World Vision Middle East, Eastern Europe RegionProduced by the Development, Learning & Impact teamChild Protection & Participation Learning Hub

Building Sustainable Programmes for Children with Disabilities: The World Vision Romania Case

This case study is part of a series of Evidence 4 Change publications that World Vision’s Middle East, Eastern Europe region (MEER) has produced to document the impact of Word Vision (WV) and partner programmes to ensure child well-being. It was prepared by MEER Child Protection & Participation Learning Hub and WV Albania & Kosovo (as its host), with the immense and valuable contribution of the WV Romania team.

Contents

WV MEER Case Study

Acknowledgements and Contact Information

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Abbreviations

Summary of the Issue

WVR’s Contribution to Change

Learning from WVR: Choices toward Sustainable CwD Programming

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Framework for Sustainable Programming 19

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1. Maximise Stakeholder Participation and Coordination2. Increase Child Voice3. Combine Approaches for Diversity, Holism and Empowerment4. Leverage Evidence-based, Local-level Advocacy5. Pursue National Reforms6. Promote Spiritual Nurture

World Visions’s Transformational Change

World Vision’s Social Drivers of Sustainability

The Building Blocks of Sustainable CwD Programming that Brings Change

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WV MEER Case StudyOne of the major directions of World Vision (WV) Middle East & Eastern European Region’s (MEER) 2014–2018 strategy is to intentionally capture, document and publish the evidence-based practices of WV and its partners that successfully contribute to changes in the well-being of children. In this context, the Child Protection & Participation Learning Hub (CPP LH) developed a case study regarding children with disabilities (CwD) with a particular focus on World Vision Romania (WVR) programmes.

Since 1998, WVR held a vision for the well-being of CwD and planned strategically toward it. In this vision, the national office had a desire that CwD living in institutions would be cared for through a creative, innovative model of care. They would be integrated in foster care with no risk of being abandoned. They would be identified and offered

support early, and receive community-based services. It is this holistic vision that inspired almost two decades of WVR’s dedicated programming, which first focused on more than 2,000 CwD and their parents in Romania through multiple local area programmes, and then impacted all CwD in Romania through changes to Romania’s system and services.

The purpose of this case study is to learn from this experience and apply the findings to future regional programming in order to enhance WV’s technical approaches and programming regarding CwD and therefore enhance the well-being of these vulnerable children. The audience for this case study are development facilitators, technical experts, national and regional office senior leadership teams, partners, and donors.

Acknowledgements and Contact InformationCPP LH would like to express the highest gratitude to WVR, especially to Daniela Buzducea, its national director, whose leadership made the documentation of this case study possible and the achievements captured therein, and to Loredana Giuglea, Mariana Arnautu, Aurora Popp and Beatrice Ciubotaru, for their significant input to this case study, continually providing constructive criticism and useful feedback.

CPP LH is thankful to Eljona Boce Elmazi, David Whitbourn and Ioanna Charalambous for their excellent input and contributions.

CPP LH would like to especially thank Lauren Taylor for her brilliant leadership in documenting this case study.

Copyedited by Lynn Otto.Designed by Patrick Thatch.

CPP LH is humbled by the lives of the boys and girls included in the WVR programme who have inspired the work that is documented in this case study, and is grateful to all WVR staff and partners involved in the challenging but rewarding endeavours for child well-being, especially CwD.

For more information, please visit www.wvevidence4change.org or contact MEER_DLI@wvi.org

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AbbreviationsBiH Bosnia and HerzegovinaCPP LH Child Protection & Participation Learning HubCwD Children with disabilitiesEU European UnionGfK Growth for KnowledgeNGO Non-governmental organisationPwD People with disabilitiesWV MEER World Vision Middle East, Eastern European regionWVR World Vision RomaniaYwD Youth with disabilities

Summary of the IssueThe well-being of CwD in MEER is a significant issue. According to a 2016 study conducted by WV in Bosnia and Herzegovina (BiH),1 CwD are one of the most marginalised and excluded groups. They are often likely to be among the most vulnerable and poorest members of the population and are less likely to attend school and have access to medical and social services.2 Their disabilities also place them at a higher risk of physical abuse.

Similar alarming results were reported by a 2016 national disability study conducted in Albania by WV, Save the Children and the research firm, Growth for Knowledge (GfK).3 According to this study, a total of 56 per cent of children between 2 and 17 years old experience at least one type or some degree of disability. Prevalence of moderate or severe disabilities, as reported by parents, across areas of development, learning and emotional/behavioural adjustment is relatively high: 1 in 10 children. This degree of CwD has serious implications for the demands on health, educational and social services, especially the need for early identification and integrated interventions. CwD endorsed by the government commissions for medical certificates are only 4 per cent. This means the majority of CwD in Albania do not have access to the services to which they are entitled. Moreover, the model of certification of disability from government is purely medical, without recognising other domains of child development (such as behavioural, social and emotional in particular). Parents lack access to or knowledge of health and education services. The rate of attending a

health specialist service is very low (below 30 per cent) for the majority of domains of child development. Furthermore, 11 per cent of CwD are not enrolled in school. In the meantime, those who are enrolled do not receive personalised/individualised assistance. Also, only 2 per cent of CwD receive social services.

In Georgia, the situation is unfortunately similar. According to a 2014 baseline study conducted by GeoWel Research for WV in Georgia,4 there are problems in the availability of social services for CwD, as well as problematic attitudes regarding violence towards these children and holes in the social protection system. The level of poverty amongst families who have CwD is also striking. The fact that 44 per cent of the families who participated in the study were formerly officially registered as ‘poor’ strongly supports the belief in the existing literature that disability in a household has a large correlation to poverty. ‘Disability’ in Georgia often carries a social stigma. As a result, some parents may seek to hide the impairments of their children and may do so by not allowing them to engage in society or even leave the house. This is extremely worrying as these children are denied their basic human rights, access to education and services, and are left alone to face the emotional consequences.

In Romania, there are also similar challenges, such as (1) the lack of coherent government strategies for the provision of social care and the scarcity of funding available to vulnerable groups nationwide due to cuts in public service budgets; (2) the lack of

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professional capacity to provide care for CwD, alongside the lack of established spaces and mobile professional teams; (3) unequal access to support by the poorest of the poor, especially in rural areas; and (4) the lack of suitable solutions in the education system.

In 2016, WV MEER launched the Child Protection Index,5 which is an analysis of each country’s actions to end and prevent violence, and care and protect girls and boys in situations of vulnerability. An analysis of a number of the countries’ actions in the area of disability shows that

while governments may have signed the Convention on the Rights of the Child, most countries in Eastern Europe are failing to achieve their commitments to CwD. After focusing on the issues for years, Romania has the highest status, achieving 71 per cent of the necessary actions (e.g. law and policy, accountability, services, capacity) to achieve the government’s commitments under the Convention. Most countries, however, are much lower; the lowest being BiH at only 33 per cent and Kosovo at 36 per cent.

In 2013, the CPP LH conducted a portfolio review of programming for CwD in MEER in

Analysis of each country’s actions to end and prevent violence, and care and protect girls and boys in situations of vulnerability. Scores are provided by issue and based on the five dimensions of government action.

Comparison of Child Protection Issues

order to learn from and contribute to the effectiveness and long-term sustainability of interventions for CwD. This review highlighted learning and the key areas that need to be strengthened in order to best serve CwD. Some of the recommendations that resulted from this review include the need for harmonised planning across the local, national and international level; the importance of placing CwD and their families at the centre of programming

focused on inclusion; and the need to leverage the role of civil society, especially faith-based organisations. Through this process, the review also discovered that WVR’s programming over the past years encountered many successes and brought about change, particularly in terms of working toward the inclusion of CwD in society. As a result, the CPP LH partnered with WVR to learn from their experience.

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While there is still work to be done in Romania toward the inclusion of CwDs, evaluations of WVR’s and its partners’ programming in three of WVR’s area development programmes in Constanta, Dolj and Valcea found that the experience of CwD is much improved compared to the situation in many other parts of the country. CwD in these communities are more protected and are participating to a greater degree in the life of their community and schools, including mainstream schools, more so than other national statistics reveal. The environment around them (e.g. family, community, schools and laws) has also improved for CwD, placing them in a better position to fulfil their rights.

For example, a 2013 evaluation of the Dolj area development programme6 found the following:

• 55 per cent of interviewed parents consider CwD to be integrated and participating in activities

• 53 per cent of parents consider that CwD are treated equally as other children in the community

• 58 per cent of parents consider their CwD’s rights to be respected and protected

• 45 per cent of CwD were integrated in mainstream schools in all communities. Children and parents reported supportive attitudes towards inclusive education.

To a reader outside the Romanian context, these numbers may seem low. They are, however, a significant deviation from the

status quo. According to a 2015 report by the European Centre for Children with Disabilities (CEDCD),7 which has a Romanian branch, there were 60,645 disabled children of school age in Romania of which 31,486 were in segregated special schools, with 17,975 did not attending school at all. This means that 49,461 of CwDs (81.6 per cent) were either not in school or in segregated schools and not in mainstream education.

Further, CEDCD’s research reports that once children go to special schools, they are often trapped there. In Bucharest, out of 3,000 CwD in the special schools, only 30 managed to transfer to a mainstream school. So, while less than 20 per cent of Romanian CwD are in mainstream education, 45 per cent are in mainstream schools in Dolj and 55 per cent of parents interviewed consider their children well integrated and participating in community activities.

WVR’s Contribution to Change

Children with disabilities come to school, they are equal to us; one of them comes to the initiative club with us.

- The Brave Initiative Club from Bucovat

The people treat well children with disabilities, they offer their help.

– Parents from Carpen

Children with disabilities attend the school in the community; they are not marginalised.

– Parent from Argetoaia

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In an evaluation of the Constanta area development programme,8 participants in the evaluation were also asked about their perception regarding the integration of CwD in the communities. More than 65 per cent considered the CwD integrated in the communities and 72 per cent considered their rights protected.

According to an evaluation of the Valcea area development programme,9 medical records show there were 157 children with disabilities registered in area development programme communities at the time of the evaluation, while secondary data from school records demonstrated there were 123 children with disabilities integrated in the schools of Valcea, where World Vision operates, representing 78.3 per cent of children in schools. Additional data from the evaluation showed the following:

• 82 per cent of parents perceived CwD as treated the same as the other children from the community, with 6 per cent disagreeing and 12 per cent who did not know.

• 69 per cent of parents perceived CwD as regularly accepted and integrated in the community/participating in activities, with 8 per cent who disagreed and 23 per cent who did not know.

• 74 per cent of parents perceived the rights of CwD as respected and protected in the community, with 23 per cent who disagreed and 4 per cent who did not know.

Although the annual monitoring process showed that 93 per cent of community

members in Valcea and 68 per cent of teachers understand the importance of including children with disabilities in social life, the parents’ responses gathered during the evaluation showed that there is still progress needed to move from acknowledgement to application. Community members know children with disabilities should be fully integrated in the community and have equal rights and treatment as other children, but the reality is that changes in practices and behaviours take a longer time to happen.

Another result in Romania’s experience was ownership. In Constanta, a parents’ group

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became a formal association as a result of WVR building their capacity and enabling exchange visits with other associations. A partnership between the local government and this local parents’ association then gave birth to the shared ownership of a centre for CwD. As one mayor stated, WVR and partners taught communities to consider the needs of CwD. For example, WVR donated wheelchairs for disabled children, which led to community representatives continuing to provide the wheelchairs themselves.

After the projects were finished, most of the best practices developed and implemented with WVR support were sustained through different ways:

• According to school management, WVR’s approach to training teachers in the necessary skills to work with disabled children is now included in the state curriculum.

• The tools used in screening the CwD within WVR projects introduced in the early days of WVR’s work in 1998–2002, such as Bayley II, Vineland Behavior Scales and Autism Behavior Checklist, Portage and H.E.L.P. (Hawaii Early Learning Profile), are used today as part of the students’ curriculum and also in the practice of professionals in the disability arena.

• The early intervention model of multidisciplinary child intervention

(such as psychologist, speech therapist, special educator and physical therapist) and including parents of CwD as equal partners is embedded in the centres.

• Guidance on how to work with children in a diversity of settings, such as group and individual, inside/outside schools, with/without parent present, parent co-therapist working at home with the baby, is embedded in the rural intervention model (in other areas) with the concept of mobile units.

The programmes also transformed relationships of CwD with government services and with their peers. WVR facilitated access to specialised services, which increased the health status and autonomy of CwD. It also facilitated access to education services, which contributed to their cognitive development and stimulated their interpersonal skills. These services contributed to the social integration chances for CwD, who were able to participate in various events and to socialise and make new friends as part of the community. Some of the CwD are integrated in the public education system, and have good results and good relationships with their peers. They now have the chance to demonstrate that they are resources for their communities.

Social accountability also improved as a result of the projects. WVR built the capacity of the families through various trainings, events and exchange visits with other persons active in the disability area. As a result, families were empowered to continue to support their children and to help them integrate in the community and in the public education system. Parents received information about their rights so that they were able to start a dialogue with the local authorities in order to

The self-confidence of the parents’ association grew during the time, as they were able to start their own projects, raise their own funding and make key-decisions relating to the take-over of the centre together with the local government. Today, the parents manage the centre without WVR support. (Constanta Evaluation)

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identify solutions for the needs of CwD. If the dialogue was not successful at the local level, parents were encouraged to advocate at the county level. One measurable result was the setting up of an inclusive class for CwD at the local community level so that children would not need to commute to Constanta city every day. The state was a partner from the very beginning; the local authorities were always part of events and meetings with children and their parents; and opportunities were explored for ways to successfully take-over the activities.

The evidence of WVR and partners’ work regarding CwD is also reflected in the improvement of legal and policy framework. WVR and partners reinforced the implementation of Romanian Law 272/2004 on the protection and promotion of children’s rights and helped to remove the barriers to healthy relationships that contribute to the sustained well-being of CwD, improving access to the following:

• special care, adapted to their needs (art. 46 par. 2)

• education, rehabilitation, compensation, and integration, adapted to their own opportunities, to develop their personality (art. 46 par. 2)

• the right to enjoy the highest attainable standard of health condition, facilities for treatment and rehabilitation needed

to ensure effective achievement of this right (art. 43 par. 1)

• the right to enjoy a living standard enabling the development of physical, mental, spiritual, moral and social development (art. 44 par. 1)

• social assistance and social security, according to the resources and situation in which the child is located, and of the responsible person that takes care of the child (art. 45 par. 1).

Overall, the centre established for CwD in Corbu,10 a commune in Constanta, is a successful example of a sustainable initiative. The activity in the centre is done by volunteers, with the support of the town hall, and people realised the importance of local services provided at the centre. Teachers and children are involved as volunteers. Family doctors are supervising the activity in the centre, and the town hall covered transportation expenses for the CwD coming from Corbu neighbourhoods for centre services. The ‘Suflete Curajoase’ association is aiming at other funding sources as well, in order to expand the centre. Other small community initiatives aiming to sustain families with CwD were conducted by the Corbu community, such as kids who made and sold martisoare. This is a promising beginning, showing the paradigm shift among the youngest community members. The centre also brought behavioural changes among disabled children, noted in comments such as ‘children are less marginalised, fearsome and their self-esteem has been improved’ and ‘children relate better’. The progress in children’s rehabilitation is evident as stated by the specialists at the centre, as well as by parents and teachers.

Parents’ associations became important elements of social accountability as they are the ones to become a voice for their children’s rights to mainstream education, social inclusion and also rights to appropriate specialised, tailored services to different types and levels of disabilities (for example, autism, Down syndrome).

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Learning from WVR: Choices toward Sustainable CwD ProgrammingThese results took time and were achieved by WVR in collaboration with partners. To address the needs of CwD, WVR started to work to create and implement a model of interdisciplinary and continuum social services that contributes to the well-being of CwD and Youth with Disabilities (YwD) and their families.

Although WVR’s programming for and with CwD did not start with a specific sustainability framework or approach, WVR thought through the opportunities and made adaptations along the way to their programming with sustainability in mind. This ‘create, review and adapt’ sequence was a useful approach to ensure programming became more sustainable, with this sustainability influenced from shifts in the approach throughout the years. The following captures some of this ‘create, review and adapt’ approach:

• WVR’s earliest interventions after the fall of communism, from 1990 to 1997, involved direct response with medical supplies and medical teams, food supplies, clothes, toys for residential institutions and training of caregivers.

• From 1997, WVR provided direct input to the new government reforms in child protection and promoted alternative services to child institutionalisation. It also provided services to families of CwD.

• In 1998, WVR started the implementation of a cycle of projects that addressed disability

from a holistic viewpoint: with focus on deinstitutionalisation, early intervention, family strengthening, inclusive education and labour market access for YwD and parents.

This history provides valuable general lessons regarding CwD for any programme:

• First, existing programming can evolve and move to increased sustainability throughout implementation, although this might not be the initial aim.

• Second, even when programmes need to start small in size to respond to the emerging issues, it is wise and possible to use the initial phase for learning, positioning and then enriching the programme increasingly towards sustainability factors.

• Third, along with solid field experience, advocacy is a core tool and approach to translate evidence and learning from the field into advocacy objectives at the local and national level for broader, more sustainable and scalable change.

The following captures six additional and more specific lessons from WVR’s experience, particularly when looking through the lens of sustainable programming for CwD.

1) Maximise Stakeholder Participation and Coordination Since the beginning, WVR involved a wide range of stakeholders from the local

community level, county level and national level, including public and private institutions in the area of child protection (especially of CwD), local and national authorities, other NGOs, churches, parents and community members.

Through the timeline of implementation of programmes, WVR involved partners so as to return the responsibility regarding CwD to where it should belong. This was a journey of transformation for both WVR and partners. The role of WVR moved from implementer and service deliverer into facilitator, broker or intermediary, capacity builder and technical supporter. In this journey, WVR reinforced the legitimate roles that local and national stakeholders have regarding CwD as a precondition for sustainability. Partnerships were concluded with local government in each local area development programme where WVR developed projects, both at the local and county level, for the take-over of centres after the projects’ completion. Partnerships with other parents’ associations or other

NGOs for CwD or People with Disabilities (PwD) and schools also contributed to sustainability.

Local government and parents’ associations contributed by linking the families with the foster care network and providing spaces for the development of early intervention activities/therapeutic centres and day care for CwD. The university partners’ contribution provided therapeutic services in the centres. This range of stakeholders in WVR’s programming mirrors the formal and informal actors in the WV system approach to child protection as shown in this diagram.

As WVR worked with a wide range of stakeholders, it identified a large gap: the lack of inter-institutional collaboration for child welfare within their context. The gap was identified through a study by WVR in 2012 and 2014, Child Welfare in the Rural Area,11 which (1) revealed both the lack of inter-institutional collaboration and

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When the project in Craiova was ending, the Child Protection Department of Dolj County discontinued the partnership due to a lack of funds. While this marked one of the most challenging situations, it also marked a significant learning point on turning a challenge into an opportunity. The team decided to use their experience with other authorities, who were not part of the project from the beginning. As a result, a new partnership was started with the University of Craiova, Faculty of Physical Therapy, which took over the physical therapy by incorporating the Multi-Functional Centre in the practice curricula for its students.

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children’s needs that remained unfulfilled due to this lack of collaboration, and (2) also negatively affected resource allocation from national and local budgets for emergency child services. There was no coordinated effort or networking among the Ministry of Health, Ministry of Education and Ministry of Labour, Family and Equal Opportunities in direct relationships with CwD and YwD and their parents for a proper child welfare implementation in the area.

In response to these issues, WVR positioned itself in a new advocacy arena and focused on resource allocation and coordination between services. The experience showed WVR that while working in CwD programmes, it is of crucial importance to not only map stakeholders’ relationships but to also analyse and enhance the coordinating role of government amongst these stakeholders. The process to ensure sustainability should include the exploration for coordinating roles of government. Such assessment informed the programming, so WVR started to build capacities for the government staff who were supposed to do the coordination.

2) Increase Child Voice WVR also observed that the voices of CwD and YwD were not often heard. The aims were to ensure that essential services for CwD and YwD were aiding children’s recovery from development delays from their early ages, and to hear the parents’ voices and empower

them to be voices for their children. WVR found that in some occasions, parents did not want to allow their CwD to speak in public or express their needs because of feelings of ‘shame’ from being different and ‘not good enough’. WVR decided to have, in future programming, dedicated processes through appropriately tailored techniques, such as language signs and pictures, to help CwD communicate their thoughts regarding how their rights could be fulfilled, as all other children do.

3) Combine Approaches for Diversity, Holism and EmpowermentOne of the most significant areas of learning for WVR was to diversify its programmatic approaches and blend them to best achieve both impact and sustainability. As the programme went through its previously mentioned ‘create, review and adapt’ process, the programmatic pattern mirrored this reflection-based programming. Through the process, WVR continually and

Starting with improvement of

residential institutions' quality

Moving to introducing alternative methods of care, early intervention,

family support

Enhancing with support services, inclusive education, community-based centres including spiritual

nurture and peer-to-peer support

Landing in supporting parents & disability

NGOs; local, national & international level advocacy; partners'

ownership

strategically enriched the focus, enabling the programme to move from direct service in residential institutions to more holistic services to build the capacity of and empower local partners and actors that led to better and more sustainable results. In this process, a five-dimensional approach ultimately informed the strategy to diversify and create holism and empowerment, an approach that could be adapted to any CwD programme. The approach included (A) embracing a lens of child protection, (B) introducing alternative methods of care, (C) organising mobile medical teams, (D) involving a professional development programme, and (E) fostering local ownership for integrated services.

A. Embracing the lenses of child protectionOne of the first key elements was to adapt programming to include child protection. Disability-focused programmes implemented by WVR benefited from solid child protection components, in particular those related to increasing the quality of child protection services at the local level. Benefits were also produced when focusing on specific goals, such as deinstitutionalisation of children, and offering specific solutions, such as developing a foster care system, where ownership at the end remained local—within the local child protection structures.12

WVR aimed to reinforce the circle of care for CwD and, by doing so, transform relationships to contribute to sustainability. The circle of care initially included medical and charity models, and then expanded to social inclusion, a third dimension which helped increase self-esteem and courage to experience new things. The new experiences

helped CwD and their parents to become closer, to have hope and to trust each other. Their example of commitment was inspirational for local community members, volunteers and other stakeholders, who were encouraged to support the project activities, to contribute to fundraising, to invite CwD to various events to facilitate their social inclusion and to build social cohesion. Strengthening these aspects can build collective efficacy and social cohesion.

B. Introducing alternative methods of careAnother key element was to introduce alternative methods of care. Early interventions (1998–2002) addressed improvement of residential institutions’ quality, while at the same time introduced alternative methods of care13 such as building the capacity of institutional caregivers, providing early intervention, offering family support services and creating connections with the local community. The combined approach helped to integrate children back into the communities.14 It is important to note that WVR did not support institutionalisation in any of the projects, but rather created these alternative services to prevent child abandonment. These are some examples of the alternative services:

• In 2009, a maternal shelter was opened for pregnant mothers and mothers with babies in vulnerable situations of abandonment, with a capacity of 8–10 couples.

• In 2010, a day care centre was opened for children 0–4 years old, with capacity for 30 children.

• In 2012, a rehabilitation day care centre was opened for a capacity

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of 60 children, 0–10 years old. All children could come every day and benefit from free services provided by the child protection department, sustained with public funds from the local council.

• In part of an old orphanage15 that maintained a small residential institution to provide specialised services and medical treatment for 20 children with severe disabilities who could not be placed in alternative services such as foster care or home groups, WVR trained the caregivers and adapted a life-skills programme for those children and offered inclusion activities in the community. A priest helped youth use the time in a constructive way and organised spiritual-nurture activities. These efforts changed the environment of the multifunctional centre.

At a later stage (2008–2015), training was offered to the local child protection staff to raise the quality of services for institutionalised children with severe disabilities.16

Other services introduced included early intervention and tailored care for each child with rehabilitation therapy, socialisation activities, daily meals and life-skills training, as well as independent living in home groups – all of which were success factors.

C. Organising mobile medical teamsAn approach for reaching CwD in rural or remote areas was to organise a mobile team of rehabilitation professionals, which included a physical therapist, psychologist, speech therapist and social worker. The

mobile team paid weekly visits to children’s homes for therapy and guidance. In some regions, schools or kindergartens were also used as locations for individual and group rehabilitation activities.17

D. Involving a professional development programme WVR includes professional development. The interventions included guidance to parents, teachers and children on inclusive education, mentoring the school to include CwD, helping parents establish peer-to-peer support, organising campaigns to raise awareness and continuing professional development programmes for teachers on individualised teaching.18 Parents accessed information and counselling, peer support and vocational training opportunities.19

Resource centres for information and counselling for parents and children were established. Parents’ associations were empowered as a result of the centres and have become advocates for CwD issues. Supporting and strengthening parents’ capacities to act in associations was an approach for stimulating influence and advocacy.20

E. Fostering local ownership for integrated servicesAccessing EU funds for projects in partnership with local partners was important to expand interventions. Some of the project outcomes were the development of skills, behaviours and attitudes of the targeted group, which can be utilised throughout life because strong partnerships and respect for each other underlies the successful implementation of interventions and project sustainability. Each partner participated in preparing the

application, contributing to sustainability, evaluating the project, providing financial and human resources and maintaining a management plan.21

Local partnerships established community-based centres, which served as integrated models of social, educational and rehabilitation services for the needs of CwD and included group therapy sessions, support groups for parents, vocational guidance for YwD, coaching sessions for youth to link with the labour market and information campaigns on children’s rights. Again, the combination of these approaches was a critical factor for rehabilitating CwD and YwD and increasing their chances for integration in public education and the labour market.

Sustainability was strengthened by, among other things, creating affordable and child-friendly centres, combining resources (such as World Vision’s private nonsponsorship funding, EU funding, local donations, gifts-in-kind and community resources), relying on volunteer work, creating internship opportunities for students, developing a transition plan jointly with government authorities, relying on parents’ support to fill the gaps that government alone could not manage and sharing documented best practices with practitioners and parents.

WVR learned many lessons in establishing the community centres, which included the following:

• In order to obtain commitment for budgeting, a detailed plan and agreement need to be made along with the commitment. Doing so provides an opportunity for local government to more easily make a commitment for some parts of the budget line, if not all. A transitioning budget agreement can be developed with local government so that, each year, the government progressively increases its commitment or looks for funding sources other than WV.

• The plan needs to be well thought out, but also to have some flexibility. In case the local government does not take over the project, WV needs a clear plan B, such as empowering a parents’ association to assure short-term sustainability while continuing to advocate for governmental responsibility regarding public services for CwD.

• Working with middle management helps ensure sustainability given that the heads of institutions might leave since they are in political positions.

• Due to the high turnover of local administration staff, especially after elections, it is important to nurture relationships with other, non-political government representatives so that projects can continue without side effects caused by the changes.

• Interventions must be complemented with guidance services and vocational training, followed by employment services for YwD.

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In Constanta, a blended partnership between the local government and the local parents’ association (Med-Cer Parents Association) gave birth to the shared ownership of the centre from Medgidia. One important factor was the active involvement of the local mayor of Medgidia and the parents’ association, who understood their roles and contributed to the project development.

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Six out of ten multifunctional centres remained operational after the closure of the project, a result of the strategic partnership with local authorities, parents’ associations, universities and other partners.22 Centres were legally licensed to exercise their activity, setting a model for multidisciplinary programme interventions for CwD and YwD ages 0 to 23.23

The diversity of the interventions was implemented in partnership with local government, the parents’ association, other NGOs and churches, which in turn contributed to sustainability drivers such as ownership, social accountability and partnering.

4) Leverage Evidence-based, Local-level Advocacy Through either direct intervention or advocacy, building evidence on the child protection system gaps in order to address the rights of CwD was core to the programme.

In 2007, through a direct intervention programme for institutionalised children, WVR identified 1,000 CwD who did not have access to services. In response to this, WVR addressed the issue to the child protection department, involved parents of CwD, wrote public petitions and engaged in public debates with key actors on CwD rights. After three years of local-level advocacy, the authorities prioritised and allocated funds to create new sustainable services for CwD in the community. In 2008, after evaluating the situation of all institutionalised children in Santa Maria Orphanage, WVR found that five out of 140 children without parental care were living with the extended family.

WVR worked in partnership with the child protection department during 2007–2013 to deinstitutionalise the children from the orphanage. It created alternative services and partnership with other NGOs to place orphan children in family-type home groups and foster care. For the children with severe disabilities, WVR improved the living conditions and staff capacity to provide quality services in the same institution. The home group model was created by WVR in 2010, benefitting 40 children.

WVR used local-level advocacy beginning in 2008. WVR supported parent’s associations and informal structures of parents to organise around issues of CwD in the community and influence authorities. The local pressure created through dialogue, awareness of decision makers and a focus on finding solutions as a community was beneficial to building a sustainable partnership. This partnership was critical to creating a new continuum of services for the development, participation and equality of CwD. Additionally, previous projects developed by WVR in its local area development programmes laid a good foundation for future collaboration, as the trust relationship was already established. For certain issues, such as the multifunctional centres, media also played an important role in influencing the change.

5) Pursue National Reforms Experience demonstrated that parents’ groups can be effective in influencing policy change and the allocation of resources for meeting the specific needs of their children. WVR, in partnership with the parents’ association, appealed to and influenced the local council in one area development programme to allocate space

and resources for CwD services, which would create opportunity for inclusion. Parents’ associations became involved in monitoring the implementation of existing laws, encouraging other parents to push for improved access to educational and rehabilitation services for their children, and advocating together for the rights of CwD. WVR facilitated exchange-learning experiences between parents’ associations in the country and abroad, encouraging them to organise advocacy campaigns on CwD rights, community awareness events in public spaces and schools, and round tables to debate with central and local authorities regarding short- and long-term solutions.

Alongside family and services support, WVR joined forces with other NGOs to impact the disability landscape in the realm of policy implementation to reinforce the implementation of Romanian Law 272/2004, which aimed to remove the barriers caused by society that inhibited CwD from enjoying their rights. The wide range of influence covers care, education, inclusion, development opportunities, compensation, social assistance and social security, in order for CwD to enjoy a living standard that enables their physical, mental, spiritual, moral and social development.

6) Promote Spiritual NurtureWVR promoted spiritual nurture in all the activities with children, parents and child protection staff by involving the churches from the community to be part of the urban ministry. Through partnerships with local churches, priests and pastors provided spiritual nurture, and the Christian faith became a resource for children, parents and child protection staff.24

For example, the child protection department understood the importance of faith development. They created a small orthodox chapel in the Santa Maria Centre and hired a priest to provide spiritual support and invite the community members to the multifunctional centre. Weekly, the priest visited the home groups with orphans and provided pastoral care for those children and for the staff who worked with them. Monthly, the priest organised a special devotional time for parents and CwD in the Santa Maria Centre. Parents, children and staff have come to know that this pastoral service will always have an open door and open ears; they can speak and seek support without shame. This pastoral service complemented the other services created by WVR for the most vulnerable children; once other needs were covered, addressing the need for spiritual development naturally followed.

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Framework for Sustainable Programming

WVR’s experience demonstrates that sustainable programming for CwD is built through different societal levels and social drivers, which apply across programming. Over time, its ‘create, review and adapt’ approach to its programming with CwD came to effectively demonstrate World Vision’s overall organisational approach for sustainable programming.

World Vision’s Transformational ChangeFirst, as an organisation, World Vision believes transformational change comes through engaging a number of different levels to sustain child well-being:

1. children as key actors in their own well-being and partners in development

2. households and families

3. communities

4. the broader enabling environment of systems and structures for child well-being.25

World Vision’s Social Drivers of SustainabilityWorld Vision has also identified key social drivers of sustainability that are built into its Development Programme Approach and increase the likelihood that improvements in children’s well-being will continue beyond WV’s involvement in a programme area.26 There are five:

Local ownership means that the programme vision and priorities are developed with and owned by the community and local partners

after an in-depth shared exploration of child well-being in their own context. It also means that there are clear plans for how local actors will continue mutually accountable dialogue and action on child well-being priorities after WV’s engagement has ended.

Partnering evolves through shared projects and is developed and implemented by multi-stakeholder working groups. Local groups and organisations develop and use the skills to work effectively together for child well-being, balancing their priorities and interests. Governments, regulators, traditional structures and the private sector are engaged and play a role. Churches and other faith-based organisations are actively engaged, building on their sustainable presence and influence with their congregations and wider communities.

Transformed relationships become visible as God calls World Vision and the Church into a ministry of reconciliation. Men, women, girls and boys care for each other, for their community, for their environment and the wider world. Relationships within households and communities are defined by trust, equitable gender relations, conflict prevention and resolution, voluntary sharing of time and resources and the valuing and protecting of all children, especially the most vulnerable.

Social accountability involves ongoing activities by citizens and local groups to hold government service providers accountable for the quality and quantity of services delivered for the community in general, and for children more specifically, against what is called for in plans and policies. The

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community members develop a greater sense of their own agency and power to impact systemic and sustainable change.

Building resilience and reducing disaster risk is integral to sustainable child well-being. Community-based adaptation and risk reduction approaches are also built into the development programme approach and act as an ‘insurance policy’ that protects the development gains of households and communities. Building a culture of resilience and adaptive capacity through knowledge and education about risks enables vulnerable families to thrive and not just survive shocks and stresses.

The Building Blocks of Sustainable CwD Programming that Brings ChangePlotting the lessons learned and the practice of WVR against the four areas of World Vision’s Transformational Change (x-axis) and World Vision’s Social Drivers of Sustainability (y-axis), the following strategic framework emerges that can guide practitioners for sustainable programming for CwD. The framework can be useful to practitioners and programme designers when thinking about the components necessary for a holistic, sustainable programme.

Children Families Communities Systems & Structures

Social Accountability

4. Leverage Evidence-Based Local Level

Advocacy

Resilience 2. Increase Child Voice

3. Combine Approaches for Diversity, Holism and Empowerment (C. Mobile Teams, D. Professional Development

Programme/Resource Centres)

Transformed Relationships

6. Provide Spiritual Nurture 3. Combine Approaches for Diversity, Holism and

Empowerment (B. Alternative

Methods of Care, D.

Professional Development Programme)

5. Pursue

National Reforms

3. Combine Approaches for Diversity, Holism and Empowerment (A. Child Protection, D. Professional

Development Programme)

Partnering

3. Combine Approaches for Diversity, Holism and Empowerment (B. Alternative Methods of Care)

1. Maximise Stakeholder Participation and Coordination

Local Ownership 3. Combine Approaches for Diversity, Holism and Empowerment

(A. Child Protection Services, E. Community Centres)

Wor

ld V

isio

n’s

Soci

al D

rive

rs o

f Sus

tain

abili

ty (y

-axi

s)

World Vision’s Transformational Change (x-axis)

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Endnotes1. WV Bosnia and Herzegovina, Children with Disabilities in Bosnia and Herzegovina: I Don’t

Think I Am Different (2016).

2. Ibid.

3. WV Albania, Save the Children, and GFK, Prevalence of Child Disability in Albania: National Household Survey (2016).

4. WV Georgia and GeoWel Research, Baseline Study for WV Georgia: Caucasus Sub-Regional Social Inclusion of CwD Project (2014).

5. http://2016.childprotectionindex.org/

6. See WV Romania, Evaluation Report: Dolj Area Development Programme (2013), 19. The evaluation used a sample size of 302 participants, through a mixed methodology of (a) desk review; (b) focus groups based on ‘Child cared for, protected and participating’; (c) caregiver survey; and (d) lot quality assurance sampling (LQAS).

7. M. Turza, 100 milioane euro/an – costul izolării copiilor cu dizabilităţi, European Centre for Children with Disabilities, 20 October 2015, retrieved 14 February 2017 from http://www.cedcd.ro/100-milioane-euroan-costul-izolarii-copiilor-cu-dizabilitati/.

8. WV Romania, Evaluation Report: Constanta Area Development Programme (2012), 19.

9. WV Romania. Evaluation Report: Valcea Area Development Programme (2014), 17.

10. Corbu is a commune in Constanta ADP. It has been part of the sponsorship programme since 2003.

11. G. Badescu and N. Petre, Bunăstarea copilului din mediul rural: 2012 (Risoprint, 2012), retrieved 30 April 2016 from http://www.worldvision.ro/_downloads/allgemein/Raport_Bunastarea_copilului_din_mediul_rural.pdf.

12. WVR, Child Welfare and Protection Project (1998–2002).

13. This was the case of the Child Welfare and Protection Project and the Early Intervention Programme.

14. WVR, Early Intervention Programme.

15. Santa Maria in Bucharest sector 5.

16. WVR, Empowerment and Mentoring Programme

17. This approach was implemented during 1999–2013.

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18. WVR, Inclusive Education Program (2008–2014).

19. WVR, Changed Forever (PNSF) Project (2010–2013).

20. WVR, Information and Counselling Centre for Parents with Children with Disabilities (2008–2010).

21. EU Project, ‘Multifunctional Centre, a chance for the future of children and youth with physical, mental and social disabilities from the North-West, South-East and South-West Oltenia region’ (2010–2013).

22. Ibid.

23. WVR, Changed Forever (PNSF) Project – Bucharest Urban Program Sustainability in 2016.

24. A. Arnautu, The Transition Plan for Urban Area Programming, Bucharest Sector 5 FY14–16 (WVR, 2014).

25. This section is adapted from a WV Second Discussion paper, Sustained Child Well-being: How Can World Vision Best Contribute? (WVI, 2014), by Camilla Symes, Senior Director, Development and Programme Effectiveness, and the review committee from the WV Child Development and Programme Effectiveness Team (CDPE) and the Global Knowledge Management Team.

26. This Development Programme Approach describes the essentials of WV development work, focusing on equipping local-level staff to work effectively with communities and partners toward the sustained well-being of children, especially the most vulnerable.