Deinstitutionalization – “Still muddling, not yet through” Goals, Pitfalls, Learning, Challenges Radostina Paneva Andro Dadiani SOS Children`s Villages International

Deinstitutionalization (De-I) is: Decreasing reliance on institutional and residential care with a complementary increase in family- and community-based care and services; Preventing separation of children from their parents by providing adequate support to children, families and communities; Preparing the process of leaving care, ensuring social inclusion for care leavers and a smooth transition towards independent living. De-I is systematic policy implementation not just sporadic projects

Timeframes of Reform Processes UN CRC Ratification 1992 “Social Services and Social Assistance law” (2002 Approved De-I plan 2015 Reduction of number of children to 24 in 3 group of 8 201 Only 800 children to remain in institutional care by 2023 Latvia UN CRC 1991 CPC and first steps of child care reform 2000 De-I Strategy and Plan approved 2010 Closed all institutions for children with disabilities – 2016 All institutions to be closed by 2025 Bulgaria UN CRC ratification 1997 Launch of De-I processes 2000 First De-I action plan 2005-07 Closure of all (49) but 2 state institutions 2013 Last “wave of De-I” 2015 Georgia

Lithuania as seen from the outside UN CRC concluding observations (CRC/C/LTU/CO/3-4, 4 October 2013) The large number of cases of deprivation of parental rights and placement of children, in particular children under the age of 3, in care institutions; Very low number of foster families and inadequate support provided to them; Lack of monitoring system of non-governmental children’s homes which often fail to comply with the legal requirements for hygiene, quality of services and space

Management of the De-I process Challenges Clarity of plans and their timeframes Division of roles and responsibilities between various agencies responsible for children’s issues Monitoring and evaluation Communication of De-I goals and progress of reforms to stakeholders and wider public Lesson learned Changing of legislation are essential (with regards to rights, services, finance) Leaders within the country championing De-I processes Regular monitoring and modification of plans Closure of institutions should be an important planned milestone Less developed services for prevention and reintegration = no decrease of children in formal care Plans are often developed “under conditions of maximum ignorance and minimum experience”

Financial mechanisms – Key issues Comparing the cost of institutional care and community-based services Currently provided care which is free to the state in reality is a hidden cost, paid by external donors Economic implications Ring-fencing the current volume of funding Initial investment for starting up the needed services Costs must be based on, and reflective of the structure of specific services

Cost implications of keeping institutions

Service development – key issues Financing of services Regulation of services Variety of available alternatives Flexibility of existing services to address the emerging needs of children Understanding that new quality services should be cheaper than institutions in short term period

Examples: Georgia Emergency foster care ensured that all new referrals to child protection system were diverted to family based care Foster care – main family substitute care alternative SGHs – a service used for sibling groups, older children (variety of models) Specialized SGHs (e.g. for children with severe disabilities) 1424 Children in Foster Care – o/w 210 children with disabilities 352 Children in SGHs – o/w 7 in specialized SGH 387 Children in large scale residential care (in 2 State run and 2 Church run institutions) Per/capita amount of financing in FC and SGH are the same although financing modality very different

Community based services Institutional care Support in a family Alternative care Prevention services Reintegration Kinship care Guardianship (with an extended family or family friends) Adoption Foster Care Small group homes Support services needed by all children: Medical services Education services Social services Universal services for all children not just the ones at risk ones

Workforce Staff of the old institutions Staff of the new community based services, especially SGHs Professionalization of the staff Staff turnover and regular support Foster care givers

New placements – key issues Thorough assessment of children Stability/permanency of the placement Scrupulous preparation of a child for a new placement Placement dilemma: close to the family or close to the services? Referral mechanisms Child is not a number in the statistics

Children and Families’ Support services Centers for community support Day care centers Short term/emergency care placement Crises centers Mother and baby centers Integrated services for early childhood development Day care centers for children with severe mental disorders Integrated social – health services Universal services for all children

Residential care or small institutions Small group homes Number of children in the service Target group Professionals working in SGH ( various options) Standards for physical environment = standards connected with quality of life Coordination between social and health and education systems (for children with special needs) Residential care or small institutions

Child at risk Foster care Services for a child Services for foster families Child at risk Child and risks assessment Decision to place in foster care Matching with suitable foster family Formal placement in foster family Child is cared for by foster family Child leaves foster care Child at risk Recruiting foster families Assessment and training Accredita-tion of foster families Matching and first placement Support and develop-ment of foster families Foster family retires or withdraws

Children in institutional care as % of child population Lithuania – (3276) 0.58 % Latvia – (1218) 0.31% Bulgaria - (1050) 0.08% Georgia – (387) 0.04%

Bulgaria

Bulgaria Professional foster care was established in Bulgaria in the framework of a 3-year state project (2012-2014) “I have a family too” financed by the EU, operative programme “Human Resources”. It was implemented in 83 municipalities. Total budget - 10 500 000 EUR. (2015) ; 202 Results (31.01. 2016): 2220 foster families in total 2206– professional foster families. Number of children in foster families – 3195 children; 5% children with disabilities. 80 % coming from families 12 % from institutions 8 % SGH

Examples: Bulgaria Professional foster care: Foster parents receive the same as above monthly allowances per child plus financial compensation for their work. For one child in care: 435 BGN/217 euro per month/child and this is 150% of minimum salary in the country; For 2 children in care: 464 BGN/232 euro per month/child and this is 160% of minimum salary in the country; For 3 children and more in care: 493 BGN/247 euro per month/child and this is 170% of minimum salary in the country. Financial standard for the service “foster care” including support services for foster parents and children is under development.

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