Deinstitutionalization Of Orphans And Restructuring Of Romanian Child Welfare Programs
Care for Children International, Inc. (a non-profit corporation organized under I.R.C. sec. 501 (c) (3))
Prepared by Dr. Ronald Steven Federici, Developmental Neuropsychologist
President, Care for Children International, Inc.
Deinstitutionalization Of Orphans And Restructuring Of Romanian Child Welfare Programs
Historical Data
Romanian Child Welfare reform has been a long and arduous process with limited success. Over the past 10 years since the fall of communism, numerous humanitarian aid groups in addition to millions of dollars in federal aid have been spent in an attempt to provide assistance to the Romanian government to restructure Romanian institutions which have been renowned as being highly deprived and damaging care centers for children. Numerous international documentaries have focused on the plight of Romanian orphans and the horrendous conditions these orphans reside in due to a long legacy of improper categorization of the children; continual influx of children into institutional settings due to poverty and socio-economic problems in addition to a lack of consistency and continuity within the Romanian Child Welfare departments of labor, Education and Handicaps.
Recent attempts at child welfare reform began to yield positive results although the volume of children residing in institutions has continued to present as being an overwhelming problem to the Romanian people and have continued to bring out issues which infringe on human rights of the unprotected child. Romania has gone through a very intense economic crisis, with child welfare programs often receiving the lowest amount of financial support due to a modicum of government objectives and a general lack of funds. Certain counties throughout Romania tend to be more deprived than others although Romanian institutional issues continue to be at the forefront of humanitarian efforts and continue to require the United States federal aid which can, hopefully, focus on a more intensive, constructive and long-term program in which change will finally occur.
Over the past decade, millions of dollars in federal aid have been spent to address the issues pertaining to child welfare. There have been numerous "grantees" of these federal aid grants who have attempted to complete programs with only partial success. Many of the programs now cease to exist with only a very few remaining at a very small level (i.e. small number of children actually be assisted). While there have been many attempts at proper programs such as rehabilitation facilities, HIV programs maternal and child healthcare centers, fostering programs and improving the infrastructure of certain counties and their Romanian constituents, there continues to be an overwhelming need for wide scale reform throughout the entire Romanian institutional system and governmental agencies dealing with child welfare issues.
Care for Children International, Inc. is an International Humanitarian Aid Organization initially organized in 1990 in England. Care for Children International, Inc. had previously worked in conjunction with the Romanian Challenge Appeal which began working in the most deprived neuropsychiatric institution in northeastern Romania known as Siret. The Romanian Challenge Appeal and Care for Children International, Inc. began with meager resources and was funded solely by private benefactors who were interested in providing a degree of humanitarian aid and care to the children in the Siret Neuropsychiatric Institute facility as the conditions were deplorable with all children being exposed to the most severe forms of medical, nutritional, psychological, physical and sexual abuse and neglect.
Care for Children International, Inc. has been the longest running independent charity working in Romania. While there have been numerous humanitarian support groups which have included Doctors Without Borders, Mother Teresa's "Sisters of Charity", UNICEF, World Vision and a host of others, there now exists only a very few programs in actual operation throughout Romania, even after millions of dollars of funding have been poured into such programs. Many of the humanitarian aid programs have been affiliated with United States adoption agencies who had an initial intent to provide some type of humanitarian aid and care to Romanian children and their families as well as to orphans in institutions, but again the majority of these programs are presently nonexistent which seems primarily attributed to the lack of focus and proper project directives. There has always been a rift between governmental and private objectives in terms of humanitarian aid, social service programs and federally funded programs specifically. This type of non-productive collaboration over the past several years has further lead to the demise of many well intentioned programs and the creation of larger and more damaging institutions throughout Romania which are now housing even more children.
Foster care programs have been attempted but, due to the Romanian economic crisis and lack of focused training programs for Romanian families (i.e. social work and psychological training aimed at Romanian family reunification and support for the Romanian family infrastructure), programs have continued to come and go. While there may be foster programs in existence, their current numbers nowhere match the millions of dollars of federal aid provided at the initial stages. There are still programs emphasizing rehabilitation and treatment for HIV. While these programs are certainly admirable, they represent a very small portion of Children in Romanian needing services.
Over the past decade, Care of Children International, Inc. has sustained short and long-term goals and is well received at the local and governmental levels. Since its implementation, Care for Children International Inc. has expended over $5 million in international financial aid from private benefactors as opposed to receiving any type of federal grant or research funding. Over this past decade, the British chapter of the Romanian Challenge Appeal and Care for Children International, Inc. has organized and collaborated, and has been able to carry out remarkable changes in one of the most remote and desolate areas of Romania as well as working in one of the most over crowded and damaging neuropsychiatric institutions known as the Siret Camin Spitul.
Over this past decade, Care for Children International, Inc. along with the Romanian Challenge Appeal has de-institutionalized over 90 children and has provided continual humanitarian support for the Siret institution in addition to the entire town of Siret and the District of Suceava. Care for Children International, Inc. has well over 50 highly qualified volunteers who have a permanent residence in the town of Siret, with staff members alternating based on specialty needs. Staff members range from social workers, psychologists, medical specialists, engineers and builders of all disciplines, teachers and educators, or any volunteer who has experience in child welfare.
The over 75 children who have been de-institutionalized have been placed in supervised, renovated apartments and homes; two newly built group homes (one housing 15 children and the second housing 25 children); older children now working as staff members for Care for Children International, Inc. with several of the older children working in "day-vocational training programs" within the community (i.e. volunteer activities in order to learn a skill).
The remarkable success of Care for Children International, Inc. and the British Romanian Challenge Appeal's "Siret De-Institutionalization Project" far surpasses any program which ahs been thus far implemented throughout Romanian. The "Siret Project" has sustained 10 years and has continued to gain momentum and support throughout the town and local county officials. It has been truly remarkable to enter one of the most deprived Romanian institutions in 1989-1990 and have the opportunity to rebuild, restructure, and de-institutionalize and progress such an institution to where there can be productivity observed in the children in addition to ongoing forward momentum that even more children will be de-institutionalized and mainstreamed back into Romanian society as the purpose of the apartment and group home programs are for short-term medical and psychiatric assessment, care, rehabilitation, vocational training and placement back within Romanian society.
One of the most critical factors which has lead to the success of Care for Children International, Inc. is the joint collaboration between both British and American groups who bring together a large group of skilled professionals trained in "International Adoption Medicine" and training in institutional care setting. The newly formed "Romanian Orphans Connection" (referred to as CCI) consists of well over 30 medical, psychiatric, occupational and physical therapy, educational, social work and administrators who have worked extensively in third world countries performing the most comprehensive medical and neuropsychiatric evaluations for children in institutional settings. All of these medical specialists are renowned for their expertise in "international adoption medicine" within the United States, and are strategically placed throughout the United States evaluation the treating the volumes of families who have adopted children from Eastern Europe-with Romania and Russia being in the forefront of the international adoptees. Crisis medical and psychiatric evaluations are regularly provided to Romanian institutions with the collected research greatly assisting in the development of prevention and comprehensive treatment programs.
Extensive research pioneered by Dr. Dana Johnson, a world renowned Neonatologist and Pediatrician (and the Chief Medical Officer of the Romanian Challenge Appeal) with expertise in international adoptions, clearly indicates the damaging and long-term effects of institutionalization. In a multitude of studies completed by many members of Care for Children International, Inc. Medical Team, Romanian and Russian orphans showed the most intense and chronic physical and psychological problems, particularly when the length of institutionalization exceeded 18-24 months (see attached research summary and articles).
In summary, historical data regarding Romanian institutions clearly indicate a need for wide scale de-institutionalization and restructuring in addition to focal efforts on Romanian family reunification; prevention programs; and medical and psychiatric expertise which can be passed along to Romanian specialists in order to work collaboratively, effectively, and help maintain long-term change in a child welfare system which ahs been resistant to change despite recent attempts by the Romanian Department of Child Protection and Romanian Adoption Committee.
Project Proposal:
Short Term Goals
1. Comprehensive medical and psychiatric evaluation and research regarding the damaging effects of short and long-term institutionalization. Ample research has currently been published with more data being collect and organized for publication. Principal medical and psychiatric researchers from across the country will continue to provide pertinent research regarding institutionalization in Romania with the goals of establishing prevention, treatment and rehabilitation programs.
2. Immediate assessments and interventions for urgent medical and nutritional needs of institutionalized children.
3. Wide scale de-institutionalization program for all orphans residing in Romanian institutions, particularly those children who are handicapped; need of urgent or long-term medical and psychiatric care; older children eligible for work or vocational training; and children adequately assessed for adoption potential.
4. Creation of "regional medical and neuropsychiatric clinics" for comprehensive evaluations which address the health care status of all institutionalized children.
5. Training, education and supervision of Romanian physicians, mental health professionals, social workers and caretakers needed to sustain programs. Of critical importance is for the immediate establishment of Romanian-U.S. medical-psychiatric clinic and training program.
Reorganization of current institutions into a "tier system:. Institutional programs will be gradually "broken down" into three levels:
1. Chronically handicapped children in need 24 hour care and supervision.
2. Children who have been institutionalized but show "recover potential" with proper medical and psychiatric treatment. Goal will be to reintegrate back into Romanian society and/or Romanian family origin.
3. Programs geared towards maintaining medical and psychiatric health of children eligible for inter- and intra-country adopting. These would be the "highest functioning" children with the strongest potential for recovery and successful placements.
6. Creation of an infrastructure to support the initial stages of de-institutionalization. This would involve governmental training, coordination and designation of a "hierarchy" of Romanian NGO activities.
7. Creation of an independent American-Romanian NGO-PVO program to oversee, condense and coordinate MGO "fragments" which are currently operating within Romanian. The emphasis would be to create "man power" by combining as many small, medium and large size humanitarian-based programs currently operating within Romania. It is imperative for a "governing body" or separate entity to be immediately created to begin new support programs consistent with Romanian child welfare needs as opposed to the needs of individual providers.
8. Use of the currently established Care for Children International, Inc. "Siret Project" as a model for de-institutionalization and community involvement seems logical as this has been the most long-term, practical, economic and well received program. Furthermore, the "Siret Project" has de-institutionalized more children into appropriate placements than any other program throughout the various regions.
9. Coordination between Care for Children International, Inc. and principal Romanian foundations SERA (Dr. Cristian Tabacaru, Director) and Copii Fericiti (Dr. Bogdan Ivanescu-Director).
Long-Term Goals
1. Project goal is 3 years to recategorize all institutionalized children via joint U.S.-Romanian medical and neuropsychiatric clinics.
2. Providing long-term training, education and maintenance for serious mental and physical health issues (nutritional/starvation, psychiatric, social deprivation, hepatitis, HIV/infectious diseases, and taratogenic exposure such as lead, alcohol, herbicides and pesticides.
3. Accessible regional clinics for all high-risk families requiring social service support, medical and psychiatric care.
4. Restructuring of high-risk Romanian family units who are at a stage of child disruption. Support staff will train local team of social workers, therapists and medical specialists for ways to manage the child at home as opposed to an institutional placement.
5. Providing "respite workers/caretakers" for families keeping children as it is necessary for Romanian families to work or receive in-house support for a child with handicaps or disabilities.
6. An increase in inter-country adoptions and foster care programs. Romanian family stability and reunification should be a utmost priority in addition to the ongoing expansion of well trained Romanian foster care families and respite care programs. The greatest need is to assess and stabilize a de-institutionalized Romanian orphan while also providing coordination for longer-term placement options with the appropriate county/regional authorities who may handle inter-country adoptions or long-term foster care contracts. Foster families will need to be compensated at a reasonable rate (approximately $60.00 - $75.00 U.S. per month, per child).
7. Strengthening the current Department of Child Welfare and Handicaps by continual liaison and active involvement in the projects of de-institutionalization, family stabilization, and humane medical, nutritional and psychiatric care for those children residing in institutions. It will be imperative that the appropriate Romanian departments work closely with the U.S.-Romanian NGO-PVO assessment and treatment team in order to allow for a smooth transition and "restructuring" of the current institutions.
8. Cost containment strategies per county and per institution. The necessary evaluation of how money is spent for food, medical and staff needs should be made via economic and medical assessments. Medical personnel are more than qualified in assessing how money should be allocated for food, medical care as well as providing counseling for institution administrators regarding staff-child ratios.
9. Soliciting Romanian families to serve as alternate "caretakers" for children who are institutionalized. The primary selection would be for stable Romanian families who are interested in providing "relief work" to full-time caretakers (employees). A small stipend will need to be provided.
10. Prevention for high-risk pregnancies via training, appropriate medical care and epidemiological surveys (evaluation of toxins such as lead and alcohol). Prevention programs will be set up in each region under the county health department/medical facility. Prevention programs will reduce the number of children institutionalized.
11. Accessing existing hospitals and university medical centers to be readily available to provide additional personnel to assist in the care of institutionalized children. For example, medical students or excess physicians can be readily assimilated into the treatment team.
12. Ultimate goal is to rename and reorganize current institutions as true hospitals, rehabilitation and triage centers for short-term use and limited long-term care. Strict criteria will be established for children entering any institutional setting. This will be in the form of proper "regional clinic evaluations" regarding the child's medical and psychiatric status.
13. Agricultural development ties in extremely well to the entire concept of de-institutionalization. There is an abundance of available farm land which can be utilized to house and vocationally train older children which is the prime directive. Romanian farm land is in abundance and highly rich in potential, and has thus far been grossly under utilized. Farm land is readily available and reasonably priced, and ca be quickly molded into a financially productive venture.
14. The utilization of farm land projects as an alternative to institutionalization will enhance privatization, self sufficiency, vocational skill training and incorporation of de-institutionalized youth and young adults into productive Romanian society.
15. Utilization of specific local-community businesses to serve as "mentors and employers" and allow de-institutionalized children the opportunity to participate in either volunteer or paid employment. For example, in the Romanian Challenge Appeal and Care for Children International, Inc. "Siret Project:, IKEA furniture company based in Sweden has built a plant in Siret (Suceava District) and has now employed 3 older children who have been de-institutionalized from the Siret Neuropsychiatric Facility. These youth have embarked on a training program with the business assuring continual support for this type of training and employment opportunity.
Phases of Project
Phase I Presentation of Care for Children International, Inc. and solidification of USAID grant for a minimum of $25 million over the course of 3 years.
Phase IIImmediate creation of the joint U.S.-Romanian partnership (Care for Children International, Inc. and SERA- Copii Fereceti). All programs must be consistent with previously initiated governmental program needs which began in 1997 with the newly created Department of Child Protection.
Phase IIIIntensive training, by region, of medical and mental health specialists lead by Care for Children International, Inc. medical team.
Phase IVSystematic evaluation of each and every child in every institution (medical and neuropsychiatric evaluation)
Phase VCoordination of efforts of interested NGO's who meet the criteria for involvement in the program. Goals must be consistent with aforementioned short-term and long-term goals. Man power is critical but it is more imperative that independent entities work under an "umbrella organization" with a focus and systematic strategy for de-institutionalization and restructuring.
6 Months Review
1. Review of regional medical and neurophsychiatric assessment centers.
2. Review of medical and psychiatric data following evaluations
3. Assessment of children entering in and/or leaving institutions
4. Assessment of the numbers of available and readily trained Romanian foster families
5. Assessment of movement towards "tiered system" for institutions
6. Assessment of Romanian medical, social work and Romanian caretaker staff training programs
7. Assessment of the number of recruited "respite workers or alternate caretakers" for families at home in addition to respite care workers working in currently established institutions and hospitals.
8. Ongoing assessment and coordination of program directives with Romanian Department of Child Welfare programs
9. A "6 month review" staffing will all departments, Care for Children International, inc. and designated Romanian NGO's, particularly project coordinator, is imperative.
1 Year Review Goals
1. Assess reduction in institutionalized children and assess number of newly placed children into alternate care programs and family-fostering program
2. Assessment of reorganization of currently run institutions into the "Three-tiered system"
3. In-place medical, psychiatric and rehabilitation programs
4. Vocational training programs aimed at de-institutionalizing older institutionalized children into Romanian society
5. Creation of well supervised short-term group and foster homes preparing newly de-institutionalized older children for movement into the Romanian work force or back into their Romanian family or origin.
6. Ongoing assessment of medical, nutritional and psychiatric needs. Regional medical and psychiatric evaluation centers should be in full operation. At this point, local county officials and governmental authorities should be working in unison at cost containment efforts in order to provide the required amount of medical and nutritional care and supplements. By the first year program, there should be no shortage of necessary food and basic medical supplies following the medical team evaluation of institutions and assessment of the amount of food and cost per day, per child.
7. Following first year review, a wide scale hepatitis, HIV and infectious disease prevention program should be underway in conjunction with local, regional and national medical personnel who have been working in conjunction with Care for Children International, Inc. medical team of the Romanian Challenge Appeal. Epidemiological surveys and assessments will be thoroughly discussed with numbers pertaining to mortality rate, old and new cases of infectious disease, and assessment of nutritional neglect via medical examinations.
8. A strong assessment of caretaker roles within the institution should be completed by the first year. Most importantly, by the first year of the de-institutionalization and restructuring project, Romanian caretakers currently working in institutions should be more properly trained and placed on an hierarchical system which may parallel a routine hospital setting (i.e. director, co-director, team leaders and line staff).
9. Within the newly created infrastructure of Romanian caretakers, it will be imperative to provide incentives, bonuses, promotions, or any means of financial or material support in order to keep moral and motivation at the highest level. Additionally, by the first year, it will be very clear which caretakers and Romanian personnel need to be removed from the programs an replaced by newly recruited Romanian staff and volunteers who will be afforded an honorarium or small stipend in order to provide support to children housed in the institutional environment. The most important aspect will be for proper recruitment of caretakers who are willing to maintain "hands on" involvement with the children.
10. Assessment of farm land purchases and agricultural program development. The "working farms" for older children (under supervision by the program) should be in operation. Agricultural development in Romania will be a prominent asset as it will provide an abundance of alternatives to institutionalization while also creating an additional "market system" and privatization (i.e. cost containment and earning potential).
11. Social work and educational programs will focus on physical and occupational therapy; expansion of educational programs; and basic physical and social-interactional programs in order to prevent regressive tendencies for children who have been in institutional settings for long-term periods. It is imperative by this first year "review point" that active social work and recreational training programs be "in place" within each and every institution.
12. The principal Romanian project coordinator will have an annual report from each and every institution regarding meeting short and long-term goals and objectives; problems and obstructions; staff and " problems regarding the implementation of a "tiered system program" both for the actual institution and involved personnel.
2 Year Review/Goals
1. In place tiered system which has involved wide scale "movement" of children to the most appropriate and functional setting.
2. Fully operational regional medical and neuropsychiatric clinics and readily available to all institutionalized children and also accessible to "high risk families" about to place a child in an institutional environment.
3. In place Romanian foster families with an estimated (minimum) amount of 500 throughout various counties in Romania.
4. Establishment of short-term de-institutionalization, training and "moving on" programs for older de-institutionalized children. The "Siret Program" will be used with the goal of having a minimum of 2-3 such facilities in each county nationwide. The Romanian project coordinator will secure the building, remodeling, supervision and staffing of each "de-institutionalization group home setting".
5. Establishment of independent living situations within the community where apartments are utilized and supervised by the American-Romanian team.
6. In place, extensive vocational training programs with an emphasis in mainstreaming older de-institutionalized children into the Romanian work force, particularly farming, labor activities, factory work, or any activity in which a modest salary can be obtained in order for the individual to gradually become self-sufficient. Agricultural and farm land programs should be in full operation and production.
7. A "mentoring program" by Romanian elders should be in full operation to supervise those de-institutionalized older children who are attempting to live independently, work, manage basic finances and activities of daily living. The recruitment of "mentors" is a critical part of the long-term project goals and success. Again, the recruitment of senior and elder Romanians to serve as alternate caretakers and mentors will ensure a degree of "parenting and supervision" while also employing even more Romanians into the concept of de-institutionalization and reunification of the Romanian family and society as a whole. It is anticipated that, as the children go through a "de-institutionalization program" and gradually become more productive and engage in meaningful work, vocational and possible educational activities, more Romanian families will be interested in being part of the team (success and accomplishments within Romanian society)
2-3 Year Review/Goals
1. Strong emphasis in sustaining the currently established programs now being primarily run by designated Romanians. Ongoing employment of well trained Romanian project coordinators who are committed to long-term change and management/coordination with governmental agencies.
2. Imperative collaboration and coordination between Romanian governmental agencies (Ministries of Labor, Handicaps, Education and Child Welfare)
3. Economic scrutiny and auditing of programs should be on an ongoing basis (every 3-6 months). Care for Children International, Inc. oversight and collaboration with higher-level government officials in charge of delegating to county and regional authorities approvals, financial allocations and general administration.
Length of Project and Funding
LENGTH OF PROJECT PROPOSAL: THREE YEARS
ESTIMATED FUNDING FOR PROJECT PROPOSAL: $20-25 million
The following serves as a preliminary budget:
1. Travel expenses and per diem for rotating 15-30 American medical specialists.
2. Conferences, training, materials and supplies for Romanian medical, social work and administrative personnel.
3. Accommodations, food and lodging for Care for Children International, Inc. personnel traveling at 3 month intervals.
4. Necessary allocation of urgent nutritional supplements and medical supplies.
5. Inter-country travel with appropriate Romanian staff (drives, translators, project coordinators and co-coordinators and security as needed).
6. Preparation of medical and neuropsychiatric evaluations per child.
7. Preparation of evaluations for entire institution (physical facility, structure, staffing and personnel, needs, etc.)
8. Preparation of list of necessary medical supplies to sustain long-term nutritional program and infectious disease prevention programs.
9. Hotel, lodging, staffing and conference preparation per locale, region and nationally during various stages of the project.
10. Preparation of medical research and reports to federal government agencies sponsoring project.
11. Publication of medical research and program.
12. Recruitment of additional Romanian caretakers, respite care workers and mentors.
13. Extensive expansion of foster programs (with stipends).
14. Organization of vocational and rehabilitation training programs.
15. Possible purchase of land in order for agricultural and farming development.
16. Necessary equipment and machinery (as project progresses).
17. Environmental health consultants and economists.
SUMMARY AND CONCLUSIONS
Care for Children International, Inc. in conjunction with well recognized Romanian NGO's (SERA, Dr. Cristian Tabacaru, Project Coordinator and with the Romanian NGO Copii Fereciti, Dr. Bogdan Ivanescu, Director) have extensive experience in dealing with complicated institutional and governmental situations which have plagued Romania for years. The current proposal constitutes the most comprehensive, aggressive and well organized approach to de-institutionalization of Romanian orphans and restructuring of the Romanian Child Welfare programs currently in existence. The current proposal emphasizes medical and neuropsychiatric evaluations, research, care and a total reorganization of institutions and caretakers with an extra emphasis in Romanian family reunification, reintegration of a select group of Romanian orphans back into society; in addition to building a strong infrastructure which can be completely consistent with Romanian governmental directives as opposed to independent programs which have a history of only short-term duration.
Furthermore, the current project proposal involves a wide scale collaborative effort between American medical specialists in international adoption (institutional medicine) and designated Romanian medical, social work, psychological and administrative professionals. This "join venture" is imperative as the Romanian institutional problem has continued althoug