Report prepared by Svetlana Rijicova, consultant, based on the results of a visit to Kazakhstan within a framework of a technical assistance project to the Government (стр. 3 )

· To assist in the participation of the social workers at the meetings of the commission of tutorship and guardianship authority where the cases of the families with risk of child abandonment are discussed in order to present the results of the assessment of the family situation and family needs, the assistance provided to the family on the basis of the developed individual family support plan, as well as to participate in the analysis of the proposed solutions to the family problems. 

· To provide Demeu Centre with a status of a methodical office on provision of support to the social workers of all polyclinics of the Astana city, who will learn and adopt the experience, gained during the piloting phase. 

4.2. Karaganda, NGO “Family”

NGO "Family" included into the working protocol / algorithm on the prevention of child abandonment has facilitated the establishment of collaborative relationships with the agencies included into this working model, has developed appropriate forms, has helped to increase the quality of services provided to families, women during pre-birth and post-birth periods. The regional health care department has been informed about the NGO “Family" activity and highly appreciates their assistance.

The following is recommended in order to increase the work efficiency: to review the role of the NGO “Family" in the working algorithm on the prevention of child abandonment. The NGO should be encouraged to share their experience and support the improvement of the working protocol / algorithm, as well as to provide support to the social workers in improving the quality of their work. In this way, the NGO " Family" will be able to withdraw from the process of working directly with clients and will focus its efforts on  the provision of methodological assistance to the social workers and increase their presence in the work of the commission to review the cases requiring interdepartmental solutions (within the program: 5 steps).

4.3. Semey

The Semey city has all the necessary prerequisites for the introduction of the working protocol / algorithm on the prevention of child abandonment.

The following is recommended at the second stage:

· To begin with the provision of a methodological support to the social workers in order to increase the quality of their work on case management.

· To use, as a supervisor, the coordinator of the social workers from Demeu or the NGO "Family", which, in turn need to be trained in the implementation of the professional supervision mechanism.

· It looks more effective to establish relationships on the basis of an inter-institutional agreement concluded between the institutions included in the process of prevention of child abandonment, such as polyclinics, children’s homes, maternity hospitals. To set up necessary flows of information about the family and child when they move from one institution to another.

· Further implementation of the project is possible using the same strategies in all the pilot sites: training and institutionalization of the mechanisms of professional supervision, creation of a mechanism for preventing the separation of the child from the family, signing of an interdepartmental protocol and its implementation, etc.

For the first two pilot sites especially problematic is the filling out the documentation and keeping records on the number of families who have received help, who have been  supported by the social worker. Due to the lack of a recording system the social workers work with the same data which have been mentioned in the reports from the previous visits and do not add any new data reflecting the work with new cases. In this regard, it is necessary to develop a standardised data recording system (a database) for all project pilot sites; a simple and cost-effective model could be designed in Excel. 

5. General recommendations to the project

More specific recommendations are described above.

The situation in the pilot sites registers a positive dynamics in understanding and following the working protocol / algorithm on the prevention of child abandonment, in using case management tool and setting up partnerships at the local level.

At the same there have been identified areas that could be consolidated and new mechanisms that could be developed in order to improve the quality of the provided services and their integration into a common system.

The following is recommended at the second stage of the project implementation:

5.1.It is possible and necessary to develop a common for all pilots framework protocol for collaboration of state structures that will allow to ensure its institutional sustainability and future replicability. Inclusion in the working protocol / algorithm of the NGO's social workers to replace or compensate the role of the state structures is not stable and sustainable and does not guarantee that the state structures will use this experience.

The framework protocol should be improved in the following ways: to bring the protocol / algorithm in accordance with the decrees of the Ministry of Health regulating the work of the social workers; to strengthen the part regulating the determination of the level of risk and more clearly define algorithms of work depending on the level of risk (how to act at a high and how to act at medium or low risk); to more clearly describe the moments associated with the collaboration of the institutions included into  the algorithm of work (maternity hospital, children’s home); to include into the protocol / algorithm the flows of information from one institution to another and back; to review and improve the forms fill out by the  social workers;  the format and language of the protocol should be more formal, typical for the regulatory documents developed in this country, which has an impact on the perceptions  and attitudes to the document.

The framework protocol once passed the piloting at the local level may be suggested for a future implementation in other areas of the country. In the longer term, there will be a need to develop a working protocol / algorithm for the regional level that will include all rural settlements (villages / auls).

5.2.It is necessary to develop a protocol of interdepartmental cooperation at the local level, taking into account the existing services for children and families and to approve it by all departments (social protection, education, health, law, protection of the child's rights, Akimat). This will help to regulate the process of interdepartmental cooperation and increase responsibility of partners, and as a result the quality of provided services will be increased. 

5.3.It is necessary to change the approach to the social work - from mother with a child to the family with a child. Even if it looks like that the child abandonment cases are more related to the to the mothers, especially single mothers, the prevention and support in  pre-and post-natal periods could not be performed without the involvement of the members of the biological and extended family. Thus, the social worker should focus its work on the family as a whole, using the family as a resource.

5.4.The social workers and psychologists in polyclinics (and a lawyer in the Demeu centre) to be merged into the psycho-social support department / team.  Even if currently they are part of the prevention department, they should be considered as separate unit/team. It does not mean that the cooperation with the medical personnel will worsen; on the contrary it will create an opportunity to better structure and organize the work of this service. At the same time, it will prevent the transfer on the social workers and psychologists of the responsibilities inadequate to their official duties (for example, the responsibility for screening, responsibility for preventing of hospitalization of the elderly people, etc.).

5.5.To create a system to prevent the separation of the child from the family and placement to a residential institution (gate-keeping system). In doing so, to review the statute, roles, functions and competence of the Commissions of Minors (described above).

5.6.Assist in the development and implementation of the mechanisms of professional supervision for all pilot sites (described above).

5.7. Support the development of foster care services in accordance with established standards and its more effective inclusion in a system of alternative care services used to prevent child abandonment and protect children without parental care. To develop short term and emergency foster care for young children, as well as for under-aged mothers with their babies. To reconsider position / regulation of the services and remove the requirement of the compulsory pedagogical education for potential applicant for foster care which significantly reduces the number of candidates for this job. To develop the quality standards for the service and to familiarize all social workers with them.

5.8.To develop the methodology (provision / regulations and quality standards) for the Family support service and train social workers in providing this service (perhaps by a cascade method).

5.9.Clearly define job duties/ job descriptions of the different types of personnel in polyclinics - medical, social worker, and psychologist. It is absolutely necessary to develop / revise the duties of the social workers and psychologists as well as for the medical personnel, which should include the duty of mutual information between the medical staff and social workers about the family dynamics. The question of determining the boundaries of competence of the social worker in the health care system is very important, as this determines the policy of professional training of future specialists and content of this training, and in the future the development of other systems - accreditation, certification etc.

5.10. To develop  typical  functional duties of the social worker in the health care system, subject to  the regulatory documents approved by the Ministry of Health:  the Decree  907 on arrangement of the social workers activity in  the  health care system, the Decree  630 on standards of social services , the Decree  134 on qualifications requirements  and certification rules, the Decrees  693 and 689 on encouragement system.

5.11. To change the criteria for the social workers’ performance evaluation - excluding the criteria used in the performance evaluation of the medical personnel and to develop the social work criteria based on the number of prevented child abandonment, number of prevented placement of children to the children’s homes and boarding schools, number of families who have received support to overcome difficult life situations, etc. The social work methodology is quite uniformed regardless of the department where the social worker works. The differences are determined by the range of social problems and the groups of people the social worker works with, as well as the partners involved in his/her work. Thus, the criteria for the performance evaluation of social workers may include the uniform criteria, such as the number of identified families with children in difficult life situations, the number of families assisted by the social worker, the number of the families who have overcome difficult life situations and have acquired the ability to solve their problems independently etc.) who constitute the majority. In addition, the performance evaluation criteria can be formulated, depending on the institution where the social worker works in order to reflect the specifics of the institutions (e. g., number of found mothers, number of the reintegrated children – for the workers of the children’s home; the number of infant abandonment - for the maternity hospitals). It may be that for the evaluation of performance of the social workers from the polyclinics, the uniform criteria will be mainly applied as this work is at a level of primary care.

5.12. To develop a standardised recording system to register families / children who have been provided with the various forms of support in order to overcome difficult life situations.

5.13. To assist the Ministry of  Health of the Republic of Kazakhstan to develop various methodical materials to support  the social workers : methodology of case management in the health care system, the methodology of professional supervision, referral mechanism of readdressing cases to the social services system, etc..

5.14. To design a mechanism for increasing qualification of social workers. At the moment it looks like a more effective option to use the methodological centres described above, which would assess the training needs, select universities and practitioners to carry our trainings. The great advantage in this situation is the availability of the finance resources for professional development in the health care system.

6. Annex

Annex 1

Meetings Schedule

Date / Location	Organization / Specialists	The work performed/Information
26.03.13 Ust - Kamenogorsk	UNICEF - Tatiana Shulman Nassyrovna Mukanova - National Center of Health Development	· The Program  of 5 steps - creation of organizational structures at the central regional and local levels in order to create an integrated approach for  _ working out the cases that require provision of social services. · The responsibility on the child's rights protection is distributed between four departments at the national and regional level. At the local level all functions of the child’s rights protection have been delegated to the Commission on juvenile delinquency. · The mandate of the Commission on juvenile delinquency - expansion of the  responsibility area , addition of a new role to prevent  the  children placement into the  institutions of boarding school type  (competence, motivation)
Supplemented 26.03.13 Ust - Kamenogorsk	The Department of Child Rights Protection - Arkady A. Isayev	· The structures on protection the child's rights are represented at the national and regional levels. The representative office at the regional and city level is not provided. · Well informed about the groups of children in difficult life situations, collects a quantitative information on the number of children deprived of parental rights and sent to orphanages paid benefits and support  for the school entering.
26.03.13 Ust - Kamenogorsk	Department of Health - Elmira Zhanatovna responsible for health care at the local level for social workers the health care system Alia Mubarakovna Begalina - responsible for the organization of treatment and prevention work.	· Changes in the number of social workers: - 2social workers, - 2Social Workers. · Professional status - is low-skilled workers who take care of elderly people at home. If we save this aria of liability then their inclusion into the health system and provision of services in cooperation with the nursing staff is justified.  However, the other groups of population requiring such type of services remain uncovered with social services.  The question who and how can make it is still open.
27.03.13 Semey	A round table with social workers of polyclinics and health department of Semey on the program of prevention surrender of the children.	· Simulation of the work protocol based on accumulated experience with a group of social workers and psychologists have been implemented. · The needs for consolidation of a professional competence of social workers have been defined. · The necessity of creation a mechanism of a professional supervision for the social workers has been defined. Some social workers have felt the necessity of this work themselves initiated the elements of supervision at an intuitive level.
27.03.13 Semey	Polyclinic no. 12 Head doctor Social worker Psychologist Chief Pediatrician of the City Health Department	· Cooperation of the social and psychological services of the polyclinic with other social services of the city -  the algorithms of work · Job duties of the social worker and psychologist · Arrangement of  the  documentation for the work performed by the  social worker and psychologist · Work on prevention of the child's surrender · Contacts with the orphanage · Contacts with the maternity house
28.03.13 Semey	Orphanage  Head doctor Social worker	· Analysis of the procedure of the  children placement and exit from  the orphanage · Placement of the children to the orphanage: from maternity house via a doctor/ nurse, directly to the maternity; · Foundlings through the police by act of transfer to the orphanage; from the mother's application for temporary accommodation.  In all cases, the placement of a child shall be registered in a guardianship and custodianship agency, but after actual placement of the child. · Exit of the child from the orphanage (by priority): to a biological family, guardianship, adoption and foster family. In all cases, the child's exit from the orphanage should be procedurally established by the guardianship authorities.
29.03.13	Demeu Director Coordinator of Social Workers Psychologist	· Analysis of inter-sector cooperation of the center with other departments responsible for child protection · • Analysis of the algorithm of work of the center with maternity, local social services for the family and child, state agencies.
30.03.13	Demeu Coordinator of Social Workers Psychologist Social workers	· Algorithm of work of the social worker and psychologist · Work on prevention a child's surrender · Collaboration with other experts, services · Job duties of the  social worker and  psychologist · Arrangement of  documentation on the work performed by the  social worker and psychologist
01.04.13	Karaganda NGO “Family”	· The  model / algorithm of work have been discussed  · Cooperation with organizations / institutions · Possible perspectives
01.04.13	Karaganda Regional Department of Health care Representatives of the polyclinics, orphanages, maternity	· Model / algorithm of work of the   polyclinics, orphanages, maternity  , and movement of the cases from one service to another · Coordination of social workers activity · Interdepartmental  cooperation · The role, competence of the Commission of the juvenile
02.04.13	Karaganda	· University - a professional training of social workers · The Department for the Child's Rights  Protection: functions, partners, changes
03.04.13	Astana	· Ministry of Health care - discussion of the consultant's recommendations · • UNICEF - discussion of the conclusions and recommendations