The inception of deinstitutionalisation in Macedonia (1994–2004)

Awareness of the need of deinstitutionalisation appeared in the last decade of the previous century. The first actual action was to establish a day centre in Kriva Palanka and the centre for social work in collaboration with Poraka and Red Cross soon after withdrew Kriva Palanka residents to foster families. The beginning of a systematic deinstitutionalisation, however, is considered to be at the onset of the previous decade with the UNICEF project in Demir Kapija of resettlement of 30 children to their original families or foster care in 2000s. Simultaneously mental health reform was staged and, in 2008 National Deinstitutionalisation Strategy was adopted. That gave spin to a process of resettlement of 67 residents of Demir Kapija to the group homes in Negotino and Skopje, which was performed by Mental Health Initiative (MHI) and Poraka Negotino.

 

First action – retrieving residents

A first action that in deinstitutionalisation mythology of today seems to neglect what happened as a targeted (but isolated) action, which in fact was the first step of deinstitutionalisation in Macedonia.  Centre for social work Kriva Palanka, in cooperation with RCPLIP – PORAKA and Red Cross, resettled in 1996–1997 all of its users from Demir Kapija to foster families, through local initiative supported by the municipality Kriva Palanka.  Namely, the centre for social work initiated the process of resettlement into foster families (families that were in social risks and with unsolved housing need) and the municipality provided small houses (so called social houses). In this way, resolving two issues at one go – solve the housing issue of the foster families and resettle people from Demir Kapija. The identified foster families moved together with the resettled users in the social houses. Total number of nine users from Demir Kapija were resettled within this action.

Unlike subsequent projects, this project was neither initiated nor funded by an international agency. The leader of the project Mihajlo Kolev, a social worker at the local centre for social work was a member of RCPLIP – PORAKA, which has already had discussions on deinstitutionalisation and community based services. In fact, in 1994 the first day centre was created in Kriva Palanka. Again in cooperation between RCPLIP – PORAKA (with a leading contribution of Violeta Dimoska), Red Cross and centre for social work with MoLSP.

Children First – from Demir Kapija to foster families

In 2000, after the moratoria of new admissions in the Special Institute Demir Kapija, UNICEF initiated and supported a project focused on deinstitutionalisation of children with intellectual disabilities. The UNICEF funded project ‘Educational and social activities with children form the Special Institute Demir Kapija aimed at deinstitutionalisation’ was implemented by a project team led by prof. Petrov from the Institute of Defectology (now Special Education and Rehabilitation), with help of an Italian NGO EducAid in the period 2001–2004.

The goals of the project were (Petrov, 2016):

-          To organise educational and socialisation activities with the children, in order to create condition for a certain number of children to develop independent living skills as a precondition for their acceptance by their original or foster families.

-          To organise close cooperation with the centres for social work that will have to provide conditions for successful integration of the children in the communities (to re-establish connections with the original families or to provide foster care).

In this way, the project was simultaneously seeking to act within the institution – changing the perspective on the children and ways of working with them, and to act outside preparing the services to accept the children.

Challenges faced during the implementation of the project (Petrov, 2016):

-          Difficulties in organising day care centres for children;

-          To abandon the medical approach and to create ’Macedonian model’ of deinstitutionalisation, adapted to the local circumstances;

-          To be patient, not to burn out in own ambitions.

This meant that the project started at a slow pace, with a lot of conceptual and practical considerations and preparations.

A team of young and committed professionals carried out the preparation for resettlement of the children. They worked directly with the children in the institution, developing the potential of the children while encouraging attachment with the project staff in first place, then to foster families. In the period of four years, a total number of fifty children were involved in the project activities, but only thirty left the institution. At that point the project was ended – prematurely so for the remaining children – possibly also challenged by slow implementation.

Claimer: This blog is intended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008–2018, which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog, Vlado Krstovski is considered to be co-author.

Reference:

Petrov, R., (2016), 15 godini od procesot za deinstitucionalizacija na deca od specialniot zavod Demir Kapija (15 Years of the Deinstitutionalisation Process of Children from the Demir Kapija Special Institution), Skopje: report for the MoLSP.

Special care to protect children against institutionalisation (UNCRC)

The UN Convention on the Rights of the Child (UNCRC) emphasises the need for special protection and care for children who are vulnerable and at risk. Both the declaration and convention of children rights recognize the rights to all children regardless of their disability or health condition. The roles of the family in caring for children and the state in providing support are highlighted.

Children living in institutions has been contrary to the Declaration of children’s rights already since 1959 since it states that ‘children have the right to live in healthy environment’. Already in 1951 Bowlby has proven that even a few days of institutional life for children is damaging for the development of their brain and has negative effects on a child’s well-being and behaviour. Therefore, institutions cannot be defined as healthy environment for children.

The UNCRC in the opening articles (article 2) declares children with disabilities as having equal rights as others and they should not be discriminated against.

Article 7 sets the right to know and be cared for by their parents which usually is not the case for children growing up in institutions. It is really hard for a child to get to know their parents when they live separately and see each other a few times a year or every few years as it usually happens to children living in institutions.

Children have the right to live with his or her parents (article 9) unless this is deemed incompatible with his or her best interests. Even when separated from them they have the right to maintain contact with both parents. Institutions do not explicitly forbid or prevent contacts with parents, but they also do not act upon enabling children to exercise their right to keep in contact with their parents.

The article 18 states that parents have joint primary responsibility for raising the child and the State shall support them in this. This is in particular the case for parents of children with disabilities where the main support that parents get is institutional care. In order to enable the parents to take responsibilities to raise their children with disabilities at home adequate support service should be provided. 

Children should be protected from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse (article 19).  Especially in institutions physical abuse and neglect can be observed as a routine. Children tied to cot beds, left alone in one room without any care and left to bang their heads until bleeding is typical for institutional abuse and neglect. 

Article 20 recognizes the right of children without family life for support and care especially in foster care and adoption and in special cases care in suitable institutions. Large institutions cannot be interpreted as suitable institutions as they breach many other rights from the convention. Suitable institutions are group homes (where max. 4 children live together) that provide children with a life as similar as possible to family life.

Article 23 is particularly aimed at children with disabilities. They have the right to live in dignity, self-respect and environments that enable their participation and inclusion in society. This right can be exercised only if suitable services in community are established and institutionalisation prevented.

The right to education (28. And 29. Article) is totally denied to children with disabilities in institutions. Instead of having a family life and being included in mainstream school system, they are placed in the social care system with very few education possibilities.

Article 37 most explicitly forbids the depriving children of their liberty unless in extreme cases and even that should be performed for an as short time as possible. This should be interpreted very narrowly; which means that it should be understood that the shortest possible time should be counted in hours and not in days or years. The same article states that every child deprived of their liberty should not be institutionalised together with adults but should have special services for themselves.

Family reintegration is the return of a child on a permanent basis to the family of origin who has been provisionally separated by an alternative family care placement or more usually a stay in residential care.  Where it is safe family reintegration constitutes the most desirable permanent solution for a child who has been in care. It should be sought as a priority, even if the family of origin does not seem “ideal” or their customs and ways of life are different from those of the majority of the population.

United Nations (1990) UN Convention on the Rights of the Child. Available at: http://www.unhcr.org/uk/4d9474b49.pdf

Claimer: This blog is intended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008-2018 which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog Andreja Rafaelič is considered to be co-author. Acknowledgment to Andrew Dunn (UNICEF expert) for useful contribution.