The Institutions for Children with Special Needs in Bulgaria by BG Helsinki

THE INSTITUTIONS FOR CHILDREN WITH SPECIAL NEEDS IN BULGARIA

This text is the introduction to the publication of the Bulgarian Helsinki Committee on the homes for mentally and physically disabled children, Children in Institutions, volume 5: Homes for Children with Special Needs. The research was carried out in the framework of the project “Monitoring and Lobbying for Legislative Change in the Homes for Accommodation of Children with Mental and Physical Disabilities” supported by the Democracy Commission at the US Embassy in Sofia. Antoaneta Nenkova is the author of the publication. The entire publication (with reports from the homes and relevant legislation) is available in Bulgarian only.

CONTENTS Introduction, by Antoaneta Nenkova and Krassimir Kanev Year-round homes for disabled children aged 3-18 – factories for outsiders, where the children’s development is slowed Placement in institutions Material conditions and funding of the homes Medical diagnosis and treatment Human potential Training and opportunities for social integration Mortality in the institutions Main conclusions

3 6 7 8 11 14 15 19 20

General overview of the system of social services in day-care centres for disabled children and youth aged 3-18

General problems in the system of social institutions for the professional training of youth aged 14-35 with slight mental retardation (social-educational boarding schools) The future of SEBS Funding Stimulation and motivation of SEBS specialists Chances for professional realization and social integration

22 23 23 24

Recommendations

INTRODUCTION

his book is the fifth in a series of publications, in which the Bulgarian Helsinki Committee gives a detailed overview of the situation of children in Bulgarian institutions. Since 1995 BHC researchers and their colleagues from other international organizations, including Amnesty International and Mental Disabilities Rights International, have been visiting homes for children in Bulgaria and attracting public attention to the situation of the Bulgarian children who have been left without care. This publication deals with the problems of social institutions for children with serious mental disabilities. These children are treated as “uneducable” and consequently are placed in institutions under the jurisdiction of the Ministry of Labour and Social Policy (MLSP), and are not subject to the control of the Ministry of Education and Science. The BHC began observing institutions for children with mental and physical disabilities in the year 2000. The observations focused on the following problems: the legal regulations and procedures for placing children in institutions; the living conditions in the institutions; the relations between children and the institution staff; punishment; the educational and socialization aspects of the institutions’ work; medical care, diagnostic examinations and follow-up treatment; cases of financial abuse; common violations of the children’s rights; and the workload, qualifications and motivation of the institutions’ personnel. In order to analyse the conditions of the institutions for children and youth with mental and physical disabilities in a more detailed fashion, the BHC created a questionnaire, which allowed researchers to make generalizations based on concrete data about the problems at hand. During the period from 2000 to 2001, the number of children in specialized institutions for disabled children was around 19,300, according to data from the National Statistical Institute, the Ministry of Health (MH), the Ministry of Education and Science (MES), and the Ministry of Labour and Social Policy. Depending on what type of disability a child suffers from, they may be placed in institutions under the umbrella of any of the latter ministries.



The institutions of the MLSP specialize in caring for children with severe physical and mental disabilities aged between 2 and 18. They also provide professional training for young adults between the ages of 14 and 35 with minor mental disabilities. In 2002 4,341 people are institutionalised in the MLSP’s establishments, though in reality only 3,424 live in them full time.1



13,848 children attend the MES’ special schools for disabled children. 2

These and the following figures covering the year 2002 were provided by the Ministry of Labour and Social Policy. 2

According to Form 1 of the Ministry of Education’s department of special schools, 141 special schools existed in Bulgaria during the 2000-1 academic year. Their total enrolment was 15,827 children. According to the National Statistical Institute, 867,400 children were enrolled in regular schools during the same year. Of these, 16,346 students (1.9%) study in 138 special schools. These include 23 sanatoria, 76 schools for mentally disabled children, 9 reform schools, 3



According to the Bulgarian Helsinki Committee’s data, 3,379 children were institutionalised in the year 2000 in the Ministry of Health’s homes for medical-social care. BHC data show that 30% of them (1,300) are disabled children. These children, aged between 0 and 3, have congenital and inherited physical disabilities, and most were abandoned by their parents at birth. 3

The state cares for 4,341 disabled children and young people in 57 institutions in the system of the Ministry for Labour and Social Policy. There are 16 day-care centres with a capacity of 455 included in the above figure. The children in these centres have living parents who still care for them. There is 1 home for mentally healthy children with physical disabilities. There are 31 year-round homes for children with mental disabilities between the ages of 3 and 18 who have been abandoned by their parents. 2,129 such children are institutionalised in these homes. There are 9 social complexes for the professional training of youth over the age of 14. Their capacity is 1,627 youth.

As at December 2001, a total of 4,341 children were accommodated in social institutions in Bulgaria. 1,627 of them are in Social Educational Boarding Schools (SEBS), 455 are in day care centres for mentally disabled children and youth, and 2,129 are in year-round Homes for Mentally Disabled Children and Youth (HMDCY). There is also one home for physically disabled children with normal intellect where 130 children live. Children in Bulgarian social homes, December 2001

Daycare homes

455 2 259

SEBS 1 627

Year-round homes

Chart 1: Children in Bulgarian Social Homes: day care homes, social educational boarding schools (SEBS), year-round homes

21 social educational boarding schools, 4 schools for deaf children, 2 schools for blind children, and 3 for children with speech difficulties. Educational boarding schools and social-pedagogical boarding schools are institutions to which the state forcibly sends juvenile delinquents. Cf. Children in Institutions, volume 1: Educational Boarding Schools and Social-Pedagogical Boarding Schools. BHC, Sofia, 2001 (in Bulgarian). 3

See Children in Institutions, volume 2: Homes for Medical-Social Care. BHC, Sofia, 2001 (in Bulgarian). 4

Of the total of 31 year-round children’s social homes (HMDCY), 25 are located in small villages in economically depressed regions at an average distance of 30-100 kilometres from the nearest regional social services office. According to data from the MLSP and the State Child Protection Agency, about 35,000 children (2.15% of all Bulgarian children) were institutionalised in 2002. 4 This is one of the highest ratios of institutionalised to non-institutionalised children in Europe.

BHC received these data from the State Child Protection Agency and the MLSP IN 2002. 5

I. YEAR-ROUND HOMES FOR DISABLED CHILDREN AGED 3 - 18 – FACTORIES FOR OUTSIDERS, WHERE CHILDREN’S DEVELOPMENT IS SLOWED

total of 2,259 disabled children who have no parental care are institutionalised in year-round social institutions for children and youth with mental and physical problems.5 The system of state care for disabled children and orphans who have been abandoned by their parents that functions in Bulgaria has several basic characteristics: 

It is implemented primarily through state and municipal establishments of a residential type.



Until now, public institutions have been the only option available in Bulgaria for the care of disabled children whose parents have abandoned them.



Children’s social homes are located in far-off settlements, usually small villages.



There is no synchronization between the activities of the various individual institutions that implement state child-care policies.



The existing system of institutionalised child-care is archaic, expensive, and largely ineffective.



The working environment, motivation, and low living standard for personnel in homes for disabled children make their jobs the lowest paid in the country.

When the new Child Protection Act took effect in June of 2000, a new form of raising and caring for children without parental care was introduced: the foster family. This new form of care was necessary, especially considering the low standards of care available in state institutions at the moment. For now, however, the foster family program has not begun functioning effectively. It is still not clear to what extent this program will correspond to the needs and interests of the abandoned children. According to the Child Protection Act, the Child Protection Agency and the specialized organs of the Social Welfare Assistance Services are responsible for protecting children’s rights. According to the decrees of the Social Welfare Assistance Act and the regulations for the Act’s enforcement, children’s social service institutions are state or municipal institutions, or are privately run. Despite the new tendency that came about in the past few years to solve the problems of the social service system by privatising it and creating new models of cooperation between the state and the third sector, the vast majority of children’s social institutions in Bulgaria are still state- and municipally run. The number of private centres for handicapped children has increased in the past few years, however.6 These new centres, though, are predominantly day-care 5

These data are from the Ministry of Labour and Social Welfare.

The National Centre for Social Rehabilitation, a Bulgarian NGO, has opened day care centres in Sofia, Burgas, Varna, and Pomorie with the financial assistance of the Flemish Foundation for Invalids in Belgium. IntPsych, a non-governmental organization for the support of disabled people, established the Karin Dom day care centre and the Centre for the Rehabilitation of Invalids, both in Varna. BALIZ also opened a social day care centre in Drjanovo. 6

establishments intended for children who still live with their parents, and they have very limited capacities.

Placement in institutions The conditions and rules for using social services are described in Chapter V of The Ministry of Labour and Social Policy’s Decree № 4 of March 16, 1999. According to the Decree’s regulations, year-round and day care homes for disabled children and youth are establishments for social services outside the normal home environment, and therefore fall under the direct control of the Municipal Social Welfare Assistance Services (MSWAS). The laws, sub-legal normative acts and regulations, and various decrees that regulate the MSWAS activities in the social sphere place the municipal services in a paradoxical position. On the one hand, the directors of the municipal social services are appointed by the National Social Welfare Assistance Service and are therefore administratively subject to the control of the NSWAS. On the other hand, however, their budgets are provided by local mayors and municipal councils. In order to make the relationship between the state and the municipal social services more effective, several changes are in order: the MSWAS directors should be appointed by local mayors at the recommendation of municipal councils; human resources should be decentralized; financing should come from a mix of state and local sources. Facts about the children in the year-round homes The most common reasons why children end up in the year-round homes are:  Poverty/unemployment of the parents,  Illegitimate children,  The traditional view of the homes are resource centres for social services used for satisfying social needs (food, care, rehabilitation). Ethnic belonging of the children in the year-round homes for mentally disabled:  Over 50% of the children in these homes are of Roma origin, the others are of Bulgarian, Turkish, and other ethnic belonging. Between 10 and 30% of the children in the year-round homes have episodic or regular contact with their parents, family, friends. Between 70 and 90% of the disabled children have been abandoned by their parents.

Municipal Social Welfare Assistance Services implement placements into children’s social institutions after all necessary documents have been obtained. 7 Medical evidence of a child’s psychological condition, a medical report from Regional Medical Experts’ Consultative Council (RMECC – for children up to age 16) and an expert decision from the Commission of Occupational Health Experts (COHE – for those over 16 years of age) are the basic documents necessary to determine the child’s type of disability and/or degree of mental disability. It is on the basis of these documents that the MSWAS make their decisions to place children and youth into social institutions.

For more information, see Decree № 4 of March 16, 1999, in the Appendix to this report (in Bulgarian). 7

Until now, it has been common practice for psychiatrists from the regional Centre for Mental Health, psychiatric dispensaries, and psychiatrists’ offices or doctors from the homes for social medical care to provide the medical reports for abandoned children under the age of 4. Frequently, these documents are never prepared for abandoned disabled children. When they are prepared, depending on the type of disability in question, they are usually not accompanied by concrete results from any specific medical tests. The procedure for diagnosing the special needs of these children is purely medical in nature. It should, however, be both medical and pedagogical. In other words, disabled children’s needs should be diagnosed not only in terms through medical treatment, but also through education. Contemporary special education has shown time and again that care for disabled children should use a more comprehensive process involving both medical treatment and education.

Material conditions and funding of the homes Bulgaria does not come close to satisfying the minimum European norms for the social care of children and adults. The average European Union member country spends about 28% of its Gross Domestic Product on social welfare policies. Bulgaria, by contrast, spends about 15%. Considering the Bulgaria’s total GDP is only 23.2% of the GDP of the average European country and the huge network of institutions, the extent of under-funding of Bulgarian institutions should be obvious.

The material conditions of institutions are of decisive importance in the implementation of social welfare assistance. The reconstruction of old facilities is absolutely necessary, and new facilities must be built. The European criteria for good social practice also require the furnishings, linens, and equipment to be replaced. Most of Bulgaria’s Homes for Mentally Disabled Children and Youth and almost all of the Social-Educational Boarding Schools have not been renovated in years.8 Buildings of the children’s social homes 

3 buildings were built specifically to house children’s social homes



26 homes are housed in the buildings of former schools, hospitals, city councils, built between the 50s and 70s of the last century



1 home is housed in the building of a former army barracks



1 home is housed in a building formerly designed to be used as support premises for a train station



1 home is housed in the building of a former frontier post.

Twenty-five of the 31 year-round social homes for mentally and physically disabled children in Bulgaria are located in small villages in economically depressed regions, far from regional centres. Most of the buildings housing year-round social centres for children are old, decrepit former hospitals, schools, army barracks, government office buildings, and train stations. Only one single year-round social institution in 8

See Is There Corruption in the Social Sphere?, Civil Society Development Foundation and Legal Studies, Sofia, 2001 (in Bulgarian). 8

the country – the one in the village of Vasil Drumev near Shumen – is housed in facilities built especially for the care of disabled children.

One children’s social home with a capacity of 50-80 disabled children costs the Bulgarian state between 60-150 thousand leva per year. Two-thirds of this sum is spent on the wages for the personnel and on insurance. Only one-third or less of the total is spent on maintaining a standard of living for the children.

The BHC found that in 2000 the state provided 5 stotinki [0.025 Euro] per child per meal for food in the HMDCY for children with serious mental disabilities in the village of Fakija, in the Sredets municipality. The state did not budget a single stotinka for food, medicine, or linens for the social home in the village of Mogilino in 2000, but in 2001 it provided 17 stotinki per child per meal. Because of the lack of funds, the home often went without electricity and heat in the winter of 2000-2001. In 2001 for the social home in the village of Medven, near Sliven, the municipal budget provided 24 stotinki per child per meal. In 2001 the BHC researchers found that the budgets for children’s social homes were the same or even less than they had been in 2000. For comparison, one might note that the combined cost of living for Bulgaria’s 240 members of Parliament was 19 million leva in 2000. In 2001 the MPs increased their own budget to 24 million leva. A child in a HMDCY is provided with food worth anywhere between 0.60 and 2.50 leva per day. Living costs (food, clothing, linens) account for up to one-third of the homes’ budgets. The average annual budget of a home with a capacity of 50-80 disabled children is between 60 and 150 thousand leva. The BHC established a daily food allowance of up to 1 lev in eight homes – the ones in Borislav, Fakia, Mogilino, Medven, Rudnik, Strazha, Gomotarci, and Kula. In Bulgaria, Decree No. 16 of the Ministry of Healthcare establishes the physiological norms of nutrition for the population (State Gazette, no. 64, 9 August 1994). These norms include standards for daily intake of energy, proteins, carbohydrates, fats, vitamins and minerals. The norms vary according to sex, age, height, weight, and intensity of the physical labour. As at March 2001 the Institute for Social and Trade Union Research at the Confederation of Independent Trade Unions in Bulgaria calculated that 122.55 BGN, or 3.95 BGN daily, were necessary for producing 3,669 kcal for 1 person in Bulgaria. The Institute for Social and Trade Union Research puts down the norm of app. 3 - 3.50 BGN per day for children aged 10-189.

See Institute for Social Care and Trade Union Research newsletter Life Standard, no. 1, 2001 (in Bulgarian). 9

Daily food allowance for 1 child in HMDCY (information for 2001 in leva) 18 17

16 14

Up to 1.00 lev

12 10 8 6 4 2

Between 1.10 - 1.40 leva

About 1.50 leva

4 2

Between 2.00 - 2.50 leva

0 Chart 2: Daily food allowance per child in HMDCY (2001, in leva).

The acute problems of the miserable conditions, malnutrition, and lack of funding were solved in some of the homes in 2001. The BHC researchers witnessed, for example, positive developments in the situation of the Home for Mentally Disabled Children in the village of Fakija, which is in the Strandzha region. Six of the home’s children had eaten only milk for years. The other 36 seriously mentally disabled boys and girls ate only vegetable soup, tea, paprikash, and expired tomato paste. Misery, hunger, cold (-20 degrees Celsius in the winter), and unqualified personnel characterized the home in 2000. One year later, however, the situation was changed. The monthly food budget increased fivefold in 2001. Donations from Bulgarian and foreign organizations tripled the budget for overall living expenses. After the BHC’s intervention, with the help of the MSWAS of the Sredets Municipality the staff of Fakija’s children’s home was replaced. Six new specialists were hired, including a teacher, a social worker, and a doctor. Dental care was also secured for the children in the home. The BHC found positive developments and solutions to the problems in other social day care centres, as well. In 2001 the new building was completed for the social home in the village of Vasil Drumev. Thus the children’s social home that had been temporarily housed in the city of Shumen was finally moved for good into the only building in the country that was designed especially for the care of disabled children. The children’s social home in the city of Kula also underwent significant improvements in its material and living conditions. With financial assistance from the Irish government, a single-family home and a new, modern rehabilitation centre were built near the institution. The children’s social home in the village of Pravda was closed in 2001, and the profile of the children’s social home in the village of Prekolnitsa was changed. The latter is now a home for mentally disabled adults. Still, as a whole the situation of Bulgarian homes for mentally disabled children remains serious, especially from the viewpoint of children’s human rights.

The directors of the children’s social homes explained to the BHC observers that the children in nearly all of the year-round homes are poorly nourished and poorly educated. No year-round social institution in the country can count entirely on budget subsidies for its maintenance. In most of the homes, private donations make up a greater percent of the budget than do funds provided by the state for food and equipment. Because of the small budgets, children’s social institutions often try to save money by skimping on food, soap, hygienic materials, disinfectant, and sanitary napkins for girls and women.10

Medical diagnosis and treatment The procedure for diagnosing the special needs of children with problems is purely medical. Contemporary special education has shown time and again that care for disabled children should use a more comprehensive process involving both medical treatment and education. To this end, therapy should be combined with other methods of social-educational and professional rehabilitation. 11 That, in turn, means that the process of diagnosing a child’s disability must be both medical and pedagogical. In other words, it should contain both medical tests and psychological and educational tests. Most often it is the doctors in the homes for social-medical care and the supervising psychiatrists who diagnose the special needs of the children. For children who have been abandoned by their parents, this medical evaluation is almost never accompanied by concrete results of previous medical examinations and tests. The documents required depend on the disability, and may include: an electroencephalogram, statements of psychiatric, neurological, and psychological status, documentation of sleep disorders, audiograms, and other documents at the discretion of the doctor. Children’s diagnoses have until now most often been made using a test for neurological and psychic development at the age of 3 using the Manova-Tomova tables (ICD-10). Many specialists, however, believe that this method is outdated. 12 The BHC observations show that so far no new, modern, unified system of testing methods has been established for mandatory use according to carefully specified instructions in all diagnoses. There is no firm regulation about primary diagnosis. There is also no mandatory system for ongoing follow-up medical tests and observation over the years. The result is that the children in Bulgarian social homes have imprecise diagnoses or have never been diagnosed at all. Most of them remain in the system of social care for their entire lives, but cases of re-diagnosis are rare. Early and preventative diagnostic methods are not used at all in Bulgaria. It is a well-known fact that modern clinical psychiatry continues to be faced with many forms of mental retardation whose origins are unknown. It is also well known, however, that many and various factors can cause mental retardation. That is why 10

See the data for the children’s institutions in Dzhurkovo, Strazha, Mogilino, and Ilakov Rat.

General Impressions from the Homes for Mentally Disabled Children: Problems and Ideas, Report of Prof. Jordanka Gacheva, medical advisor for Care International-Bulgaria, 1999. 12

Prof. Meglena Achkova, Dr. Valentina Majstorova, Dr. Georgi Ivanov. The interview with the experts in included in this publication (in Bulgarian). 11

specialists recommend the collection of complete and precise data about the affected person’s family, as well as personal data about the disabled person. They recommend a thorough analysis of the total clinical picture, including information about somatic, neurological, and psychic status. A precise initial diagnosis is a prerequisite for effective and timely treatment. In addition, clinical facts show that mental disabilities are constantly being influenced and changed by internal and external factors.13 Therefore, periodic observation and re-evaluation by specialists is necessary. In practice, in Bulgarian children’s social institutions, both complete initial diagnoses and periodic psychological examinations are the exception, rather than the rule. During the period from December 1999 to June 2000, Nedka Stefanova, the director of the HMDCY in Shumen, completed research and observations in the home with the help of Associate Prof. Shosheva and Prof. Ivan Karagjozov of the Special Education Department at the University of Shumen. This research suggested that the children in the home had various types of mental disabilities that could be categorized into 8 groups. Data about the causes of mental retardation in the cases observed in the HMDCY in the village of Vasil Drumev Etiology of mental retardation in the observed cases

I nappropriate family environment

2 2 ,5 0 %

C ongenital valvular dis eas e, hydroc ephaly,

1 7 ,5 0 %

mic roc ephaly, s trabis m P remature birth H ereditary defec tive c hildren U nc lear origins , as phyxiation, pathologic al pregnanc y, abus e C ombined fac tors

1 2 ,5 0 % 1 2 ,5 0 % 1 7 ,5 0 % 1 7 ,5 0 %

Chart 3: Origins of mental retardation in the cases observed.

Once the children are “labelled” as having moderate, severe, or very severe intellectual deficits (these labels are taken from the ICD-10 classification, which is the international standard), the disabled children in the children’s social homes have almost no chances of changing their diagnosis. And according to the Ministry of Education’s Instruction № 6 of March 18, 1997, for the placement of children and pupils with physical or mental handicaps in special schools, the more seriously disabled children are considered uneducable. According to information from medical specialists and directors of the institutions, mentally disabled children spend 10-15 years or longer with the same label. Only in rare individual cases are disabled children in institutions ever re-evaluated and placed in different groups. 13

Prof. Stefan Mutafov, Clinical Forms of Mental Retardation, Sofia, Sofia University Press, 1995 (in Bulgarian). 12

The Ministry of Health’s Decree № 19 of October 3, 2000, represented an attempt at making the rules for diagnosis more precise. This Decree stipulates that Regional Medical Experts’ Consultative Commissions (RMECC), together with the Central Doctor’s Expert Commission, provide expertise about the types of disabilities affecting children up to the age or 16. The Commissions may call upon consultants, including teachers, psychologists, and social workers, but the participation of consultants is not required. So far, the Decree’s regulations are not enforced in children’s social institutions. During even the first visits of last year, the BHC noticed, for example, that the homes for disabled children in the villages of Mihaltsi in Pavlikeni Municipality and Petrovo in Sandanski Municipality are home to groups of 10 children each who either have no initial psychiatrists’ diagnoses in their medical placement records or who have initial diagnoses that are obviously inappropriate to the children’s’ conditions and abilities. In 2001 the BHC’s team of researchers and medical experts found that the children’s initial diagnoses had never been re-evaluated over the years. It was determined that both institutions had accepted children without medical records that provided a clear psychiatrists’ diagnosis of the degree of their mental disability. (For additional details, see the data from the reports.) The only case of systematic observation and re-evaluation of initial diagnoses in the Bulgarian system of social services for disabled children in the past several years was an initiative of the NGO Care International-Bulgaria, implemented in 1999. This project resulted in observations in 12 year-round children’s social homes. The quality of medical care is another serious problem in the system of care for disabled children. With few exceptions, there are no doctors on staff in the institutions for mentally and physically disabled children. Dental care usually consists of nothing more than extractions. Caring for the abandoned children’s health is usually the responsibility of General Practitioners who practice in the cities or villages, kilometres away from the children and their institutions. Only 3 of the 31 year-round children’s social homes have staff doctors working fullor part-time. Only one year-round home has a staff dentist with a part-time contract. Staff doctors in HMDCY

Without a staff doctor 86%

With a full- or part-time staff doctor 14%

Chart 4: Staff doctors in HMDCY.

Human potential The rules for personnel in social institutions have been re-worked, but they still need changes. The number of staff is not sufficient to guarantee the satisfaction of the special needs of disabled children and youth. The BHC researchers and experts in social work have also established that the ratio of staff to disabled children is inadequate. The Ministry of Labour and Social Welfare’s Decree № 5 of February 16, 1999, stipulates that the normative ratio should be 1 teacher to 12 children and 1 orderly to 24 children.14 According to MLSP data, a large proportion of the nearly 10,000 social workers in the system are administrators who do not work in the field. 15 More new jobs can be created through programs for flexible social assistance and cooperative projects with non-governmental organizations. In Germany, Israel, and the USA, new practices of social assistance for risk groups transform social security payments into hourly wages for certain kinds of workers. Instead of giving disabled people money to pay for help or disability pensions, these countries provide people, who function as social assistants to the disabled people. Although in 2001 some of the homes for disabled children and youth underwent staff changes, the personnel in the majority of these institutions remains inadequately qualified. Since 1959 Bulgaria has had programs to train special education teachers. According to data from the Ministry of Education, 6 Bulgarian universities have also been training social workers for nearly the past 10 years. The BHC’s research, however, shows that young social workers have a hard time finding work in the state and municipal administration. The situation is the same in children’s social institutions. The miserable salaries (170-190 leva monthly), the distance from cities, problems with transport, and the unpleasant working environment are all factors that hold qualified specialists at a distance from the homes for social services. The share of support personnel in the homes for mentally and physically disabled children is between two and three times higher than that of specialists. The prevailing majority of educators in the HMDCY do not have any special qualification.

There is an inexplicable difference between the salaries of administration and specialists in the Labour Bureaus of the social welfare assistance system and the specialists who work in the social institutions. Municipal social workers working “in the field” and in the social homes are the worst paid of all. The teachers’ years of work in children’s social institutions do not count towards their pensions. These teachers are also not eligible for extra compensation for their work with specialneeds children.

See the Ministry of Labour and Social Welfare’s Decree № 5 of February 16, 1999.

Is There Corruption in the Social Sphere?, Civil Society Development Foundation and the Institute for Political and Legal Studies, Sofia, 2001. 14

According to data from the Agency for Social Analysis, in 2000 two-thirds of social workers were completely dissatisfied with the pay that they received for their work. Less than 1% were satisfied. The majority were also dissatisfied with their opportunities for professional development. One in three were dissatisfied. 16 The BHC researcher’s observations showed that the majority of specialists and personnel in the social homes for children and youth (with some exceptions in the day care centres) think that their work is not adequately paid, that their working environments are unpleasant, and that they have nothing to look forward to in their professional futures. The BHC teams also found symptoms of burnout among the employees. In other words, the everyday problems associated with work in the institutions are such that they lead to disappointment with the profession as a whole.

Training and opportunities for social integration In 1994 the UNESCO World Conference on special education, held in Salamanca, ratified the “Education for All” Program. 17 The organization’s main recommendation was that disabled children should not be separated into “educable” and “uneducable” groups, regardless of the extent of their handicaps. Social integration for everyone, according to the WHO program, must be accompanied by systemic correctional and educational activities. This will lead to the children’s development of communications skills and useful practical knowledge. Children with more severe mental disabilities are considered uneducable. 18 The BHC found many cases, especially in the homes for children with severe symptoms, in which disabled children were raised as though they were vegetables. The BHC’s October 2001 – April 2002 study of the right to education for children with special needs suggested that there are some institutions in Bulgaria that offer educational services outside the national education system. These include homes for mentally disabled children and youth and Social Educational Boarding Schools. These institutions fall under the Ministry of Labour and Social Policy and are established by Decree № 4 of March 16, 1999. The HMDCY house the so-called “uneducable children.” The state uses the term “uneducable” to refer to children who are not accepted into special schools or other special establishments for education and care. According to the Ministry of Education’s Instruction № 6 of March 18, 1997, uneducable children are those children with: 1. Severe personality disorders (e.g. psychopathic disorders) with frequent and severe epileptic fits or their psychological equivalent, 2. Schizophrenia or other psychoses that prevent them from participating in normal activities with other children and pupils, 16

Ibid.

UNESCO World Conference, Salamanca Statement and Framework for Action. Available on the Internet at: http://www.unesco.org/education/educprog/sne/salamanc/covere.html. 18

For more details, see the section “Bulgarian Children: Excluded from the National Educational System”, Boyko Boev, and Diana Tzokova, Education Opportunities for Children with Considerable Learning Difficulties, Sofia, 1997. 15

3. Severe problems with movement, which prevent them from feeding themselves and performing other normal tasks on their own, 4. Mental retardation of a severe type – in which case: а) there are special schools and kindergartens for those children with moderate, severe, and very severe retardation, b) there are other establishments for the education and care of children and pupils with both hearing or vision problems and moderate, severe, and very severe retardation, 5. Both blindness and deafness. According to Instruction № 6 of March 13, 1999, special kindergartens and special schools reject not only those children listed above, but also “children and pupils with temporary obstacles to their psycho-physical development, those who have been neglected pedagogically, asthenic, and infantile children,” as well as children and pupils with mental abilities on the borderline between normal and pathological (see Rubric 310 of the International Classification of Diseases). Children’s social institutions follow the MLSP’s special programs for education and care and correctional-compensatory activities for disabled children, which were established in 1997. The HMDCY activities are structured around the capacities, age groups, diagnoses, and personnel of a given institution. The exact title of the MLSP’s set of programs is “Programs for activities, corrective compensation, and care of children aged between 3 and 18 with moderate/severe mental retardation in social care institutions.” The programs include classes for the development of speech (sound production and pronunciation), the environment, beginning math skills, elementary reading and writing, job training, physical education, and art projects. In the social institutions, children with moderate and severe mental disabilities do not pass grade levels. Instead, they gain elementary knowledge and habits for social integration. In some of the homes (the HMDCY in the village of Mezdra, the HMDC in Tarnava, the HMDCY in Petrovo near Sandanski, the HMDCY in the village of Mihaltsi, and the Social Day Care Complex in Blagoevgrad), specific forms of special education are used. In the homes or in local schools, those disabled children with greater abilities are educated according to the programs of special schools. These individual cases cannot compensate for the fact that children with more severe disabilities in Bulgaria are considered uneducable and in practice are thrown out of the system of education – both regular and special education. 19 In practice, modern ideas about social education are ignored. These modern ideas include the idea that even the most disabled children are educable and that caring for children with retarded development is a multi-faceted process of both medical and educational care. This process should combine methods of medical treatment with other methods of defectology, speech therapy, rehabilitation, art therapy, and so on. The more severely disabled children in Bulgaria are treated as purely medical cases. Therefore, their initial diagnoses, which form the basis upon which their therapy, correction, and compensation is determined, remain completely medical in nature.

These diagnoses do not include psychological and educational tests, especially in cases of children with moderate and severe intellectual deficits. During its observations, the BHC found some individual cases, particularly in the social day care centres, in which psychological diagnoses became a basic element of the medical and educational work with disabled children. An adequate psychological diagnosis of a disabled child’s problems plays an important role in the creation of conditions for the maximum development of his potential. This diagnosis is a prerequisite for adequate psychotherapeutic procedures, which in turn stimulate the child’s attention span, ability to concentrate, memory, fine motor skills, knowledge, emotions, social skills, and contacts. Complex studies of the disability can uncover a child’s level of intellectual, emotional, motivational, and volitional spheres, processes of recognition, behaviours, and specificities of communication. Diagnostic methods include various kinds of tests, extrapolative methods, observations, interviews, and studies of a child’s creative efforts. The regular periodic observations of a psychologist should be the foundation on which other specialists in children’s social homes base their work. The psychological diagnosis, for example, determines the accents in the work of the social pedagogues. The latter are the people who help the disabled children take their first steps into the world of caring for themselves and interacting with others. Only a few individual HMDCY actually carry out separate work with the different categories of disabled children. Work designed to stimulate the fine motor skills, to make speech more automatic, and to develop eye-hand coordination and objectsymbol distinctions is rare in the year-round children’s homes. Even though nearly all year-round homes have rehabilitation rooms, not all of them have physical therapists on staff. The programs for rehabilitation do not always take into account the individual specificities of each child’s disability. One-third of the institutions have still not obtained the necessary equipment for physical therapy with weights and pulley devices. Those institutions that have the equipment do not always use it effectively with all the children.20 Only a few day care centres’ social offices have modern resources such as Montessori therapy, for example. The latter is a system of learning by memory – it involves big and small blocks with different colours, shapes, and sizes, which are used to build various objects. The BHC noticed that, in contrast to the children’s day care centres, the year-round social homes rarely use aromatherapy, they do not use one-on-one activities to stimulate development of hearing. The tactile senses are also stimulated primarily in the social day care centres, and not in the year-round homes. Children with speech and learning disabilities in the year-round homes are not provided with individualized speech therapy programs. Only one year-round children’s home in Bulgaria has a speech therapist on staff. Art therapy is another underused corrective and compensatory method in the work of specialists in the social homes.

See the reports for the HMDCY-Medven, HMDCY-Dzhurkovo, HMDCY-Mogilino. 17

The accent in the institutions for disabled children is on physiological care, and not on the children’s education or socialization. This tendency is also evidenced by the fact that the number of auxiliary (support) staff is much greater than the number of specialists in all institutions. Correctional-compensatory and educative activities are limited in most social homes for children who have been abandoned by their parents.

The fate of disabled children abandoned by their parents is to spend their whole life going from one institution to another. Once they fall into the system of social institutions, these children almost never get out of them again. After the children’s institutions they are placed in institutions for adults with absolutely no chance for integration in society. The BHC believes that the year-round children’s social homes are factories for outsiders, where children’s development is slowed.

As the years go by, the opportunities that an institutionalised disabled child has for integration and for a normal life become fewer and fewer. As these children get older and leave the children’s social homes for the institutions that house adults with mental and physical disabilities, they can expect worse material conditions, less specialised care, fewer donations, more limited health and social services, no opportunities for relaxation, and minimal contact with the outside world. In short, the institutions into which grown-up disabled children are placed after they turn 18 are more isolating, more closed, and more repressive of development. In 2001 the BHC stated in its annual report that in some of the homes for mentally retarded and mentally ill adults, residents’ lives are at serious risk because of the miserable conditions, the systematic malnutrition, and the inadequate medical care. 21 The material conditions and the treatment of the residents in some of the institutions were equivalent to inhuman and degrading punishment. In some of the social homes (Sanadinovo, Cherni Vrah, Radovets, Samuil, Podgumer, Dragash Vojvoda) the BHC discovered metal cages, dungeons, and pantries that were used for isolation residents for extended periods of time. The material conditions (heating, the condition of the buildings, the food, the condition of sanitary facilities) in many of these homes were appalling, and by alone constituted inhuman and degrading treatment of residents.

Mortality in institutions In the past few years, data on mortality in homes for severely mentally and physically disabled children show death rates between 5 and 18%. The directors of the children’s homes with the highest death rates explain the high mortality with the children’s severe pathologies. They also point to other possible explanations, such as the socio-economic difficulties of the Bulgarian transition, which worsened the conditions for the care of children in inpatient institutions. The BHC believes that some important reasons behind the high mortality rates in some of the children’s institutions include the outmoded, expensive, and ineffective system of care in the 21

Human Rights in Bulgaria in 2001, Annual report of the BHC, Obektiv, March 2002, available online at www.bghelsinki.org. 18

institutions and the limited possibilities for development and stimulation of children with special needs. Available data shows that mortality in the children’s institutions decreased in the year 2001. The homes with the highest death rates registered only 1-2 deaths that year. Mortality in some social homes in the past several years According to the BHC findings, the following children’s social homes had the highest death rates: 

HMDCY - Vidrare:

1997 – 18 1998 – 12 1999 – 4 2000 – 1 2001 – 1



HMDCY - Mogilino:

1999 – 5 2000 – 4 2001 – 6 2002 – 2



HMDCY - Dzhurkovo: 1997 – 14 1999 – 3 2000 – 1 2001 – none



HMDCY - Fakija:

until 1998 – average 6-8 children per year 2000 – 2 2001 – 2 2002 – 1

The institutions’ archives most frequently show that the reason for death is acute double broncho-pneumonia or heart failure, which occur in a context of serious preexisting conditions, such as children’s cerebral palsy, Down Syndrome, epilepsy, hydrocephaly, polymalformative syndrome, etc. There is enough evidence to suggest, however, that in fact some of the cases of broncho-pneumonia were brought on by insufficient or inadequate care during the winter period. 22

Main conclusions The main things that must be achieved in order to ensure the rights of disabled children in institutions are: 

A decrease in the number of children in institutions through improved preventative work and support for the children’s parents. It is a fact that the majority of the abandoned children in question do in fact have living parents.

See also Antoaneta Nenkova, The Horror of Fakia, Obektiv, July 2000, and Antoaneta Nenkova, The Horror of Fakia, 24 Chasa daily, August 2, 2000. 19



The closure and re-structuring of institutions (according to the criteria: number of institutions in a municipality, quality of care, material and human resources/inventory, psychological climate, location of the facilities, ratio of staff to children, characteristics of personnel in terms of salaries length of service, and qualifications).



The creation of alternative forms of institutionalisation (the following are only a few of the many examples of successful alternatives in various countries: In Holland, the interest from health insurance and pension deposits are used to care for children such as those in the village of Fakija. Great Britain is encouraging a foster families program. In Germany and Belgium social micro-homes have been established for the education and care of groups of 5-6 children). The creation of standards and control over children’s services is also necessary.



The creation of an information system for child protection.



The provision of new family environments for abandoned children through adoption or foster family programs.



The increase of the qualifications of the people employed in the system of social care for children.



The provision of additional motivation and stimulation for the personnel in children’s social homes.



The creation of special programs for work with minorities, as well as cooperative projects between the state and non-governmental organizations.

In 2001 the European Commission recommended in its annual report that Bulgaria improve the situation of mentally disabled children in year-round institutions. 23

European Commission, 2001 Regular Report on Bulgaria's Progress Towards Accession. Available at: http://europa.eu.int/comm/enlargment/report 2001/bu en.pdf. 20

ІІ. GENERAL OVERVIEW OF THE SYSTEM OF SOCIAL SERVICES IN DAY-CARE CENTRES FOR DISABLED CHILDREN AND YOUTH AGED BETWEEN 3 AND 18

he state established children’s social day care centres in the 1990s. These centres care for disabled children aged between 3 and 18 who still live with their families. As early as its first visits to the social homes in 2000, the BHC established that the conditions in the day care centres are incomparable to the conditions for the care, education, and social adaptation in the year-round homes for mentally disabled children who have been abandoned by their parents. The reason for the contrast between the day care centres and the year-round children’s institutions is, in the first place, the fact that these institutions were established in Bulgaria only after 1992. The establishment and furnishing of the new children’s social day care centres was entirely the project of donors, the state, and the municipalities. The funding for the centres continues to come primarily from foreign sponsors. The second decisive factor behind the difference in the conditions for raising children in day care centres and in year-round homes is the fact that the children in the day care centres have living parents who still care for them. The requirements and oversight of the families creates constant pressure for improvement and results in the raising of the standards until they reach the highest European standards.

The facilities in which the day care centres, with the exception of the one in Vidin, are housed are irreproachable. The specialists employed in the centres – from the nurses and teachers to the psychologists, speech therapists, and physical therapists – have all the necessary qualifications. The structure and organization of work is consistent with the most modern paradigms in social services for mentally and physically disabled children, including those with vision, hearing, and mental problems. Everyday care in the children’s social day care facilities includes: sensotherapy, rehabilitation (fine motor skills and fitness work), use of Picht machines and hearing aids, regular examinations and medical care from dentists, neurologists and paediatric specialists, physical therapy, art therapy, colour therapy, conductive therapy, swimming, and crafts and textile projects, such as weaving, sewing, pottery, wood working, modelling, etc.24

See the information in the reports on the social day care homes. 21

ІІІ. GENERAL PROBLEMS IN THE SYSTEM OF SOCIAL INSTITUTIONS FOR THE PROFESSIONAL TRAINING OF YOUTH AGED BETWEEN 14 AND 35 WITH SLIGHT MENTAL RETARDATION (Social-Educational Boarding Schools)

he Council of Ministers’ Ordinance 63 of April 11, 1991, established SocialEducational Boarding Schools (SEBS) in Bulgaria. These schools are legal entities with budget funding, and are subordinate to the municipal social welfare assistance services in the municipality where they are located. The Ministry of Labour and Social Policy methodically directs all the activities of the SEBS. Funding for the schools’ activities comes from the national budget and the budgets of the municipal councils. The municipalities also provide the necessary material and technical facilities. For the past few years the MLSP has been considering the possibilities for restructuring the existing social institutions for professional training of the mentally disabled. The licensing and accreditation of the existing institutions is likely, and this will probably reduce the number of such institutions. One of the ideas that the BHC believes deserves attention is the restructuring of the existing 9 social-educational institutions to accept not only mentally disabled children, but also disabled people and Roma over the age of 16 who are interested in the professional specializations offered at the institutions. The former Trud educational-vocational enterprises were turned into social institutions with the Council of Ministers’ Ordinance № 63 of April 11, 1991, which created the SEBS for the training and re-training of the disabled. The conditions and procedure for placing people in the social-educational institutions are currently governed by the MLSP’s Decree № 4 of March 16, 1999, and by the Regulations for SEBS Activities. The SEBS are legal entities with the status of institutions for social welfare with budget funding. They are responsible for professional-educational training, as well as social services and assisted living. According to the Regulations for SEBS Activities, which were written by the Minister of Labour at the beginning of 1992 (State Gazette, January 3, 1992), the socialeducational institutions determine appropriate professions for and train all categories of invalids, as well as people with minor mental retardation and hearing problems between the ages of 14 and 35. Several significant factors hinder the organization of activities in the social institutions dedicated to job training. These include: the unclear perspectives, the lack of a categorical position within the MLSP about the future of the SEBS, the inadequate funding and the lack of possibilities for self-sufficiency, and the low likelihood of social integration for the youth who have been trained in the SEBS.

The future of SEBS In the opinion of every SEBS director in Bulgaria, there are three major legislative loopholes that both reduce the number of people who want to study in the SEBS and lead to the acceptance of students who do not meet the regular requirements for 22

placement in social-educational institutions. The first is the outmoded normative and legislative framework and the unclear or unspecified criteria for placing children in these institutions. The second is the lack of qualified experts on the topic of the SEBS within the Ministry of Labour and Social Welfare. The third is the opening of classes through the tenth grade in special schools in the Ministry of Education system, even though the Ministry lacks the necessary facilities and qualified teachers for these classes. During its monitoring in 2000-1, the BHC found that Article 13, paragraph 2 of the MLSP’s Decree № 4 of March 16, 1999, creates problems for accepting students into the SEBS. The text of this law, the SEBS “may also accept children from families who find themselves in a disadvantageous social position.” This text opens possibilities for the acceptance of children who are not mentally retarded or physically disabled. In practice, therefore, the application of this text could deprive children from poor families of their right to adequate education. The directors of the SEBS believe that a new set of regulations for the activities of these social institutions should be written. The fact that the students in these social institutions in Bulgaria have been ignored in the Child Protection Act is inexplicable. The SEBS model is mentioned in only one place in the Act’s text and this is only in the context of a list of the types of social services for children available in Bulgaria.

Funding During its first visits to the SEBS, the BHC established that all the SEBS directors are of a single opinion: the state must fund these enormous complexes for professional training adequately, and it must also give them the opportunity to produce things and to undertake activities (rehabilitation, vacations, agricultural activities) that will help them become self-sustainable.

Of course the SEBS directors understand that their own initiative is an important factor in the improvement of the conditions and atmosphere in the institutions. They also understand that not all social-educational institutions have the same opportunities, facilities, and material conditions.

Stimulation and motivation of SEBS specialists More than once the BHC reports highlighted the problems of insufficient motivation and length of service of employees in the realm of social services. The salaries of teachers in social institutions are the lowest in the country. There is no sign that additional funding for stimulation of these teachers is forthcoming. The working day for social institution teachers is one hour longer than that of their colleagues in the regular schools under the Ministry of Education, and they receive fewer benefits. For example, the teachers do not accrue time towards their pension while they are working in social institutions.

Chances for professional realization and social integration As mentioned above, the BHC has already noted in this October 2001-April 2002 study, “The Right to Education for Children with Special Needs in Bulgaria,” that the homes for mentally disabled children and the social-educational boarding schools are the only institutions in the country that provide educational services outside the regular national education system.25 The MLSP, in cooperation with the Ministry of Education and Science and the Ministry of Health, approves the curricula, lesson plans, and training courses and follows up to ensure that they are properly applied. The Regulations for the Activities of Social-Educational Institutions stipulate that the SEBS are organized with the goal of determining appropriate professions for and training all categories of invalids and people with minor mental retardation and hearing problems between the ages of 14 and 35 years old. Decree № 4 of 1999 for the conditions and manner of providing social services broadens the group of handicaps and mentions people with disabled senses in general, rather than only those with hearing problems. According to this Decree, the SEBS may provide social services to children over the age of 14 from families in disadvantageous social positions. This means that both children with special needs and children from poor families may be sent to and accepted into special institutions. Students are accepted into the SEBS by order of the director, at their own request, or at the suggestion of the directors of educational, health, or social institutions or other people or organizations. The SEBS accept the following people for job training and re-training:  People aged between 14 and 35 who have recommendations from the Commission of Occupational Health Experts (COHE) or the Doctors’ Consultative Commission (DCC) to study one of the professions taught at the SEBS; 

Youths who have completed their education at a special school for people with minor mental disabilities or hearing problems.

The course requirements for students in the SEBS are determined by the curriculum approved for the training associated with the profession in question. The SEBS provide full room and board. Children from the town or village may also use the boarding plans of the SEBS if they wish. There are 6-11 students in each class, and 12-22 students in each counselling group. If, by 3 months after his initial enrolment in the SEBS, a student does not show that he is successfully learning a trade, the Pedagogical Council reconsiders his situation. The Council may decide to transfer the student into another class or specialty in the same SEBS, to transfer him to a different SEBS, or to send him back to the COHE for evaluation or re-evaluation. Students may repeat a grade level after failure only once during their educational careers. 25

For details, see the BHC study, “The Right to Education for Children with Special Needs in Bulgaria,” October 2001-April 2002, available in Appendix № 5 of this publication. The report is also available online at the BHC web site www.bghelsinki.org, special reports section. 24

The training program culminates in an examination that covers both the theory and the practice of the trade that the students have studied at the SEBS. The examinations are administered in a manner and according to procedures established by the Ministry of Labour and Social Welfare. Students do not receive grades for physical education classes. Those students who pass the examination receive a certificate of professional qualification. Students who do not pass the examination by the time it is administered for the last time, do not receive a certificate of qualification, but rather a certificate stating what they studied, what they learned successfully, and what types of work they are capable of doing within the profession that they studied. The COHE must approve the latter type of certificate. Students who graduate from a SEBS also receive copies of the proof of their professional qualification from the Ministry of Labour and Social Welfare. In 2000 and 2001, the BHC found that some individual graduates of the SEBS do achieve professional realization. Most of the rest, however, become potential criminals. The municipal social services, which take over responsibility for the students after they graduate, are unable, in practice, to provide them with housing and work. Most of the young people end up on the streets. Like the other social institutions, the SEBS are also factories for outsiders, where children’s development is slowed. In addition, in the SEBS the children learn to become criminals. The BHC found widespread violations of the laws in Article 58 and Article 59 of the Unemployment Insurance and Employment Encouragement Act (passed in the National Assembly on December 2, 1997 and published in the State Gazette). According to the texts of the Act, the Job Re-Training and Unemployment Fund pays employers the equivalent of the minimum gross monthly salary for each unemployed person whom they hire. However, employers do not know about this law, and the state does not oversee its enforcement. This sort of law should be a stimulus to the hiring of unemployed people and people with special needs. The BHC’s general evaluation is as follows: Despite the fact that the socialeducational institutions have a good track record of care and training youth in the SEBS, despite the fact that they constantly strive to improve the material conditions in the schools, and despite the fact that they are experimenting with provision of additional services, these institutions are still hindered by their clumsy structures. The capacity of the SEBS is large and that makes it difficult to maintain the facilities and the quality of education. The relations between staff and students are undermined by stereotypes, negative practices, and imprecise legislation. Under conditions of chronic budget deficit there are no opportunities for renewal of the facilities (most SEBS facilities have not undergone renovation in years) or for the organization of activities that might create a more pleasant environment. The personnel in the SEBS are unmotivated because of their low salaries and their limited opportunities for re-training.

The SEBS exist in conditions of constant expectation of structural changes. The lack of clarity about the status of the social institutions for job training creates serious 25

difficulties for the organization of activities and in the psychological climate in these social institutions. Everyday social problems distract the SEBS directors from their attempts to consolidate the SEBS’ position as a social institution of a new type. The curricula that are used in the SEBS, approved by the MLSP, and coordinated with the Ministry of Education are not up to European educational standards and do not provide the necessary encouragement for children with minor mental retardation and physical disabilities to become integrated into society. During its visits to the SEBS, the BHC found that these institutions for the professional training of mentally and physically disabled children and youth between the ages of 14 and 35 do not have textbooks or other teaching materials. This year the directors of the SEBS-Varna, with the support of private donors, undertook the publication of a first set of textbooks on special topics of professional training for the SEBS system. The complexes have good facilities (workshops) for studying and producing things, but these facilities are underused because of the lack of money for raw materials and the lack of a market for things they might produce. The state could stimulate the production of goods and services in social-educational institutions by encouraging hospitals, military bases, and other social institutions to purchase these goods and services, which include products such as underwear and furniture and services such as construction work and woodworking.

ІV. RECOMMENDATIONS

n order to effectively guarantee the human rights of mentally disabled children in institutions in Bulgaria, the Bulgarian Helsinki Committee recommends the following to the government and the other state organs in the Republic of Bulgaria: 1.

Legislation should be passed to establish norms for food, clothing, and maintenance in the institutions for mentally disabled children, and these norms should be adequate to satisfy all of the children’s needs.

The institutions’ capacity should be decreased through the dissolution of the existing institutions into several smaller ones. Programs for the gradual deinstitutionalisation of children in these homes should be initiated. Every effort should be made to gradually place institutionalised children into families and to assist these host families in order to guarantee that all the children’s needs, including their need for education, will be met.

The number of staff in the institutions should be increased to a level that can guarantee adequate and multifaceted care, including education, to the children.

Legislation should be passed to establish standards of medical care for mentally disabled children in institutions. A sufficient number of sufficiently qualified medical professionals should be hired, in order to provide adequate medical care for the children.

The salaries of personnel in the institutions should be increased.

Periodic evaluations should be introduced to check up on the conditions of the children in institutions. Individual criteria should be established and should conform to international standards.

The notion that children with moderate, severe, and profound mental retardation are “uneducable” should be rejected. These children’s right (and the right of all children) to education according to their abilities must be guaranteed. To this end, the mandate and functions of institutions should be restructured and they should become part of the national educational system. Academic curricula should be introduced, as should institutional control over the quality of education in the facilities.

Measures should be taken for the preparation and training of teaching and other staff who deal with mentally disabled children.

Mechanisms should be established to encourage teamwork among the teachers, specialists, parents, and others during the implementation of the program for the children’s integration and for the oversight of the children’s development.

10.

A system of periodic state inspections should be introduced in the institutions for mentally disabled children. These inspections should be performed by qualified specialists, who should evaluate all elements of the organization of the institutions’ activities according to specific criteria. The inspections should also evaluate the guarantees of children’s rights available in the institutions.

11.

A system should be established for the effective investigation of all complaints related to violations of the rights of children in institutions. 27