Piloting and development of occupational therapy in 2 social care homes in Belarus

When the Iron Curtain opened up in 1989 the West witnessed one of the saddest heritages of the centrally governed planned economy: over a million children, handicapped and elderly people were locked away in institutions in the countries of the former Soviet Union. This heritage came into being as a result of the social politics during soviet times and the soviet science of defectology.

People with intellectual disability in institutions, the so-called ‘internaty’, lived under very bad, even inhumane circumstances. They were isolated from the society, which was not informed about the real situation in these institutions and therefore didn’t make any pressure towards politicians and officials to improve the situation of residents of social care homes in Belarus. The specifics of Belarus were the weak developed civil society, lack of solidarity among its members and underdeveloped traditions of voluntary work. Under these circumstances it was not possible to rely entirely on the nongovernmental sector: according to the partners of the project, Public Association “Voice of Heart” was the only one, which had started radical change of life of this target group. As there was a big need for revolutionary changes in mental health care in Belarus, the cooperation with experienced international partners was very important. Therefore Public Association “Voice of Heart” approached the situation in Belarus and asked for cooperation improving mental health care in this country.

They came to the idea about establishing occupational and working therapy in 2 social care homes because of the following reasons:

• (1) as most areas of social life were strictly controlled, it was impossible to achieve radical political and systemic changes but
• (2) as there was a big need for readiness to cooperate “from the bottom” they could start improving living conditions inside the system.
• (3) Residents, who would take part in the occupational and working therapy activities, would obtain new skills, capacities and some degree of the autonomy. This would serve as a positive example, as an argument to change the entirely institutionalized system of mental health care in Belarus.

The overall objective was to improve quality of life of residents of 2 social care homes by training staff of social care homes and stimulating activities of NGOs in the sphere of mental health care in Belarus in general and capacity building of partners’ organization “Voice of Heart” by enabling it to fulfil its role as advocate and representative of intellectually disabled people and residents of social care homes in particular.

Specific objectives of the activities were:

• Introduction into the Belarusian society of an alternative approach towards intellectually disabled people.
• Improving quality of life of residents of social care homes: first of all the structure of their day would become well marked, divided not just according to the meals and rest hours but according to the interesting activities. It means it would be more similar to the daily activities of their peers and this fact will contribute to the self-esteem of the residents. Secondly the role of work is crucial for mental, emotional and physical well being of every person; furthermore work of intellectually disabled people is often regarded as one of the most important contributions to their integration. Thirdly the administration and staff of social care homes would have trainings about the marketability of goods produced by the residents of social care homes. This would enable them to sell the production and give some financial incentive for residents of social care homes.
• Changing attitudes of administration and staff of social care homes towards residents of these institutions: instead of understanding them as human beings without capacities, motivation and abilities, having just physical needs, the project staff would gain a chance to see their clients as personalities who have their own attitudes, wishes, values and strengths. This objective was reached during trainings, study visits and discussions.
• Providing administration and staff of social care homes with information about Lithuanian practical experience organizing occupational and working therapy and employment of residents of social care homes.
• Providing residents with an opportunity to develop (or newly obtain) their social skills, abilities, capacities and gifts by establishing special occupational activities in social care homes (physiotherapy, social skills, music and art therapy).
• Providing every resident with vocational activity a form acceptable for him/her (thus, to return to them the right to work guaranteed by the Constitution).
• Acquiring vocational skills and habits, that are necessary both as a help to one’s own institution and in case of leaving it.
• Establishing contacts: between Belarusian NGOs and social care homes, Lithuanian NGOs working in mental health care and their Belarusian counterparts, Lithuanian and Belarusian social care homes.

The project was carried out according to the specifications. The results were performed in seventeen activities related to the objectives above mentioned:

Activity 1 - Meeting of project implementation team.

The meetings of all four persons involved in project implementation took place in Minsk. During the first meeting (month 1) detailed plans of further activities were discussed and both social care homes were visited. The second meeting took place in the middle of the first year of the project. The third meeting (month 12, year 1) was combined with project evaluation. During the first and the second meetings were discussed first years’ activities, achievements, difficulties; the second year was planned and visits to both social care homes.

Activity 2 - Empowering NGOs working in mental health care by providing trainings for members of NGO on NGO management and patient advocacy.

The NGO training aimed to enhance the overall NGO capacity in Belarus, in order to build a network of active NGOs in mental health care that can play a key role in its consequent reform. The program targeted existing NGO together with potential NGOs, which would be organised amongst users, relatives and professionals. Trainings were organized in Vilnius.

More particularly trainings were oriented on:

• User and relative involvement.
• Role of NGO among other stakeholders in mental health and possibilities to develop.
• NGO management (objectives, planning, organising).
• Organisation of activities (e.g. information bulletin, self help groups, advocacy project, activity centre - art, music, computers and so on).
• Provision of community based mental health services.
• Communication with other organisations (institutions, government, international organisations) – creating a platform.
• Project management (proposal writing, budgeting, financial reports) / Fundraising.
• Information on how to develop and manage reforms in mental health care.

Activity 3 - Renovation of premises and equipping of organization “Voice of Heart” with office supplies: 2 computers, printer, scanner, photocopier, fax/phone, and office furniture.

This activity was very important, building the capacity of the partner organization, because at the time the organization had no premises and it was a big obstacle to develop current activities and new initiatives.

Activity 4 - Visit of Belarusian partners and selected staff of social care homes to Lithuania.

The visit was organized in the way which covers all the system of social services for intellectually disabled people in Lithuania: day care services for children and adults, occupational centres, family support centres, integrated kinder gardens and schools, supported employment centres, independent living homes and social care homes. During this visit the trainees attended a 4 hours introduction course about Lithuanian system of social services for intellectually disabled people.

It was expected that this acquaintance with the system in Lithuania would give to the trainees understanding about importance of daily occupation and work for disabled people and the different ways in which it is possible to achieve this goal. At the same time the trainees understood about the particularities of social services system for disabled in Lithuania, which is distinguished for the cooperation among state, municipalities and NGOs. This visit was also an opportunity to meet the Lithuanian trainers, which further gave seminars for the administration and staff of social care homes and for employees and volunteers of NGO “Voice of Heart”.

Activity 5 - Adaptation of premises for music and art therapy, social skills and sheltered workshops in social care homes.

Equipping the premises for therapy and workshops. Social care homes in Belarus are located in old buildings, they are poor equipped and current ascetic working and living conditions stimulate neither the staff’s nor residents’ motivation to establish and develop new activities. Newly renovated premises would attract huge attention from residents and staff of social care homes and would increase their motivation.

Activity 6 - Launching trainings for the administration of social care homes.

Administration is the body of the institution, which is responsible for organizing work of staff, implementation of innovations, contacts to the outside world and other internal and representative functions. Establishment of occupational therapy rooms and workshops in the social care homes would cause changes in division of responsibilities among staff members, new tasks, additional costs and profits but most of all changes of attitude towards clients.

Therefore training curriculum for the administration of social care homes consisted of the 2 modules:

Module I “Changing attitudes”:

• Development a concept of disability. Arguing out a common definition of disability: how to conceptualize a disabled person, his strengths and weaknesses, his facilities, needs and help / support / trainings / education / services;
• Opportunities of disabled person’s development;
• Flexibility and openness to new ideas, working methods and approaches;
• Disabled person’s needs and abilities testing;
• Human rights for disabled people.

Module II “Management issues within the social care home and communication to the outside world”:

• Discussions about principles of communication within the team of different professionals: social workers, medical, pedagogical staff, administration and unqualified assistants;
• Organization of occupational and working therapy in social care home: selecting staff, residents, organization of staff trainings, effective using of premises;
• Introduction of the project to the local community, broader society, counterparts in other social care homes, local and central government;
• Marketability of goods produced by the residents of social care homes.

Activity 7 - Internship for the staff of social care homes.

Staff of social care homes, which were directly responsible for working therapy of social care homes’ residents (six persons from each social care home), had an internship in three social care homes in Lithuania: Social care home in Aknysta, Social care home in Pabrade and Social care home in Ukmerge. The institutions for internship were selected according to some criteria: (1) location not far from Vilnius; (2) good equipped workshops and rooms for occupational therapy; (3) staff was well trained and able to give to the trainees benefit from their experience.

The internship included:

• Daily work in occupational therapy rooms and sheltered workshops with clients;
• Theoretical introduction and practical trainings on methodology of setting up individual occupation plans of residents, which includes assessment of individual capacities, abilities, motivation, social skills, etc…
• Introduction to functions of social care home, its place in the local community and society, cooperation and collaboration with local and central government, NGOs, medical, educational and other institutions.

Activity 8 - Analysis of needs and opportunities of the residents.

According to this information the occupation of residents was organized. Investigation was made using a special questionnaire, which was prepared in Canada and adopted in Lithuania. Though Lithuanian system of social services for intellectually disabled people was developed much better than in Belarus, this questionnaire was suitable for residents of social care homes in Belarus, because it was used in Lithuania to investigate intellectually disabled people, which were not educated and trained.

Activity 9 - Daily work with clients providing occupational and working therapy and daily living skills trainings:

• Physiotherapy;
• Art therapy;
• Music therapy;
• Daily living skills;
• Woodworking;
• Sewing.

Activity 10 - Day to day communication among staff and administration of social care homes in Belarus and their counterparts in Lithuania: mutual exchange of experience, discussions about difficulties, encouragement and counselling. “Zenevos iniciatyva psichiatrijoje” was responsible for involvement of representatives of Lithuanian social care homes.

Activity 11 - Supervision of working after 2 months by Lithuanian counterparts.

Two Lithuanian experts spent one week in every social care home, observed and assisted in daily work in new established workshops and therapy rooms. Discussions about difficulties, achievements, new ideas were organized.

Activity 12 - Translation and publishing of books:

The Art Therapy Sourcebook by Cathy Malchiodi. Published by Lowellhouse, Illinois 1998. Digest of international scientific articles and research on occupational therapy for people with mental disability. The book and the digest was translated into Russian language (this language is more common in Belarus) and edited in 500 copies of each. Distributed free of charge during the open day and other projects’ activities among:

• NGOs, working in field of mental health care in Belarus;
• Staff of social care homes;
• Politicians and officials, who are responsible for development and implementation of policy of mental health.

Activity 13 - Open day in the both social care homes at the end of the project was organized.

To this final event were invited representatives of other Belarusian social care homes, local and central government, NGOs and media. This open day consisted of visits to both social care homes, presentation of the projects results and achievements, problems and further ideas were discussed, and published books were distributed.

Activity 14 - Evaluation.

In the end of first year of the project and in the end of the whole project, an outside expert travelled to Belarus in order to carry out an evaluation of the project in accordance with the log-frame as part of this project proposal. The evaluation assessed the level of internal and external communication, qualify if the progress was proceeding according to the project plan, and how far were arrangements in place to assess on an ongoing basis progress to the goals set in the project description.

Activity 15 - Financial audit.

In the end of the whole project an audit by an approved auditor, who is a member of an institutionally recognized supervisory body for statutory auditing was carried out.

Activity 16 - Opening Conference in Brussels.

Coordinating team of the conference participated in opening conference in Brussels.

Activity 17 - Closing Conference in Brussels.

Coordinating team of the conference participated in closing conference in Brussels.