Reducing Alcohol Problems in the Baltic Sea Region

Anna Skvortsova,

St. Petersburg, Russia

Reducing Alcohol Problems in the Baltic Sea Region

International Conference on Effective Approaches to Tackle

Alcohol Related Problems in Local Communities

Workshop 1: Strategies to reduce harm caused to children in families with alcohol problems

Supporting children in families with substance abuse problems in St. Petersburg and Leningrad region

Alcohol and other substance abuse have strongly increased among women in many countries during the last decade.International experience reveal numerous obstacles for reaching substance abusing pregnant women and mothers. Once the problem becomes known, there seems to be a lack of effective working interventions to help both the mother and the child. Substance-abusing mothers often have a strong sense of guilt and denial brought about by fear of losing their child because of their somatic problems, and they also fear losing custody of the child. Confronting the problem is made more difficult because of insufficient resources and treatment programs available to these mothers. As a consequence, mothers with substance abuse problems tend to withdraw from health care – in Russia, as well as for ex. in Finland, - and social systems until their situation becomes so difficult that their children are taken into custody.

In 2006 in Leningradregion there were implemented 2 projects attempting among other goals to find models of solution for this difficult problem, and in the end to prevent the placement of children into orphanages. The first project was aimed at a development of services for children and families in difficulties in a small village called Plodovoye. Second project was targeted to preventionof new-born babiesabandonmentinGatchina. Both were developed in a frame of a program “Support to Poverty Reduction in Leningrad Oblast” (SPRILO) 2005-2007 financed by DFID[1].

In 2007 in St. Petersburg and Leningrad oblast will be launched a new project «Development of the program of social and psychological support and rehabilitation of the pregnant women and mothers who have infants and small children and are depended on alcohol or drugs». The joint treatment of mothers and infants has been developed in Finland for over ten years in mother andchild shelters for substance abusers. Now we are attempting to develop this work in North-west region of Russia.

Speech consists of 2 parts:

1. Lessons learned from the projects in Leningrad region;
2. Short description of a new project.

1. “Development of an Integrative Program of Services for Assistance to Families and Children in Difficult Living Situation in Otradnenskaya volost of Municipality of Priozersky District of Leningrad Oblast”

Plodovoye is a village with some 1,500 inhabitants in Priozersk district of Leningrad region. It’s a part of so called “Otradnenskaya volost” consisting of 14 villages with 2,500 inhabitants total. The life in Plodovoye is strongly depended on agriculture and the main source of income for the villagers is the farm “Pervomayskoye” that gives job for 350 people that is much less than in previous year but still is almost a half of the officially registered working people in the village. So the role of the farm in the life of a community is still big as it is the main actor in labor market.

There is still a habit from previous Soviet times that the management of the farm is organizing a close monitoring of their workers by keeping a continuous list on the absence of the workers. In most cases this is caused by alcohol. So there was an idea (or maybe a dream?) of farm’ managers to help these families with problems of alcohol abuse and they discussed it with a department of social protection of population of Priozersk administration and in the beginning of 2005 there was established a group that started to discuss how to help the risk families. It consisted of a representative of the district administration, management of the farm “Pervomayskoye”, a teacher of the local school of Plodovoye, director of the local Culture House and director of the kindergarten, the representatives of village militia, the head of the war veteran council. Some time later also a social worker and a psychologist from Priozersk social committee and the doctor of substance abuse treatment unit of Priozersk were invited to join the group. In the end of 2005 the group consisted of 14 activists, who became the main initiators of the project and were also actively involved in it’s implementation.

According to the estimation of the group, there are 90 families with some 120 children in the village that meet serious difficulties because of extreme poverty and/or alcoholism of the parents. As a result, children in these families are usually left without supervision, they are having problems at school, they become the clients of social services and eventually in many cases are taken from the families into custody, to the shelters and children homes. One must also remember that the nearest health and social support services are located in the town of Priozersk in some 30 km from the village.

Priozersk district (rayon) was chosen as a pilot area for the SPRILO program implemented in Leningrad oblast during 2004-2006 and financed by DFID GB. There were 4 components in SPRILO. The poverty, social exclusion and the problems of alcohol abuse in lots of families in Plodovoye correspond with the objectives of the component 3 of SPRILO “Social Exclusion: Children and Families at Risk” that was designed to provide practical activities and alternatives that demonstrate more effective and cost efficient methods of providing services for vulnerable groups within the Leningrad Region. So, SPRILO project team started to support the initiative group of Plodovoe in developing of local community work with risk families. The primary goal was set to avoid the replacement of children to institutional care.

The local project group worked with 2 main target groups of families: 1. so called “problem families” (17 families with 27 children in which except social problems parents have also problems with substance abuse. For the 2-nd group there were chosen 10 families having so called “difficult living situation”.

In the beginning the attitude of the project group (which was basically the initiative group of the village started already before the project) towards the “problem families” was something like to work with “not-so-decent” people not behaving properly. But already in 2-3 months having participated in the initial training sessions by SPRILO experts, the attitudes were changed, the new assessment methods of the families were learned and the principles of special community work was being launched. Next step was to develop a range of services and to plan structured activities that could be supported afterwards by local authorities.

What has been done this far in the project:

-individual plans based on family assessment have been set;

-for each family there are chosen key workers, who have developed a close relationship with the families;

-specialists (social pedagogue and/or psychologist) are visiting families twice a month;

-some other social services were tailored in the individual needs of the families.

Of course, 1 year is a very short time for any major changes, but there are some clear positive results to been seen at least in 9 families from the total 17 families of the total target group of Plodovoe project. During this time only 1 child has been placed temporarily in the social-rehabilitation center (shelter). The most difficult problem is still to assess the positive impacts for the children living with drinking parents. The project made obvious the need for social and psychological services in the village – parents who got support these services started to take better care of their children even if they didn’t quit drinking. The administration of the village can’t provide enough finances to organize the twice a month consultations of the specialist, which is seen to be the least the families need to make some positive progress. The project group is now discussing this question with the administration of Priozersk. It is hoped that this will help to change the existing situation where the therapy of alcoholism often starts and ends after the first step phase of rehabilitation (detoxification) and in some cases “continues” only by so called “chemical protection” or coding (that is using different suggestive techniques for keeping a person sober). This means also the necessity to remake the whole system of recovery from alcoholism in Russian federation. Nowadays the therapy consists only to cure the physical effects of the dependence, too little is done with the real therapy where the whole personality must be involved.

It is obvious, that the “problem families” need to be supervised and the positive changes supported in some longer-term perspective, one year is definitely not enough. Some special program (for ex., so called “targeted social program”) is seen to be good solution for the future post-project supporting activities in Plodoye village, and it’s also the easiest way to be financed by the local budget.

One lesson learned from the project is that there is an urgent need for the real community work in nowadays Russia. A nice result for our work in Leningrad district is that the neighboring village Kuznetchnoye is now willing to start the work launched by SPRILO project in Plodovoe. We are having the negotiations with local authorities how to continue the work. Also Plodovoye is included into some new activities I will discuss a bit later.

“Prevention of abandonment of newborn children in Gatchina”

During the last 10-15 year the figures of abandoned babies right after birth has reached some epidemic levels in Russia, which is for example proved by the fact that there are not enough places for these children in our orphanages in today! Fortunately, our social policy seems to be changing quite rapidly and some alternatives for the institutional care are being developed. But as we know, children cannot wait[2]…

In Gatchina, small city located nearby St. Petersburg, there were 27 cases of abandoned children registered in the regional maternity hospital in 2006 and other 13 didn’t happen thanks to local community initiative in a frame of the SPRILO project. It was 3,5% from all newborn babies there[3]. In previous years, those babies had been left in the hospital till hospital found place for them in the orphanage. Sometimes it took several months because of children’s poor health, not to mention about suffering from early deprivation.

In 2006, through SPRILO program, local team in Gatchina started to work with 16 women who wanted to abandon their babies in MaternityHospital and provided the intervention.

-Age: 7 women – age under 18, 6 women – age 20-30, 3 women – age 30-40

-First baby – 7 women, second – 6 women, third – 1 women, fourth - 2 women

-All single mothers

-Living in countryside – 10 women

-11 women without secondary education and any qualification

Four stages of intervention where a woman is planning a refusal:

-Crisis period in the hospital (5 days) requires intensive intervention in the hospital and at the woman’s home (assessment including her family members).

-Immediate post crisis period at home (1 month after leaving hospital) – intensive intervention and support;

-Medium term support at home (6 months) – less intensive support once crisis has been resolved and immediate needs met.

-Long-term support in the community until the child is 2 years old includes several home visits, self-help groups attending, other necessary services that help mother to care for her baby.

Psychologist and social worker from St. Petersburg Korchak centre started regular supervision (twice a month) for local project team since the end of the March 2006.

The local team together with SPRILO consultants started to work on description of standards of evaluation and support for families who are at risk of abandon their newborns

Reasons of abandonment:

• Emotional problems
• Social problems
• Substance abuse
• Living with substance abusing relatives (parents), conflicts with relatives
• Low income
• Housing problems
• Living in countryside – far away from social services
• Social helplessness (poor knowledge about rights and social allowances available, need for assistance in getting registration and buying things for the baby etc.)
• Social patronage of the family necessary at least for 2 years after intervention.

Results:

• Project team succeeded to re-ensure mothers in 13 cases and babies came back to the families.
• Work continued also after project has been completed
• Local administration provide financing of prevention service (salaries of the specialists who support these families) for 2007

Difficulties:

Project team faced real difficulties in 4 other cases when mothers agreed to cooperate but didn’t manage with different odds and children were placed into the orphanage later. The main reason was that mothers were heavily depended on heroin and couldn’t stop it. Children have placed into the orphanage temporarily (until 2 years age) and local team try to help mothers and grandmothers with visiting children there.

Needs addressed to local community and authorities:

• Crisis center / social services for pregnant women and young mothers in crisis in local community Day center (shelter) for the children
• Preventive programs for the schools
• Programs for improvement of parenting skills

Challenge for the project team is still:

-To show to the local authorities that prevention of baby abandonment is realistic goal and it helps strongly decrease the number of children placed into orphanages;

-To calculate effectiveness of this kind of work (that it’s cost effective that children stay in families instead of institutional care);

-To complete development of prevention service structure and system of standards in social and psychological support for families who are at risk of abandon their newborns babies.

Work continues also after project has been completed. Local administration provide financing of prevention service (salaries of the specialists who support these families) in 2007.

So what is common in these 2 different projects – that our social and health system face real difficulties when clients (families) have multiple needs (drug-depended mothers, housing problems, low income and so on). Existing system is not enough prepared to meet those needs with existing recourses and knowledge. There are urgent educational needs for our social workers in:

-Work with substance abusing parents

-Modern knowledge about HIV infection and support programs for people with HIV

-Development of community social work

-Networking and establishing effective cooperation between various institutions

-Social work with the families needs to be updated and changed from “targeted assistance” (distribution of benefits) to real practical work based on family assessment and individual planning.

2. “Development of the program of rehabilitation of pregnant women and mothers who have infants and small children and are depended on alcohol or drugs, in St. Petersburg and Leningrad oblast”[4]

This new project will be started this year in St. Petersburg and 2 regions of Leningrad region with financial support from Ministry for foreign affairs of Finland. It’s based on 6 years cooperation between the Finnish NGOs: The Mother and Child Home of Helsinki, The Federation of Mother and Child Homes and Shelters and St. Petersburg city shelter for young mothers with newborn babies “Little Mother”. It’s the only shelter of this profile in whole Russia, which provides a short-term (max. 1 year) support for pregnant girls or girls under 18 with infants in some crisis situation. The specialists in Malenkaja mama help the girls to improve their basic skills with babies, which prevents them to abandon their children and minimize the high figures of children living in residential care in Russia.

Half of the clients of the “Little Mother” are graduates from the children homes. Many of them have used drugs. The staff of Malenkaja mama doesn’t have skills to take care of the mothers who are substance abusers, and their children.

Since 1998 The Federation of Mother and Child Homes and Shelters has supported in opening of seven mother and child homes in Finland that have specialised in the care of pregnant women and mothers who are substance abusers, and their babies (a project called Hold On). Homes has usually max 10 beds (5 mothers and 5-6 children), it provides the three-month to one year treatment programme for women with a drug or alcohol problem. Thetreatment is developed in collaboration with researchers and child psychiatrics.

The objective is to develop collaborative work between social services and health care services inmeeting these families and in referring them to treatment. The forms of intervention are:

-Residentialtreatment units (Mother and Child Home)

-Open Care Units

-Home visit based intervention.

Child protection and treatment of drug abuse problems are combined in the treatment.

1. The first primary task at the home is to give support to pregnant women over from intoxicants. Taking intoxicants is chemical violence against the baby. If woman has consumed alcohol during pregnancy, the child may be born with some degree of damage.