In this section, models of good practices of deinstitutionalisation and of community based care services are presented. These models can serve as examples for organisations but also for the society as a whole as it proves that the transition to community-based care is possible and beneficial for all.
The Open Dialogue approach
Recovery as a function of being in life
Open Dialogue is an innovative, network-based approach to psychiatric care that was first developed in the 1980s by Jaakko Seikkula, Birgitta Alakare, Markku Sutela and their multidisciplinary team at Keropudas Hospital in Tornio, Finland. In contrast to standard treatments for early psychosis and other crises, Open Dialogue emphasizes listening and collaboration and uses professional knowledge with a “light touch” – rather than relying solely on medication and hospitalization. It comprises both a way of organizing a treatment system and a form of therapeutic conversation, or Dialogic Practice, within that system.
Several Key Principles of Open Dialogue
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Immediate help that begins with a treatment meeting within 24 hours
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A social perspective that includes the gathering of clinicians, family members, friends, co-workers and other relevant persons for a joint discussion
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Embracing uncertainty by encouraging open conversation and avoiding premature conclusions and treatment plans
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Creating a dialogue, or a sense of “with-ness” rather than “about-ness” with meeting participants by dropping the clinical gaze and listening to what people say – rather than what we think they mean
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EQ – Positivity based on longevity of experience
EQ has made its views known at policy level. However, in the context of delivering day-to-day care to children and young adults with special needs, dwelling on difficulties is highly counter-productive. No organization can pursue quality from a standpoint of adverse criticism and negativity.
We are actually very fortunate in three respects:
1. We have been directly involved in the management of family-type accommodation since the introduction of the practice in Bulgaria. The Ruse facility for disabled children commonly known as the Pink House (see below) has received a great deal of attention since it opened in 2009 to help support the closure of the notorious Mogilino institution for children with disabilities.
2. We manage the centre of social support of children and families from which we draw managerial and material resources
3. Through dogged campaigning, extensive media relations and the development of a strong and sustainable relationship with the local community, EQ has contributed to disability awareness in the Ruse region. These relationships provide organizational confidence, a steady flow of material support and access to community resources.
The Pink House – development of a working model
The Pink House has come to be seen as a centre of excellence. What are the key components of this success?
1. A non-ideological approach: It is very easy to become rigidly attached to models introduced to Bulgaria from other countries. International know-how is important but so are the discernment and flexibility that allow development at a pace that is compatible with local conditions.
2. Celebration of small successes: A gradualist approach was essential – the ability to say “We aspire to these standards but we are not there yet. It will take time.” We chart each child’s progress meticulously supporting the development of independence. We believe in the capacity of those children in our care to achieve self-actualization. However, this is something that emerges naturally and it shows itself in subtle ways. We avoid the temptation to act as “helicopter care providers” that is something akin to over-ambitious parents. Patience is our watchword.
3. Extensive outdoor activity: One of our earliest priorities was the development of an enclosed sensory garden adjacent to the Pink House. The more able children help with EQ’s cultivation and drying of herbs and seaside holidays have become an annual fixture.
4. Significant input from the Ruse complex for social support of children and families: The complex provided a managerial (and social) hub, access to a multidisciplinary team and myriad resources (including the potential for top-up funding). Management of the Pink House as a discrete venture would have been extremely difficult. By the same token, the ability to use the Ruse complex as a resource pool provided the confidence to take over the management of the two FTPCs for young adults created under the national DI programme.
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A CCF/HHC MOLDOVA’S INNOVATION: SOCIAL CRECHE
The European Expert Group on the Transition from Institutional to Community-based Care 