Transforming Lives

Acknowledgements to contributors to the Project

We would like to acknowledge the vision and commitment of our partners from national government, Deputy Minister of Health, Desislava Dimitrova, Deputy Minister of Labour and Social Policy, Valen- tina Simeonova and Head of the State Agency for Child Protection, Nadya Shabani. Special thanks for their courage and foresight must go to the Mayor of , Nikolay Pavlov and his deputies Boris Vrabevski and Marin Damgov, to the Teteven Directorate of Social Assistance and especially to the team from the Child Protection Department and their colleagues from the adjoining districts. This courage and foresight was shared by Dr Antonio Marinov, Director of Teteven Institution for Ba- bies and his staff. We would like to express our warmest thanks to the village mayors and those local offi cials and media who helped us conduct our foster care campaign in district and adjoining municipalities. We are grateful for the fi nancial support of The Abandoned Children’s Trust UK, and the generosity of SANDVIK Bulgaria. In order to protect the children’s right to privacy, all names have been changed in the case studies and situations have been generalised. The project team

Project ’Restructuring of the Home for Medical and Social Care for Children (HMSCC) in Teteven and development of alternative social services for children and families (Centre of Social Support)’ was implemeted by:

Dr. Delia Pop – Director of Programmes, Hope and Homes for Children

Galina Bisset – Regional Manager for Central and Eastern Europe, Hope and Homes for Chil- dren

David Bisset – Project Manager, Equilibrium

Desislava Encheva - National Coordinator, Equi- librium

Georgy Simeonov - Government Liaison Officer,

Stefka Peteva, Ivelina Dimitrova, Nadejda Petro- va, Nadejda Deneva and Milena Vlahova – Train- ers

Veselina Bosilkova PhD – Supevisor of the new service team

Petya Chikulova - Field Social Worker, Teteven

Tsvetan Dimitrov - Local Coordinator, Teteven

living in 32 institutions.

On the 28th December 2010, the Bulgarian Council of Ministers an- nounced the offi cial closure of Teteven Institu- tion for children 0 to 3 years old (offi cially named Young children are too often placed in institutions ‘Home for Medical and Social Care for Children’ throughout the world and this occurs despite – HMSCC). The decision was in line with the Na- wide recognition that institutional care leads to tional Strategy ‘Vision for Deinstitutionalising the extremely negative consequences for children. Children in the Republic of Bulgaria’ as well as By being placed in institutions, children under the with the concept for deinstitutionalising the chil- age of three are signifi cantly more likely to suf- dren from the baby institutions approved by the fer from poor health, physical underdevelopment Ministry of Health. and deterioration in brain growth, developmen- tal delays and emotional attachment disorders. The closure took place within the project ’Re- (Carter 2005; Johnson, Browne and Hamilton- structuring of the Home for Medical and Social Giachritsis, 2006). Care for Children (HMSCC) in Teteven and de- velopment of alternative social services for chil- Children need more than good physical care. dren and families (Centre of Social Support)’ im- Children need love, undivided attention and an plemented jointly by NGO Equilibrium (Bulgaria), attachment fi gure from whom they can develop Hope and Homes for Children (United Kingdom) a solid foundation for all their future relationships and the Municipality of Teteven (Bulgaria) and in life. Research on the attachment theory com- supported by the Bulgarian Ministry of Health, menced in 1945, most signifi cantly with John the Ministry of Labour and Social Policy and the Bowlby. A scientifi c understanding of the child’s State Agency for Child Protection. This support developmental needs was established and this was ratifi ed in formal agreements that guaran- led to policy changes in post-war Europe and the teed a smooth transition between institutional United States with regard to the care arrange- care and the operation of a complex for social ments for young children. Despite the scientifi c services for the children and families from the evidence and the daunting results of research in community. The project was conducted over a the early 1990s showing the damaging effects of period of 24 months - from January 2010 until institutional care, the practice of placing young December 2011. children in institutions continues to be widespread around the world. In January 2010, in Bulgaria there were 2,334 children under the age of three Hope and Homes for Children (HHC) is a British wealth of experience in direct social work as well children’s charity which has been working for 17 as in the development of innovative services. years in Central and Eastern Europe (CEE) and has a track record of pro- Africa for improving the lives of children without viding social services for children, including Day parental care and those living in hardship. HHC Care Centres for Children with Special Needs and carries out national programmes in 10 countries a Small Family Home for a group of young adults in CEE and Africa working with children, families from Mogilino Institution. Teteven HMSCC had a and their communities as well as central govern- capacity for 50 children. However, over the last ment and local authorities to set up, develop and few years prior to the project it catered for only 25 disseminate sustainable models of family based – 27 children on average. The institution was the care. Over the past 10 years, the organisation only HMSCC among all 32 assessed in 2006 as has managed the closure of 37 specialised insti- needing to be restructured meaning ’transfer of tutions and provided technical support for the clo- the existing resources towards alternative com- sure of a further 18 large institutions. The model munity based services for children and families’. of deinstitutionalisation developed by HHC is The Municipality were aware of these recom- recognized by UNICEF and the World Health mendations and supportive of the national policy Organisation, as representing best international towards deinstitutionalisation. practice in this area. The project was funded by The Bulgaria Aban- Equilibrium (EQ) is a non-governmental organi- doned Children’s Trust (TBACT). sation based in Ruse, northeast Bulgаria which manages the Complex for Social Services in Ruse, consisting of a Community Support Centre with an Emergency Admissions Unit, a Centre for working with homeless children and a Small Fam- ily Home for disabled children. EQ has pioneered the development of alternative services for chil- dren and families and team members have a Baby institutions represent one of the main en- try points to the childcare system and are asso- the experts who monitored the quality of residen- ciated with long years of institutionalisation and tial care, provided guidelines on how to start the increased developmental delays. process once all indicators and criteria were in place. The context of the project at the end of 2009 is best summarised by Mrs. Mariella Licheva, Direc- The HMSCC team was included in trainings on tor of the Social Assistance Directorate in Ruse, developing a plan for restructuring, but there was who was then Head of the State Agency for Child no commitment to change. Protection Regional Department, responsible for Teteven Municipality: At the same time statistics showed that in 2007 – 11 children were reintegrated with their biologi- “According to the law, HMSCCs are health es- cal families, 1 into his / her extended family and tablishments, manned by teams of doctors and 13 children were adopted nationally. nurses as well as specialised personnel such as rehabilitators, pedagogues, psychologists This data confi rmed that the national policy of and social workers. Teteven HMSCC was not a gate-keeping and reducing the number of chil- typical institution for infants 0 to 3 as there was dren in institutional care works, and the process only one pediatrician who was also the Director. of replacing residential care with a range of com- Despite the fact that it did not cater for children munity based social services was ready to start.” with disability, there was a rehabilitator while, by way of contrast, the need for a psychologist (re- quired to prepare children for reintegration and During 2010, there were major developments in adoption) was overlooked and the establishment childcare policy that gave momentum, ensuring lacked such a specialist. the successful completion of this pilot project: • February 2010 – launch of national strat- The expert from the State Agency for Child Pro- egy: ‘Vision for De-Institutionalizing the tection who chaired the inter-agency team that Children in Bulgaria’ carried out the assessment and provided the • November 2010 – launch of action plan recommendations for restructuring, as well as in support of this strategy envisaging the closure of all institutions within the next From HHC 10 to 15 years. On 24 November 2010 an Director of Programmes and Regional Project implementation plan was approved by the Manager: training and alignment of local ac- Council of Ministers tivity with international best practice, liaison • Early stages in the implementation of na- with local and national government – strat- tional DI programmes funded by the EU egy and policy namely: 1. Closure of all institutions for disabled From EQ children including those children Project Manager: coordination / reporting / over the age of 3 years currently ac- financial supervision commodated in the institutions for National Coordinator: methodologist guiding babies field work and liaison with other professionals 2. Closure of 8 average-sized baby in- (eg Child Protection Departments, Municipal stitutions Authorities) 3. Development of foster care in sup- port of the closure of those baby in- Trainers: Retraining of institutional staff; fos- stitutions ter care campaign and training of candidates; • Rounds of meetings with all directors of in- raising the awareness of local professionals stitutions and local authorities to promote – social welfare and healthcare – multidisci- the national policy plinary approaches to supporting children at risk; training specialists in the new Centre of Social Support 1. Setting up the Team Field social worker: assistance with cases HHC recognised the advantages derived from of children accommodated in the baby instiu- having a Bulgarian implementing partner, EQ, tion and new prevention cases in collabora- with a long track record in prevention of aban- tion with Child Protection Departments donment and reintegration work with children Local coordinator (Teteven): communication and families while its own experts were adept in with local administration and coordination of the processes specific to a closure programme. local activities Building the implementation team involved inter- Consultant (Sofia): methodological support organisational collaboration between HHC and for strategic communications of the project EQ with the support of additional people primarily to fulfill communication and coordination func- Support and administration: financial control- tions in Teteven and Sofia. ler (accounting / procurement) and drivers The team comprised: Before starting the project, the in-country im- plementation team acqainted itself fully with the HHC closure model and reviewed as- - living conditions and improvements needed sessment tools and protocols for applicability - family and social relationships and inter- to the task ahead. ventions needed - education and skills 2. The Initial Assessment of the Children - household economy and support required from HMSCC and their Families The assessment process normally lasts 4-6 weeks but this depends on the family’s contacta- On 1 January, 2010 there were 28 children in bility and duration of residence in a particular lo- the institution aged 0 to 3 and 38 children in total cation (where childcare authorities can reason- passed through the institution during 2010. The ably expect to find them) and a willingness to institution was not set up to cater for children with be subject to assessment. The duration of resi- disabilities or underweight children. dence is also important for planning reintegration During the first phase of the project, the children and post-reintegration measures. placed in the HMSCC (32 in number at the begin- Assessment was made difficult because many ning of April 2010) were evaluated as were their of the families were in locations remote from families to assess the potential for reintegration. Teteven or simply could not be traced. Some par- This was done jointly with specialists from the ents were overseas and not contactable, while Departments for Child Protection in the Lovech others deliberately avoided contact with the child district and in those neighbouring communities protection authorities; it was difficult to form a where the children accommodated in the HMSCC relationship that supported the assessment proc- came from. ess. Another problem we encountered was eco- Child’s assessment covered: nomic migration linked to very fragile household economies and tenuous means of ensuring an - family structure income with no familial capacity to cope with - health status and needs emergencies. - development status and needs The focus is on the best interests of the child, - family and social relationships but the assesment process, while being flexible - recommendations for placement and very well resourced, must also acknowledge - additional support required to facilitate the limits of practicability within a reasonable placement time-frame taking into account the ill-effects of prolonged institutional care. - post-placement support services Family assessment covered: - family structure 3. Placement Recommendations and orous matching process the chosen family with- Service Design drew. Our plan B was temporary placement with a carer from the institution with whom the child Individual plans for the removal from institutional was familiar pending successful adoption. care and subsequent placement of every child into an appropriate form of family care were According to the needs and in the best interest of developed including contingency provisions. In the children, we planned to reintegrate 11 infants some cases, while not abandoning our attempts but successfully reintegrated 10 of them in to 8 to trace parents / relatives, we started the lengthy biological families with the 11th child joining a fos- and bureaucratic procedure of registering the ter family. We planned 5 temporary placements children for national adoption. In one case, the in foster care prior to adoption but did not need to recommendation was reintegration but, despite exercise this measure and only one child was tar- extensive work with the family, they themselves geted towards long-term foster care. In the end, decided they could not cope and the child was 2 children were placed in long-term foster care. placed in long-term foster care. In another in- Overall, 20 children were adopted. stance, adoption was planned but during the rig-

To summarise:

Initial assessment of 32 children placed Recommendations Eventual Placement in HMSCC Reintegration 11 10 Adoption 15 20 Long-term fostering 1 2 Short-term fostering prior to adoption 5 0 Total 32 32

The project team worked simultaneously on: • Development of foster care • Building local capacity to support children • Finding family alternatives for all 32 cases in their local families or in alternative fam- of children placed in the institution as per ily care 1 April 2010 • Prevention of abandonment of babies 4. Preventing Children from being For the children who cannot live with their fami- Placed in Care lies, one of the most important alternative servic- es is foster care, including emergency and short- Another important component of the project was term accommodation for children under the age preventing the abandonment of newborn babies of 3 years. In Lovech and in the Municipality of through the provision of advice and financial sup- , we have delivered 19 multime- port. We worked together with the Departments dia presentations about the nature of foster care. for Child Protection from all districts from which They were attended by about 200 people. The children had previously been sent to HMSCC - cable television networks in Lovech, Teteven and Teteven. We have worked on the prevention of broadcast specially prepared material on 21 cases of abandonment of young children and the topic. We have trained 16 candidates to be- have provided food and baby supplies, finance come professional foster parents. Child protec- for the issuing of documents, travel expenses, tion officers from the whole district took part in building materials and firewood. order to improve their general competence in the To optimise our work on the prevention of child field of foster care. After the training, an existing abandonment and institutionalisation, a 2-day foster family changed its profile and registered to training was conducted for Child Protection De- care specifically for babies. This family took a 3 partments and Regional Health Authorities dur- year-old from the institution. Three couples were ing May 2010. We focused on prevention as a approved in Teteven and one couple took care philosophy of social support making use of an of a 10 month-old baby from the institution. Two extensive network of local resources. The nega- more couples were registered in the Municipal- tive effect of institutionalisation on young children ity of Cherven Bryag and one of them provided and the crucial importance of foster care for new- emergency care for a baby born in Teteven Ma- borns without parental care were highlighted. ternity Hospital in December, 2010. Our experience shows that foster care for new- born and young children is possible if additional 5. Moving Children and Post-Placement material support is given to the foster family at Support the time of placement eg cot, bedding, pram, During the period of preparation for reintegration, nappies, baby milk, bottles, toiletries and clothes. we provided families with the following: access to These were supplied by the project but can also municipal housing or to a rented flat, payment of be provided by services such as Centres of So- domestic overheads, health insurance costs, fees cial Support. In addition, we paid for the issuing for obtaining personal identity documents and of the documents required by foster care appli- birth certificates, transportation to the HMSCC cants. when visiting the children, food, clothing, baby National adoption can be a sustainable solu- equipment and household appliances. tion for children 0 to 3 who cannot live with their families. European models of best practice were After a thorough analysis of the existing services presented to local professionals to improve their in Teteven Municipality and the needs of chil- capacity to prevent child abandonment and sup- dren at risk it was concluded that a wide range port children in alternative family care. The third of social services is necessary. It could be pro- training module, in the context of the reform, took vided within the framework of a Centre of Social place on 24 and 25 June, 2010. It was on the Support (CSS) funded by the State. subject of ‘Adoption in the best interest of the The premises occupied by the institution have child’ guaranteeing the right of the child to be been converted and as from 1st March 2011 they raised in a family and a viable alternative to in- have been operating as a CSS for children at risk stitutional care. from the age of 0 to 18. The centre is staffed by a team of 25 comprising social workers, psycholo- gists, teachers, nurses, a rehabilitator and care 6. The Newly Developed Services assistants. The CSS contains the following basic During 2010, Teteven Municipality implement- units: ed the project “The future of the children in our 1. Emergency Placement Unit for crisis ac- hands” (Contract BG 051PO001-5.2.03-0030- commodation, with a capacity for 6 chil- C0001) undertaken with the financial support dren of the Operational Programme ’Development of Human Resources’, co-funded by the European 2. Centre for Foster Care Union through the European Social Fund (ESF). 3. Mobile Unit working on the prevention of abandonment and institutionalisation During the implementation of the project, within a period of 100 days, EQ experts provided training, 4. Centre for children with deviant behaviour supervision and a practical introduction to new and at risk of dropping out of school work practices to the staff of HMSCC – Teteven. The CSS premises comprise: Training included social work case manage- • 2 bedrooms and a living room with a ment, child development, the consequences of kitchenette for the Emergency Place- institutionalisation, group work with children and ment Unit families, counselling for children with behavioural • Play room and rest room problems and for their families and the formation • 2 open-plan offices room for the of social and life skills. This possibility for retrain- staff ing (pre-qualification) helped many of the partici- • 1 room for staff meetings and recrea- pants to secure employment in the new services. tion Out of 27 institution staff, 21 applied for a job in • 2 rooms for individual meetings with the new Centre of Social Support and 16 were children or family members offered employment. • 1 room for teaching and helping with homework 7. Overall Project Results: • 1 room for group activity • 10 children from HMSCC reintegrated with • Court yard with playground their 8 biological families • 2 children from HMSCC placed in long- A car has been provided to support activities in term foster care the community. • 20 children from HMSCC adopted nationally CSS - Teteven offers: • 21 children aged 0 to 3 years from Lovech District supported to live with their families • Individual support by a key social worker • 16 trained candidates for foster parents • Specialised consultations with, for exam- • The first 3 foster families in Lovech District ple, a psychologist, pedagogue or reha- were registered in Teteven; 2 new foster bilitator families were approved and the profile of • Referral, mediation and the accompany- an already active foster family widened to ing of clients when dealing with bureau- include emergency foster care for babies cratic procedures in Cherven Bryag Municipality • Practical support for solving every-day • 1 newborn baby placed in foster care di- problems rectly from the maternity hospital • Social support in the home of the child and • 30 professionals from Lovech District and the family (Mobile Social Work Team) Cherven Bryag Municipality trained • Daycare, individual psychological and so- cial work, school support and club activi- ties for the children during the day 8. Project Impact • Training and support to biological parents, The implementation of the project has created foster carers and adoptive families a model for the reform of Bulgarian institutions CSS -Teteven works in the field of early preven- for children aged from 0 to 3 years and for the tion of risk by identifying, accessing and support- provision of care for children at risk based en- ing vulnerable children and families in the com- tirely on a set of alternative services for support- munity. ing the family or through the provision of family- type care. HMSCC - Teteven is the first institution The beneficiaries of the services are primarily of its kind in the country to be restructured into children and families at risk who live in the Mu- a new type of social service. The liquidation of nicipality of Teteven but the Emergency Admis- HMSCC - Teteven was carefully coordinated sions Unit, the Mobile Team for prevention of with the opening of a Centre of Social Support abandonment and the Centre for Foster Care will with state funding to avoid gaps both in relation also operate regionally. to family support and the redeployment of staff to the new service. The liquidation procedure and budget relocation were tested and the need for and not apart from it. changes in the regulation were identified in order to ensure better synchronisation and transferabil- ity of assets when replacing the residential care 9.2 Preparing the Ground: Working with with alternative social services. Our partners National / Local Government and Donor from central and local government honoured the Organisations agreements defined in the Memoranda of Un- Pre-empt the effect of unprecedented situa- derstanding (MoUs) and participated actively in tions on operational activity and the regulatory finding solutions when faced with unprecedented framework in which it takes place by assessing situations and untested procedures. risks and planning measures to cope with them if/when they arise. 9. Key Learning Points Avoid adding extra components to existing bu- reaucracy. Ensure that resources flow freely. 9.1 Implementation of a A DI programme depends on three essential Deinstitutionalisation Programme components: Maximise the use of local practical expertise. o Procedural momentum The decision making capacity should be vested o Coordinated activity in different locations as far as possible in the local team. Progress suf- and probably under the auspices of differ- fers when the learning curve of key team mem- ent authorities bers is long or the comprehensive localisation of implementation models based on international o Cashflow and the coordinated and ra- know-how has not been dealt with at the outset. tional flow of resources. (It is important to Progress suffers when implementation teams release tranches of funding in a manner have to wait for decisions to be made. that coincides with the needs of the pro- gramme and not only the administrative A similar advantage arises when team members tradition of the donor / financial monitor.) have a track record of working together and are cognisant of each others’ capabilities, styles of Deinstitutionalisation programmes often give rise working and communicating. Within the group, to situations that are unprecedented in terms of there is a limited need to spell things out to one legislation and bureaucratic operations. Novel another and the accent is on communication be- forms of communication will arise between minis- tween the implementation team and other play- tries, between donors and recipients of funding, ers in the deinstitutionalisation process. within organisational hierarchies and between departments / organisations involved with the The group leader and instigator of operations provision of childcare. should, ideally, be part of the operational team There are three key issues: Such a closure strategy requires the early im- plementation of a moratorium on placements in o The implementation team benefits con- the institution that is being closed meaning that siderably from direct access to all key institution- options for the separation of children from their al stakeholders parents / families in cases of genuine emergency o A single, influential legal team should be must be rationally catered for by use of emer- created to support the deinstitutionalisation proc- gency foster care or temporary short-term place- ess at governmental level as opposed to having ment elsewhere. Authority needs to be vested in ad hoc advice provided to different actors from a Gate-keeping Coordinator to work with all the different sources child protection departments , maternity units and local stakeholders that could be affected. o Key decision-makers should be identi- fied at the outset and the bureaucratic means by which decisions convert to practical outcomes 9.4 Foster Care should be clearly defined. New regulation or gov- ernmental directives lacking precedent need to Foster care development requires professional be communicated in a comprehensible manner foster care teams. and well before the point in time at which they The creation of public awareness, recruitment, need to be acted upon training and monitoring of foster carers demands full-time foster care professionals working in self-contained teams within a larger, support- 9.3 Gate-keeping and Prevention of ive, multidisciplinary framework. The successful Abandonment promotion of foster care cannot be achieved by Ensure care options and a multidisciplinary com- hard-pressed social workers who dedicate only munication network is in place to support a mora- an affordable proportion of their working time to torium on placements in institutions marked for the issue. closure. Appoint a single coordinator for the process. 9.5 Emergency Foster Care HHC / EQ advocates an approach of simultaini- Emergency foster care allows flexibility and ous closure of an institution and the transfer of provides childcare professionals with the time its budget and assets towards the development needed to pursue reintegration options that are of a range of alternative services within a rea- difficult but feasible. sonable timeframe allowing the institution staff to retrain and participate in the provision of the new The duration of a reintegration attempt is linked services. primarily to the capacity of the family and time- tables need to be defined when closing institu- • A significant proportion of children in tions. At what point is it reasonable to abandon baby institutions are from the Roma community reintegration attempts that are coming to be rec- • Kinship care is normal within the Roma ognized as unrealistic? community • There is a lack of training that is sensi- Time can be bought if emergency foster care is tive to the needs of Roma parenting available. A child can be placed in emergency • The parenting criteria supporting the foster care while professionals are working with model are based on a (recently westernised) the biological family. Emergency foster care is mainstream conception of parenting also a very important part of a package of gate- • This is often at odds with Roma parent- keeping measures because it provides the pos- ing practices and values which, as a result, be- sibility for temporary removal of a child from a come devalued and disapproved harmful domestic environment. • This can undermine efforts to support An early step in any programme should be the Roma children in their families and communities. assessment of existing foster families in the vi- cinity. Is there the potential of placing more chil- dren with these families? Once this option has 9.7 Adoption been considered and children and families have Consider where adoption fits into a system de- been assessed, the scale of the commitment to void of institutions. recruit new foster parents becomes clear. A 2009 amendment to the Bulgarian Family Code gives authorities the right to put a child up for 9.6 Reintegration and Kinship Care adoption in cases in which the biological parents have withheld contact with institutionalised chil- Professional assessment of parenting skills dren for six months. This is seen as especially needs to take account of minority cultures. important in the context of the inability of the au- Promote development of a culturally appropriate thorities to trace a parent / the parents – a prob- placement framework for reintegration and kin- lem that has escalated with the increased level ship care among the Roma. of economic migration following EC accession. The measure is also a significant disincentive to The sharing of childcare is a traditional practice in those who may view (temporarily) abandoning a some ethnic / cultural groups such as the Roma baby as a type of family planning - an effective and kinship care is, therefore, normal practice in means of striking a balance between a fragile these cultures. However, to take advantage of household economy and the number of residents the benefits that kinship care provides, the child- that depend on it. care system has to be understanding of minority practices in raising children Without significant programmes in family plan- • Many institutions are currently located in ning and education in certain sectors of Bulgar- remote locations or neighbourhoods that are far ian society it is likely that adoption will remain an from ideal – Are these acceptable locations for attractive option because of an inability to ex- alternative services? pand alternative care options to the appropriate • Small Family Homes are supposed to levels. be homely and having them located in old insti- tutional buildings is generally an unacceptable The adoption procedure is still too long from the compromise. point of view of a baby’s life and interests and • Phasing the closure of an institution by is often performed for the administrative conven- inelegantly placing new services in close proxim- ience of those involved in it. ity to old institutional practices tends to produce costly, dysfunctional facilities. 9.8 Accommodating Alternative Services and When it is seen to be rational to accommodate the Rehabilitation of Institutional new services by renovating an institutional build- Buildings ing and adjusting its layout, it is likely that you will need to achieve this while there are still some Ensure expert and transparent decision-making. infants accommodated there. Therefore, work Recognise that the more compromises that are needs to be phased so that those children still in made, the greater the impact on the new services residence can be relocated within the facility to in terms of both the standard of service and the areas that are safe and comfortable and in which long-term value for money . the requisite utilities are maintained – power, wa- ter and heating. Purpose-built facilities tend to be more functional than converted buildings and building from the ground up is often cheaper than large-scale reno- 9.9 Training and Re-deployment of vation. There can be significant hidden costs as- Institutional Staff sociated with the accommodation of a service in the wrong facility or location and these can have Realistically assess institutional staffing profiles both a financial and an operational impact. Nev- and the true potential for redeployment to alter- ertheless, there is no absolute rule that says new native childcare services. services should not be accommodated in old insti- Encourage the development of enlightened train- tutions. Also, staff from the old institution making ing schemes and review retirement possibilities. the transfer to new services will be accustomed to working in a particular locality. However, some Any deinstitutionalisation programme conducted actions are legitimately challengeable – at municipal, regional or national level demands a sea-change in childcare philosophy and sys- tems. You cannot talk about philosophies without considering the people who subscribe to them make it impracticable or undesirable to target all or, indeed, depend on them to help define their institutional staff towards these services. Those professional identity. You cannot talk about sys- of the older generation with outdated qualifica- tems, processes, methods or operations without tions or no paper credentials at all may be espe- considering the people for whom they represent cially vulnerable. the comfortable status quo, a rational outcome It is important to view this issue expansively, of their education and training and the means by scanning at local levels the whole domain of which they earn a living. professional engagement with children –(health Training for employment in alternative childcare care, pre-school care, education, childcare serv- services may lead to new job opportunities but ices, the NGO sector, forthcoming projects – to the tradition of ‘clinical medical’ care in baby insti- pinpoint opportunities. tutions and current levels of over-manning could

10 Financial Aspects: Comparison of Annual Budget of HMSCC with the Annual Costs of Alternative Services

Annual budget of HMSC (2009) 313 600 lv Annual budget of CSS (2011) 205 280 lv Reintegration benefits for 10 children for 12 months 2 000 lv Child allowances for 10 children for 12 months 4 200 lv Foster care payments for 2 children in 2 different families for 12 16 680 lv months TOTAL: 313 600 lv 228 160 lv

Comparison Between Project Expenditurs on Prevention and Reintegration

Average duration Average cost Reintegration 8 months 1000 lv direct support to 1 family Prevention 3 months 500 lv direct support to 1 family

It should be noted that additional to the direct family support is the time, travel and communication costs of a multidisciplinary team (social worker, psychologist, nurse). Bearing in mind the duration of reintegration, these costs make it a much more expensive service than prevention. Yordan Tsvetana and Grigor were visiting their family We met Yordan in January, 2010 as we started in Lovech, 130 km from their home in Sofi a, closing the Teteven Institution and replacing it when their son Yordan was born prematurely. with a range of alternative services such as a Weighing just 1,430 grams (3.2 lbs) and with foster care network and a centre of social sup- under-developed lungs, his life was at risk and port to help families like Yordan’s and prevent he was immediately moved to the specialist more children being placed in the institution in care of the Neonatal Ward in Lovech General future. Hospital. Our fi rst priority was to try to locate Yordan’s As Yordan battled for survival, his parents faced family. Working from an old contact address, the harsh realities of their lives - a gravely ill we found Yordan’s maternal grandmother and child, no money to make regular visits to the after making frequent return visits and gradu- hospital, the responsibility of caring for their ally building a relationship with the extended two year old daughter, work commitments to family, we eventually met his mother. ward off the threat of even greater fi nancial Yordan’s parents have a complex and unpre- hardship and a volatile relationship. Without dictable relationship; the mother and daughter the necessary fi nancial and emotional support lived with the mother’s family and the husband networks in place, the family simply could not was in separate lodgings. They had considered cope and all contact with Yordan was lost. giving Yordan up for adoption as they could not Following four months of intensive care, Yordan cope with the diffi culties in their relationship or was discharged from the hospital. The Child the care of a sick child. Thankfully, they were Protection Department tried but failed to locate happy to work with us and as a result of their his parents. As there were no alternatives, he efforts, coupled with our extensive tailored was moved to the Teteven Institution for Ba- support, the family reconciled. Although they bies in Lovech County in December, 2009. were living apart, they were ready to become full-time parents to Yordan. As is the case for most institutionalised babies, According to a recent examination by his pae- Yordan’s physical and emotional development diatrician, Yordan is now reaching the develop- had faltered while he was in care. At 10 months mental milestones applicable to his age group. old, when we reunited him with his mother and According to the paediatrician, Yordan’s early father, he was unable to hold his head up, roll developmental delays were a direct result of over or sit unaided; these important childhood his institutionalisation. milestones were delayed through a lack of Despite the harsh realities of living within a time one-to-one care and stimulation. of severe financial hardship, Yordan’s family Yordan’s first few weeks back home were hard are now strong enough to support themselves on him and his family. He was restless and un- and no longer need our assistance. Yordan settled and his asthma was getting worse. His is thriving within the love of his parents, sister older sister felt threatened by the new arrival and extended family, a world away from life in and was initially aggressive towards him. The the institution in Teteven, which was formally family were daunted by the reality of raising closed in December 2010. two small children on a very small income. Gradually, the extended family started to ral- ly around to help, things got calmer and the family settled into a happier routine. With our support, Yordan’s mother registered him with a local GP and he was referred to a lung disease monitoring programme that is ensuring his breathing difficulties are carefully managed. Once at home, Yordan’s progress was swift. Within three weeks of returning to his family and with the love, attention and stimulation he so obviously needed, he was able to hold his head up. Five weeks on, he could sit unaid- ed and just eight weeks after leaving the in- stitution, he took his first steps, supported by his mother. He has also begun to say a few words, mostly reserved for his favourite people - “mammy” and “daddy”. Andrei to her family. He felt that Andrei was better off where he was and that his granddaughter had come to no harm from spending the first five Andrei was only a few days old when he was years of her life in an institution. He added that moved from a maternity hospital to the Teteven the family were planning to ask for Andrei’s Institution for Babies. Healthy and blissfully placement to be extended for a further six unaware of his vulnerable circumstances, he months. joined the other 31 children in residence at the Over the following weeks, we regularly met institution. Andrei’s grandfather and carefully explained We met Andrei when we began our assess- the legislative changes and the pending clo- ment of the children at the Teteven Institution sure of the Teteven Institution for Babies. We in January, 2010. We discovered that the Child also explained that Andrei could be placed on Protection Department had placed him in the the adoption or foster care register if his family institution at the request of his mother. Unable did not take immediate action. Eventually, An- to cope with caring for her son and being the drei’s grandfather recognised the seriousness sole provider for her family, she believed the of the situation and contacted his daughter. institution would provide a safe environment The possibility of losing Andrei altogether was for her baby while she sought work overseas. the catalyst the family needed to re-evaluate Andrei’s nine year-old sister, who now lived the long term solution for Andrei’s care. Deeply with her maternal grandfather, had spent the shocked at the prospect of Andrei being placed first five years of her life in an institution and with foster parents or added to the adoption in the family’s opinion had survived the experi- register, his mother returned from Greece and ence without any noticeable harm. It is difficult began working with us and the two Child Pro- for us to comment on this as we were not work- tection Departments involved to arrange to ing with the family at the time of her institution- have Andrei return home. alisation. Yet research shows that all children In June, 2010, when Andrei was six months suffer developmental delays as a result of in- old, the family were delighted to have him re- stitutionalisation. turn home, happy and healthy. The extended Andrei’s grandfather regularly visited his baby family started providing Andrei’s mother with grandson at the institution and was undoubt- the childcare solution she desperately needed edly interested in his development. However to enable her to find work and provide her with our initial meetings with him were challenging. an income for her family. When she needs to He said that Andrei’s mother had found work in travel for work, her father and a close relative Greece and was sending much-needed funds look after her children. The family are now so settled into their routine that they no longer need further assistance from us. If, in future, the family needs support to stay together, they will be able to get practi- cal help and guidance from qualified staff at the new Centre of Social Support that has opened in the former Teteven Institution building.