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Expedited Case Management during Covid-19

Farzana Tamboli, Education Coordinator at Miracle Foundation, was recently published in India Alternative Care Networks’ (IACN) quarterly newsletter. Click here to see the full newsletter or read Farzana’s article below.

Explore and assess the possibility of safe reintegration of children through the Expedited Case Management Process during Covid-19

By Farzana Tamboli

Education Coordinator, Miracle Foundation India

BACKGROUND AND CONTEXT

When the COVID-19 pandemic hit India, several states mandated children in Child Care Institutions (CCIs) to be sent back to their families to avoid the risk of infections in crowded institutions. At the same time, this created a potential risk for harm for children sent home immediately without any prior preparations. These children returned to families who were facing financial setbacks due to the pandemic in addition to the pre-existing hardships that landed children in CCIs in the first place. Two hundred seventy-two children from Miracle Foundation India (Miracle for this article) facilitated 08 CCIs to restore children in their families.

To ensure the safety of children and their fundamental rights, we re-focussed to:

  1. Provide immediate relief support to children and their families for basic necessities
  2. Ensure continuity in care by delivering services and connecting virtually
  3. Deploy a reliable framework to Expedite Case Management (ECM) for low-risk placements so families can stay together post-lockdown

PURPOSE OF ECM

The purpose of ECM is to determine the feasibility of permanent reintegration of children in their families quickly and without long periods of preparation during urgent circumstances such as natural disaster, civil unrest, COVID-19, immediate official orders. Miracle developed it in response to the immediate return of children to their families due to COVID-19. ECM is aligned with the Honourable Supreme Court of India’s orders urging CCIs and child protection functionaries to follow up and support children to stay in families’ post-lockdown and can be customised to fit different contexts.

The goal is for children to remain in their family home after the urgent circumstances end, if possible, or move to other family placement such as kinship or foster care as appropriate. That means completing the paperwork/ procedures of reintegration and avoiding readmission to the CCI after the urgent situation subsides.

CASE MANAGEMENT PROCESS

To ensure adherence to the standard Case Management (CM) process consisting of Assessment, Planning, Implementation, and Follow-up, and to address the immediate needs of the child considering the urgency of the process and situation, the following steps are followed.

Interventions activated are carried forward in the long term and uphold child rights long after the pandemic ends.

  1. Prioritising Children for Permanent Placement
  2. Assess Safety
  3. Home Thrive ScaleTM
  4. Minimum Standards for Permanent Placement

The CCI teams were trained in using the CM tools and trackers. The Case management tracker helped us to analyse and prioritise children having the most significant opportunity and possibility for permanent placement through summarised information in one place. The importance was given to build relationships with the families and children and support them remotely in this crisis and unpredictable situation. After identifying potential reintegration cases, we assessed the families using our proprietary Home Thrive ScaleTM tool developed by Miracle. The Home Thrive ScaleTM is a rights-based tool addressing 24 of the 42 rights listed in the UNCRC (1989). During this process, guidelines for remote interactions were followed, and consent was taken from the child and family. The findings and documentation helped us to get an insight into the strengths and concerns that needed intervention, highlighting actions required for permanent placement.

In an ideal situation, we follow up with the re-integrated child for a minimum of two years. The structure of follow up visits is – 1st month, 3rd month, 6th month, 1 year, 1.5 years and 2 years. Due to the ongoing pandemic, the Home Thrive ScaleTM was updated fortnightly for some critical cases, otherwise monthly for all the families during follow up since August 2020.

The assessment process using The Home Thrive ScaleTM helps us to find out minimum standards for permanent placement. It calculates the percentage score for each domain along with the overall Home Thrive ScaleTM score. These values help us understand if the family is – vulnerable, in crisis, safe or thriving. At this stage, we considered other factors like – the safety of the child, absence of neglect/abuse, the willingness of family and child to live together, availability of resources to fulfil basic needs of the child, including the availability and access to health, mental health and education facilities. In cases where high or critical risk was found, the child was moved to an alternative family setting or returned to CCI with the approval of the Child Welfare Committees (CWCs). Around 61 children returned to the CCIs due to child protection risks, the debt burden of family, family discord, migration of parents/guardians, among others.

When making placement recommendations, in addition to the assessment of safety and the Home Thrive ScaleTM, we ensure the CCI makes the updated assessments available as well (like Social Investigation Report (SIR) and Individual Care Plan (ICP)).

While implementing the process, the families were linked to social protection schemes and NGOs such as Haqdarshak, Counsel to Secure Justice, Anulom. The other aspects of support included providing tablets to children who lacked access to digital devices, cyber security training to the children and the staff members, online financial literacy sessions, life skills education, awareness on child abuse.

CHALLENGES AND LEARNING

Preparedness of family and children is essential in the transition process. After restoration, children witnessed changes in the daily schedule, meals, and playtime. A few children reported weight loss because of the change in diet. The issues were addressed with rigorous guidance to the families to make them aware of the nutrition value of different food sources available to them, the health needs of the child, and the importance of personal and environmental hygiene.

Remote counselling sessions with children and parents conducted by the consultant Psychologists helped to address the psycho-social needs of the children and families.

The CCI teams were facing difficulties in reaching out to families, conducting remote assessment due to poor mobile network or the unavailability of phones. In this situation, the services of community volunteers and resources such as AWWs, ASHA and Village Head were utilised as “community watch” for ensuring child safety. The CCI teams and Miracle presented the updates on ECM processes with the families to the CWCs wherever possible. “Collaboration is the key” has been kept in mind while working with the children and families. A WhatsApp group of parents/guardians was created to encourage sharing and learning, creating a sense of solidarity and ensuring the active involvement of families and children in the reintegration process.

Miracle was supportive in handholding when CCI teams had extensive workload right from dividing the caseloads to the redeployment of other care giving staff. The process was complemented with diversion of funds by the State, corporate social responsibility partners and individual donors to ensure the basic necessities of children and families were met.

CASE STUDY FROM A CCI IN MAHARASHTRA

After the demise of her father, Neha’s mother was unable to take care of her and her sibling. Her paternal uncle was feeling burdened with the added responsibilities of the family and was unable to provide for them. This pushed Neha’s mother to take the hard decision of placing Neha in a CCI. Neha returned to her family in March 2020 in light of the lockdown due to the pandemic.

To support a smooth and safe transition, the CCI intervened in the following ways-

  1. As a part of the regular case management process, ICP, SIR and Home Thrive ScaleTM assessment were conducted
  2. Intervention with Neha: Health & education support, relationship, psycho-social counselling support and life skill education support
  3. Intervention with Mother: Family and social relationship, CCI team supported her to build relation with the neighbours and brother-in-law’s family. She is a daily wage earner.

After she moved with her family:

  1. PRIORITISED FOR PERMANENT PLACEMENT
  2. REGULAR REMOTE FOLLOW-UPS AND HOME THRIVE SCALETM ASSESSMENT
  3. DEVELOPED INTERVENTION PLAN

Today, 13 years old Neha is happily re-integrated with her family. Her mother supports her paternal uncle with his farm. Regular interventions, counselling and support helped her uncle feel empowered to take care of his brother’s family. Her mother was guided to apply for widow pension and other social protection schemes.

IMPACT

  • Out of 272 children in ECM, 180 children are permanently placed
  • Children are thriving which has been reported through an average of 68.6% on the Home Thrive ScaleTM • 100% children continued with school education and 96% (109 out of 114) with higher education and vocational training
  • 145 families were connected to social protection schemes.
  • Engagement with 7 districts authorities (around 20 members) to orient on ECM
  • Regular follow up helped connecting to children on timely manner who were under the risk of child marriage: dealt with 2 such cases successfully
  • Increased awareness among families on importance of supporting children in pursuing education remotely while being in families
  • Families are aware of different schemes, resources available and gain confidence to access it.

NEXT STEPS

Miracle’s experience of working with CCIs during the pandemic using ECM reiterates that many children staying in CCIs have families who would be willing to be with their children if they are supported in a timely, adequate and sustainable manner. We are consistently working with children and families towards continuity of the placement, ensuring that children are safe and thriving in families. Our work with the CCIs continues, with an aim that children are placed in their families wherever possible. If not, they have access to a range of care settings that are family-based.

 

END NOTES

Resources

Contact for more information and support with using the tool at safelyhome@miraclefoundation.org. The tool is part of a case management toolkit available on Miracle Foundation India’s website which also includes guidelines, templates and the Home Thrive ScaleTM.

 

References

UNCRC, November 20, 1989,

https://www.ohchr.org/en/professionalinterest/pages/crc.aspx

  1. Right to Best Interests of Child; Right to Life, Survival and Development; Right to Sharing Thoughts Freely; Right to Protection from Violence; Right to Health, Water, Food, Environment; Right to Food, Clothing, a Safe Home; Right to Protection from Harmful Work; Right to Prevention of Sale and Trafficking; Right to Making Rights Real; Right to Keeping Families Together; Right to Protection of Privacy; Right to Children without Families; Right to Review of a Child’s Placement; Right to Access to Education; Right to Protection from Harmful Drugs; Right to Protection from Exploitation; Right to Family Guidance as Children Develop; Right to Respect for Children’s Views; Right to Responsibility of Parents; Right to Children with Disabilities; Right to Social and Economic Help; Right to Rest, Play, Culture, Arts; Right to Protection from Sexual Abuse; Right to Everyone Knowing Children’s Rights.
  2. Name changed to protect the identity of the child

 

About Author

Farzana Tamboli

She has been associated with Miracle Foundation India for last 4.5 years. Her role is actively involved in ensuring that children getaccess to quality education and a safe, loving and caring family environment to reach their full potential. Farzana has coordinated the ECM process for her assigned CCIs efficiently.

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