Intellectual Disability Services in Bulgaria

by Angela Lynch, Principal physiotherapist with KARE Services Co. Kildare


While progress has been made in many aspects of support for people with intellectual disability in Bulgaria—largely prompted by the EU accession process—little changes have occurred in relation to the provision of early intervention for children with disabilities. EUMAP has made specific recommendations that early intervention services should be made widely available throughout Bulgaria in order to maximise the potential of children with intellectual disabilities and facilitate their social inclusion to the fullest extent (www.eumap-org).

Failure to make progress in this area has been one of the stumbling block on Bulgaria’s progression to full accession of the EU (UNCRC, 2008).

In October 2008 the South West University at Blagoevgrad undertook an awareness-raising conference on early intervention—the first conference in Bulgaria on this topic. The Sisters of Charity of Jesus and Mary, Moore Abbey (Muiriosa Foundation) and Inclusion Ireland (through the Adam’s Fund) have been involved in partnership projects in Bulgaria since 1990 and through these contacts, I was invited to participate along with three of my colleagues to relay our experience at the conference, presenting our model of early intervention in the Kildare /South Wicklow Early Support Team. The conference was the first step in raising awareness about early intervention practises and models of service, and to support the emergence of a framework for early intervention from the responsible directorates of social care.

Following the conference, a two-year pilot project on early intervention was agreed, to be supported by a grant from the Irish Embassy in Bulgaria. This was to be a partnership between the municipality of Vidin and The Children’s Home in Vidin, with the team from the Sisters of Charity of Jesus and Mary providing a support and training role. The University of Blagoevgrad team, led by Dr Vaska Stancheva, provides an evaluative role in relation to the project. The pilot project is set to last two years, with the aim of developing an early intervention team to address the needs of 15 children (aged 0-7) with identified disabilities living at Vidin Children’s Home. It will also support the development of an outreach program for children living at home.

According to 2001 data from the National Institute of Statistics, there are about 30,000 children with disabilities in Bulgaria.(Petia Gueorieva – conference presentation March 2008 )A National Strategy for Protection and Social Integration of Children was drawn up (2003-2005) to guarantee implementation of the UN Convention on the Rights of the Child and to provide for the protection and social integration of children with disabilities in Bulgaria.

The predominant institutional model of care in Bulgaria to date has centred all supports for people with disability, and ongoing health or care needs, through large care homes and orphanages. Unfortunately, there has been little ‘emptying’ of these orphanages, with a disproportionately high number of children with disabilities continuing to be admitted to them because of a lack of integrated services for young children in the community. (Approx 19,000 children with mental, psychological and physical impairments resided in institutions, according to 2001 statistics.) Service developments to date have primarily been in the area of education and adult deinstitutionalisation and the development of day centres. While these are without doubt positive developments, the existing model continues to be one of specialists/experts providing intervention at a remove from the context of family and society. For very young children with disabilities there still appears to be the lack of an integrated response to support the families of these children, with no clear access to services, no early intervention teams in place in the municipalities, and with many specialists providing services in isolation from parents and other specialists.

To date, the Irish team (which consists of a speech and language therapist, two clinical psychologists and a physiotherapist) has visited Vidin twice, with a further visit planned before the end of 2009. The objectives for the Irish team include:

  • Developing a process of screening, team assessment and support for families and children in liaison with the professionals working in the Children’s Home in Vidin,
  • Ensuring the skills and knowledge in place can become more focussed to provide support to children, carers and families,
  • Supporting the local team to strengthen their outreach into a community setting,
  • Developing criteria for access to an early intervention service, and
  • Supporting the development of the team as a knowledge centre for parents and other professionals.

The work that has taken place within the visits so far has included developing a process of assessment through play, the evaluation of eight children resident in the Children’s Home, working on a process of EI with the team, discussion of the core concepts and practises in early intervention, development of plans for children/families, and strengthening the team approach. Short workshops on autism, feeding, and managing children with multiple disabilities were also presented to influence practice among all the participants and to aid the process of sharing information across professional boundaries for the benefit of the child. The issue of maintaining a professional ‘aloofness’, which is prevalent in Bulgaria, has been a particular surprise and difficulty for me personally, as full parental involvement and open communication of relevant knowledge has been an integral part of practice in my experience.

The project has presented many challenges, not least the difficulties and reduced pace necessitated by the language barrier. There is a significant lack of information and resource materials and much time is lost and effort diverted into trying to address this. The larger picture is, of course, the cultural context of a country just emerging from the authoritarian approaches of communism and the subsequent economic difficulties that followed, as well as the slow transition from a pervasive medical model of care.

Future visits may continue to focus on the development of a process or framework that the Bulgarian team feel may fits the context in which they are working, involving parents as partners in the therapeutic process, as well as further workshops on topics identified by the team in Bulgaria.

Contact with the university team has been maintained and they had an opportunity to visit Ireland in June of this year to build on their own knowledge. The hope would be that some of this could be incorporated into their university training for new therapists. The visit also strengthened their links with the project, in that they are supporting the team in Vidin in carrying through on target areas agreed between visits of the Irish team. While the project still has 15 months to run, some evaluation of progress seems necessary at this point in order to ensure that the outcomes for all the partners are achieved, or at least that progress is made towards meeting these goals.

On my recent visit there was an opportunity to visit some beautiful sites in Bulgaria, the most memorable to me being Rila Monastery and Blagordchik rock fortress. Vidin itself is situated on the bank of the Danube and is a town that has been occupied by many invaders over the centuries, all of whom have left some impact upon the town and area. We were also warmly welcomed and entertained by the local branch of BAPID, the Bulgarian parents group for people with intellectual disability.