COMMUNITY FOR ALL – MOLDOVA PROGRAM

Quarterly Progress Report

January 1– March31, 2013

Submitted to:


Mental Health Initiative /

Submitted by:

Charles J. Hooker, III, CEO / Ludmila Malcoci, Executive Director

LIST OF ABBREVIATIONS

EAE – Equal Access to Education (part of C4A-MD)

BFR – Biological Family Reunification program

C4A-MD – Community for All – Moldova

ED – Executive Director

FSS – Family Support Services department

LFD – Legal Framework Development department

CSD – Community Services Development department

JMSG – Joint Media Strategy Group

HMI / OSF – Health Media Initiative / Open Society Foundations

KHS US – Keystone Human Services US

KHSIMA – Keystone Human Services International Moldova Association

ME – Ministry of Education

MF – Ministry of Finance

MHI / OSF– Mental Health Initiative / Open Society Foundations

MLSPF – Ministry of Labor, Social Protection and Family

MH – Ministry of Health

MoU – Memorandum of Understanding

OSI/ECP – Open Society Institute/ Early Childhood Program

RMPPC - Republican Medical Psycho Pedagogical Consultation

IDP – Individual Development Plan

DI – Deinstitutionalization program

IAP – Individual Assistance Plan

IEP - Individual Education Plan

PP – Prevention Program

CH – Community Home

MTS – Mobile Team Service

SIB-R – Scale of Independent Behavior – Revised

SLS – Supported Living Service

TOR – Terms of Reference

Community for All – Moldova Program

Quarterly Progress Report

(January1 –March31, 2013)

OVERVIEW:

C4A-MD Programservices chart

The C4A-MD Program is active in 28 rayons from the total of 35 rayons of the Republic of Moldova.

Milestones reached:

  1. To date, and with Keystone Moldova support, the following legal and normative acts have been elaborated and approved: the Law on Social Inclusion of Persons with Disabilities; the Strategy for Social Inclusion of Persons with Disabilities; the Regulations and Standards for Community Homes, Supported Living, Mobile Team, Personal Assistance and Respite Care Services; Regulations on reallocation of funds within the reform of residential care institutions;and the methodology of implementation of inclusive education in schools.
  1. To ensure the financial sustainability of the new community based services for persons with disabilities, Keystone Moldova provided assistance to the national and localgovernments to develop andplan thecosts for new services. Starting with2012, the Moldavian Government is allocating funds for theservices developed by local public administrations with Keystone Moldova supportin annual national budget. Thus in 2012, the Government of Moldova allocated 1.251.700 MDL for 11 developed services. In 2013,the financialresources allocated by the state budget increased up to 9.506.500 MDL (see Table 1).

Table 1.

  1. To date, the C4A-MD Program delivered services to2,818persons, including 1,421children and adults with disabilities,and 1,397parents of children and adults with disabilities. Compared with the previous quarter, the number of served beneficiaries increased by 172, including an additional 62 children with inclusive education support, 14 children receiving Mobile Team service,sixadditionalchildren and families receiving Respite services,and 5 more persons deinstitutionalized from Orhei institution (see Table 2).

Table 2.

C4A-MD beneficiaries, January 2009 - March 2013
Program / Persons with disabilities / Parents
Biological Family Reunification / 43 / 43
Deinstitutionalization Program / 50 / 50
Prevention Program / 44 / 44
Foster Family / 3 / 3
Shared Living / 3 / 3
Community Home / 14
Supported Living / 10
Mobile Team / 321 / 321
Inclusive Education support (IEP, Support teachers and RCIE) / 474 / 474
Respite services / 25 / 25
Playground Room / 434 / 434
TOTAL / 1421 / 1397
  1. 73children and adults have been moved from Orhei institution (an increase of 5 as in the previous quarter): 43 were reintegratedinto their biological families;14 in Community Home services; 10 in Supported Living service; 3 moved in Foster Care services; and3 adults moved intoa Shared Living service.
  1. 41 out of 44persons referred to the Program by the Ministry of Labor, Social Protection and Family and the Republican Medical Psycho Pedagogical Consultation were prevented from institutionalization and remained with their family (except one beneficiary who died this year).
  1. 100% of persons in direct assistance of C4A-MDprogram for more than three months, have Individual AssistancePlan and SIB-R.
  1. 90% of program beneficiaries who received support for one year improved significantly with their motor skills, social interaction and communication, personal living and community living skills.
  1. 100% of beneficiaries with behavioral problems improved significantly with their behavior after12 monthsof interventions.
  1. 100% of persons moved to communities/prevented from institutionalization are integrated in at least one community service.
  1. Keystone Moldova supported the LPAs to create 118community based services (an additional 16 new services, including 10 new support teachers in the pilot schools)to support the social inclusion of persons with disabilities (see Table 3).

Table 3.

C4A-MD developed services
Service units (up to Dec 2012) / Service units (up to March 2013)
Foster Family / 3 / 3
Shared Living / 1 / 3
Support teacher / 28 / 38
Psycho-pedagogue / 19 / 20
Personal assistance / 19 / 21
Respite / 2 / 2
Community Home / 3 / 3
Supported Living / 2 / 3
Mobile Team / 9 / 9
Resources Centers in Inclusive Education / 15 / 15
Playground Room / 1 / 1
Total / 102 / 118
  1. Keystone Moldova has been piloting inclusive education in 22 community schools from 15different rayons (including the seven additional communities).
  1. Keystone Moldova signed partnership agreements with rayonal authoritiesfor the creation and implementation of community based services and for the implementation of inclusive education. These agreements ensure the sustainability of the created services.
  1. Keystone Moldova contributed to the creation of194 new jobs, 15 more compared to the previous quarter(including 10 new support teachers in pilot schools, 2 new Shared Living Services Providers, 2 new support specialists, and 1 new employee in the third Supported Living service) - see Table 4.

Table 4.

New jobs created
Type of services / Units nr
End of December 2012 / End of March 2013
Support specialists (personal assistants, support teachers, psycho-pedagogues) for FSS beneficiaries / 46 / 48
Support specialists (psycho-pedagogues and vocational specialist) for CH and SL beneficiaries / 3 / 3
Foster care providers / 3 / 3
Shared Living providers / 1 / 3
Respite service providers / 6 / 6
Community Homes staff / 18 / 18
Supported Living staff / 8 / 9
Mobile Teams staff / 60 / 60
Resources Centers coordinators / 13 / 13
Playground Room coordinator / 1 / 1
Support teachers in pilot schools / 20 / 30
Total / 179 / 194
  1. Keystone Moldova developed capacities of services provider staff, community representatives, persons with disabilities and their parents and its own staff. To date, 11.636 person/days of training have been conducted, including 1,389 persons/days of training during the reported period of time.
  1. 100%(54) of program partnering communities developed Plans for prevention of institutionalization of persons with disabilities.

Difficulties/setbacks:

  1. Lack of local community services and highly specialized services for people with disabilities make the intervention work difficult and hard to supportprogram beneficiaries in the communities.
  2. Staff fluctuation in newly created services is due to low salaries.
  3. Difficulties in promoting and implementation of the new community based services for persons with intellectual disabilities (community homes, supported living, shared living and foster care) at rayon levels, due to low level of accountability and responsibility of local public administration regarding the deinstitutionalization process and the quality of services to be delivered to persons with intellectual disabilities, and to limited financial resources planned by the state for those services (small salaries and operational costs).

*Needs for development (i.e. - training, technical support):

* Upcoming events (i.e. - round tables, participation at international conferences etc.):

Relevant information concerning reforms in health, education and/or social welfare policy that will have an impact on mental disability:

Income/expense balance (percentage of the budget spent to date):Please see financial reports.

DETAILED PROGRESS REPORT:

Project goal: To contribute to the reform of care and social protection of persons with disabilities for their better social inclusion through: a) the development of community based services that meet the varying needs of people with disabilities and their families/caregivers, b) the development of legal and normative framework for regulation of newly created services, and c) the development of supportive community environment through changing attitudes and behaviors of population regarding persons with disabilities

Objective 1: To Develop Community Services based on the Needs of People with Disabilities and Their Families/caregivers

Under the first objective, the C4A-MDProgram was focused on implementation of four sub objectives:

  1. Family support for integration of persons with mental disabilities into their own biological, extended, or foster care families,
  2. Assistance to communities and service deliverers in developing community based services for persons with intellectual disabilities,
  3. Assistance to communities in educational inclusion of children with special education needs,
  4. Capacity building of community representatives, service deliverers, and C4A-MD Program staff in community based social care services for persons with disabilities.

Subobjective 1. Family Support for Integration of Persons with Mental Disabilities into their Own, Extended, or Foster Care Families[1]

In the reporting period, 110 people with disabilities received family support services (3 more compared to the previous report). Currently, in total, 143 C4A-MD program beneficiaries have been assisted by the Family Support Service team, including 33 that have been discharged based on their attended progresses and family level of independence. In the reporting period, 2 new beneficiaries have been moved from Orhei institution into their biological family and 2 others in Shared Living services. Additionally, one adult has been transferred from Biological Family Reunification program to Supported Living (more information under Sub-Objective 2). In total, 43 persons with disabilities have been moved in their biological families, three adults with disabilities have been placed in Shared Living services, 3 children in Foster Care services and 44 beneficiaries and their families received assistance from FSS team to prevent the placement in Orhei institution. This quarter, one child from Orhei institution died due to severe health problems. In total, there are 253[2] residents in the Orhei Institution.

This quarter, the FSS team and local hired specialists (personal assistants, psycho-pedagogues and support teachers) delivered 5,641.6 hours of assistance to the beneficiaries under the FSS support (by 36 % less than in the previous quarter) – Figure 1.

Figure 1

The decrease of the direct number of assistance has been determined by several factors: the decrease of number of beneficiaries receiving specialized support, from 23 in the previous quarter to 18 – in the reporting period; the involvement of FSS team in preparing the files of 18 beneficiaries and elaboration of informative notes for each of them to be presented to the Local Authority when transferring the case from Keystone Moldova assistance to local government[3]. 92% of hours of assistance have been provided in the field (community, home, school etc.) by the specialized support (19 contracted people)

Needs Assessment of Beneficiaries and Their Families. According to Figure 1, during the reporting period, the amount of time for needs assessment of beneficiaries decreased. FSS team conducted 12 Person Centered Planning sessions (seven less as in the previous quarter), including four initial (for two new beneficiaries in Biological Family Reunification and two in Shared Living) and eight updated (two updated first time, two updated third time and four updated fourth time). All in total, up to the moment there was 286 Person Centered Planning sessions completed, including 26 North Star Person Centered Planning sessions (Figure 2). Also, this quarter, six SIB-R sessions have been conducted, including two initial. The SIB-R tool was applied to 93 beneficiaries (two more compared to the previous reporting period) during 220 sessions (initial and updated).

Figure 2

Support for LPA and Service Providers. During the period, the C4A-MD support to LPA and service providers decreased. The majority of the interventions continued to be focused on supporting the Rayonal Departments of Social Assistance and Family Protection in developing the support services (the personal assistance and inclusive education services) for FSS beneficiaries or on inclusion of beneficiaries in mainstream community services.

Behavioral Support. During the period, nine beneficiaries received behavioral support based on Positive Behavior Support (PBS) plans (one less compared to the previous period as he had no need any more for PBS). The hours of behavioral support provided by FSS team decreased insignificantly comparatively to the previous quarter (by two hours less). The PBS continued to be focused on assistance to children and adults to improve the behaviors and on assisting the parents to support the positive behaviors. According to the data provided by parents and specialized support, four beneficiaries from nine decreased to “0” all the targeted behaviors; one beneficiary decreased to “0” two targeted behaviors and, also, registered a decrease for other three targeted behaviors; one beneficiary also registered a decrease for all challenging behaviors. The other three beneficiaries registered this quarter a small increase of number of challenging behaviors manifestations: in two cases due to the fact that the parents didn’t respect the recommendations provided by the C4A-MD team, and in one case due to some external factors (the children were triggered by some of pupils from the school).

Medical Support. The hours of medical support provided to FSS beneficiaries increased from 12.5 to 30.3 hours. This increase was determined by the fact that in the reporting period the physician established new treatments for 10 FSS beneficiaries, including 7 that received new treatments with Keystone Moldova financial support and 3 from their own budgets. In the case of 9 beneficiaries, the new treatments are focused on increasing mental functions and cognitive stimulation, and in case of 1 beneficiary, the treatment is focused to reduce and stabilize the challenging behaviors. In this regard, the Keystone Moldova physician conducted medical assessment of those children, supported the families in drugs procurement and conducted training activities with the parents on drugs administration. Additionally, the physician is monitoring the drugs administration by verifying the Daily Form on Drugs Administration completed by the family members. Also, the physician continued to monitor the situation of 9 children and young people with epilepsy or convulsions (by four less comparing to the previous report as they didn’t had convolution crisis over the last year). From the total number of children with epileptic syndrome monitored this quarter, five children had “0” convulsions this reporting period and one registered a decrease of number of convulsion crisis (due to the new treatment they started to receive). One child had a stable situation (the same number of convulsions) and two children registered regression (high epilepsy activity due to status epileptics – crisis in series). One of the factors that determined the regression in these two cases is related to the fact that the parents didn’t administrate the medication correctly and in time.

Psychological Counseling. Duringthe period, the number of hours of psychological counseling decreased insignificantly (from 31,8 to 28,3 hours). This type of assistance is provided at the families’ request when crisis situations occurred and it is oscillating from one quarter to another. In total for this quarter, C4A-MD conducted psychological counseling to13 FSS beneficiaries and their families, especially to the two families that this quarter took back their children from Orhei institution and for the two new Shared Living services providers and adults placed in these services.

Inclusive Education and Personal Autonomy Support.The FSS beneficiaries received 552.7 hours of inclusive education support (including 540 hours provided by the support teachers hired in the field and 12.7 hours provided by FSS team) and 4,728.4 hours of life skills education support (including 4,692 hours provided by the personal assistants and psycho-pedagogues and 36.4 provided by FSS team). Compared to the previous quarter, both types of support (inclusive education and personal autonomy) decreased, due to the reduced number of beneficiaries receiving these types of supports (five less this quarter, as they improved their abilities and do not need intense educational and personal autonomy support) and due to winter and spring school holydays from this period. This quarter, 18 people with disabilities received specialized support from 19 contracted people (two support teachers, five psycho-pedagogues and 12 personal assistants). In total, 45 beneficiaries reintegrated in their biological family / Foster / Shared Living service or prevented of institutionalization received specialized support provided by 48 persons (including eight support teachers, 19 psycho-pedagogues and 21 personal assistants).

The teacher and specialized support staff performed 5,232 hours of education and life skills development support during the current reporting period (290 hours per months per served beneficiary). 78% of beneficiaries that received education and life skills development support have been deinstitutionalized from Orhei institution and other 22% of beneficiaries have been prevented of institutionalization.

During the reporting period, the number of beneficiaries from the BFR and Prevention Program included in schools and kindergartens remained the same. All in total, there are 29 children included in schools, from which 27 are included in regular community schools (including two in kindergarten) and two children with severe mental disabilities attend special education institutions.

Social Assistance and Support in Improvement of Children’s Well-being (arrangement of child’s personal place, procurement of clothes, furniture, equipment, etc.). During the reporting period, 25 activities (26.1 hours) on improving children’s wellbeing were completed. The Keystone Moldova Executive Committee approved eight budgets for family support. In total, from June 2009 through January 2013, the C4A-MD Program supported materially and with services 77 families, from which 49 were from the BFR and DI programs and 28 from the Prevention program.

The total cost of support to biological families for the period June 2009 - March 2013 has been US $298,892.4, including US $12,889.70 for the current reporting period. The average cost of material and services support per one beneficiary is US $3,881.72. The analysis of the support in function of interventions shows that 58% of the total support was focused on life skills development and inclusive education (salaries of support teachers, psycho-pedagogues, and personal assistants), 31% - was focused on improvement of home environment and economical wellbeing, 5% - on improvement of health conditions and 5% - on other interventions.