EU/WHO Daphne 2003

Daphne project: 2003-046

Daphne Programme – Year 2003 Annex to the Final Report

Project Nr : 2003/ 046/C

Title: Identifying good practices in the deinstitutionalisation of children under 5 years from European institutions

Start Date: 01 April 2004 End Date: 30 April 2005 Co-ordinating Organisation’s name: Centre for Forensic and Family Psychology Contact person: Dr Catherine Hamilton-Giachritsis and Professor Kevin Browne Name: School of Psychology, University of Birmingham Address: Edgbaston Postal code: B15 2TT City: Birmingham Country: United Kingdom Tel. N°.: +44 121 414 43319 Fax Nr.: +44 121 414 8248 e-mail: [email protected] [email protected] Website: http://psg275.bham.ac.uk/ Annexes 1. List of Keywords describing project 2. List of materials produced during project a) Paper trail Proforma b) In-depth study Background information form c) In-depth study follow up form for home visits d) In-depth study follow up form for institutional visits e) Publication list

 CD Rom of Athens Conference presenting results of the end of the project to 100 international participants (8th April 2005), published by WHO Regional Office for Europe, Copenhagen with EU logo and Daphne Programme acknowledgement.

 De-institutionalising Children from Residential Care: A Guide to Good Practice. Manual in press. To be published by UNICEF with EU logo and Daphne Programme acknowledgement and WHO Regional Office for Europe logo.

 ‘Identifying good practices for the deinstitutionalisation of young children from European residential care’. Book to be published by the University of Birmingham (Centre for Forensic and Family Psychology) in collaboration with the EU Daphne programme and WHO Regional Office for Europe, Copenhagen. All logos will appear on the front cover.

Daphne project: 2003-046_1 ANNEX 1: KEYWORDS

The main purposes of the Daphne Programme are to create networks and to encourage the exchange of information and best practices. The Commission has therefore set up a database containing the details of all completed Daphne projects. This database is accessible via the Daphne page on the EC web site:

(http://europa.eu.int/comm/justice_home/project/daphne/en/index.htm).

Beneficiaries Daphne Objectives Areas x Children Support to the collaboration of organisations  Sexual violence  Young people x Support to multidisciplinary networks  Gender violence  Women x Exchange of good practices x Violence in family x Studies x Violence in domestic context Specific groups Support to public awareness  Violence in schools  Homosexuals  Information campaign x Violence in institutions  Migrants x Information sources  Violence in urban areas  Refugee x Recognition and reporting  Violence in rural areas  Asylum seekers  Violence in the work place  Trafficked persons  Trafficking in human beings x Ethnic minorities Specific Objectives  Commercial sexual exploitation x Handicapped x Prevention of violence  Internet  Domestic workers x Protection from violence  Child Pornography  People in prostitution  Treatment of victims  Racism  Elderly x Reintegration of victims  Self-harm  Prisoners  Counselling victims  Physical punishment x Support to families  Female genital mutilation Targeted Audience  Legislative measures x Health impacts  Violent men  Treatment of offenders  Perpetrators / offenders  Reintegration of offenders Instruments x Public Authorities x Network with NGOs x General Public x Multisector network x Medical staff x Awareness-raising x Educational staff x Dissemination of good practice  Police staff x Guidelines / Counselling x Judicial staff x Models (analysis / development) x Media / Journalists x Training x Production of materials x Conference / seminar  Telephone / Internet Helpline x Field work

Daphne project: 2003-046_2 Annex 2a. EU Daphne programme/WHO: Identifying best practice in the deinstitutionalisation of children under 5 years from Institutions PAPER TRAIL PROFORMA FOR CASES OF DEINSTITUTIONALISED CHILDREN (corrected final version)

Country: Data collector: Today’s date:

Child code Child’s gender: MALE / FEMALE Date of birth: number:

Date of admission: Name of Ethnicity institution:

Length of time in family before child was placed in care: ______Was the child breast fed? YES / NO

* For each question below please indicate where information was obtained from If information was gained from staff member but is also available in files then please circle both. If the source is ‘other’ please explain on the final page.

1. Does the child have any disabilities or medical problems? YES / NO

*FILE / STAFF / OTHER 2. What type of placement has the child been moved to? (tick as appropriate) If yes, tick all that apply Downs syndrome *FILE / STAFF / OTHER Cerebral palsy 3. Why was the child placed in institutional care? Developmental delay With at least one biological parent (tick all that apply) Blind (specify degree of impairment in box With other family members (unpaid) below) With other family members (allowance) *FILE / STAFF / OTHER Deaf (specify degree of impairment in box Foster family (kinship) Biological orphan below) Foster family (state funded) Disability Mutism/elective mutism Foster family (NGO funded) Medical problem Physical disability (specify disability in Adopted within-country (state organised) Abandoned by parents box below) Adopted within-country (NGO organised) Poverty of parents Foetal Alcohol Syndrome Adopted within-country (kinship ) Cultural stigma (e.g. single parent, illegitimate Drug induced abnormality Adopted internationally child) (please specify) Autistic spectrum Moved to a smaller institution Hydroencephaly Moved to a larger institution Heart malformations Other (please specify below) Epilepsy Severe ill health of parents Other (specify disability in box below) Substance abuse in parents Mental health problems in parents Parents in prison

Daphne project: 2003-046_3 Abusing parents Institution manager Neglectful parents FILE / STAFF / OTHER State Authority Violent family member in household Case conference (Joint decision) Housing difficulties (e.g. homelessness) Parent/relative Professional making decision alone (e.g. Family breakdown ‘New’ parent/carer or representative psychologist, social worker) Other (please specify below) Institution manager Other (please specify below) State Authority Any appeals on decision yes or no? Case conference (joint decision) Professional initiating decision alone (e.g. * i.e. who chose the actual foster family not who decided that the psychologist, social worker) child should be in foster care Other (please specify below)

4. Why was the child moved? (tick as many as appropriate)

*FILE / STAFF / OTHER 5b. Who made the recommendation about the new Institution is closing placement? (tick as appropriate) Initial placement was short term *FILE / STAFF / OTHER Better placement found 6a. Was there an assessment of the child prior to Parents wants child back Parent/relative the decision being made? Parents have agreed to alternative placement ‘New’ parent/carer or representative YES / NO (e.g. fostering or adoption) Institution manager Health/special educational needs of child have State Authority changed *FILE / STAFF / OTHER Case conference (Joint decision) Difficult child – institution can not cope Professional making recommendation Change in institution structure/legislation If yes, tick the areas which were assessed alone (e.g. psychologist, social worker) Child has reached institution leaving age Health Other (please specify below) Developmental status Court decision Disability To re-unite siblings Family situation Review procedure Other (please specify below) Other (please specify below) 5c. Who* finally decided on the new placement? (tick as appropriate)

*FILE / STAFF / OTHER

5a. Who initiated the decision to move the child? Parent/relative (tick as appropriate) ‘New’ parent/carer or representative

Daphne project: 2003-046_4 6b. How was the assessment made? (tick all that apply)

Professional home/institutional visit Professional clinic By NGO In institution by institutional staff Non-professional home/institutional visit Other (please specify below)

Daphne project: 2003-046_5 7a. Was there an assessment of the new placement? YES / NO 8. Was the placement matched to the needs of the *FILE / STAFF / OTHER child? YES / NO 10. Was there preparation for the move? Physical environment *FILE / STAFF / OTHER Primary caregiver suitability YES / NO Social or family environment (e.g., other If yes, tick the areas which were matched children in placement) Health needs *FILE / STAFF / OTHER Financial situation Special needs (e.g., disability) Other (please specify below) Developmental needs If yes, tick as appropriate Ethnicity Child was talked to about the move Accessibility of parents or family contact Child had life-story work / pictures etc Avoidance of change to nursery/school Transitional objects introduced to child Other (please specify below) Child visited new placement before move 7b. How, by whom, was the assessment made? New carers visited child in institution (tick all that apply) Professional talked to family New carers trained (e.g., foster carer) *FILE / STAFF / OTHER Was the placement context prepared and adequate to the child’s needs (e.g., house Professional home/institutional visit ready and physically safe) Professional clinic 9. Does the new placement consider the child’s Other (please specify below) By NGO siblings? In institution by institutional staff YES / NO / NA Non-professional home/institutional visit Other (please specify below) *FILE / STAFF / OTHER

If yes, tick as appropriate Siblings are going to same placement Contact will be maintained with siblings Contact will be re-established Other (please specify below)

Daphne project: 2003-046_6 11. Does the child have any siblings?

YES / NO / UNKNOWN

If yes, how many?

Please indicate the age and placement of siblings

A. Age B. Placem C. Adult With other With other Foster Foster Foster Adopted Adopted Adopted Adopted ent not living family family members family family family within- within- within- inter- known independ members (allowance) (kinship) (state (NGO country country country country ently (unpaid) funded) funded) (state (NGO (kinship ) organised) organised)

Length of stay in current institution If yes, please state How many times 12. Timeframes Total length of stay in institutional care For how long? (in years and months) If yes, was this (tick as appropriate) FILE / STAFF / OTHER Follow-up by telephone Visit with the child at the new placement When did child enter first residential Visit with the child at the institution care (i.e. first placement) ? Visit with new carers at the new placement Where did child enter from (e.g., maternity ward) Visit with staff at the institution Number of placements since first 13a. Did the institution follow-up the child after the Formally assessed/recorded placement (including current move? Other (please specify below) placement)? YES / NO / UNKNOWN *FILE / STAFF / OTHER

Daphne project: 2003-046_7 If yes, please state Visit with new carers at the new placement How many times Visit with staff at the institution 13b. Did the State Authority follow-up the child For how long? Formally assessed/recorded after the move? If yes, was this (tick as appropriate) Other (please specify below) YES / NO / UNKNOWN Follow-up by telephone *FILE / STAFF / OTHER Visit with the child at the new placement Visit with the child at the institution

14. Is the institution aware of any further Please use this space to add in other information that is relevant or that could not be fitted placements after the initial move? into the boxes. Please write the question number at the start of any additional comments

YES / NO / UNKNOWN

If yes, was this because (tick as appropriate) Breakdown in placement Natural/biological parent withdrew consent Natural/biological parent took legal action successfully Whereabouts of child unknown New family rejects child Child rejects new family Professional initiates removal (for sound reason) More appropriate placement available Financial problems Change in circumstances (e.g., carer dies) Child died Other (please specify below)

Daphne project: 2003-046_8 Annex 2b: BACKGROUND INFORMATION ON INSTITUTIONALISED CHILDREN BEFORE TRANSFER TO NEW PLACEMENT (Form 1: Pre assessment to be completed for ALL children in in-depth study of deinstitutionalisation)

Country: Data collector: Today’s date: Child code Child’s gender: MALE / FEMALE Date of birth: number: Date of admission: Name of Ethnicity institution:

Length of time in family before child was placed in care: ______Was the child breast fed? YES / NO * For each question below please indicate where information was obtained from. If information was gained from staff member but is also available in files then please circle both. If the source is ‘other’ please explain on the final page.

1. Does the child have any disabilities or medical Adopted within-country (kinship ) problems? Adopted internationally YES / NO 2. Physical characteristics (closest to the date prior Moved to a smaller institution to the child leaving the institution) *FILE / STAFF / OTHER Moved to a larger institution FILE / STAFF / OTHER Other (please specify below) If yes, tick all that apply Downs syndrome Heighta Cerebral palsy Date recorded: Developmental delay Weighta 4. Why was the child placed in institutional care? (tick all that Blind (specify degree of impairment in box Date recorded: apply) below) Head circumferencea Deaf (specify degree of impairment in box Date recorded: FILE / STAFF / OTHER below) a Please specify unit of measurement Mutism/selective mutism Biological orphan Physical disabilities (specify disabilities in 3. What type of placement has the child been Disability box below) moved to? (tick as appropriate) Medical problem Foetal Alcohol Syndrome Abandoned by parents Drug induced abnormality FILE / STAFF / OTHER Poverty of parents Autistic spectrum Cultural stigma (e.g. single parent, illegitimate Hydroencephaly With at least one biological parent child) (please specify) Heart malformations With other family members (unpaid) Epilepsy With other family members (allowance) Other (specify disability in box below) Foster family (kinship) Severe ill health of parents Foster family (state funded) Substance abuse in parents Foster family (NGO funded) Mental health problems in parents Adopted within-country (state organised) Parents in prison Adopted within-country (NGO organised) Abusing parents

Daphne project: 2003-046_9 Neglectful parents Violent family member in household Housing difficulties (e.g. homelessness) Family breakdown Other (please specify below)

5. Why was the child moved? (tick as many as appropriate)

FILE / STAFF / OTHER

Institution is closing Initial placement was short term Better placement found Parents wants child back Parents have agreed to alternative placement (e.g. fostering or adoption) Health/special educational needs of child have changed Difficult child – institution can not cope Change in institution structure/legislation Child has reached institution leaving age Court decision To re-unite siblings Review procedure Other (please specify below)

6a. Who initiated the decision to move the child? (tick as appropriate)

Parent/relative ‘New’ parent/carer or representative

Daphne project: 2003-046_10 Institution manager Other (please specify below) By NGO State Authority Any appeals on decision yes or no? In institution by institutional staff Case conference (Joint decision) Non-professional home/institutional visit Professional initiating decision alone (e.g. * i.e. who chose the actual foster family not who decided that the Other (please specify below) child should be in foster care psychologist, social worker) Other (please specify below)

6b. Who made the recommendation about the new placement? (tick as appropriate)

FILE / STAFF / OTHER 7a. Was there an assessment of the child prior to Parent/relative the decision being made? ‘New’ parent/carer or representative YES / NO Institution manager State Authority FILE / STAFF / OTHER Case conference (Joint decision) Professional making recommendation If yes, tick the areas which were assessed alone (e.g. psychologist, social worker) Health Other (please specify below) Developmental status Disability Family situation Other (please specify below)

6c. Who* finally decided on the new placement? (tick as appropriate)

FILE / STAFF / OTHER 7b. How was the assessment made? (tick all that apply) Parent/relative ‘New’ parent/carer or representative FILE / STAFF / OTHER Institution manager State Authority Case conference (Joint decision) Professional making decision alone (e.g. Professional home/institutional visit psychologist, social worker) Professional clinic

Daphne project: 2003-046_11 8a. Was there an assessment of the new placement? YES / NO

FILE / STAFF / OTHER 9. Was the placement matched to the needs of the child? YES / NO Physical environment 11. Was there preparation for the move? Primary caregiver suitability FILE / STAFF / OTHER Social or family environment (e.g., other YES / NO children in placement) If yes, tick the areas which were matched Financial situation Health needs FILE / STAFF / OTHER Other (please specify below) Special needs (e.g., disability) Developmental needs If yes, tick as appropriate Ethnicity Child was talked to about the move Accessibility of parents or family contact Child had life-story work / pictures etc Avoidance of change to nursery/school Transitional objects introduced to child Other (please specify below) Child visited new placement before move 8b. How, by whom, was the assessment made? New carers visited child in institution (tick all that apply) Professional talked to family New carers trained (e.g., foster carer) FILE / STAFF / OTHER Was the placement context prepared and 10. Does the new placement consider the child’s adequate to the child’s needs (e.g., house Professional home/institutional visit siblings? ready and physically safe) Professional clinic YES / NO / NA Other (please specify below) By NGO In institution by institutional staff FILE / STAFF / OTHER Non-professional home/institutional visit Other (please specify below) If yes, tick as appropriate Siblings are going to same placement Contact will be maintained with siblings Contact will be re-established Other (please specify below)

Daphne project: 2003-046_12 12. Does the child have any siblings?

YES / NO / UNKNOWN

If yes, how many?

Please indicate the age and placement of siblings

D. Age E. Placem F. Adult With other With other Foster Foster Foster Adopted Adopted Adopted Adopted ent not living family family members family family family within- within- within- inter- known independ members (allowance) (kinship) (state (NGO country country country country ently (unpaid) funded) funded) (state (NGO (kinship ) organised) organised)

Total length of stay in institutional care If yes, was this (tick as appropriate) (in years and months) Follow-up by telephone 13. Timeframes Visit with the child at the new placement Visit with the child at the institution FILE / STAFF / OTHER Visit with new carers at the new placement When did child enter first residential Visit with staff at institution care (i.e. first placement) ? Formally assessed/recorded Where did child enter from (e.g., 14a. Did the institution follow-up the child after the Other (please specify below) maternity ward) move? Number of placements since first YES / NO / UNKNOWN placement (including current FILE / STAFF / OTHER placement)? If yes, please state Length of stay in current institution How many times For how long?

Daphne project: 2003-046_13 14b. Did the State Authority follow-up the child If yes, please state Visit with new carers at the new placement after the move? How many times Visit with staff at institution YES / NO / UNKNOWN For how long? Formally assessed/recorded FILE / STAFF / OTHER If yes, was this (tick as appropriate) Other (please specify below) Follow-up by telephone Visit with the child at the new placement Visit with the child at the institution

15. Is the institution aware of any further placements after the initial move?

YES / NO / UNKNOWN

If yes, was this because (tick as appropriate) Breakdown in placement Natural/biological parent withdrew consent Natural/biological parent took legal action Please use this space to add in other information that is relevant or that could not be fitted successfully into the boxes. Please write the question number at the start of any additional comments Whereabouts of child unknown New family rejects child Child rejects new family Professional initiates removal (for sound reason) More appropriate placement available Financial problems Change in circumstances (e.g., carer dies) Child died Other (please specify below)

Daphne project: 2003-046_14 Annex 2c: HOME VISIT (6-12 months after deinstitutionalisation) FOLLOW-UP FOR DEINSTITUTIONALISED CHILDREN IN FAMILY-BASED CARE TO BE COMPLETED DURING HOME VISIT (Form to be completed for de-institutionalised children who have been moved to a family setting e.g. adopted, fostered or returned to their own families)

County: Home visitors name: Today’s date:

Child’s name (including Child’s gender: MALE / FEMALE Date of birth: surname): Ethnicity: Date child was originally Name of old institution (if Any previous institutions YES/NO placed in residential care known): (if specific date unknown, please give the age): Was family assessed YES / NO Was the child prepared YES / NO Date child entered the before the move for move new family:

A. INFORMATION ON CHILD’S 3. Does the child have any disabilities or medical PLACEMENT: 2. Physical development** problems? YES / NO Height (cms) on admission to If yes, tick all that apply 1. Identity and registration institution (if known): Downs syndrome Weight (kilos) on admission to Cerebral palsy Has the child a registered identity? YES/NO institution (if known): Developmental delay Blind (specify degree of impairment in Head circumference (cms) on If yes, could the carer show you the YES / box below) admission to institution (if child’s birth certificate? NO Deaf (specify degree of impairment in box known): below) Is the child registered with a doctor YES / Date of measurements: Mutism/elective mutism NO Physical disability (specify disability in box below) Was the carer provided with medical YES / Foetal Alcohol Syndrome information about the child on arrival NO Drug induced abnormality (e.g., immunisation records)? Autistic spectrum Does the child have visual problems YES / Hydroencephaly (e.g. need glasses)? NO Heart malformations Does the child have hearing problems YES / Epilepsy (e.g. need hearing aid)? NO Other (Please specify) 4. Why was the child originally placed in 8. Has the child been followed up? YES/NO institutional care? (tick all that apply) Biological orphan If yes, by whom? (Please tick all appropriate.) Disability Medical problem 6. What type of placement is being visited? (tick as Not applicable (child has not Abandoned by parents appropriate) moved) Poverty of parents Institution staff Cultural stigma (e.g. single parent, illegitimate With at least one biological parent State officials child) (please specify) With other family members (unpaid) Community nurse Severe ill health of parents With other family members (allowance) State social worker Substance abuse in parents Foster family (kinship) NGO staff Mental health problems in parents Foster family (state funded) Parents in prison Foster family (NGO funded) Abusing parents Adopted within-country (state organised) Please use the space below to add in other Neglectful parents Adopted within-country (NGO organised) information or comments that are relevant or that Violent family member in household Adopted within-country (kinship ) could not be fitted into the boxes. Please write the Housing difficulties (e.g. homelessness) Adopted internationally question number at the start of any additional Family breakdown Other (please specify below) comments. Other (please specify below)

7. Siblings 5. Why was the child moved to the current How many siblings does the child placement? have? Institution is closing Does the child live with any of YES / NO his/her siblings? Initial placement was short term If yes, with how many? To re-unite siblings Does the child have contact with all YES / NO Parents wants child back his / her siblings? Parents have agreed to alternative placement (e.g. fostering or adoption) Health/special educational needs of child Difficult child – institution can not cope Change in institution structure/legislation Court decision Child has reached institution leaving age Review procedure Other (please specify below) B. CURRENT SITUATION: 1 = not child friendly 10 = very child friendly 1. Physical characteristics of the child at follow-up visit g) Food and nutrition: How sufficient and 1 2 3 4 5 6 7 8 9 10 (PLEASE MEASURE) nutritionally appropriate would you rate the Height (cms) food the child receives? Date recorded: 1 = very poor 10 = excellent Weight (kg) h) Overall, how would you rate the quality of 1 2 3 4 5 6 7 8 9 10 Date recorded: physical care? Head circumference (cms) 1 = very poor 10 = excellent Date recorded:

3. Psychological care of the child: please circle as appropriate 2. Physical care of the child: please circle as appropriate a) Affection: How affectionate is the carer(s) 1 2 3 4 5 6 7 8 9 10 a) Accommodation: How would you rate the 1 2 3 4 5 6 7 8 9 10 (e.g. touching, holding, comforting, showing accommodation in terms of physical concern)? conditions such as heating, hot water and dry 1= very poor 10 = excellent bed? 1= very poor 10 = excellent b) Security: How consistent and predictable is 1 2 3 4 5 6 7 8 9 10 the carer(s) (e.g. settled patterns of care and b) Overcrowding: What is your perception of 1 2 3 4 5 6 7 8 9 10 daily routines)? overcrowding? 1 = very poor 10 = excellent 1 = very overcrowded 10 = lots of space c) Guidance: How developmentally appropriate 1 2 3 4 5 6 7 8 9 10 c) Environment: Is the environment provided 1 2 3 4 5 6 7 8 9 10 and consistent is the carer(s)’ discipline of the for the child colourful/friendly? child (e.g. setting boundaries, providing role 1 = not colourful 10 = very colourful model)? d) Home hygiene: How would you rate 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent cleanliness and hygiene of the home (e.g. d) Individuality: To what extent is the child’s 1 2 3 4 5 6 7 8 9 10 odours)? individuality respected (e.g. own bed, place 1 = very poor 10 = excellent for clothes, toys) e) Child’s appearance: How would you rate the 1 2 3 4 5 6 7 8 9 10 1 = not individual 10 = very individual child’s appearance, clothing, cleanliness and e) Independence: Is the child encouraged to do 1 2 3 4 5 6 7 8 9 10 hygiene? developmentally appropriate activities for 1 = very poor 10 = excellent themselves (e.g. put shoes on, wash, clean f) Safety: How child friendly and safe would 1 2 3 4 5 6 7 8 9 10 teeth, use cup and make choices)? you rate the environment? 1 = very poor 10 = excellent f) Stimulation: Is the child encouraged to 1 2 3 4 5 6 7 8 9 10 requests (e.g., asking for toilet and drink)? explore, ask questions, play and interact (e.g. 1 = very poor 10 = excellent given appropriate toys, books, education)? e) Acceptance: How accepting is the carer(s) of 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent the child’s characteristics and personality? g) Reinforcement: Is the child praised and 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent rewarded for appropriate behaviour and attempts at new activities and self-care)? 1 = very poor 10 = excellent 5. Parents/new carers difficulties with new child (please tick all that have occurred since the child’s arrival) h) Overall: How would you rate the overall 1 2 3 4 5 6 7 8 9 10 Difficulty: Tick if Does the parent/carer(s) quality of psychological care for the child? present see it as a problem? 1 = very poor 10 = excellent Sleep problems/nightmares YES/NO Feeding difficulties YES/NO Toileting difficulties / bed-wetting YES/NO 4. Carer’s sensitivity to the child: please circle as appropriate Physical health problems YES/NO Physical disabilities YES/NO a) Perception: How positive, realistic and 1 2 3 4 5 6 7 8 9 10 Communication difficulties YES/NO developmentally appropriate are the carer(s)’ Learning difficulties YES/NO perceptions and expectations of the child (e.g. Developmental delay YES/NO to wrongly expect the child to sit quietly Behaviour difficulties YES/NO alone and play for hours)? Discipline difficulties YES/NO 1= very poor 10 = excellent Hyperactivity YES/NO Irritable child YES/NO b) Sensitivity: how smoothly does the carer(s) 1 2 3 4 5 6 7 8 9 10 Distressed child YES/NO facilitate interaction with the child (e.g., turn- Others (please state) YES/NO taking rather than intrusion and interruptions)? 1 = very poor 10 = excellent c) Supportive: How responsive is the carer(s) to 1 2 3 4 5 6 7 8 9 10 6. Coping and support communication from the child (e.g., Did the carer/parent receive support for the difficulties identified YES/NO appropriate interpretation and reaction to above (in question 5)? child’s message)? If yes, what support? 1 = very poor 10 = excellent d) Accessibility: How prompt is the carer(s) 1 2 3 4 5 6 7 8 9 10 response to the child’s needs and appropriate From whom? There is an adult living in the home with violent tendencies 1

Has the child been smacked? YES/NO Total number of factors

7. Index of need for child, new carer(s) and family

Complications during child’s birth/child premature or separated from 1 family at birth Please use the space below to add in other information or comments that are relevant or that could not be fitted into the boxes. Please write the question Child is (a) seriously ill (b) under-weight (< 10th percentile) OR another 1 number at the start of any additional comments. child in the home is (a) seriously ill (b) under-weight (< 10th percentile)

Child has physical or mental disability OR parents/carers have another 1 child in the home with a physical or mental disability

Twins or less than 18 months between children in the new home 1

Either new carer/parent under 21 years of age 1

Single carer/parent (one-parent family) 1

Either carer / parent is not biologically related to the child (e.g., step- 1 father/mother; foster carer, adoptive parent)

Either carer/parent has indifferent feelings about the child 1

Either carer/ parent feels isolated with no one to turn to 1

Either carer/parent has serious financial problems or lives in poverty 1

Either carer/parent has intellectual/learning disability that affects of their 1 daily functioning (e.g. independent travel)

Either carer/parent has a mental illness or depression 1

Either carer/parent has a dependency for drugs or alcohol 1

Either carer/parent was physically or sexually abused as a child 1 Annex 2d: FOLLOW UP INSTITUTION VISIT (6-12 months after new placement or on waiting list) FOLLOW-UP FOR CHILDREN IN A NEW OR THE SAME INSTITUTIONAL SETTING TO BE COMPLETED DURING VISIT (Form to be completed for children who have remained in the institution or been moved to another institution, including small children’s home)

County: Visitors name: Today’s date:

Child’s name (including Child’s gender: MALE / FEMALE Date of birth: surname): Ethnicity: Date child was originally Name of old institution Name of new placed in residential care (if known): institution/children’s (If specific date unknown, home: please give age): Was new institution YES / NO Was the child YES / NO Date child entered the assessed before the move prepared for move new institution/ children’s home:

A. INFORMATION ABOUT CHILD’S 3. Does the child have any disabilities or medical PLACEMENT: problems? YES / NO If yes, tick all that apply 1. Identity and registration 2. Physical development** Downs syndrome Has the child a registered identity? YES/NO Height (cms) on admission to Cerebral palsy institution (if known): Developmental delay If yes, could the staff show you the YES Weight (kilos) on admission to Blind (specify degree of impairment in child’s birth certificate? /NO institution (if known): box below) Head circumference (cms) on Deaf (specify degree of impairment in Is the child registered with a doctor YES admission to institution (if known): box below) /NO Date of measurements: Mutism/elective mutism Physical disability (specify disability in Was the staff provided with medical YES box below) information about the child on arrival /NO Foetal Alcohol Syndrome (e.g., immunisation records)? Drug induced abnormality Does the child have visual problems YES Autistic spectrum (e.g. need glasses)? /NO Hydroencephaly Heart malformations Does the child have hearing problems YES Epilepsy (e.g. need hearing aid)? /NO Other (Please specify) 4. Why was the child originally placed in institutional care? (tick all that apply) Biological orphan Disability Medical problem 6. What type of placement is being visited? (tick as Abandoned by parents appropriate) Poverty of parents Please use the space below to add in other information or comments that are relevant or Cultural stigma (e.g. single parent, illegitimate Moved to a smaller institution that could not be fitted into the boxes. Please child) (please specify) Moved to a larger institution Severe ill health of parents write the question number at the start of any Original institution (child has not moved) additional comments. Substance abuse in parents Other (please specify below) Mental health problems in parents Parents in prison Abusing parents Neglectful parents Violent family member in household 7. Siblings Housing difficulties (e.g. homelessness) How many siblings does the child Family breakdown have? Other (please specify below) Does the child live with any of YES / NO his/her siblings? If yes, with how many? Does the child have contact with all YES / NO his / her siblings? 5. Why was the child moved to the current placement? 8. Has the child been followed up? YES/NO Not applicable (child has remained in one institution) If yes, by whom? (Please tick all appropriate.) Institution is closing Initial placement was short term Not applicable (child has not To re-unite siblings moved) Health/special educational needs of child Institution staff Difficult child – institution can not cope State officials Change in institution structure/legislation Community nurse State social worker Court decision NGO staff Review procedure Other (please specify below) B. CURRENT SITUATION: you rate the environment? 1. Physical characteristics of the child 1 = not child friendly 10 = very child friendly (PLEASE MEASURE) o) Food and nutrition: How sufficient and 1 2 3 4 5 6 7 8 9 10 Height (cms) nutritionally appropriate would you rate the Date recorded: food the child receives? Weight (kg) 1 = very poor 10 = excellent Date recorded: p) Overall, how would you rate the quality of 1 2 3 4 5 6 7 8 9 10 Head circumference (cms) physical care? Date recorded: 1 = very poor 10 = excellent 2. Physical care of the child: please circle as appropriate 3. Psychological care of the child: please circle as appropriate i) Accommodation: How would you rate the 1 2 3 4 5 6 7 8 9 10 i) Affection: How affectionate is the 1 2 3 4 5 6 7 8 9 10 accommodation in terms of physical staff/carer(s) (e.g. touching, holding, conditions such as heating, hot water and dry comforting, showing concern)? bed? 1= very poor 10 = excellent 1= very poor 10 = excellent j) Security: How consistent and predictable is 1 2 3 4 5 6 7 8 9 10 j) Overcrowding: What is your perception of 1 2 3 4 5 6 7 8 9 10 the staff/carer(s) (e.g. settled patterns of care overcrowding? and daily routines)? 1 = very overcrowded 10 = lots of space 1 = very poor 10 = excellent k) Environment: Is the environment provided 1 2 3 4 5 6 7 8 9 10 k) Guidance: How developmentally appropriate 1 2 3 4 5 6 7 8 9 10 for the child colourful/friendly? and consistent is the staff/carer(s)’ discipline 1 = not colourful 10 = very colourful of the child (e.g. setting boundaries, providing l) Home hygiene: How would you rate 1 2 3 4 5 6 7 8 9 10 role model)? cleanliness and hygiene of the home (e.g. 1 = very poor 10 = excellent odours)? l) Individuality: To what extent is the child’s 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent individuality respected (e.g. own bed, place m) Child’s appearance: How would you rate the 1 2 3 4 5 6 7 8 9 10 for clothes, toys) child’s appearance, clothing, cleanliness and 1 = not individual 10 = very individual hygiene? m) Independence: Is the child encouraged to do 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent developmentally appropriate activities for n) Safety: How child friendly and safe would 1 2 3 4 5 6 7 8 9 10 themselves (e.g. put shoes on, wash, clean teeth, use cup and make choices)? staff/carer(s) response to the child’s needs and 1 = very poor 10 = excellent appropriate requests (e.g., asking for toilet and drink)? n) Stimulation: Is the child encouraged to 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent explore, ask questions, play and interact (e.g. given appropriate toys, books, education)? j) Acceptance: How accepting is the 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent staff/carer(s) of the child’s characteristics and personality? o) Reinforcement: Is the child praised and 1 2 3 4 5 6 7 8 9 10 1 = very poor 10 = excellent rewarded for appropriate behaviour and attempts at new activities and self-care)? 1 = very poor 10 = excellent 5. New staff/carers difficulties with new child (please tick all that have p) Overall: How would you rate the overall 1 2 3 4 5 6 7 8 9 10 occurred since the child’s arrival) quality of psychological care for the child? Difficulty: Tick if Does the staff/carer(s) see 1 = very poor 10 = excellent present it as a problem? Sleep problems/nightmares YES/NO Feeding difficulties YES/NO 4. Staff/carer(s)’s sensitivity to the child: please circle as appropriate Toileting difficulties / bed-wetting YES/NO f) Perception: How positive, realistic and 1 2 3 4 5 6 7 8 9 10 Physical health problems YES/NO developmentally appropriate are the Physical disabilities YES/NO staff/carer(s)’ perceptions and expectations of Communication difficulties YES/NO the child (e.g. to wrongly expect the child to Learning difficulties YES/NO sit quietly alone and play for hours)? Developmental delay YES/NO 1= very poor 10 = excellent Behaviour difficulties YES/NO Discipline difficulties YES/NO g) Sensitivity: how smoothly does the 1 2 3 4 5 6 7 8 9 10 Hyperactivity YES/NO staff/carer(s) facilitate interaction with the Irritable child YES/NO child (e.g., turn-taking rather than intrusion Distressed child YES/NO and interruptions)? Others (please state) YES/NO 1 = very poor 10 = excellent h) Supportive: How responsive is the 1 2 3 4 5 6 7 8 9 10 staff/carer(s) to communication from the child 6. Coping and support (e.g., appropriate interpretation and reaction Did the staff/carer receive support for the difficulties identified YES/NO to child’s message)? above (in question 5)? 1 = very poor 10 = excellent If yes, what support? i) Accessibility: How prompt is the 1 2 3 4 5 6 7 8 9 10 From whom?

Has the child been smacked? YES/NO