[Bulgaria] 3 barriers and a method for ending institutionalisation, an article by Dr. Galina Markova

08 Oct 2019
Know How Centre for Alternative Care for Children

Like all socialist countries in the former Soviet bloc, Bulgaria developed a state-based child care system in the second half of the 20th century.

This system was based on the socialist ideology which allowed the state to control families and “shape” future generations within the collectivistic values.

The state took it upon itself to make the children good, socialist citizens. The most drastic way the state did this was by taking children away from their parents and placing them in institutions. Before the socialist regime came to power in 1945 there were just 30 institutions in the whole country. When the regime fell in 1989, there were 285 with 35,000 children living there. Just 2% of these children were orphans.

The regime was guided by a doctrine of “state paternalism”, in which the state is the dominating force in people’s lives. This overreliance on the state makes people reluctant to take the initiative in solving their own problem, resulting in a state of “learned helplessness” at the individual level. This aspect is often neglected in deinstitutionalisation (DI).

Closing doors is not enough

Taken together there are three major barriers to deinstitutionalisation.

The first barrier is that DI is often viewed narrowly. It is seen as a process of eliminating the big institutions rather than as a cultural phenomenon maintained by factors that have to be addressed systemically. This perspective also overlooks the long-term interventions which are especially needed when working with the most marginalised communities whose chronically unresolved problems lead to heavy reliance on the state.

The second barrier is that DI reformers often forget that we close institutions because they deprive the people living there from the most important thing: human relationships of trust and attachment.

Instead of guaranteeing that each child is given the opportunity to form relationships based on attachment, DI often leads to placing children first with one foster parent and then another, and sending them from one small group home to another without trying to reconnect her or him with their biological family.

The last barrier is simply that DI is often implemented by people who are not trained and supported properly.

Deinstitutionalisation is challenging, as it is inherently a process of change associated with multiple losses, and the disruption of lives and relationships.

This reform process should be led by motivated people who all participants — staff as well as children — trust. This speaks to a phenomenon called epistemic trust: our tendency to only accept knowledge from people we trust, in this case the knowledge needed to implement a positive change.

Overcoming the barriers

In summary, successful DI practices are those that address the three barriers — the attitude of  learned helplessness, lack of attachment, and lack of professionalisation — and these reforms should be implemented by leaders that the communities trust.

Luckily, there are many real-world examples of successful DI. Below I present one of them, which can be a model for others to replicate.

Participatory Action Research — or PAR — is a scientific method that aims at studying a process of change in order to improve it. Unlike other scientific methods that study outcomes, this one studies change as it evolves, which allows the researchers to make improvements during the process.

In the ideal scenario, the study begins with a trained team who involve all the different stakeholders as co-researchers. Together they provide data, which is then analysed and used to improve their practice. Next they collect data that to asses the improvement, and analyse it in order to improve it again. Thus, the process is circular and it integrates both practice and learning elements.

The Know How Centre (KHC) team uses PAR to study and improve the implementation of Bulgaria’s ongoing DI reform. We begin by selecting and training a team of eight researchers who over a period of 18 months study the reform process in four of Bulgaria’s 28 regions. Every month they devote one week to organising discussion meetings, conduct focus groups and interviews with relevant stakeholders. They then analyse the data, bring it back and discuss the findings with the participants.

One interesting result of the study is that the EU becomes one of the barriers to successful DI

These regions have been selected in partnership with the central government who we actively involve in the process. Every pair of researchers organise regular meetings with different stakeholders in each of the regions, informing them and involving them in the process. Usually the initial stage of the research is quite long as the methodology is new, and it easily provokes anxiety and resistance in the invited stakeholders: local government, caring professionals, child protection departments, families, and of course children.

These stakeholders are invited to learn and act on the lessons learned instead of relying on the pre-made state plans. The goal is to foster a sense of human attachment above reliance on institutional procedures (learn to trust), and in the case of the public servants involved, change their “ professional” habits and embrace new professional values.

Changing habits

During this initial stage the researchers are often viewed by the participants as DI experts whose job it is to inspect.

But gradually and with every visit, the pairs of researchers develop trust and a culture of inquiry and partnership. For example, five months into our research phase, a community Roma leader who studied his work with parents, said: “wow, have you noticed that we stopped asking you what to do?!”

After this stage of trust and partnership with the KHC team is achieved, the local stakeholders start partnering among themselves. For example, two teams of child care practitioners realised that they themselves maintained the old institutional style of working with children: when dealing with cases of abuse, their go-to reaction was to place the child in residential services, thereby separating them from the father in the family, instead of addressing the parents’ abusive behaviour.

"a small number of children who were moved from big institutions to small group homes said that they miss their previous home — the big institution — and see DI as a process of loss of stability and a clear future"

This insight spurred them to collaborate with a mental health service (who they did not trust before) as well as police to help in cases like these and to prevent children from being separated from their homes. The research process ends with big public events where central government representatives are involved in a similar process of reflecting on the results, so that their experiences are integrated in the final analysis. Like other research processes, this one also finishes with a report.

One interesting result of the study is that the EU becomes one of the barriers to successful DI. Many DI projects are funded by the EU, and these are pre-planned and administered in a top-down manner which re-establishes the institutional culture of management and control. Instead of responding to the changing developmental needs of children the funding mechanisms foster dependency.

Another challenge is that the PAR researchers were unable to involve enough children and parents in the study. This is its biggest problem as they are the beneficiaries of DI and the people who DI is supposed to empower. Still, a small number of children who were moved from big institutions to small group homes said that they miss their previous home — the big institution — and see DI as a process of loss of stability and a clear future.

The authors of the reform 

For the professionals working in children’s social care, PAR has been an important process. The ongoing dialogue with all stakeholders helped them position themselves in the changing nature of their work – from the one of institutional control – to the one of human relations based on trust

In the table above the reader can see the features of PAR that address the barriers mentioned. As the table shows, PAR addresses all three barriers by empowering the stakeholders, creating a foundation for attachment and providing an opportunity for professionals to get a deeper understanding of the best practices.

Participatory action research should be a part of every DI reform because it helps the people involved to become the authors rather than the victims of those reforms. Its participatory nature guarantees its applicability in any context. — Galina Markova

You can read the original Apolitical text here.

This project is funded by:


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