Child Specialist Meeting in Tartu 8th?9th December 1999

Report by Barbro Hindberg

Background:

Ingrid Åkerman, Head of Section and Helena Casamassima special adviser in The Swedish Special Group for Children at Risk in the Baltic Sea Region were happy to welcome the participants to the first meeting in this project for professionals working within the child protection field. Up to now only politicians and administrators have gathered to discuss co-operation concerning children at risk in the Baltic Sea region. Mrs Åkerman gave a summary about topics that had been discussed and decisions that had been made at the former meetings. The Stockholm conference against commercial sexual exploitation in 1996 was the starting point for many countries to put sexually abused children on the agenda. Sweden chose to focus on the problem of commercial sexual exploitation in the Baltic Sea region. When the Heads of Government met in Riga in January 1998 it was decided that co-operation within the region on this problem should be encouraged. Thus a conference on commercial sexual exploitation in the Baltic Sea region was arranged in Tallinn in September 1998. At this conference it became evident that the work had to be broadened to children at risk of being neglected, physically or sexually abused. It was also recognised that knowledge about children at risk had to be improved on all levels in society. This means that there has to be communication between descisionmakers and professionals and that methods to mediate information and knowledge about children at risk have to be found. On the 17th of March 1999 Ministers with responsibility for children?s issues were gathered in Stockholm to discuss ways of developing co-operation. A proposal was made by the Swedish Minister for Social Security and Children to use information technology as one way of improving co-operation, share information and for educational purposes. Since then Sweden and Norway have been striving to further develop an IT-network, an idea which was presented at a meeting between IT-experts and child specialists in Visby, Sweden, in September. The aim of the IT project is to raise the level of knowledge about how to prevent the abuse of children, to protect children at risk and to rehabilitate children who have been neglected, physically or sexually abused. The Swedish Special Group for Children at Risk in the Baltic Sea Region has, together with the Norwegian Ministry of Children and Family Affairs, started to create a home-page on internet called ?The Childcentre for Children at Risk in the Baltic Region?. The first step is to organise the homepage and make it as informative as possible. Initially the homepage will be accessible for everyone knowing the adress but the next step is to build in secret rooms accessible only for those with a special key. There will be rooms for certain professionals, national multidisciplinary centers, administrative, tele- and video conferences, the media and the public. Information with a general interest will be published in English and information with a national interest in each country?s own language. An IT-workgroup with representatives from the Visby-meeting forms the basis for developing the second step. The project will probably be presented at the Heads of Governments meeting in Kolding in April 2000. For building up the homepage and for updating it continually, it is necessary that every participating country provides the person responsible for the IT-network with information and material support. A video conference on child sexual abuse is planned to take place in June next year.

Some of the delegates pointed out that there is a lack of computers in their countries and that economic support will be needed both to buy computers and other technical equipment and to develop IT-knowledge. Presentations by the participants Julija Cirule from the Bulduri Family Support Centre in Jurmala, Latvia, said that the center?s target group is children from 6-18 years. They are children of alcoholics, physically or sexually abused children, disabled children and also youngsters with a criminal record. About 500 young girls in Latvia are having babies each year and these mothers need special support. There has also been a special program for young mothers at the centre, but owing to lack of money it has been stopped. In Riga there is a centre for street children and in one local district a centre for sexually abused children. There has been a pedophile scandal in the government. The positive outcome of this is that awareness of sexual abuse has been raised.The main problem concerning child abuse and neglect in the country is the lack of co-operation within the child protection field.

Carin Nordenstam, is working at The National Centre on Child Sexual Abuse in Oslo. The centre started 4 ½ years ago. The staff consists of 6 persons and they see 40-50 children every year. The main goal is to provide better services for children and they try to give immediate help to families in crises. The centre makes investigations, forensic medical examinations, offers treatment, pass on experiences and knowledge to the professionals and give consultations. They give about 500 consultations every year, most of them in the child protection field. They plan to work out two guide-lines; one about sexual abuse and one about physical abuse. A problem for the centre is that the staff has to travel a lot as the centre has a national responsibility. It means that they are often away and cannot be as accessible as they would like to be.

Hans Ganes is working at a county administrative board in Norway. There he is responsible for child welfare issues. His main task is to follow up all children who are staying in institutions and to control that they are treated according to the intentions of the law. He also works with the municipalities to make them deal with child protection work in a better way. Hans sees the treatment of children with behavioural problems as something that is urgently needed to be developed.

Ruta Pabedinskiene, is a Senior Specialist of the Division of family and Children Affairs at the Ministry of Social Security and Labour in Lithuania. She reported that the division was set up in 1997. Its tasks are to prepare laws and to deal with matters concerning guardianship for children who have lost their parents. The aim is to place those children in foster homes and not in institutions. National and international adoptions are also issues for the division. There is a draft law ready concerning how to deal with sexual abuse and exploitation. The Council of Europe has financed seminars about children at risk in the three Baltic states and Save the Children has set up a centre for children at risk. Lithuania plans to appoint a Children?s Ombudsman and the division is working on the idea. The biggest problem in the country is alcohol abuse.

Vladimir Borisov from S:t Petersbrug is the director of a centre for the rehabilitation of children 3-18 years old. They give support to children at risk and also have a special program for mothers under 18. The work consists of medical examination, social support, law and passport matters, security and psychology training. There is a day-care centre and a place where young people can come in directly from the street. Vladimir considers it important to work both with the biological families and with foster families. They also teach children how to use computers and in S:t Petersburg there are plans to start a special computer program for children, which will be called ?Our House?. It will teach children how to get information about social services. Concerning the IT-project he has a positive attitude but thinks that it ought to be tested at some child support centres with enthusiastic staff and sufficient knowledge before it can be used on a broader scale. He thinks that each country?s technical and training level has to be investigated.

Piia Egel, Specialist at the International Relations Department, Ministry of Social Affairs in Tallinn, said that Estonia has two centres for children at risk, one in Tallinn and one in Tartu. There are some projects about children at risk financed by Denmark. Estonia intends to start a pilot project about street children. Its aim will be to train professionals how to identify street children. The Estonian government will make it possible to buy the PRIDE program and to translate it. A social development centre will be started in Tallinn to train foster families with the help of PRIDE.

Education in sexual and phsyical child abuse Carl Göran Svedin M.D. is a child psychiatrist, associate professor and director of the only specialist clinic in Sweden for sexually and physically abused children. It is called BUP ? The Elephant and was started in 1995. It is situated in Linköping in Sweden. It is a multidisciplinary unit that is engaged in treatment, research and education. There are three target groups: children who have been abused, young offenders and women who been abused during childhood. Everyone working in the unit is involved in research. That is a way to prevent burn-out, as the pressure on people working with child abuse can be very hard. Especially those among the staff who have to look at video-filmed abuse are deeply affected and need de-briefing. The clinic gets about 100 new cases every year. The clinic has taken the initiative to a special course in sexual and physical abuse. It is run by the Faculty of Health Sciences at the University of Linköping. The course offers further training for all kinds of professionals working with abused children and lasts 1,5 years (3 terms). The group meets one day every second week the first term of the course. Everybody included in the multidisciplinary proceedings can attend. This means: social workers, policemen, prosecutors, child psychiatrist and psychologists, pediatricians, gynecologists and therapists. The course is based on the method ?problem based learning? which means that the students formulate the problems and then seek the answers themselves. The teachers mainly have the role of advisors. Much emphasis is laid on the multidisciplinary work and basic knowledge is given about:

- Definitions

- Insidence/prevalence

- Sexuality

- Sexual behaviour among children

- Traumatic memories

- Crisis theory

- How to talk to children

- Police interviews

- Physical abuse

- Sexual abuse

- Law and judicial proceedings After one term the police and medical staff leave the course. Term 2 and 3 is for investigators (social workers) and therapists. The teaching methods used are: seminars, group work, supervision, literature studies and writing papers. The topics for therapists during term 2 and 3 are:

- Crisis intervention

- What is helpful in therapy?

- What is good treatment?

- Individual therapy

- Group therapy

- Family treatment

- The importance of network

- Treatment for the abuser and for the social workers: - Crises intervention - Child protection - Roles of different professions - Models for investigation - What has the social services to offer? - Children in care

 The participants agreed that it seemed likely that most of the content in the course would be possible to spread through video conferences. Common parts could be combined with local training activities.

The Children?s House in Reykjavik

Bragi Gudbrandsson is the Director General of the Government Agency for Child Protection on Iceland. Its tasks are to support and supervise the child protection committees in the country (will be 55 from 1st January 2000). The agency also offers counselling in individual cases, does some research and is responsible for a center for adolescents, residential treatment and for the Barnahuset ? The Children?s House. 1993 ? 96 there were 115 new cases of sexual abuse each year on Iceland, which was considered to be a very high number. 50 of them were investigated by the police, 30 were referred to the prosecutor and 10 were taken to court. Them main reason why so many cases were dropped ? from 150 to 10 ? was believed to be the lack of coherent work. There was also a lack of treatment and support for the abused children. In America the Icelanders found a working model at the Children?s Advocacy Centers, which they took with them back to Iceland. The concept is a multi-agency approach and that all professionals involved work under the same roof. In the Children?s House the child protection services, health services, law enforcement and prosecution work in partnership. Joint investigation interviews are made. This is very important as sexually abused children seldom show any physical signs of abuse and almost never has there been any witnesses. Thus what the child tells becomes crucial. If the interview with the child is not made in a very professional way, there will be no evidence to lean on for the police and the prosecutor. In the Children?s House the interviews are made by specially trained people. It is broadcasted to another room, where representatives from different agencies can follow the interview and also communicate with the interviewer. The interview is videotaped and the tape can be shown in court, which means that the child doesn?t have to appear there. There is also a medical clinic in the house to carry out the medical examinations and assessments. The final part of the programme is to assess the child?s need of psychological treatment. The non-offending parent is also supported. The Children?s House is child-friendly. It is not as frightening as the police house might be. Another advantage is that the child only has to go to one place. During one year 125 children has passed the programme. In 99 cases the suspicions were confirmed. An alarming figure is that 25 % of the offenders were under 18. Until recently all cases of child sexual abuse in the country were referred to the Children?s House. However, the law has been changed which has lead to judges deciding how and where to make the interviews. There is therefore a risk that children from Reykjavik are interwied in court instead of in the ?Barnahus?. It might be that politicians were not aware that this could be an effect of the new law.

Tartu Support Centre for Abused Children

Ruth Soonets is the Head of the center and had invited the participants to visit the centre, which is located in a block of flats in the outskirts of Tartu. The centre was established in 1995 and is run by an NGO. It was the first institution in Estonia to focus on abused and neglected children. A multi-professional team is working there. It consists of 1 pediatrician, 3 child psychologists and 3 social workers. They get supervision by two Swedes. From 10 am to 4 pm people have to have an appointment to come to the centre, but after 4 pm until 7 pm it is an open house.

The main functions of the centre are:

- To provide the abused children and their families with psycho-social and medical counselling and treatment

- To provide training courses for specialists involved in the work with children

- To raise public awareness about abused children

- To develop a network of professionals in the child protection field In one of the rooms there is a video-camera, which makes it possible to film interviews. They sometimes make the interviews together with the police. In another room there are several computers that can be used by children who want to practice. Special activities going on in the centre are pensioners coming to sew and knit together with the children, read to them etc. There is also a project ?Big Brothers. Big sisters?. Christel Altosar, social worker at the centre, informed about this project. Students at the School of Social Work in Tartu are engaged to support children and young people at risk. The centre selects, trains and supervises these volunteers. The centre is involved during one year and then it is hoped that the relation shall continue without any support. Both the children, their parents and the volunteers are satisfied with the arrangement so far. There is a mandatory reporting system in Estonia, but it doesn?t work according to Mrs Soonets. One explanation could be that if no help is available, it is not considered useful to report. Thus more resources are needed to help children at risk. There is also a need for guide-lines, that ought to be confirmed at a national level. The Ministry of Social Affairs was financing the centre from 1995 to 1997. Thereafter both the centre in Tartu and the centre in Tallinn have been financed by the Soros foundation. Next year there will be no more money from the Soros foundation and the future of the centres is uncertain. How can the IT-network be used? Who will gather and forward information? Lithuania: A system for information needs to be created. For instance there ought to be computers in each child centre with the possibility to be connected to internet. The computers plus training would cost about US $ 250 000. Latvia: Internet cannot be reached by many. Connections have to be made to make it possible to use internet for consultations and training for instance.

1. Ingrid Åkerman replied that we cannot wait for the technical development. We have to start with the centres that are already connected with each other. Then they can spread information to others. To get the IT-project going the countries can already now give Helena Casamassima as much information as possible to put into the home-page from now on. The legislation that can be found on the home-page today is not up to date. It needs to be overlooked and then translated. Another topic for the home-page is guide-lines that should be presented both in English and in the native language. Somebody responsible for gathering and passing on information to be included in the home-page needs to be appointed in each country. Sweden is responsible for the co-ordination this year. From 2001 it is hoped that it will pass on to for the CBSS secretariat. All countries considered it possible to make lists of addresses to all centres/agencies/NGO:s etc working in the child protection field. The meeting agreed that all countries should make up such address lists and also keep them up-dated. Is it possible to use IT-project for educational purposes? Training is needed in all countries. It would be a waist of money and time if every country had to work out its own training programme. It was agreed that the education should have a multi-professional approach. To be able to use IT for educational purposes there has to be at least one educational centre in each country that is sufficiently equipped. Ingrid Åkerman will ask the IT working group to estimate the costs. Someone responsible for educational matters has to be appointed in each country. It is also necessary to appoint a co-ordinator. Statistics The lack of statistics is a problem in each country. It was agreed that it would be an advantage if all multi-disciplinary teams used the same questionnaire. Financing It was agreed that the most urgent issue is to stabilise the services for children. For instance the two child support centra in Estonia need a stable economic base. Carl Göran Svedin commented that time-limited projects much too often is all that is offered when it comes to children at risk. The politicians all say that they are concerned, but in reality the child protection field has an ad hoc character. It was agreed that the problem with time-limited projects and the lack of long term strategies ought to be highlighted. It was also generally agreed that it is important to improve practice in child interviewing and law proceedings and to underline the interdisciplinary nature of child protection work. It was noticed that much emphasis is laid on child sexual abuse. However, other disciplines can benefit from this work.

Conclusions

 The meeting agreed on the following:

- That there is an interest in getting ?The Childcentre? started.

- That all countries gather information about law, guide-lines and on-going projects and pass it on to Helena Casamassima.

- That all countries make address lists of child support centres.

- That there is a great interest in creating an educational program. The IT working group should be asked to estimate the costs for technical equipment and also to investigate which type of equipment that will be needed and how the systems can be co-ordinated.

- That the need developing the statistics should be considered.

 PARTICIPATION-LIST - TARTU MEETING 8-9 December 1999

 Sweden:

The Swedish Special Group for Children at Risk in the Baltic Sea Region, Stockholm :

Ingrid Åkerman, Head of Section and Helena Casamassima, Special Adviser

- Carl-Göran Svedin, Associate Professor, M.D. in Child Psyhiatry, University of Linköping

-Barbro Hindberg, Referent

Norway:

- Hans Ganes, - Higher Executive Officer, County of Aust-Agder

- Carin Nordenstam, NRSB ? National Resource Center on Child Sexual Abuse, Oslo

Russia:

- Vladimir Borisov, Director, Centre for Rehabilitation of Children and Youth, St. Petersburg

Lithuania:

Ruta Pabedinskiene, Senior Specialist of the Division of Family and Children Affairs of the Ministry of Social Security and Labour

Latvia:

- Julija Cirule, Bulduri Family Support Centre, Jurmala

 Iceland:

Bragi Gudbrandsson, Director General, Government Agency for Child Protection, Reykjavik

Estonia:

- Piia Egel, Specialist of International Relations Department, Ministry of Social Affairs

- Ruth Soonets, Head of Tartu Child Support Center andChristel Altosar, Tartu Child Support Center