Deprived Youth in Russia  Andrei Smirnov

Finding solutions to the problems of adolescent deprivation in our country is one of the most important goals for a wide range of  government and non-governmental organisations health service, judicial structures, the social services, education, social and Charity organizations. By deprivation we mean the psychological state which occurs as the result of a life situation where the subject is given no opportunity for satisfying some of his vital psychic requirements to the full extent and over a long period of time. Deprivation is a life style giving no opportunity to satisfy important psychological needs Children experiencing equal degrees of deprivation will behave differently and have different outcomes.

According to data of Russia General Statistic Department by the beginning of 1995 the number of children not in parents’ care was 443,000. The majority of absent parents are alive, 113,000 children have been adopted, 201,000 are under somebody’s guardianship or trusteeship. 112,000 were living in boarding schools for the mentally and physically disabled children.  70% of them suffer from delayed mental development and behavioral problems.

According to data of the Serbsky Institute of Forensic Psychiatry the following were characteristics in children deprived the parents’ care:

Psychic pathology               80%

Mental retardation               33%

Organic CNS damages        39%

Organic disorders                  7%

Psychopathic qualities           6%

Oligophrenia                        18%

Neurotic disorders                12%

Chronic psychic diseases       6%

One of the main characteristics of recent years in Russia is a return of the problem of homeless children which existed after the Civil war and the Second World War. There are no exact statistics of the number of uncared for children. According to the results of the investigation of two hundred children in one of the Moscow asylums within three years there were 8% of real orphans (the lack of the both parents), 59% of them had one and 42%- both parents alive.

The main reasons for placing a child in the asylum are following: anti-social style of life of the parents, poor hygienic conditions and hunger- 35.5%; losing the child (deliberately or by default) at the railway station, while shopping, while visiting an outpatients’ clinics without efforts to search- 26.5%; nomadic lifestyle because of having no parents’ care- 14.5%;  escape from home after the family conflicts- 8.5%; the death or continuous staying in the hospital (more often in psychiatric or addiction unit) of the single parent - 9%; Lost accommodation as a result of crime - 6%.

Recent years shows a significant increase in the level of adolescent crime (data of the Moscow Serbsky institute).

Trends in Juvenile Crime 

Moscow adolescents over a 5 year Period.

Murder                                                  +141%

Grevious bodily harm                             +20.2%

Robbery                                                +122.1%                 

Fraud                                                   +102.7%

Drug dealing and manufacture      +392.8%

Crimes in alcoholic state                        +111.7%

Crimes in drugged state                 +140.7%

The same growth in adolescent crime was noted in Russia in the above-described periods of time, characteristic of a high level of homelessness and absent caring for children.

Organisations dealing with the problem. There are some structures dealing with the adolescent deprivation in present day Russia:  Social service (called here as the Social defense service)- provides the organization of asylums for adolescents and children where they stay not more than six months and after that have to be placed in an orphanage or to be adopted.  Education system- includes some specialized institutions: specialized schools for children needing intensive teaching methods, those with behavioral disorders, for the children who don’t want to study, for those escaped from home; schools for mentally disabled children; boarding schools and the orphan houses.

The Home Office structure (called Militia) also contains: special Centers for temporary stay of those escaped from home or who committed crime; labor and tutoring colonies for under aged sentenced by the court  The Health service organizations deal with the problems of adolescent deprivation in the child and adolescent psychiatric services and their main problems are: low levels of therapy with the majority of physicians oriented towards medication.

The main goal of our research is to investigate the typical so called ‘closed’ institutions which work for the social-psychological rehabilitation and resocialisation of the adolescents. These institutions relate to the three different Departments and they create the deprivation themselves while working with the adolescents.

The subjects of our research are:  The Interregional Center for the temporary isolation of adolescents (ICTIA).; Specialized School for the delinquent children. The District Social-rehabilitation Center for the under age children which lost their parents’ care and the orphans (The Asylum).

The Interregional Center for the temporary isolation belongs to the Regional Home Office Department and is intended for the boys living on the territory of the Sverdlovsk region, West Siberia and European part of Russia up to the city of Samara. There were 1246 children in a 9 months period last year and for the same period of this year - 1100 children in the Center.

The monthly rates were 138 children last year and 123- this year. There are 30-70 children at any one time. The average repeat stay in the Center is 34.5%. 14.6% of them last year and already 26.8% this year- have committed crime. Others were vagrants who attracted Militia’s attention by their behaviour (beggars, prostitutes and other social disorders). While interviewing them the lack of parents’ care and permanent place of accommodation becomes clear. Usually these children come to the Center from poor social conditions and they suffer from numerous diseases: 13%  of them last year were sick with different infectious diseases, and 10.9% of them had scabies and pediculosis this year already 57.7% of them have scabies; more than 80% of them suffer malnutrition, growth abnormalities and various chronic digestive diseases; all have behavioral disorders and most have psychological problems; All of them are terrible smokers and 70% of them used drugs and alcoholic beverages.   19 tutors, single pediatrician and 3 nurses provide the medical and tutoring activity in the Center. All of them have neither pedagogic no psychological education and there are no psychologist or psychiatrist in the Center.

Specialized School for the Delinquent Children is an educational structure. It deals with the boys committed criminal actions but who haven’t reached the age of criminal responsibility. At the moment there are about 120 children at School aged 11-15 years old who were sentenced to stay for a time of 2-3 years.   15% of children are orphans and 52% lack either of their parents. The regime at School is rather strict and meetings with relatives are permitted once a week. Most parents do not visit children or do it episodically, which serves to make the deprivation worse.

Two psychologists and one psychiatrist provide psychological services in school. It is clear to both administration and staff that they lack adequate psychological training, are unqualified in the problems of psychological rehabilitation and in working with the adolescents’ families which are usually not ready to receive the child back.

The District Social Rehabilitation Center is part of the administrative structure of one of the city districts of Ekaterinburg. This Center works with the children who have lost their parents because of different reasons: their parents have been deprived parental rights, or they are for along time in prison or in the hospital (more often in psychiatric one), or they are dead, so in the cases when they not provide their parental duties.     Its goals are:  prophylactic activities aimed at prevention of lack of care and nomad life of the adolescents;  temporary residence and welfare for the adolescents in difficult life situations. The final aim of this Center is to get the child back home or to send him to the orphanage or other family.

There are 32 children in the Center today. And the staff of it consists of twenty tutors, two psychologists, eight social workers, three physicians, Five nurses and one speech therapist.  Almost all children staying in this Center have behavioral deviations and chronic diseases; 30% of them have mental retardation and 20% have mental development delay.  Usually children stay at this Center from 2 months to one year and then they go to the Orphanage or they are  adopted by the family.

Summing up all these institutions relating different Departments have the very same problems. And it appeared that: the administration and the staff of all of them are strongly motivated to improve their professional skills in child and adolescent psychology and social rehabilitation; it is necessary to improve the level of medical and psychological aid to this group of adolescents and their families. Apart from general problems such as finance there is no organising or coordinating structure which works with the families, training of specialists and improving of their qualification (it concerns all related professionals- psychotherapists, psychologists, teachers and social workers). We suggest the elaboration of programs for training and improvement of qualification for the staff of these institutions and also diagnostic and rehabilitation programs for the children.

The main directions of them are the following: assistance for both government and non-government structures in training and increasing the professional qualification of their staff in the field of adolescent and family psychology and psychotherapy; Elaboration and realisation of training programs for the students, physicians, psychologists and social workers.; Organization and providing services for deprived youth and families in the institutions of Health care and Social services; Providing psychoprophylactic activities with the risky families; Introduction of practical and scientific ideas of Russian and foreign specialists; Participation in the accomplishment of international programs.

The Family Therapy Development Fund’s activities -  coordination of work of the institutes dealing with adolescent problems, regular consulting of the staff and administration of the above Centers in terms of organisation and methodology.; Psychotherapeutic and other medical aid for the families of the delinquent children, families who include sick and invalid people, using the methods of family therapy in both medical as in social-psychological and educational aspects; Attracting sponsors for concrete material assistance to the children from these institutions and high risk families; Providing of scientific activities- research and reports devoted to the problems of children and adolescents and their families. ; Training programs for schoolteachers, social workers and physicians in the subject of adolescent and family psychotherapy.

Objectives of the Fund. - Introduction of psychological training for staff of Center for Temporary Isolation of Adolescents, of the Special School and District Social-rehabilitation Center for Children and Adolescents;  Introduction of sexual education of school pupils, based on the results of the psycho-sociological research of adolescents, their parents and schools in schools of Ekaterinburg.; Provision of psychotherapeutic aid to incomplete families; Organization of seminars including scientific and practical issues lectures, supervisions and Balint groups for professionals; Providing joint Russian-British programs and projects on the problems of adolescents’ and family therapy; Participation in the international “Youth Support” conference on adolescent health.

Educating the Carers, Caring for the Adolescents.

Helen Russell-Johnson; Rosemary Blunden; Michelle Charles.

For those of you who don’t know me, I am not Helen Russell-Johnson, there is actually a team of three of us presenting this paper, my name is Michele Charles and I’d like to introduce my colleagues, Helen Russell-Johnson and Rosemary Blunden. All three of us are senior lecturers at the University of Hertfordshire and we’ve been involved in the last few years in developing courses for multi-professional groups who are caring for adolescents and so we would like to tell you this morning about our experience in developing those courses and about wider educational opportunities that are available for those caring for adolescents.

We certainly heard much during this conference about the need for education and this became very apparent to us several years ago. We felt there were several reasons for us wishing to see this work in developing courses. First of all we were aware of the need certainly in this country, it’s been  reiterated on a number of occasions dating right back to 1959 that adolescent would receive some special attention and particularly reports which called for  separate facilities for adolescents. This has been reiterated later by the Home Office, by the Department of Health in the 1991 document on Children and Young People in Hospitals, more recently by the National Association for the Welfare of Young Children Hospitals and of course in its new recommendations for sick children. And most recently of all in the 1997 House of Commons Select Committee Report on Children’s health called very strongly for better adolescent facilities, particularly adolescent mental health facilities. So we felt there were multiple reasons why we needed to pay particular attention to adolescents.

Our research project has also indicated that nurses felt rather ill-prepared for working with adolescents. Many nurses in fact were working on adult wards working with adolescents and had very little or no educational programmes at all, and even those who are registered sick children’s nurses had found that perhaps there wasn’t enough about adolescents, many were quite apprehensive still about working with this age group. Certainly looking round there were either no other comparable courses, there were a number of courses on child and adolescent psychiatry which were excellent in their own right but didn’t perhaps fulfil the need of all nurses and of course many nurses couldn’t get secondment to those courses. So began to see that there was a particular need, various other research findings by ourselves and others had indicated that nurses were calling for these courses, my colleague Helen Russell-Johnson’s experience of setting up very short one-day courses had proved very successful but indicated there was again a much greater need.

We were particularly fortunate in having a group of colleagues both from the service side and multi-professional colleagues too, both in the psychology section, my colleague Rosemary Blunden will tell you more, both in the  juvenile crime area, a whole range of people who were willing to help us work on these courses. And within the University if Hertfordshire we were fortunate in having a number of us who had this particular interest, so combined with anecdotal evidence from our colleagues, indication of demands from our service colleagues and the expertise that we felt that we had available we then set about developing these courses so I leave it to my colleagues to tell you a little bit more about this.

Helen Russell-Johnson - Thank you Michele. The first course we developed was called “Caring for the Adolescent”. We didn’t call it nursing, because we wanted a much broader base, it’s open to nurses but also to many other professionals. The only thing we asked specifically is that prospective students are actually working with young people. The reason for this is because we relate the theories to practice the whole way through and without the practice you just can’t do it. We also need to ensure they’ve had a little bit of academic education first.

We have three modules, the first one is based on the tasks of adolescent development. In fact we use the tasks as a framework but we bring in as many theories as available from all sorts of areas so we use all the child development theories, psychological theories, sociological theories. The next module is completely focused on communication. And the third module encourages the students to go somewhere else and compare their practice with their own place. So we are aiming to do is  we take people who are already working with adolescents, who feel that they have got some skills and of course they have and we provide theoretical underpinning for those skills. They do increase them and gain in confidence from them. A lot of this is done by a range of learning methods and together that is the whole group with their very varied backgrounds and all our speakers who are from multi-professional backgrounds they develop constructs on adolescents. And it’s a very enriching experience not just for the students, we learnt an awful lot in our first year. We are now in our third year.

We look at as many theories of adolescence as we can, we look at the communicating with adolescents, and we share experience  with as broader base as we possibly can. The assessment is related entirely to practice and it has to relate to the young people with whom the students are working. I’ve never enjoyed  marking terribly but these are absolutely fascinating to read and a joy to mark the communication ones especially. Following on from this we’ve developed a course on adolescent sexuality which is Michele’s forte which adds to and complements the basic one. And over to Rosemary now.

Rosemary Blunden   As part of our networking procedure because we decided that we couldn’t possibly be the only group in the country, I mean a course for the care of adolescents, we’ve networked mainly with other nursing groups, but when we collected the flyers we’ve found that many of them have already opened their courses to a multi-disciplinary group. And particularly the NB603 which is child and adolescent psychiatry, these places are operating, Birmingham offers a degree, Bristol and Cambridge offer a diploma in health studies, Hertfordshire, Huddersfield  and Ipswich all have this Caring for the Adolescent course which again is multi-disciplinary and in always run by a multi-disciplinary team. The next one. Newcastle I think was the first one to open it to a multi-disciplinary group. And that has been running successfully with a group of professionals as students. This is a year-long course which certainly is practice-based. The Maudsley Hospital has a 603, we are not quite sure of their content. Oxford, somebody earlier was asking for psycho-social training, this is an Oxford-Brooks and this is a course specifically for dealing for those difficult adolescents, that particular group, somebody was talking about this earlier, how do you learn about how to deal with adolescents who are opting out and with difficult behaviour. And Oxford-Brook runs this module. I think it is also a multi-disciplinary recognition because our is not a nursing qualification. Portsmouth, have the child psychiatry, Slough, campus of Thames Valley University and South Bank University have modules in caring for the adolescents.

We are looking for solutions because there are so few courses. We draw our students from the whole of the south of England, from Birmingham downwards. Every year we’ve had somebody from the Midlands who travels down to do this course. There is a support group in the West Midlands. We were looking particularly at how we could improve the knowledge of nurses in the care of adolescents. So we look to improve education in the care of adolescents in all pre-registration nursing courses to all nurses across the board. We will in the future have nurse practitioners lecturers who are specialists in this field, and we feel that some of our early students certainly from last year will be amongst that group.

Post-registration skills courses. Again these people who we had last year and who are coming from other places Ipswich and the Huddersfield will be the leaders in this field. We are looking towards specialist practitioner awards in care of the adolescents BSc and ultimately MSc and I think the MSc will be a complete faculty course as opposed to the department course. I think our colleagues from psychology and other disciplines will be very keen to join us in planning this course. Hopefully this will lead on to specialists practitioners providing in terms of hospitals trust via education, both theory and practice based which is absolutely essential. And Helen and I‘ve been delighted to hear people throughout the conference stressing the need, I was so delighted yesterday when I was listening to Helen Fonseca saying that people should have a good knowledge of the task of adolescents, this is our whole purpose of being really, we need people to understand that kids don’t just have a problem, but they are adolescents and they have to carry all that with them as well. I was absolutely delighted.

In the meantime because there is such a dearth of courses we are asking nurses to enhance and develop their own practice, to use effective practice specifically if they are working with adolescents to try and enlarge the knowledge, to share their reflections with their colleagues, and to share your knowledge with students from all branches of nursing, well in our case it turns out to be all branches of everything. To form small support groups, and these are happening, they are beginning to form. To form regional networks and again these are beginning to start within nursing and I am sure from what you were saying you have similar networks in social work and certainly the Association of Child Psychology and Psychiatry have special interest groups.

Formations of educational networks and we have already started on our formations of educational networks, we’ve been working particularly closely with our colleagues from Huddersfield but we have been able in the course of our network formation to contact all these groups that I told you earlier. And lastly I feel that we should be forming pressure groups to ensure that people with adolescents do have the basic knowledge which so many people have stressed during this conference, we need to work with adolescents. I just feel that everything we learnt over the last 10 years has come to fulfilment by the constant reiteration at this conference of the need for education and we are absolutely delighted. Thank you.

Chair Thank you. Any questions.

Question: I am a social worker working at the youth centre and I would wish to see much more co-operation to be help education of youth workers because they work in difficult setting with young people now I am wondering why we are so rarely talking about youth workers, because nurses or teachers, young people go there because they have to go there, young people go to a youth centre because they want to and I fear that youth workers lack education.

Answer. Yes, I would agree absolutely with that, in fact next year we will be having one certainly, but it needs to be very broadly based and very broadly spread. We tested it out on nurses, all kinds of nurses, and including a midwife and suppose that we know that it works with the broad spectrum of people from a broad spectrum of places. You know the spectrum goes from a specialist adolescent maternity unit to a hospice with adolescents, so and everything in between, so we are now ready to move into social work, we have enough colleagues in order to meet your needs.