, namely those that: services can provide cost-effective and high quality day- care while also providing employment opportunities for • Respect them and their children and treat them as women (and men) with their own young children at home. valued human beings; NGOs can be encouraged to develop day-care services not • Assess their needs and provide flexible packages only for children with disabilities, but for babies and young of support that meet those needs as accurately as possible; children whose families are experiencing difficulties. These • Take time and care to assess functioning and are types of services need to be developed in a regulated and staffed by professionals who take a holistic view of a child’s systematic way to ensure high quality of service delivery; abilities, personality and mood; and grants to NGOs with carefully crafted terms of reference and • Include parents in decision-making about health, calls for proposals are a good way for regional governments education and social support provision. to stimulate the development of such services. Where such services do not exist, parents often organize Other gaps identified include a lack of family support their own, as in the case of the parents of children with services in districts ‘feeding’ children to residential autistic spectrum disorders. These types of service institutions in EKO. developments need to be supported through targeted An immediate priority should be to train PMSP teams grants. in other districts of EKO using the Semey model. The Another option for developing disability services is to U-K CFSC Accompaniment Service can also be replicated. incorporate all types of social assistance into an individual Its methods, service specifications and case management budget that can ensure the child’s individual needs can approach are sound enough to produce positive results if be met flexibly, in consultation with parents or other replicated by organizations with sufficient resources to caregivers. This approach to supporting children (and employ qualified staff, trained to deliver these services adults) with disabilities, by assigning an individual budget to children and families in their districts most likely to be based on assessed needs, taking into account levels of referred to residential care. functioning, need for personal assistance, equipment and There is a lack of systematic assessment of the needs of other accommodations, is increasingly common in many children and families at district level and across the oblast social protection systems around the world. The role of the as a whole. social worker or disability worker is to work with parents to Needs assessment is the foundation for planning the assess needs and devise an individual plan, to monitor its systematic development of family support services. If the implementation and then revise on an annual basis. goal of national and oblast policy is to support families to Gaps in services for babies and infants include: be able to care for their children and to ensure that children • Family-based emergency care; and are safe in the care of their families, then the objectives of • Day or nursery care for babies and infants whose the oblast government system of family support services families are experiencing difficulties. are to identify the needs of vulnerable families in relation to providing care for their children, and to develop services The review found that mother and infant services are that can help to meet these needs, while ensuring adequate starting to develop in Kazakhstan and in EKO, but they are care for children. Figure 6.1 illustrates how a planning cycle in early stages of development and have limited coverage.

54 can help to ensure that regional government can achieve of services. Monitoring of services helps to inform district its goals and objectives. and oblast needs assessments and planning for service Each step of the cycle helps to inform the next; development. In order to know if services being funded individual assessments by social workers in services like are helping to meet overall social policy goals, the oblast the U-K CFSC, for example, can help to inform planning Administration needs to know if the right families are receiving the right types of services and that these services

Figure 6.1 Strategic Management Cycle; steps that the oblast government needs to be able to take to achieve the goal of preventing social orphanhood

Source: Rogers J., P4EC Russia, 2015 mimeo are effective in helping them to care adequately for their key participants. Oblast assessment must be built upon an children. Monitoring and review is therefore a critical step, understanding of the need for preventive family support helping ensure that resources are being used efficiently services in every district of the oblast. to achieve stated goals, identifying gaps in services and planning ongoing development and upgrading of services. Oblast authorities are the co-ordinating body for oblast-wide needs assessment and district authorities are

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 55 Conclusions This review has identified two promising family support practices and elements of other promising practice in a range of settings in EKO. If UNICEF intends to support the further development of the PSMP integrated service, it should be developed with the understanding that referrals to infant homes must be a measure of last resort, and that alternatives exist for emergency short-term care for children at risk, and for providing day- care services for babies and young children. The further development of family support services in EKO can be achieved by supporting the further development of the U-K CFSC Accompaniment Service and supporting the EKO Administration, to make more strategic use of its grant programme, and to support the Semey NGO Family Support Centre and other priority NGO services in the two main cities and in more remote districts. This support needs to include capacity building of existing NGOs and future service providers. UNICEF could support this process by ensuring that training and technical assistance is provided to NGOs awarded family support service development grants or by supporting EKO Administration to develop mechanisms for providing capacity building and training to NGOs. The U-K CFSC should ideally be supported in conducting a case review and in fine-tuning its practice. Ultimately, it cannot start to achieve real impact on the numbers of children without parental care in Oskemen/Ust-Kamenogorsk until a strategic decision is taken by EKO Administration to extend family support services across every district of the oblast and to permit the U-K CFSC to dedicate all its resources and capacity to developing its Accompaniment Service, as well as supporting rayons in developing their own family support and accompaniment services. The existing EKO child protection and social services monitoring system needs to be adjusted to capture disaggregated data, so that it can demonstrate the effectiveness of family support services. This data can also be used to assess the need for family support services on an ongoing basis and to identify gaps in services.

56 7 Bibliography

-Law on Social Services 114-IV of 2008, Government of Kazakhstan National Plan of Action to Strengthen Family Relations, and Moral-ethical and Spiritual Values in the Republic of Kazakhstan 2015-2020, Government of Kazakhstan -Social Development Concept 2030, Government Order No. 396, of 24 April 2014 Note for 2015 to the state social order ‘Creation of Services to Support Families in Difficult Life Situations’ (mimeo, Child Protection Committee of the Ministry of Education, provided by UNICEF Kazakhstan) -UNICEF, 2013 Children Under Three in Formal Care in Eastern Europe and Central Asia http://www.unicef.org/ceecis/UNICEF_Report_Children_Under_3_2013_ ammended_January_2013_Web.pdf -Fourth Alternative Report by NGOs on the Implementation of the CRC, 2014 (mimeo, provided by UNICEF Kazakhstan) -Shabdanova, S., 2015 Опыт интегрированной работы социальных работников и психологов учреждений первичной медико-санитарной помощи, родильных домов и Дома ребенка в г.Семей по программе «Профилактика отказов от де- тей от 0 до 3 лет (mimeo, provided by UNICEF Kazakhstan) -Annual reports 2009-2014 ‘On Organizations Providing Special Social Services in Kazakhstan - Series 13’, Statistics Committee of the Ministry of National Economy of RK, downloaded 18 August 2015 from www.stat.gov.kz -Gentry, C. E., 1994, Crisis Intervention in Child Abuse and Neglect — U.S. Department of Health and Human Services

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 57 Annex A Case study from other promising practice, adapted from materials provided by service providers

CAM Family Support Service, Semey – casework been lost or were never registered. The work of the FSS is with families, mainly focused on social administration: focused on restoring birth certificates, helping to register arranging documents and benefits, and providing for loss of breadwinner benefits, and gathering documents and testimony about parents. advice There are a range of reasons for referral to the FSS, The ‘Family Support Service’ (FSS) began its work in including: death of a parent and the other parent not having December 2011. Its main goal is to support children, the right documents to arrange for loss of breadwinner adolescents and their parents at difficult times in life. When benefits; no registration and no identity papers, meaning they are in despair, disillusioned, suffering and tormented that a young single mother with no family could not register by doubt, or unable to independently resolve problems that for loss of breadwinner benefits; an 11 year old child with have arisen, they expect understanding, sympathy, human no birth certificate, born at home, needing support in support and concrete help. The main goal of the CAM is to restoring her documents; and a child from Uzbekistan left help in word and deed, so that each individual can believe orphaned and without an original birth certificate. in him or herself. 466 documents were restored from December 2011 to The main role of the FSS is to restore and organize December 2014, including 78 birth certificates, nine claims children’s documents and to determine a child’s status. for loss of breadwinner benefits and 18 registrations on the If a child is from a ‘poor’ family (an ill-being family or housing waiting list. ‘neblagopoluchnii’) most have no documents or these have

Case examples from CAM FSS Semey A young man from Uzbekistan, born in 1997, and his sister, born in 1992, were left orphaned when their mother was murdered. The FSS helped to restore the young man’s birth certificate, to arrange loss of breadwinner benefits and to place him into guardianship care. Three minors from one family had no birth certificates and the exact place of their birth was not known. The FSS helped their relatives to find their birth certificates by sending requests for information to other regions of Kazakhstan. All three were issued with birth certificates. A boy, born in 2007, from Shulbinsk village, had no documents; after restoring his birth certificate, registering him and undergoing full medical examination, he was returned to his family. A girl, A, was removed from her guardian and placed in the CAM. She had no original birth certificate, no registration and no individual insurance number. She had not seen a doctor for at least two years. A heart defect was identified during a medical examination and she was transferred to a children’s home. The FSS has worked with 40 child-migrants since it began its work, including 28 children from Kyrgyzstan and ten children from Russia. The FSS contacts the consul of the relevant country and establishes contact with the child’s legal guardians by telephone and they are eventually returned to their parents or guardians.

58 Children’s Home No. 3, Semey – service data and case examples from the FSS case journal Since its inception in 2011, the FSS at Children’s Home No. 3 has worked with four referrals for adoption, five referrals for patronat care (including one family that took ten children), six reintegrations and one case of guardianship.

DOCUMENTING EAST-KAZAKHSTAN OBLAST EXPERIENCE IN ESTABLISHING FAMILY SUPPORT SERVICES 59 Semey Family Support Centre – case studies

THE CASE OF T AND A In August 2013, an unusual boy, T, came into the care of the CAM in Semey. He was unchildishly serious, thoughtful and preoccupied. During psycho-diagnostic and psycho- correctional sessions, he was quick on the uptake, interested and demonstrated creative thinking. He was sociable and friendly in communication with his peers. He really took to the course on daily life and social skills and learned how to behave in society, to be frugal with bread, and show respect for elders. With the help of the social worker and lawyer, T was referred to an internat for low-income families. His mother, A, is deaf and dumb and was living at the time in a hostel. It is not known why, but she left her job and went to the countryside. When she returned to the city, her place in the hostel was, of course, no longer available. She had to move back in with her former husband, also deaf and dumb, who was unemployed, using alcohol and causing scandal. Because of this, A ended up having to leave and live wherever she could. During a visit to T, at the internat, he told us about A’s situation and we invited her to our office. The problems of this family were resolved with the help of the police and the press. A was placed in our Crisis Centre, where she received psychological, legal and social help and help in finding work.

THE CASE OF M A homeless woman was referred to our Family Support Centre. She was completely lost, with dull eyes. Her situation was extreme, with no job, no money, no home, without documents and beaten by her husband.

Firstly, she underwent comprehensive psychological rehabilitation. A series of preventive conversations were conducted with her husband, together with the police, and a protective order was issued. Our lawyer carried out detailed and extensive work to restore identity papers and to advise her on family rights and housing issues. She received material support, clothing and New Year presents for her children. Her children were helped to prepare for school, with clothing, school supplies and stationery.

Most importantly, with our help, she found employment and now works as a social worker in another NGO. Now, she has confidence in her future, in her new career and in her new circle of friends.

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