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. 1 )

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

Visit period: 25.03.2013 – 04.04.2013

Content:

1. Introduction

2. National and regional level

3. Local /urban level ( image of pilots)

3.1. Interdepartmental cooperation (for all pilots)

3.2. The system of prevention of the child’s family separation and placement in a children’s home (gate-keeping system, GK)

3.3. Specialized social services for the children at a local (city) level

3.4 Integration of specialized social services to prevent child abandonment in pilots

3.4. Data collection and monitoring

3.5. Competence of social workers in the health care system

4. General conclusions on the pilot sites

5. General recommendations on the project

6. Annex

1. Introduction

The report is based on the analysis of information collected in the process of carrying out the individual interviews, focus group discussions, panel discussions, visits to the three pilot sites. The report was prepared in accordance with the tasks stipulated in the TOR.

The report contains a description of the situation and recommendations on improving the model / protocol of the works on each analysed aspect. The general recommendations are included at the end of the report. In some aspects, the content of the report is beyond the defined objectives.

I would like to thank the colleagues from the UNICEF Kazakhstan, Tatyana Aderikhina and Violetta Krasnikova for the excellent arrangement of the visit and information provided on the status of the projects’ implementation, as well as all partners of the pilot sites who have offered their time, arranged meetings and round table discussions, and provided valuable information on progress so far.

2. National and regional level

At the moment, there is little awareness regarding the need of combining the responsibilities for the child's rights protection into a single social protection department at the national and regional levels. Especially as the changes in the health care system associated with the introduction of a social aspect of work were implemented only in 2011, the fact that makes it difficult to introduce any systems changes again. In this situation it is necessary to conduct a large scope of explanatory work to achieve the changes at the awareness level, changes in the institutional and social stereotypes, as well as to revise the responsibilities for each of the departments involved in the child’s rights protection. The interdepartmental approach in dealing with complex cases of difficult life situations does not mean a separation/ fragmentation of responsibilities related to family and child social protection between different governmental departments. Interdepartmental approach means, first of all, involvement of appropriate professionals from different departments as partners in solving the problems of children and their families within their level of responsibilities and competence. This understanding will come in time.

In given situation the two strategic approaches might be applied:

· Piloting of new working models at the local level and promoting the results to the national level in order to make the informed policy decisions;

· Parallel explanation, persuasion at the national level in order to change the strategic approaches in terms of solving the issues related to the protection of children’s rights, elimination of fragmentation of responsibilities as well as overlaps of functions between different governmental departments. To do this it may be helpful to involve international experts having relevant experience in CIS countries through arrangement of learning and exchange visits, in country events to discuss different possible approaches.

The child’s rights protection structures are represented at the national, regional and local levels by the tutelage and guardianship authorities. The Child’s Rights Protection Department has its representative offices at the national and regional levels and at this point in time does not have its subdivisions at the local level. It looks like there is a substitution of functions in this structure such as collection of data for which other departments are responsible, project management (for example prevention of suicide). At the same time, there are functions that are not performed, such as statistical analysis, establishing trends in the social situation of children who are in difficult life situations, strategic planning and development of children’s services, developing and ensuring the implementation of policies on the prevention and protection of children from abuse, neglect and exploitation. In the situation when the structure is not represented locally, the possibility to promote and monitor the implementation of children’s rights at each community level is quite limited. The social protection system is widely represented at the national and regional levels and is poorly represented at the local level where the system's users are located and where the authorities should ensure equitable access in order to meet the needs of the population. This situation may be acceptable during the process of establishment and development of the social services system, but during the following phases of the system implementation and maintenance it will be necessary to turn over the pyramid, so that primary social services are developed at the local level and the reliance on the residential boarding school type services is decreased.

The person responsible for social workers in a regional health department of Karaganda makes an impression of a very organized, responsible manager, however, he is very technical and not enough involved in the issues faced by the social workers. She handed over the responsibility for the social workers’ coordination to an external social worker (there are 114 social workers in the region) and to an external psychologist (there are 29 psychologists in the region). This managerial decision seemed to be quite reasonable, due to her high workload and this approach can be recommended to other regions too. With a good selection and proper training of the delegated coordinators, they may perform a good coordination of the relevant specialists. At the moment, these coordinators are responsible for the social workers database (which needs to be revised), provide oversights of the social workers’ working plans, undertake controls, handle complaints, identify training needs and arrange training courses. At the moment they do not have other methodological support duties.

In the Semey city the cooperation, the understanding of social challenges faced by the social workers, the relationship between the participants of the partnership (chief paediatrician of the health department, director of the polyclinic No.12, children’s home, maternity clinic, social workers from the polyclinics) is closer, friendlier, more constructive, on equal terms; it is felt that the personnel is quite familiar with the local problems and there is a practice/culture of discussion of various issues. With information and methodological support, it is believed that the Semey city will be able to pass through the next steps of the project implementation quite quickly.

3. Local / urban level (image of pilots)

3.1 Interdepartmental cooperation

In order to establish the interdepartmental cooperation for the prevention of child abandonment (0-3 years of life) it is necessary to develop an interdepartmental protocol, which should cover  the algorithm of actions of the representatives of a health, education, social protection, internal affairs,  Akimat (Commission of  5 steps) departments. This document should be signed off by all departments, informing the employees who are directly involved in this work. In this case the social worker will not need to beg the district police officer to visit the family together; it will be clear that this is the direct responsibility of the police officer. As a result, an efficiency of cooperation and speed of reaction to the signals will increase and also the presence of a district police officer will ensure the security of the social worker visiting unsafe families.

Interdepartmental cooperation will help to structure and systematize data record and monitoring of the measures to prevent child abandonment.

I believe that the development of the algorithm and piloting of interdepartmental cooperation realistically should start at the local level. The arguments to support this are:

· better familiarity with the problems faced by the population groups;

· more active and  flexible relationships between the representatives of the departments responsible for provision of help to families and children; direct contact with the specialists providing social services to the population;

· a possibility to check the algorithms and protocols of cooperation within a limited area with further  improvements  of  these algorithms and protocols, and their recommendation for the replication of the experience in other regions of the country.

Establishment of the interdepartmental cooperation model requires the development of the protocol / algorithm for the actions of the employees subordinated to each department (who, when, what, how), the clients’ record keeping as well as providing appropriate services within each department, effective exchange of information in order to avoid duplication of work, to organise collection of information on indicators of common interest and in this way to improve access of population to social services. It is necessary to ensure that developed protocol of interdepartmental cooperation should be approved by all participants of cooperation (health, education, social security, public order), so that it becomes a regulatory document that is implemented by all the partners involved. This will greatly facilitate the involvement of various specialists to work on a particular case; it will identify the need to refer the case and the collected information to the social worker who subordinates to a different department (e. g. from the health care system to the education system); it will avoid duplications in the provision of social services and improve the recording and monitoring of the assistance provided to a particular family from the funds of various departments.

Thus it is necessary to identify  the structure / officer who could perform the coordinating role in this collaboration at the local level: it might be the representative of the local authorities responsible for  social problems, provided that they are motivated and competent, or it might be a regional representative of the Child’s Rights Protection Department, provided that the institutional changes that will occur in the second half of April 2013 will create the opportunity for the implementation of this role. The second option seems to be more reasonable.

3.2 The system of prevention of the child’s family separation and placement in a children’s home (gate-keeping system, GK)

There is no working mechanism for the prevention of the child-family separation under the current system. At the local level, the social worker supports and accompanies the  family (in the health care system) and the decision to place the child in the children’s home is taken by the guardianship and custodianship authority through the Commission of Minors (hereinafter refer to as CoM) subordinated to the Department of Education. Also, the initiation and preparation of documents for termination of parental rights is done by the guardianship and custodianship authority.  Sometimes, termination of parental rights could be initiated by the law enforcement agencies. The social workers, as the providers of a service that accompanies the family in the community, are not invited to the sittings of the CoM, and are not even informed regarding the adopted court decisions. In this way, the guardianship and custodianship authority makes uninformed decisions and it is not known if they analyse all existing alternatives to solve the issue in the best interest of the child.

Thus, the placement of the child to the children's home is a result of uninformed decisions of the guardianship authority, which is not based on the social work assessment and family support care plan developed and implemented by the social worker from the health care system in the period preceding this situation. Also it is not known whether the members of the guardianship authority have capacities to analyse possibilities of using various alternative forms of care and select an appropriate form of care for the situation of each individual child.

The analysis of the collected information enabled me to make the following conclusions regarding the development of the gate-keeping system:

Under the current situation, it is necessary to use CoM in the gate-keeping role, although it is not the perfect option. There are a number of difficulties such as the CoM working style, lack of capacities, presence of the stereotypes in the work, etc. However, in the situation when local authorities insist on the CoM and are not willing to establish a new gate-keeping structure, and where there are a number of other commissions established which may lead to confusions regarding their roles that can impact on the effectiveness of the work, this may be the best current option.

Arguments in favour of this decision:

· CoM  has a relatively independent status;

· CoM's  decision have  recommendatory nature; 

· CoM  works at the regional and district levels and may also be established at  each village / aul level;

· CoM  consists of  the representatives of various organizations, departments and community members;

· CoM  gathers information on the situation of children from all other local departments;

· CoM  provides an assessment of the guardianship and custodianship authority;

· More likely  CoM  will go under  control of Akimat and will be able to collaborate with other departments more closely and effectively;

· CoM will be subordinated to the Child's Rights Protection  Department which employees understand and advocate for the child's rights protection, understand the effects of institutionalization and the need for the reform of the children’s homes.

In this situation the following is recommended:

· To revise the statute of  CoM to include responsibilities for the prevention of child’s family separation and placement in children’s homes (gate-keeping);

· To revise the structure of CoM to include the professionals who directly work  and are familiar with the issues, problems of individual families and children in difficult life situations, as well as to include representatives of non-governmental organizations (NGO);

· To revise the working methodology of CoM according to the concept of filter and single window;

· Training of CoM members in terms of  new responsibilities;

· Integration of CoM into the system of prevention the child’s family separation: establishing institutional structures, developing services, providing CoM with new authorities, establishing a common recording system and of information flows.

3.3 Specialized social services for children at a local (city) level
3.3.1 Semei Children’s Home

According to the work procedures, the services provided within the children’s home are focused around the provision of temporary accommodation and care for children, with an emphasis on children’s reintegration / family placement (in biological, extended, foster care families etc.). In doing so, there are applied techniques for increasing the responsibility of mothers, encouraging and maintaining contacts of the mothers with their children during the placement in children’s home.

The children’s home operates as a separate service and does not have effective relationships with other services for family and children, e. g. it is not integrated into the local child care and protection system.

In order to integrate the children’s home into the local social services system it is recommended:

· To add a phase of work that precedes the child placement to the children’s home that includes the work of the medical personnel and social workers from the polyclinics to identify families / mothers showing a risk of a child’s abandonment, assess their situation and determine the degree of risk (high, medium, low) according to certain indicators, provide family support, and connect the family to existing community services and resources.

· To present the case where there is a risk of child abandonment at the sitting of the CoM (with gate-keeping functions) in order to make a care decision in relation to the child's  situation (further described in a priority order): support the child to stay with his/her family and provision of family support, establish the guardianship over the child (usually with extended family members), propose the child for national adoption, place the child in foster care, or in the residential care, as the last care option.

· To place the child in the children’s home for a short period of time (including together with the child’s mother, as a result of the reorganization of the children’s home) until a decision is made regarding a family placement. In this situation, it is necessary to ensure that the  information about social work assessment of the child and the family and the individual family support plan completed by the social worker from the polyclinic is transmitted(in the situation of foundling children and mothers without a fixed place of residence, this can be problematic). The transmission of the information from the polyclinic will eliminate the need for the social worker from the children’s home to conduct the social work assessment and will release his/her working time in order to  solve the other issues: find the mother, prepare the  family for the child's reintegration,  etc.

· To work with the family while the child is located in the children’s home, in order to prepare the family for the child's reintegration into the family. This should be carried out in collaboration between the social worker from the institution and the social worker from the polyclinic In case when an alternative measure is decided upon (guardianship, adoption, foster family), the same social workers should participate in the process of decision-making and placement of the child in one of these services, providing the information on the social work assessment and the work performed with the family. The information about the child gathered by the social workers should be submitted in a due form to the managers of these services.

· To add a phase of monitoring of the family (biological family, guardianship, foster family) during the integration / reintegration /placement of the child into the family in order to prevent a relapse. Taking into account the cultural context, the adoptive parents often want to keep the secrecy of adoption. This feature should be considered with a gradual change of mind-sets through public communication campaigns.

In order to increase effectiveness of the children’s homes and expanding the groups of population covered by their services, it is necessary to plan and implement the reorganisation of the children’s home that will envisage the establishment of new services such as day care services for children whose mothers attend training courses or seek employment, a rehabilitation unit for the children with special needs, psychological counselling, social work support, health support for mothers with children, etc. and any other services needed to best support the child and the parents.

The reorganised children’s home should be integrated into the system of medical / psychological / social services provided by the polyclinics, residential institutions, maternity, guardianship and custodianship agency, care agencies, as well as other local agencies and services in collaboration with which the social workers will help the families to overcome difficult life circumstances (employment agency,  day care centers, etc.). At the same time exact protocols of the partner’s interaction as well as the necessary flows of information following the child should be established. 

3.3.2 Foster care

Foster care is not developed enough and currently does not represent a viable alternative to residential placement the children under 3. The unpopularity of this service is limited by the requirement that potential foster carers should have pedagogical education. Perhaps there are other reasons that need an in-depth analysis.

3.3.3 Maternity home

There are two ways for pregnant women to be hospitalised in the maternity hospital: after recording period in the polyclinic at the place of residence, by personal address bypassing a recording period in the polyclinic.

In the first case the polyclinic - maternity relationship is not established for the transmission (there and back) of information on assessment of the family situation with identification of the risk of child’s refusal and on the assistance provided to prevent child abandonment. As a result, the psychologist of the maternity spends the very limited time (3 days) on the assessment of the situation instead of working directly with the mother on changing her decision to abandon the child. The same happens when the woman comes to the maternity hospital bypassing the polyclinic, and the psychologist uses the limited time to both assess the risk of child abandonment and carry out preventive work.

In order to change the existing situation and increase the efficiency of the psychologist’s work in the maternity hospital, it is necessary to establish a clear collaboration arrangements and information transfer between the polyclinic and maternity hospital, informing the psychologist of maternity about existing or prospective risks of child abandonment. Such a mechanism would not be possible in the case of the women coming to the maternity hospital bypassing the polyclinic. This group of women constitutes an increased risk of child abandonment and should be a priority for the psychologist work.

After the release of the woman from the maternity hospital and when the risk of child abandonment remains to be high, the psychologist should transfer the information to the social worker and psychologist from the polyclinic from the mothers’ place of residence in order for them to provide timely support and monitoring in after birth period.

In a situation of the women with no fixed place of residence and with a high risk of child abandonment, the mother-and-baby couple could be supported by providing services in a temporary accommodation which can be established as part of the children’s homes reorganization process.  

Also, the information on the social work assessment of the family and the work done should follow the child, in case when a decision was made about the child’s placement from the maternity to the children’s home, according to the CoM recommendations.

Thus a services network circuit will fall into a single system by which the clients and information in health care, social protection and education system will circulate in the context  of child abandonment prevention efforts.

3.3.4 Recommendations for the improvement of services for the prevention of the child's abandonment and protection of children without parental care

In order to increase the efficiency, coverage and diversity of services for the prevention of the child abandonment it is recommended to revise, reorganize or establish new services / programs / strategies aimed at supporting families and children in the pre-and post-birth periods. In many pilots many programs are operating; the list of the programs can be extended or differentiated both in terms of content, targeting and coverage. If necessary, these centers might be used as a resource for other pilots.

The services / programs for prevention of the child's abandonment  

· The school of future parents, especially for first-time mothers and teenage parents. Both mothers and fathers should be involved in this programme. 

· The school of preparation for childbirth, especially at the first birth. Fathers’ involvement into the birth and upbringing of children.

· The training program for parents – in the provision of child care, communication, child development, feeding the child.

· Self-support groups for mothers, fathers, and parents.

· Family planning services.

· Encouraging young parents to stay (live) with their parents. In this case, self-support groups for grandparents to support the upbringing of theirs grandchildren can be effective. This will facilitate the formation of solidarity between generations; it will encourage the support within the family; it is correlated with the cultural characteristics of the population of Kazakhstan.

· Educational programs for prevention of cruelty towards children.

· Organization of counselling services for the families by different specialists: social workers psychologists, lawyers, etc.

· Supporting the families with children with special needs.

Services for the protection of abandoned children:

· Services for urgent placement/accommodation of abandoned children (as a result of crisis situations).

· Consolidation and extension of a foster care.

· Consolidation of the children’s national adoption service, including changing approaches for recruitment of adoptive parents: family for the child, versus the child for a family.

Key ideas that should go through entire preventive work: - Holistic approach to the family, and not treating the problem just in the mother –child context. - Family - an important partner in solving the situation. - The changing of the father’s   role in preparation for childbirth, childbirth and upbringing of the child. - Development and implementation of the child’s protection policy against a violence and neglect  in all forms of social care services.

3.4 Integration of specialized social services to prevent child abandonment in pilots

3.4.1 Demeu Center - city district level model

At the moment the Demeu Center as an institution cooperates with:

· The Department of Health – the Director / Coordinator of Demeu's social workers submits reports and brings to discussion the most complex cases that require complex interventions.

· The Maternity home - the social workers from Demeu Center reports (by telephone) on women in labour who are openly declaring their intention to abandon the child, and vice versa the social workers from the maternity informs the Center regarding the children abandoned in the maternity home. Such mothers with the children are temporarily placed in ”Nadezhda" group at the children’s home.

· The guardianship and custodianship agency - collaborate if necessary to assist the mothers with their child placement in the kindergarten.

· The law enforcement authorities - when they bring the children found unattended on the street to the Demeu Center.

· The NGOs providing social services, temporary accommodation centers for the mother and child.

· There are no contacts established with the department of social protection.

Cooperation at the level of specialists from the polyclinics:

· The most effective cooperation is with the medical personnel which is the main source of information about the families and children in difficult life situations. At the same time the other sources to identify the cases are used – self-referral, hotline, etc. In the framework of prevention of child abandonment, the most effective is the cooperation with the medical personnel. In this case, it is necessary to improve information sharing and the status of the social worker as an equal professional.