Specialized Foster Care as System Approach, Deinstitutionalization of Social Protection in Case of Adults with Developmental Difficulties in the Republic of Srpska – a Case Stady

Introduction

It is estimated that more than a billion people, or 15% of the world's population are living with different disabilities. Existing data on persons with disabilities are incomplete. This situation can be explained by a number of factors including: stigmatization, isolation, low rate of registration of births, families hide children with disabilities, which is the main reason why children and later adults are not covered by the research, and remain in the sphere of "dark number ". Adults with developmental disabilities are one of the most vulnerable groups, despite the fact that Bosnia and Herzegovina with its entities ratified the Convention on the Rights of Persons with Disabilities, many of the rights listed in the Convention are not implemented in practice. The aim of this Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms for persons with disabilities, and promote respect for their dignity. The basic principles of the Convention are: respect for the dignity, individual autonomy including the freedom to make personal choices, independence, non-discrimination, full and effective participation and inclusion in society; Respect for difference and acceptance of persons with disabilities, equal opportunities, accessibility, equality, respect for the evolving capacities of children with disabilities and respect for the right to preserve his or her identity (United Nations, 2006).

Through the centuries persons with disabilities faced stigmatization, significant problems and obstacles in exercising their basic human rights. Due to the inability of independent functioning, and the families inability of caring for persons with disabilities, many of them are placed in residential care. Those institutions continue to operate on the principles that impose depersonalization. In these conditions and cultural heritage, which has promoted concealment and isolation of persons with disabilities we can talk about social exclusion of these persons, especially when it comes to adults. Protective measures and involvement in the community through various programs and activities that take place through the support system for children and juveniles ensures a certain level of participation and inclusion in society, which is a prerequisite for equality of rights.

By entering adulthood persons with disabilities are becoming more socially excluded. It is evident that the interest of society for persons with disabilities to their age decreases.

If we looking the problems in the functioning of persons with disabilities from social work prospective, we can start from the very definition of social work as a professional activity. According to the definition of the International Federation of Social Workers (IFSW, 2014), social work as a profession promotes social change, problem solving through interpersonal relationships and the empowerment and liberation of people to enhance their well-being. In accordance with theories of human behavior and social systems, social work intervenes at the points where people interact with their environment. Principles of human rights and social justice are fundamental to social work. With this definition of social work on mind, undoubtedly it can be concluded that social work as a profession, is able to ensure optimal social functioning, participation and the implementation of the rights of persons with disabilities. Foster care as a form of care in Social protection system is one of the features for avoiding institutionalization and for social inclusion of persons with disabilities, as well as their training for the daily activities at the level that their condition allows. The process of deinstitutionalization is demanding and requires a systemic approach, especially when it comes to adults with developmental disabilities who placed in residential care in high percentage.

Foster Care in the Republic of Srpska

Due to frequent political and social upheavals which have resulted in a large number of conflicts, that inevitably led to the need for care of children and adult persons who cannot take care of themselves, Republic of Srpska and Bosnia and Herzegovina as well as the region has a long tradition of foster care. Foster care as a form of care and protection in the Republic of Srpska is applying since the establishment of the state. In 1993, Republic of Srpska brings the Law on Social Protection. In the context of the social protection rights this document defines the right to accommodation in another family (Official Gazette of the Republic of Srpska no. 5/93). The development of the social work profession, monitoring of global trends in the field of social work and social welfare, Republic of Srpska developing foster care. This kind of approach is particularly reflected in the positive legislation that Republic of Srpska established with adoption of the Law on Social Protection in 2012, after which were defined a number of by-laws that more closely regulate different areas in Social protection system. Significant contribution in the area of developing foster care was given by the Local communities as founders of centers for social work that are in their jurisdiction. Foster care in the Republic of Srpska is governing by the Law on Social Protection ( “Off. Gazette of the Republic of Srpska", no. 37/12) and the Foster care Book of rules ( “Off. Gazette of the Republic of Srpska", No. 27/14), which created the formal legal prerequisites for the development of foster care. Foster care, in terms of the Law, implies taking care of the beneficiaries in the family that provides fulfillments of basic needs, family that takes care of the person and helps her in the rights exercise and the obligations fulfillment. (Article 42, paragraph. 1 of the Law on Social Protection of the Republic of Srpska). Some authors define foster care as humane mission of the community and especially humane people-foster parents, through which foster family provide care, protection, education, training and requirements for the optimal development of children who, for various reasons, cannot live with their natural parents (Jugović, Pejaković, Stevanović., 2013: 7). Family placement is an organized form of social and family-legal protection for children without parental care who are entrusted with other specially selected, motivated family in the care and custody, who received financial compensation for its work (Vidanović, 2006: 301). The foster family is a family with one or more adult persons who engages the services of care for children or for adults, which has been evaluated and training for foster care, which meets prescribed conditions and charges a fee for their work (Article 42, paragraph 2. Law on Social protection the Republic of Srpska). Normative framework of foster care in the Republic of Srpska defines the conditions and procedure for obtaining the status of a foster family, types and forms of care in foster families, beneficiaries, procedure of disposing the user rights in foster care, termination of foster care, as well as the manner of implementation of foster care. Thus, the Law on Social Protection stipulates that the right to care in a foster family can accomplish any child or adult who meets the requirements for placement in a social care.

Due to the fact that this paper focuses on adults with developmental disabilities, we will present conditions for their care as prescribed by law. Law on Social Protection of the Republic of Srpska in Article 18 defines the beneficiaries of social protection and makes distinction between children and adult persons as beneficiaries of social protection. When it comes to adult persons, in accordance with the Law, the beneficiaries of social protection are adults who do not have the necessary means of subsistence, unable to work and cannot provide funds for life on other grounds (Article 18, paragraph b. Paragraph 1. Law on social Protection of the Republic of Srpska), adults in which as a result of injury, disease or birth defects occurring loss or restriction of ability to perform activities that are necessary for everyday life (Article 18, paragraph b. Paragraph 2 of the Law on social Protection of the Republic of Srpska ), adults who due to permanent changes in psychosocial and health cannot meet their basic needs (Article 18, paragraph b. Paragraph 3 of the Law on social Protection of the Republic of Srpska).

This normative definition of foster care opens space for adults and the elderly foster care, which is not developed nor sufficiently represented in the countries of the region, Europe and the world as well, while in a few countries in which it is represented is not developed sufficiently, as it is a case in Republic of Srpska. Usually when we talk about foster care, having in mind the care of children who are unable to live in their biological family, because of various circumstances. Foster care for adults and the elderly in the Republic of Srpska, existing as foster care segment, which is governed by the Low and subordinate legislation. This opens opportunities for specific care for persons with disabilities, which creates a presumption of the exercise of rights, social inclusion and their optimal functioning in society. Specialized foster care for adults should have especially important role at the deinstitutionalization of adults with developmental disabilities.

Book of Rules on fostering in the Republic of Srpska defines three different forms of foster care: standard, specialized and urgent foster care. Standard foster care is provided for children, adults and the elderly through the foster care that provided family life and fulfillment the everyday needs related to the age of the beneficiaries who have difficulties in psycho-physical development, so they need extra care and support. Specialized foster care is provided for children, adults and elderly with disabilities, abused and neglected persons and persons with socially unacceptable behavior. Emergency foster care is ensured to children, adults and the elderly in various types of emergency situations (abandoning the child, inability of parents to care for the child, natural disasters, lack of or interruption of family care for persons with disabilities, etc. ). In addition, the Regulations on fostering regulate the procedure and method of placing of the child or the adult and the elderly person in a foster family, as well as the process of acquiring the status of a foster family. Particularly important part of the administration process through which families obtain the status of foster families. This process includes the assessment of the fulfillment of conditions for acquiring the status of a foster family, which is done by summing several elements: an insight into the prescribed documentation, interviews with potential foster parents, interviews with family members and members of the household of potential foster family, home visits and comprehensive treatment of teamwork. After a positive opinion on the assessment of the requirements for foster care, every potential foster parents are obliged to undergo training program for foster care, followed by family and officially became foster, which formalizes a certificate for foster care for a period of four years.

Case Study

In the focus of our research were two twin sisters who are adults with developmental disabilities. Specifically, research is about persons of whom one is with mild mental retardation, while the other is a person with multiple problems. Ever since the early years of childhood, they are placed in residential care because of inadequate parental care. The main reason for separation from the family was neglect due to lack of capacity for the care of the parents. Throughout their life, sisters were kept in an institution for children without parental care, then in institution for adults and the elderly, and later in an institution for people with disabilities. The total number of years spent in institutions is 20. Last institution of social care in which sisters were placed is the institution for female persons with disabilities. In this institution sisters stayed 6 years.

Methods and Techniques of Research

To collect the data used in the displaying case study, we were used test method through interview techniques, analysis of document method and methods of observation. By analyzing the content of the documents we analyzed the sisters personal files in social work center that made an accommodation for sisters, documentation analysis which was conducted at the institution for accommodation for persons with disabilities, analysis of medical and other relevant documents concerning the documentation was conducted the school they attended, and documentation related to family functioning.

Research Results

Based on the assessment that is in the best interests of the beneficiaries to change the form of social protection, issued by the team of professionals for placement and care in the Center for social work. The team carefully planned change in accommodation establishments of social protection care in a foster family. This process included finding adequate foster family, preparing them for the acceptance of this category of beneficiaries of social protection, empowerment and preparation of beneficiaries to leave the residential facility, and to change the very form of protection and support as well as help in the adaptation of the beneficiary to live in a foster home after years spent in an institution of social protection for accommodation.

Tim assessment was based on analysis of the situation and monitors the functioning of the beneficiaries in institution of residential care in which they are placed, with the help and cooperation of the professionals from the residential institution. The research showed that the beneficiaries placed in an institution for children without adequate parental care at age 7 and 9. Placement is made after that team from Center for social work estimate that the sisters were neglected by the mother and her current partner, that parents do not have the competencies required for the care of children, that children are in neglected state of health, are not included in basic education, and that they compromised sisters growth and development. During this period, team has made a detail examination of all the circumstances in which children lived, and it was decided that is in their best interest to temporarily relocate the children. During the time sisters were placed in residential care, professional team from Center for social work worked with the family on individual parental skills improvement, and the preparation and training of family for the return of children from institution. They were also ensured financial security for the family. The children were returned to their family after a year and three months. During this period, children are included in the education system and monitored their health. From the documentation that was available it was not possible to conclude how the family functioned as there were no traces of monitoring family in the period after the children were returned from residential care. After more than four years, at a time when children were 13 and 15 years old, due to the inability to function within the family sisters are again placed in residential care. Health condition in both sisters deteriorated, with the appearance of pronounced mental health problems, during the period in which the children are staying with biological family. The children were educational, hygienic and developmentally neglected. No matter what kind of neglect that has been present consequences in physical, psychological, emotional, social and spiritual development in children remains. (Delaney, 1998; Brooks and Siegel, 1996). Nonetheless, it is important to emphasize the fact that the parents addressed to the Center for social work with a request for children’s placement because they were not able to take care of them anymore. Children are placed in residential care for children without parental care, where they have been placed in the past. The analysis of the documentation shown that the family has been extended in period when the children were staying in the biological family. Mother of the sisters gave birth to two sons. The files that were analyzed in Center for social work had no detailed data on younger male children, but we conclude that there were no problems regarding care for two boys in family, based on the data we were collected from interview with one of the social workers that earlier was working on the case. Functioning of twin sisters in residential care is monitored by an expert team from Center for social work, which was documented in their files, noting the progress that has been made in their functioning. The older sister was attended school under a special program, while the younger attended classes in the ordinary course of secondary education. Upon completion of secondary education in the three-year duration, given that both sisters were adults, but that were not in the full-time education, there was no legal possibility for an extension of their stay in the residential care. Because of this fact the sisters were moved to an institution for adults and senior citizens, where they faced with the serious difficulties in their functioning. Sisters shown resistance to the new environment where they did not belong, taking into account their characteristics and their age. Living in residential care was followed by a series of problems which are primarily reflected in a variety of unacceptable forms of behavior, deterioration in mental health, several attempts arbitrary leaving the institution and attempted suicide one of the sisters. During this period, the sisters have been repeatedly hospitalized at the clinic for psychiatry. Sisters were staying in an institution for adults and senior citizens for a period of about five years, which was marked by frequent absences from the institution for medical treatment. The expert team from Center for social work made a decision to change the residential institution. The sisters were moved to a social care facility for persons with disabilities, which was located in another city. Period of adaptation to life in the new institution passed satisfactorily. Data shows that in this period expert team from Center of social work resided in the institution several times, so that together with the expert team from the institution provide support and adaptation to life in an institution for twin sisters. The sisters have accepted the environment in which they are found, and they began to actively participate in all activities of the institution. During they stay in the institution for placement of persons with disabilities they are constantly expressed desire to return to the city where they were born and lived, as well as the desire to establish contact with mother and other members of their biological family. Expert team from Center for social work considered the possibility of moving sisters to a foster care. After decision was made to move sisters to a foster family, in cooperation with the expert team from institution, and in collaboration with sisters, individual care plans were draft. That included activities related to several segments: the establishment and maintenance of adequate mental health, activities related to mastering the skills needed to function independently (maintaining personal hygiene and space hygiene, cooking, washing, handling electrical equipment necessary for the functioning of the household, etc. ), activities related to the improvement of social skills, re-establish contact with their family. At the same time while the process of preparing for deinstitutionalization were taking place, in Center for social work was started a process of identifying, preparing and training foster family for the care of the sisters. Expert team from Center for social work has targeted the family, which is estimated to have the capacity to work with people with developmental disabilities. Aggravating factor was that the family had no intention to engage in foster care for adults. This obstacle was successfully overcome in a series of interviews with family, accentuating all the challenges and benefits of foster care for adults, especially specialized foster care for adults. The foster family was presented with the family and personal history of sisters. Plan for training and education of family care for adults with developmental disabilities was made and foster family has started the educational process. The education of foster family was conducted by expert team from Center for social work. According to information obtained in structured interviews with the professionals from Center for social work and professionals from institution where sisters were placed, we concluded the following: preparations for deinstitutionalization proceeded in accordance with the individual plan for each sister. The one with mild mental retardation has adopt planed skills within the given time frame, while the other one, with multiple problems had difficulties in the implementation of planned activities, and the adoption of different skills. She also had repeatedly deterioration in mental health. When it comes to contact with the biological family, the expert team of the social work center has made contact with the brothers who responded to the call for the cooperation and join into a support network at the meso level. Foster family has also established contacts with sisters as well as theirs brothers. In the process of deinstitutionalization foster family has repeatedly visited the sisters in the institution. After a year, sisters spent weekend in a foster family. After that expert team extensively worked on their departure from the institution. Before placement in a foster family, all the conditions for a change of placement are acquired. After two years from the beginning of the process, sisters were formally placed of in a foster family. Foster family monitoring and providing professional support initially was carried out twice a week. After two months professional support and monitoring was conducted four times a month. A significant contribution to the functioning of the sisters within the foster family gives the brothers who have been involved in the support network and actively cooperated with the expert team from Center for social work. Foster parents have been involved in working with a group of foster parents, while the sisters has been included in the Day care Center for persons with disabilities for a period of three hours per day. The active support of an expert team lasted a year, after which the sisters started to led quality life in a foster family.

Conclusion

Foster care as a concept in the protection and care for adult beneficiaries of social protection is not sufficiently developed, although there are all the legal requirements for the development of foster care for adults. There is as well need to reduce the number of adults who are placed in residential care due to various causes.

Particularly vulnerable categories of care users are persons with disabilities, who are rejected, discriminated against, denied the realization of basic human rights and institutionalized. Due to the inability of independent functioning and the families inability of caring for persons with disabilities, many of them are placed in residential care that continue to operate on the principles that impose depersonalization. In these conditions and cultural heritage, which has promoted concealment and isolation of persons with disabilities social exclusion of persons with disabilities is continuing, especially when it comes to adults. One of the potentials for improving this situation is the specialized foster care for adults with developmental disabilities. In relation to the level of difficulty we can certainly speak of a successful integration of people with disabilities that are not classified in the category of severe mental retardation. Specialized foster care can provide a stable environment for these persons and their functioning in the family, the higher the level of rights, but also participation in all spheres of life, which would lead to a higher level of equality and inclusion of adults with disabilities in the local community and the society in which they live. Our case study speaks in favor of specialized foster care for adults. In order to sufficiently provide the ability to care for adults with developmental disabilities in specialized foster families, it is necessary to carry out the recruitment and training of new foster families. In addition, an essential element is the promotion of foster care, but also the promotion of specialized foster care. To help with this type of care, and promote all the opportunities it brings, both for beneficiaries and potential foster families, we have to introduce with it wider public. Although financial motivation may not be crucial to foster care, cannot be excluded, especially if we keep in mind the high unemployment and very limited possibilities for securing their own existence.

In addition to promoting foster care for adults, recruitment and training of foster families, the professional social work is facing the challenge of improving foster care training programs to be developed separately for each of the forms of foster care are in accordance with positive legislation.

For this type of fostering improvements, systematic approach that would ensure the adequate development of fostering through the improvement of professional skills of social workers and other professionals included in fostering, continuing education of foster families and the promotion of foster care in general, is necessary.

Foster care, in terms of the Law, implies takin care the care users in the family that provides fulfillments of basic needs, family that takes care of the person and helps in the rights exercise and the obligations fulfillment. Although placement in a foster family is preferred to institutional placement, it is still far greater number of adults and elderly people placed in residential care. According to the Ministry of Health and Social Welfare of the Government of the Republic of Srpska, placement in foster care as a right was achieved in 1% of the total number of beneficiaries of social protection, while the right to placement in an institution achieved 2. 5% of users (Bulletin of the social, family and child protection, 2015). In real terms, in 2015, 830 adults were placed in social care institutions, while only 125 adults were placed in foster homes. Caring for people with disabilities, compared to the normative definition is done through a form of specialized foster care. This type of care provides special services for adults with disabilities, which is due to psychological and physical health status or need extra care and support. In the Republic of Srpska there are no unique data on the number of adults with developmental disabilities cared for in foster families. This type of data collected by the Centers for social work, and there is no unique database.

Social work as a professional activity, can greatly contribute to the development of foster care for adults, and therefore specialized foster care for persons with developmental disabilities. Keeping in mind that foster care is realized only through social protection, the largest burden of responsibility for promotion, development and implementation of foster care is precisely at the social work. Positive regulations make it possible to approach the development of foster care for adults, especially specialized foster care, keeping in mind that in the Republic of Srpska are two placement institutions for persons with disabilities. Professionals agree that we have strong need for deinstitutionalization in Republic of Srpska that can be conducted through the concept of specialized foster care for persons with developmental disabilities. According to unofficial data, in the Republic of Srpska are only few foster families specialized in foster care for adults with disabilities. These families have successfully undergone the procedure of assessing the requirements for foster care, as well as a training program for foster care. All families have their place of residence in the city of Banjaluka.

Challenge for social work, as well as social workers and other professionals in social protection, at the local and at the national level, is recruitment families to become foster families, as well as their training for work in foster care. The Ministry of Health and Social Welfare in collaboration with UNICEF in 2014 was organized and conducted training of professionals who are trained to work with foster families, especially in the segment of their training for foster care. The training involved professionals from several regions of the Republic of Srpska who are employed in the centers for social work. This should thereby ensure that the profession of social work in the Republic of Srpska can meet the requirements of applicable legal regulations.

When we talk about the training program for foster care, it should be noted that training for foster families for adults is specially adapted by professionals who have been carrying out. During training, foster families processed contents related to the development of competencies foster parents, the needs of adults and the elderly, the continuity of life of adults and the elderly and their identity, the importance of family environment, cooperation of experts with foster families, modes and types of communication with adults and elderly people from different category of users, neglect and abuse of adults and the elderly, grief and losses as inevitable in the life process with special emphasis on ways of support depending on the categories of beneficiaries, preparing to begin the process of establishing foster care. All of these topics educators adapt to the group with which they work, especially caring about the form of foster care for families to be empowered, on the basis of which the elected approach to developing a theme. Special challenge for social workers is targeting and attracting families to engage in specialized foster care for adults, as well as their follow-up to the provision of the necessary kind of support.

Specific challenges for social workers are support that professionals need to provide to foster families on a daily basis. This correlates with a large number of working obligations and tasks that any professional worker in the center for social work has. One way to support foster families is group work with foster families, with dominant method of counseling, and capacity for development of self-help groups.

References