Results of the assessment of the closure of HMSC – TETEVEN

Part 1- Teteven eng

report_Teteven-2_3_4_5_Eng_edited (1)

What sort of deinstitutionalization strategy would create social change so as to improve the lives of children and ensure they actively participate in the community?

REPORT

Results of the assessment of the closure of  HMSC – TETEVEN

I.Methodology

I.1. Method

I.2. Team of the study

I.3. Background of the study – the three homes and services accommodating children

I.4. Participants

I.5. Ethical considerations

I.6. Process of data collection

I.7. Analysis of data

1. Project Implementation
2. Stage of pre-preparation

1.1. The external team and the partners

1.2. Successful Partnership

• Pre-established links
• Constant communication
• The participation of leaders
• Agreements

1.3. Mission, not a project

1.4. Involving other stakeholders

• Explaining and persuading
• Actions of the authorized persons

2. Preparatory stage

The next to pre-preparation stage in project implementation is referred to as the preparatory stage. Themes that emerged from it (that are covered in the next chapter) are trainings, work devoted to changing attitudes and ways of working, assessment of children and families and securing the requisite resources.

2.1. Trainings „The closure began with trainings undertaken by specialists from „Equilibrium.” /Source: social worker CPD, focus group/

As mentioned in the context of the study in 2010, Teteven municipality started the implementation of the project “The future of children in our hands” under OPDHR, co-financed by the European Union through the ESF. Under this project, experts from “Equilibrium” provided training and professional supervision of the staff of DMSGD extending over a period of 100 days. This allowed the redeployment of institutional staff in the new services.

Other trainings were run in parallel targeted at the SAD and especially personnel of the CPD, RDSA, RCH and hospitals. They continued until the end of the year and were held in Teteven and in other municipalities from districts of Lovech and Pleven. These Equilibrium trainings covered the subjects of foster care, adoption, reasons for abandonment and strategies for prevention.

The need and importance of the trainings are indisputable. On one hand they have a personal impact on the participants (reassurance and security) and, on other hand, they improve the quality of their work. The main impact of the trainings in the Teteven project was significant attitudinal change among childcare professionals and improved professional performance. Social workers from Child Protection Departments reported during interviews that the trainings gave them a different view of social work and helped to change their attitudes concerning the easy option of placing a child at risk in an institution. They became motivated to start looking for resources within the family.

The trainings of the personnel of DMSGD did not facilitate immediate change but, nevertheless, they were a good start. Interviews with former employees of DMSGD who work at the CCS, showed they considered the training to be “very useful” but, in their eyes, some of the issues were “unrealistic.” For example: it took a long time for them to reconcile themselves to the idea of mobile work – aiding families through visits, communication and support in their home. They developed an understanding at a later stage when, having started working in the new CCS service, they were confronted with the practical reality of managing specific cases of children and families that were referred to use the services of CCS.

It is noteworthy that the accumulated experience of the the former staff of DMSGD was transmitted to their peers in neighboring communities. The following story told by a representative of an NGO, illustrates this ‘ripple effect’. Employees of DMSGD which is to be closed in a large regional city met with former staff of DMSGD – Teteven, part of them working in the new CCS service. They were stressed and intimidated by the impending change. Having made the transition, the Teteven group, were able to offer reassurance and to explain that resistance, although natural, is counterproductive – “You just have to accept things and learn.”

It should be noted that training also affected two foster mothers. One said that despite her experience in working with children in institutions, foster parent training gave her a broader view on the problems faced by these children and the different ways to solve them. Another highly experienced foster mother stressed the importance of intensive training remarking that it is too easy to think that the experience of raising your own children will mean that it is straightforward to foster children. They overlook the emotional and behavioural issues. ”

2.2. Evaluation of children and families

According to data provided by CPD at the beginning of 2010, before the start of the project, there were 28 children in the institution. There were unspecific plans to provide care in a family environment.

As of April 1, 2010 there were 32 non-disabled children in the institution, aged 0 to 3 years and the EQ team knew only about the older cases. They first gained access to the infants at the end of June having been denied access until that time. Prior to gaining access, preliminary assessment was based on documents and social reports and these enabled contact with the CPDs responsible for the various cases and attempts to establish contact with their families.

The assessments of children and families to decide on the most suitable family environment for the child were made by social workers and psychologists from Complex of social services in Ruse, managed by Equilibrium. This was done together with specialists from child protection departments in Lovech region and neighbouring municipalities where the children were from. Checklists provided by “Hope and Homes for Children” were used. These are based on the UK Core Assessment Framework.

The results of evaluations of children and families were:

– 7 children are in the adoption process and their families were not evaluated

– Parents or relatives of 4 children could not be traced

From the remaining 19 families

– 8 were willing to cooperate towards re-integration having had partial contact with the children or resumed contact with the project team’s help

– 3 were strongly opposed to re-integration and the children were to be adopted

– 5 do not want to take care of their children and signed a declaration for adoption

– In the case of one of the children, CPD Teteven undertook deprivation of parental rights and then the child was adopted

– There were significant impediments to the re-integration of 2 children due to the mental illness of their mothers and lack of desire or inability of relatives to provide care

From 32 children identified in April 2010, 10 children were returned to their families, 20 were adopted and two children were placed in foster families.

The participants in the focus group at the daycare centre concluded that the assessments of parents of children from the social workers and psychologists from Equilibrium was good practice that contributed to the success of the project.

During the survey, it became clear that the closure of the 8 DMSGD under the project “Direction family” will make use of the successful method for evaluation of children and families applied in Teteven, but with adjustments to acknowledge the fact that there are many infants with disabilities. / Source: personal interview with a representative of the central government /

2.3. Resourcing

The work on preparing families for placement of children was supported by material resources from the NGO.

The team has a car at its disposal and a generous allowance for fuel – a significant difference compared with the resources of CPD. Those social workers who participated in focus groups appreciated the substantial role of the project team in removing children from the institution. They constantly travel by car in an attempt to find parents (scattered across a wide geographical area) and provided financial, material and psychological support to families. The searching for parents and relatives was sustained until they were found. The transport of the families from their homes and back to DMSGD to meet their children was always provided by the NGO.

The social worker from the Teteven institution also remarked on the difference between the work of the project team and his own. Before the project’s commencement, his liaison with biological families was based only on written correspondence and he believed that this was not enough. “How do you persuade a Roma parent to take their child. (S)he knows that the child is eating 3 times a day and is clean and dressed in the institution. If you do not help them to fix the house and give them clothes and food for several months, they would not take their child. It was a profitable arrangement. ”

We must emphasize that the effectiveness and sustainability of the project in Teteven was not only due to the availability of resources, but more especially to the entire model of family support that was applied. Specific forms of support are tailored to specific needs and are not pre-determined and inflexible. They vary as cases vary – from providing the necessary equipment for the care of a growing baby to cleaning the house and / or support with paying rent / utilities. / Source: Individual interviews with specialist NGOs /

In the process of helping parents, domestic budgeting is a significant issue – some do not know how to plan, allocate resources and control spending. Inevitably, they start to complain and demand more than they actually need. Adequate assessment of the true needs of the parents showed “whether they are unrealistic or really need support.” Experience has shown that due to persistence in working with parents, they begin to change and to become more responsible. / Source: personal interview with social worker /

3. Stage of placing children in a family environment

The third stage of the project in Teteven covers the period of removal of children from institutions and their placement in a family environment.

During the study of this stage, themes emerged that were familiar from the previous stages such as adequacy of resources and changing attitudes. However, new issues emerged – tracing parents, family reunification and prevention of abandonment.

3.1. Model of working with parents

The accent of this stage is the model of working with biological parents defined by the project team.

• “For the first and last time I saw attitudes to parents as people, real human beings “ For one specialist from an NGO, the most striking aspect of this model was the fact that the project team should provide support to parents that others believed were beyond help. The team believed it made absolute sense to work with parents. If someone was to help them, they would succeed and thus the team invested trust in them. They sought to find something positive in the family profile that could be built on and this would lead to simple interventions that seemed unorthodox to traditionalists eg providing transport for a parent from a small village to the district capital to take the birth certificate of the child. “It really can only be done by an NGO that is not bound by structures and frameworks. They picked up this man by car and drove him to the city and even bought him a breakfast because he has no money to eat and do some work. This is quite exotic to other professionals. “/ Source: personal interview from representative of NGO/

•  Training started with changing attitudes among professionals and the operation continued in this phase with specific work with parents and families.

Social workers from CPD – Teteven, characterized their work during this phase as “real social work. We met and communicated with people. We were truly social workers, not confined to the office all day writing reports. This period was very busy, but the expectations, the results gave us motivation.” They talk about their efforts to give hope to parents, showing the positive quality of each of them and the situation they are in. And also to build confidence in them that they will continue to support them. They are convinced that “it is half the battle to make parents believe in their own capability.”

The personal effect of working with parents and families was that “we grew and gained confidence.”

• Tracing parents

The majority of respondents reported that the major success factor for reintegrated children was the teamwork of the NGO in tracing parents and providing necessary support. The NGO team strived to unite the efforts of all stakeholders in the name of a common goal – the child should be kept in the family. Social workers from CPD noted that “some biological parents need (only) 1-2 meetings to regain their emotional attachment and want to take back their child.”

NGO expert tells a story from their experience of searching for parents of children from DMSGD. While looking for parents of a particular child at a given address – based on available documentation – they actually found the parents of another child. From then on, the team carried all documentation for all cases in its car.

Three other interviewees reported what difficulties were overcome and how the confidence of parents was won. The following story is a good example:

Some parents of children from DMSGD – Teteven lived in a neighbourhood close to the public amenities site in Lovech (the rubbish dump). Team members visited this slum area on numerous occasions trying to organise meetings with parents but other residents denied that they lived there. It took a lot of time and effort to gain access by building trust and assuring residents that they did not represent social services. “Obviously there is reluctance to be discovered because ordinarily CPD is perceived as a sanctioning body, not as supportive“/ Source: personal interview with representative of the NGO /

• Family reunification

One of the main achievements of the project is “family reunification” in its broadest sense This outcome was achieved as a result of the team’s work in Teteven which did not end with the return of the child from DMSGD to the biological family. In the case of several families, the support from the project team and CPD took account of the institutionalization of older siblings and reintegration efforts were not restricted to the target group from the baby institution.

Such is the story of a girl and her two brothers. Their parents went to work abroad and left their children in the care of their grandmother. The grandmother also decided to go abroad leaving the CPD to decide the fate of the three children. The CPD chose to accommodate two brothers in DDLRG – Gurkovo and the little girl – in DMSGD – Teteven. The parents returned from abroad when the process of closing the Teteven institution and the assessment of children had begun. They had no savings or income, no accommodation or valid documents but they visited the CPD to look for their children. The social workers referred the case to the project team who sought assistance from the municipality. The family received municipal housing. The team helped them to make repairs, provided money for new identification documents and gave them guidelines for the children. They started to attend parenting classes in CCS-Lovech and kept permanent contact with their girl in DMSGD – Teteven. She was the first reintegrated into the family. However, the parents began to visit their other children in DDLRG although they were already entered in the register for adoption. On the basis of a CPD evaluation, the youngest child was properly cared for – she attended kindergarten and parents used social aid to support her care. It was recommended the other children to be reintegrated in the family. For more than a year the three children have lived with their parents. The family has continuously lived in municipal housing. One of the children is in first grade, the other in a preschool group and the youngest attends kindergarten. Our survey was completed after reintegration. During the interview the social worker from the CPD (in tears) said: “I saw them a week ago. They were on the swings in the play park – all three children were enjoying themselves as the proud parents clearly cherished the moment. It was moving. ”

The story of M. and her sister J. is also an example of the efforts of the project team to reunite children and parents. M. is the youngest of 4 children raised in the family until age of 12 months. Financial difficulties caused the mother to decide to seek employment abroad and places M. in DMSGD and her sister J. in DDLRG – Pleven. The father disagreed but realized he could not support his family. The mother stayed in touch and, after about a year overseas, a telephone conversation with the grandmother revealed that formal notification had been provided of the decision of the authorities to put the children up for adoption if she makes no effort to take them back. Very quickly she organized her return to Bulgaria where she received support from a social worker from the CPD – Cherven Briag and the project team. In the beginning, they provided transport to the institution. After her first meeting with M. in DMSGD the mother said: “For a whole year I hadn’t seen her. I was in heaven and the people waited for me and took me back to the village. ” Unfortunately,  M. did not remember her mother. The meeting with the older girl in DDLRG was different – she recognised her mother “She ran to me and hugged me but the little one – terror and fear.”  

Now the two girls live with their parents, brother and a sister. M. is a mischievous child of 4 years and she never stops playing. Her sister J. is 5 years old and the two are friends and want to go to kindergarten together. J is named after her aunt who has no children and provides lots of loving care. The family income is dependent on the father. The mother is a seamstress by profession but there is a lack of work and she only occasionally earns by cleaning in  neighbors’ homes.

During the interview the older girl showed her happiest moments in two paintings – one is “Mum and Dad” and the other – sisters and brother with the father. The mother thinks that the second painting looks like a photo and shows it to interviewers. It dates from before the placement of the two children in institutions when all were still together. The mother suggests that she is missing in the painting, like in the photo, because she is behind the camera.

• Changing the attitudes of  parents

The last story illustrates another feature of the model of working with parents, namely the radical change in their attitudes when they experience understanding, respect and support. The mother, who now enjoys her four children at home where she and the father care for them, remembers the time 2 years ago:

” I changed radically myself, seeing how strangers try to help me to get my child back. Now much stronger is my love for them and to my family. If I sometimes find myself shouting a little at my child, I immediately imagine how it was in the institution. And before I said to myself – you are four of mine, how shall I look after you, I will place you in an institution. It’s not my child’s fault that I’m poor. Once you’ve created a child, you have to think how to care for that child…. Parents should understand that the most important thing is to take care for their children. ”

“I always believed in my heart that people will help if you want to take back your child and many mothers want. People saw that I looked further and I really wanted to get my kids. ”

• Children who never entered an institution

“When the integrity of the family is paramount, there will be less separation between parents, fewer children with a single parent, less abandonment. If the child is valued a parent would never leave that child “/ Source: Focus Group CPD social worker /

The operating model of the project team involves the coordination of removal of children from the institution with prevention of abandonment of newborns through consultative and financial support. In 21 cases, the team collaborated with the child protection departments from Lovech and neighboring municipalities and families were provided with food and baby supplies, assistance and financing for the issuance of documents, travel expenses, building materials and firewood.

In the course of the study, we interviewed 5 representatives of the NGO, the social worker on the project, a parent and a representative of central authorities and they all prioritized prevention of child abandonment.

The project social worker recognizes that the principle success factor in prevention, as well as in the work of reintegration, is a fully mobile team with the resources to respond where and when problems arise.

An NGO representative expressed her belief that work with parents on prevention is a valuable experience. The project team demonstrated that in the time between the release of an administrative order of SAD and the case coming to court, urgent work needs to be done with the family. After the court judgement, it is very late and the return of the child to the family is very difficult. The interviewee believes that this experience is valuable and shared it with her colleagues.

In her opinion, social workers from CPD sometimes have problems fully understanding the difficulties of parents when a child is born. Their prevention work tends to span a very short period corresponding to a defined clinical pathway from birth to day 3 of the post-natal period. It can take far longer to uncover the multiple causes of an attempt to abandon a child, not just those obvious at first sight. It takes longer still to address those causes.

Another NGO representative also reflected on the theme, telling the story of a family’s fourth child who is prevented from being abandoned. The family already has 3 girls and the parents are concerned and uncertain that they will cope with caring for a newborn boy. The project team helped them with emotional and psychological support and it was crucial for changing the decision of the parents. The NGO specialist stresses that parents are not always fully committed to the decision to abandon their children and, at this point, it is important to provide the necessary support.

As already mentioned, apart from reintegration in the biological or extended family, the other family options for the children are adoption or foster care.

3.2. „Adoption is not a chance in life, it’s like a childbirth. ‘/ Source: Professional social service, focus group /     

During the study, the issue of adoption is raised with a representative of central government, one representative of the NGO sector, the social worker in the institution, two parents in a focus group with staff from social services. Unfortunately the team could not e interview any adoptive parents.

 A representative of RDSA – Lovech is excited when he talks about the issue and often compares adoption with childbirth. He stated his satisfaction with the work of the Adoption Commission that is always looking for a family in which to place a child. With the project team in Teteven they discuss each case, “child by child.” The successful work on cases of adoption of children from DMSGD – Teteven is due to teamwork, quality social workers and the detailed disclosure of a child’s profile (emotional, behavioural and educational) shared with prospective adopters. The representative explained that difficulties arise because of certain attitudes of prospective adoptive parents about the child and, in these circumstances, it is necessary to hold long and detailed meetings.

The NGO that implemented the project of closuring DMSGD – Teteven, stated in its report that without serious programmes on family planning and improving the education of certain groups in Bulgarian society, adoption will remain an attractive option even when other forms of alternative care have grown to the required level. According to them, the adoption procedure is still too long in terms of the lives and interests of the baby and often serves the administrative convenience of those involved in adoption. (2, 14) This view is shared by the NGO expert interviewed by researchers for whom adoption is now a “super-detailed process” with the accent on procedural compliance and it sometimes disregards the interest of the child.

A foster parent who participated in the study, hopes that in future:

 – No cumbersome procedure for adoption, or an intermediate institution, the child is adopted from the maternity ward

– Adoptive parents to be supported by psychologists 

– According to her, children with disabilities will continue to be adopted by foreigners because “we avoid the difficulties, it will be hard to accept children with disabilities because it is a big commitment.” However, she suggests that if the system of support is changed, if there are appropriate conditions, then Bulgarians will be more willing to care for these children. An expert from the NGO considers that Bulgaria should stop the international adoption – “For a country which should take into account the fact that it’s population is declining, is criminal to effectively export children in the way it does now!”

3.3. Foster families

On the subject of foster care, the survey makes reference to the following two foster parents and two children in a foster family, a client of CCS, who wants his third child to be raised by a foster parent and one NGO representative. Additionally, the subject is mentioned in the wishes for the future of a further 2 respondents from NGOs and one from central government.

A specialist from the NGO thinks that the development of foster care in Bulgaria is worthy of celebration, but the current cost of caring for a child in a foster family (when the designated carer is not a salaried professional foster parent) is discriminatory in relation to the level of social support received by a mother who does not abandon her child. “When you create any privileges for someone in relation to others, it creates discrimination.” Discrimination arises from the financial opportunity afforded to foster parents that is not available to biological parents.  “Every parent needs assistance and advice, but in these conditions of total crisis in the country, they cannot afford professional advice and rely on friends and neighbours for practical support.” According to her, neglecting this area of professional support for parents who care for their children can cause social problems.

During the study, interviews were conducted with two foster mothers – one of the village in Lovech, the other from the region of Pleven.

The first foster parent places emphasis on love and tolerance as everything else can be learned. “Never mind what the child is like, I can love any.” She refers to fostered children as if they were her own and does not distinguish between them and her own children. She also accepts that contact with the biological parent as inevitable, despite the difficulties it can create. The mother is happy to be a foster parent: “It gives me pleasure, satisfaction, I like it.” But she expresses her desire to care for long-term foster children. “I do not want to constantly change my children. I want, if I take one, two, three, to be able to raise them.”

For the second foster mother, foster care is:

• Choice: “I cannot imagine life in any other way,“
• Dedication: “This is something that you either have inside you or not.”
• Commitment: “This gives me strength to continue“,

and children are the greatest value and achievement. When fire broke out in her house, she went to take a box of pictures, cards and other memories of her children – “I crawled to get the most precious memories of them.”

The mother believes that it is best to raise children in a family: “The worst family is better than the best institution.” She believes that in an institution, SOS-village and SGH where children grow up separated from the community, they remain labeled. “If we want something to change, children should be among the people, in the family.”

The mother shares her philosophy for children who have 2 mothers making them different from their friends and classmates: “I always say that everyone has his cross to bear and must accept his destiny as it is, if it can’t be changed. That is correct. ”

The interviewed foster parent applauded the role of the NGO’s team in the project and generally in the social field. According to her, the NGO is doing all the work, there is no involvement of the state – for her a typical clerk wants everything to be immaculate in the files but “my children do not eat documents.”

According the social workers from CPD, the foster mother is a model to be followed by others – in the place where she lives “because of her, there are already four foster families and an additional 5 are candidates.”

The research team had a conversation with two children raised by a foster mother from Lovech district. As the youngest child was drawing a house:  “Me and Mummy T.” While painting, she described the first time she met her foster mother: “She came to center. The other ladies gave me a bath and then she took me and gave me a kiss.”

A toddler also wanted to paint his most exciting moment – his birthday party. He spoke about it in vivid detail.

The interviewer asked the following question: How can social workers help children? The reply: when they see the child is not getting proper care and attention because the parents only cares about things that are important to them. Maybe the child gets sent to school without money. The social worker writes this down and she asks the child if he wants to live in another family. If he says okay, they find a proper family. So he goes somewhere where he is properly looked after and fed properly…..

4. Closuring of institutions and new social services

The last stage of the project in Teteven covers the closing of DMSGD and opening of a new social service – CCS. In the next chapter we present the issue of liquidation of the institution and the specific features of the CCS – Teteven.

4.1. Liquidation

Under Bulgarian law, as a specialized institution for children from 0 to 3 years (or 0-7 in the case of children with disabilities), permanently separated from their parents, DMSGD also functioned as a hospital. During the final phase of the closure programme, a number of difficulties arose because of this status.

The liquidation of DMSGD had to comply with the prevailing Health Act and regulation on procedures for the liquidation of the activities of hospitals. At the end of 2010, the municipal council of Teteven took a decision and submitted a proposal in the Ministry of Health (MH) for the closure of DMSGD. On 28.12.2010 by Decree № 329/2010 of the Council of Ministers, DMSGD – Teteven was declared closed. On 01.02.2011, a liquidation commission started its activities. On 09.01.2011, the activity of DMSGD – Teteven was considered suspended, having published the decree in the state gazette.

It appears that this liquidation is a complex, cumbersome and lengthy procedure. The project team in Teteven tried to facilitate the process by asking the Ministry of Health to make changes in the regulation so that DMSGDs could be treated as separate cases  covered in a separate paragraph. Although DMSGDs are defined as hospitals, they should not be treated in such a rigid manner. Representatives of the Ministry were not amenable to advice from legal experts and in an effort to be correct and legitimate by prevailing standards, were disinclined to use the power of law. / Source: personal interview specialist NGO /

Interviewed representative of the Ministry of Healthcare also emphasized the need to amend existing legislation in the light of the upcoming closures of other institutions.

A specialist from an NGO attributed difficulties in closing the institution not to a lack of political will but to a lack of expertise and initiative. The Health Ministry is characterized as apathetic. “It seems that it is easier to engage foreign donors, to commit the municipality, to carry out the work, to move out the children, than to move some money from one government department to another. Sometimes technical solutions are more difficult than conceptual change and reform.”

The liquidation of the institution was combined with the opening of a new social service with state-delegated budget. In order to operate the new social service in the existing public building, the MOH provided the municipality with a contract for temporary use of part of the property and also prepared a proposal to the Ministry of Finance so that, part of the amounts allocated as budget for DMSGD – Teteven 2011 could be transferred to the municipality. These actions allowed to new service to start providing support for children and families at risk and permitted redeployment of some staff in the new service.

4.2. New services

At the beginning of the project in Teteven, the implementing organizations analysed existing services in the community and the needs of children at risk and decided to develop a set of social services to be provided via a Centre for Social Support (CSS) a structure that qualifies for state funding. After reconstruction of the facilities in early 2011, in CSS began working with a capacity of 80 cases of children from 0 to 18 years, a team of 25 people – social workers, psychologists, teachers, nurses, therapist and nannies.

The CSS provided services in response to 104 recorded cases during the period 01.03.2011 (official opening) until 06.30.2012:

– Family consultations and support – 45 cases

– Perinatal care – 6 cases

– Deinstitutionalization and re-integration of children 4 cases

– Prevention of child abuse 2 cases

– Foster care service 3 cases

– Support for adoption 9 cases

– Prevention of deviant behaviour in children and

work with children with deviant behaviour 1 case

– Prevention of school dropout 8 cases

– Daycare for children at risk 5 cases

– Emergency reception 21, from which:

from SAD Teteven 11 children – from 0 to 1 year – 3 children; from 1 to 3 years – 2 children; from 3 to 7 years – 4 children; from 7 to 18 years – 2 children;

from SAD Cherven briag 6 children – from 0 to 1 year – 1 child; from 1 to 3 years – 1 child; from 3 to 7 years – 1 child; from 7 to 18 years – 3 children;

from SAD Lovech 3 children – from 3 to 7 years – 1 child; from 7 to 18 years – 2 children;

from SAD Sevlievo   1 child in the group from 7 to 18 years.

The theme of the CSS was often discussed in the course of this study and comments were recorded from the following sources: a social worker in the institution, a representative of local government and two from central government, five representatives from the project team, a client of CSS, a child placed in a foster family, and a focus groups from CPD – Teteven, a day centre and the new CSS (2 groups).

• Opening of Centre for Community Support (CCS)

A local authority representative explained that the project for creation of the new service CSS in the municipality, began months before the project of closure of DMSGD started and a social workers from CPD – Teteven involved in its implementation, identified the CSS as “their newborn child.” The original idea was to create the CSS as a separate service, to train new specialists and children from the institution to become its users. According to experts from an NGO, the CSS was an “gimmicky” project. Subsequently, on the basis proposed by the closure team, the plan changed to involve closure of DMSGD in accordance with international best practice. The new strategy allowed people who had worked at the institution (care staff) to work in the new services if they so desired. The idea is “not to build something new and the staff to stay on the streets for a year, but to reform very quickly in the best manner. / Source: personal interview specialist NGO /. From 27 personnel in DMSGD, 21 applied for work at the Center for Social Support and 16 people were employed.

The opening of CSS, however, was associated with some difficulties. The report given by two specialists from NGOs, illustrates once more the theme of commitment of leaders throughout the process and how to overcome resistance. The project team encountered problems in communication with the municipality during the final phase of the project, so they sought assistance from the then Chairperson of the SACP. He participated in a meeting of the municipal council in Teteven to explain DI policy, the need for the opening of the CCS after closing DMSGD and how the municipality to receive state delegated funding for the service. By making the formal decision to start new social service, the municipality fulfilled its commitment to the effective closure of DMSGD.

• Selection of the team for CCS

The theme of choosing the team in the new social service revealed two opposing views among the respondents. Two focus groups were drawn from the staff of the new CSS. One involved former employees of DMSGD and the other, new employees, mostly social workers. These groups provided opposing views.

For former employees of the institution, the opportunity to work in new service was of crucial significance and they applauded the efforts of the previous municipal management to reemploy as many people as possible. At the same time they recognize that “in order to work, they must be part of the change“; at the beginning they should be more flexible, patient and adaptable, but also strong, not to give up and to show commitment. To maximize the efficiency of the new services they felt it was important to have continuity in terms of professional experience – to take account of valuable previous experience supplemented by new know how acquired through training and practice. The possibility to work at the CSS as “new and old colleagues” allows some balance in the work.

The opinion of the new members of the CSS team is different. They believe that no member of DMSGD staff should work in new services. They felt that people, who worked 20-30 years in the old institutional system, could not adequately adjust to the new system because of a combination of fear and reluctance. “The large numbers of staff, who are not fully engaged and cannot be fully engaged, handicap the others”. A smaller and better quality team of professionals would enhance service quality. ”

An NGO representative felt that the selection of staff is an area needing improvement in the context of the future development of social services. According to her, CSS in Teteven may be compromised as a service, since the selection of personnel was not the most appropriate for a good start.

• The training started in the preparation stage of the project continued after its completion.

After the selection of the CCS team in 2011, the NGOs involved with the project provided practical, on-the-job training. Throughout the year they also provided supervision of the team, constantly consulting, providing technical support and notification of regulatory changes.

 According to experts, NGO “Equilibrium” continued to work on a near daily basis with CSS – Teteven, CPD – Teteven and  CPD – Cherven briag. The organization provided training, consultation and supervision for new and existing social services in the town of Cherven briag, and training for foster care in municipality of Roman.

According to interviewed experts, it is crucial to invest in this manner for several years in those municipalities where institutions have been closed as well as in surrounding areas to ensure sustainability of change by building up local capacity. Additionally, to secure financial sustainability after completion of a project, it is important to explore different budget options and research other project opportunities.

CSS’s work was evaluated both by users of services and the employees as necessity but they conceded that it was not popular enough.

During the study, we interviewed a mother with three children – a client of CSS – who told us about the effect of the new services on her life. She said that from the CSS, she has learned a lot and described CSS employees as approachable. She has watched how they looked after other children and she applauded their approach. When children’s parents arrived, the social workers spoke with them at length and the CSS also provided practical help to mothers when required – food, diapers, and clothing. The best thing that happened in her life was the chance to meet with a social worker from CSS because it provides somebody to rely on. “There is a person who understands the issues I face.”

Now her three children are the most precious thing in her life. She is happy and proud that she has not left her third child, who she was thinking to give up for adoption after she was born. However the mother said she was initially unaware of the true nature of the CSS – “I thought this was an institution.”

The participants in focus groups from CSS defined the work in the new service as “difficult” because of the style of working with parents instilling new habits and attitudes, and it takes a lot of skill and patience. The social worker in DMSGD who had worked in the new CSS service for almost a year, identified the quick turnaround of children placed in emergency care as an example of good practice. Within a period of three months a team – social worker, educator and nurse – work intensively on family rehabilitation – constantly talking to parents and relatives, motivating them to take the child and training them in basic parenting skills and domestic routines. “The habits we created then helped them in their lives.”

The attitude of those using the services provided by CSS staff is generally one of trust although there are users who are “ashamed” and others who “do not know” the service. They evaluate CSS as a useful service for children and families because they see real results for themselves. However, they felt it was a shame that it relatively unknown and poorly publicized.

Experts from the NGOs talk about the positive impact of working at the CCS on the willingness of staff to acquire new knowledge and apply new practices (found on the Internet for instance). There is a noticeable change in their work – a movement away from compliance with prescribed methodology to a more humane approach. There are actually a lot of complaints about the traditional emphasis on paperwork and reporting and the fulfilment of seeing genuine change in children and parents.  

One interviewee spoke of difficulties in the relationship between the CCS and the municipality caused by the change of leadership. Lack of support from local government can cause personnel to become demotivated. She said the centre should not be used as a “bargaining chip“, it should be required to continue to achieve positive results in their work and for people to be satisfied with the standard of service and not only to influence change of attitudes and policies.

Recommendation: According to her, it is important to emphasize the achievements of CSS in Teteven “to open the souls of those who depend on the development of this CSS and for whom it must not fail.” In a broader context, it is important to work in partnership with municipalities in the process of DI so that social services receive support and benefit from media coverage.

During the focus groups, the employees of the social service also referred to the lack of support from the new municipal leadership that does not acknowledge the need for the service in the way that the previous administration did during the process of closing DMSGD: “We were born, brought up and supported, and then we were abandoned.”

The employees of social service speak with bitterness about the lack of community support; for example from medical professionals (GPs, hospital staff), who should cooperate in the work on cases. An employee at the CSS told of a case in which the doors of the hospital were closed in their faces and she could hear the mocking laughter as they walked away.  

• The resourcesare topic that the interviewees refer to again in this final stage of the project.

The members of the two focus groups formed by employees at the CSS feel that, as a frontline service, they are best disposed to assess the needs of clients but their support is not always effective because they do not have adequate resources (equipment, clothing, food etc. to work with children. They complained not only about the insufficient resourcing of the service, but also about lack of transparency about its funding and budget.

For a local authority representative, CSS as delegated by the state at the time of the study, was a poorly planned service and the financial provision was inadequate in the context of balancing the priorities of a small municipality such as Teteven.

At the end of this stage we state the wishes of employees for the future of social services:

• they are popular, affordable and attractive – potential users develop an interest and actively seek them out  so that the service has more users, more children
• there are clear rules for the organization of work in the social service sector and improved coordination  with more team meetings
• there is less bureaucracy and more opportunity for direct interaction with users
• staff in services has more professional autonomy and more freedom to make decisions
• CSS has no emergency accommodation unit
• they are better supported by CPD
• change the attitudes of the community – counteract the prejudice towards service users and towards the work in the service, respect and gratitude for those working there; respect as professionals and professional parity with other social sectors

Summaries:

The closure of DMSGD-Teteven creates a model for reformation of the institutions for babies in Bulgaria and for provision of care for children at risk through family support. “Nobody believed that DMSGD could be closed. Proving it’s possible opens the door of the the reform. Teteven was waved as a flag – they did it, it is possible ‘/ Source: individual interview with representatives of NGOs /

The closure was carried out under the project “Restructuring of the Home for medical and social care – Teteven and development of alternative social services for children and families (Centre of Social Support) of the British charity “Hope and Home for Children” in partnership with non-profit organization (NGO), “Equilibrium” – Rousse and in cooperation with the Ministry of Health, Ministry of Labour and Social Policy, State Agency for Child Protection and Teteven municipality, with the financial support of the project of the British organization The Bulgaria Abandoned Children’s Trust – UK. The project was implemented over 24 months – from January 2010 to December 2011.

The profile of DMSGD – Teteven involved accommodating only healthy children, who did not require medical care and, apart from director of the institution, there were no other doctors working there. It was the only home for children 0 to 3 assessed for restructuring by the interagency assessment in 2006.

As at April 1, 2010, there are 32 non-disabled children aged 0 to 3 years in the institution As a result of the project 10 of the children were reintegrated in their families, 20 were adopted and two children were placed in foster families.

During the survey, the research team identified four stages:

1. The first stageis connected with the preparationfor the implementation of the project,  that contains some of the key success factors:
2. The presence of an external team of experts, who combined their capability in management of the process of closing an institution with the expertise of a local partner, skilled in direct social work and organizational development of innovative services.
3. Successful cooperationbetween the partners started at the stage of pre-preparation and lasted until the end of the project, due to the following factors:

–  An appropriate national policy for deinstitutionalization

– The pre-existence of a relationship between partners, which provided support for the project of Teteven municipality from the structures of the central government – SACP, ASA, MLSP, MOH, and their leaders

– Constant communication between the partners – meetings and conversations are conducted in order to convince and motivate participants to coordinate their actions

– The presence of leaders in key positions in non-governmental organizations, local and central government

– Signed agreements between the municipality, NGOs and government institutions at the beginning of the project, which empowered NGOs to implement the project

3. A characteristic feature of the project in Teteven is that for the representatives of NGOs, and for deinstitutionalization team comprising representatives of the central government, it is a mission and a personal cause.The social workers from CPD Teteven were also highly motivated and committed to the success of the project.l

A prominent theme that runs through all four stages of the project is that of the extreme effort of the implementation team to seek and use different ways of involving people who are resistant to change  – employees of the municipality, the director and staff of the institutions, directors of other DMSGD, the providers of institutional budgets. To overcome the resistance, the implementation team needed both perseverance and improvisational skill – signed agreements were backed by meetings involving painstaking explanation and persuasion.

1. The second stage is the preparation for the removal of children and their placement in the families.The themes that emerged from this stage are trainings, changing attitudes and work practice, children’s assessments and resources.
2. Trainings

In 2010, Teteven municipality implemented the project “The future of our children in our hands” upon OPHRD, financed by the European Union through the ESF. Under this project, the experts from NGO “Equilibrium” – Ruse had performed trainings and supervision of the staff of DMSGD, within 100 days. This allowed them to eventuate in the new services.

At the same time, in April 2010 began trainings for the workers in SAD and especially in CPD, in RDSA, in RHC and hospitals. These trainings continued until the end of the year and were held by the experts from Equilibrium in Teteven and other municipalities from district of Lovech and Pleven. The subjects covered were foster care, adoption, abandonment and prevention. The contribution of trainings to the success of the Teteven project is that they led to a change of professional attitudes and impacted significantly on work practice.

Some of the topics of training were not fully understood and adopted by the staff of DMSGD at the outset and consolidation would only take place when they started to work within the new CSS service and encountered children and families in the new context.

2. The assessment of children and families to select the most suitable family environment for each child are made by specialists of the Complex for social services for children and families – Ruse, together with the departments for child protection in Lovech region and neighboring municipalities. The evaluation tools were checklists of “Hope and Homes for Children”, based on the UK Core Assessment Framework.

The results of evaluations of children and families were:

– 7 children were in the adoption process and their families were not been evaluated

– the parents or relatives of 4 children could not be found

From the 19 families evaluated

– 8 were willing to cooperate with re-integration efforts – they had had a lot of contact with their children s or partially resumed them with the support of the project team

– 3 were strongly opposed to reintegration and the children were adopted

– 5 did not want to look after their children and signed a declaration for adoption

– in the case of 1 child CPD – Teteven cancelled parental rights and then the child was adopted

– There were significant impediments to the re-integration of 2 children due to the mental illness of their mothers and lack of desire or inability of relatives to provide care 

Within the study we were notified that the methodology for the assessment of children from DMSGD – Teteven and their families will be used in subsequent pilot projects of DI but with amendments to take account of the presence of infants with disabilities.

3. A major factor for the success of the project in Tetven is the provisioning of all the activitiesby NGOs – mobile working of the team of social workers and psychologists to trace parents with a view to reintegration and the use of a flexible model of family support, in which the forms of support comply with the specific family needs and are not predetermined; providing financial, material and psychological support for prevention of abandonment.

III. The third stage of the project in Teteven covers the time from the removal of children from institutions to their placement in a family environment. Again, there were themes familiar from the previous stages such as resources, changing attitudes, but some new issues emerged – tracing parents, family reunification and prevention of abandonment.

1. Central to this stage is the model of workwith biological parents employed by the project team. It emphasizes humane treatment that focuses on empowering people by engendering mutual trust and respect. This model changes the attitudes of parentstowards their children, as well as the attitudes of social workers from CPD to work with families at risk.

An important factor for the reintegration of children is the hard work of the project team in searching the parents and providing the necessary support. The implementation team strove to unite the efforts of all stakeholders in pursuit of a common goal – the child should be raised in a loving family.

Undoubtedly, “family reunification” should be acknowledged as a significant achievement of the project. The team’s work does not end with the return of a child from DMSGD into the biological family. In the case of some families, the support from the NGOs and CPD continued until the reintegration of older brothers and / or sisters from other institutions, although they were not a target group of the project.

Along with the removal of children from the institution, the model of work used by the project team included prevention of abandonment of newborns. Again, as was the case with work on reintegration, important factors for success are mobile work and adequate resources. Advisory, financial or material support was provided in 21 cases through collaboration between CPD – Lovech and neighbouring municipalities dealing with these cases.

2. The adoption of childrenfrom DMSGD – Teteven is an essential part of the project. Thanks to the interaction of social services and the NGOs and the effective work with prospective adoptive parents, many children were adopted in a relatively short period of time. Representatives of various NGOs share a common opinion that the adoption process is still overly bureaucratic and there is too much focused rigid compliance with procedure and, in this way, the best interest of  the child is overlooked.
3. The project team in Teteven placed children in foster care when they were unable to live within their own families. Two CPDs that participated in the survey continue to develop foster care in their municipalities and in their work with children at risk. They continue to prioritize family placement over residential care. Statistics for the other two departments involved in the study reveal that they continue to place children in DMSGD – Pleven.

On the subject of foster care, two foster mothers that participated in the survey expressed their preference for long-term care of children placed with them and for periodic, obligatory trainings for foster parents.

A child living with his foster mother expresses a desire to have more social workers to help more children in need.

1. The last stage of the project in Teteven covers the closure of DMSGD and opening of a new social service – CSS. The most significant topics in this stage are the liquidation of the institution and the specific features of the CSS – Teteven.
2. After the closure of the institution by a decree of the Council of Ministers from 28.12.2010, the liquidation of the institution as a medical facility took almost a year which is the period it took for preparation and placement of children in families.

At the time of closure, the inflexible procedure for the liquidation of a DMSGD became all too evident and, at the time of writing, no new mechanism for the transfer of assets from an institution to the new community-based social services has been devised.

2. The centre for community supportin Teteven began work in early 2011 in the building of the closed institution, with a capacity of 80 cases of children aged from 0 to 18. There were 104 users in the period between 1.03.2011 until 30. 06.2012.

Of the 27 employees from the DMSGD, 21 applied for work in the CSS and 16 were employed. With regard to selection of the team, two diametrically opposed views emerged from among the respondents. For the former employees of the institution, the opportunity to work in the new services was of crucial importance. For the new employees, it was considered necessary to make a qualified selection and retention of jobs but not “at any price.” The selection of the team for work in the social services is an area that needs improvement in the context of their future development.

Based on the actual results, CSS is a useful service for children and families, but it is relatively unknown and not well promoted in the community. To safeguard the development of the service and its quality in the future it is crucial to ensure continuity of support regardless of the changing political situation and the local authority and also its financial security.

According to experts from NGOs who were interviewed, it is imperative to invest in trainings, consultation and supervision for several years in municipalities where  institutions have been closed as well as in surrounding areas to ensure sustainability of change by building a high local capacity. To ensure financing after the completion of a project, it is important to consider different budget options and look for project opportunities.

According to one representative of the NGO sector, “the focus of deinstitutionalization are the homes for babies.” The efforts of all stakeholders should aim for success in there. The closure of these homes will stop the “feeding” of the institutional care system. The new alternative social services must support not only children at risk, but also families, to enable all children to grow up in a family environment.