Reducing the numbers of children with disabilities in institutions through gate-keeping practices

1. Reducing the numbers of children with disabilities in institutions through gate-keeping practices SECOND CHILD PROTECTION FORUM: “Building and Reforming Child Care Systems in Central Asia” Mrs., Deputy Minister of Health of the Republic of Tajikistan Bishkek 2009

2. Total number of people with disabilities 121.424 Number of born with disabilities (from childhood) 35.409 Number of children with disabilities (up to 16 years old) 19.471 Number of children with disabilities living in institutions 1.700 Number of orphans with disabilities 1.447 No. of children receiving a disability pension aged 0-15 19.471 Data on Disability in the country

3. High poverty situation in the households affecting the health of pregnant women The average yearly populationgrowth rate is 1.7 per cent and 65.7 per cent of Tajik households have 4children or more More than half of the children are born with the pathological conditions with the risk of forming disabilities in the neurological-psychiatric systems Increase of home delivery in rural areas without participation of medical doctors specialized in mother and child care Increase number of deliveries with the consequences of anemia and other extra genetically related sicknesses (cases of marriages between close relatives in rural areas) High indicator of goiter among young women and children at the age of 3 to 14 Basic reasons of disability

4. History of the PMPC* • The first Psychological, Medical and Pedagogical Consultation was opened at the end of 2006 to provide diagnosis, therapy and support for children with physical and mental disabilities; • Four consultation centres now operate (in the centre of regions) replacing the former local Medical Pedagogical Commissions; • The Ministry of Education and the Ministry of Health of the Republic of Tajikistan provide methodological oversight to the Centres; * PMPC – Psychological Medical Pedagogy Consultation

5. Organizational Structure 2 stage Children support at early stage (3 to 6 years) 3 stage School age children (with disabilities) 1 stage Screening and Diagnostic • Medical Pedagogical Consultation • Rehabilitation and Correction; • Legal support to families in need; • Outreach services to families; Medical and Pedagogical support • Assessment and Screening: • Policlinics/PMPC Centers, • Residential care institutions; • Pre and secondary schools; • Families with children • with disabilities; Early Childhood Development Lacking so far • Social support • Entitlement to the social pension or • allowances; • Provision of special equipment; • - Socialization activities • Pedagogical support • Referral forms to special institutions; • - Referral to Parents Education Centre • (on the base of kindergarten); • - Referral to primary/secondary schools Analysis of diagnosis and individual care planning for every child with disability Correctional Rehabilitation support - psycho social pedagogical assistance unit - rehabilitation specialists - consultation offices (dialectologist and therapists) - Medical and physical halls

6. Undertaken Actions • To reform the Medico Pedagogical Commission (MPC) into a Psychological Medical Pedagogical Consultation at the interest of children with disabilities the following actions have been undertaken: • Situation Analysis country wide to expose situation and conditions of children with disabilities with the focus on the structural gaps and normative acts • Series of theoretical and practical training to the MPC staff by international consultants to build the capacity aimed at developing skills to utilize new methodological approach to the needs of children with disabilities • Development of draft Regulation for the PMPC to function as Consultation using the residential care institutions as a last resort • Massive campaign and national round tables in the regions advocating the rights of children with disabilities for the services and family support mechanisms development • Mobilization of local NGOs to assist for fund raising to cover expenses of equipment and refurbishments of Policlinics where the PMPCs are actually located

7. Specific Functions of PMPC • Assessment and Diagnosis: Children who come to a PMPC for the first time are assessed and diagnosis is provided. Assessments are also conducted in residential institutions for children with disabilities in connection with a change of a child’s condition; • Correctional Classes: Specialists of the PMPC conduct correctional classes (therapy) for children with problems in their physical and mental development. Special training and education is also provided to family members to improve the home management and integration of the child; • Gate-keeping: The PMPC have the authority to recommend that children with disabilities be placed in a residential institution. Their focus is identifying and providing alternative care;

8. Referral and Information • There are about 84,000 children with moderate and severe disabilities in Tajikistan. There are 2,502 children in 23 institutions for children with disabilities with 2.97% of children with moderate and severe disabilities; • Approximately 97% of children with moderate and severe disabilities live at home;

9. Operational Model (Functions) • Staffing: The staffing of PMPC is from 6 to 9 with specialisation of various areas of disabilities including social worker, lawyer and director; • Training: PMPC staff have been trained in new approaches to working with children with mental and physical disabilities. This includes special training in educational, psychological and developmental skills for children with special needs; • Funding: Each PMPC is supported by Local Authorities. UNICEF provides financial support for the staff and additional assistance such as computers and supplies; • Other: The OSI Foundation provides support to Parents Associations for children with disabilities to supplement the dissemination activities for the children to be brought up in a family environment;