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Support begins at the maternity hospital immediately upon birth through breastfeeding advice,
consultations with psychologists, play groups for children and parents, home visits, play and therapist
sessions, and any other activity considered beneficial for the development of the child. Karin Dom
Foundation does not perform residential care but works in the natural environment of the child.
THE PROBLEM:
A medical centred approach
still prevails
In Bulgaria only a few services are available for chil-
dren with special needs from 0 to 3 years. The sup-
port is based on medical models of care, and parents
of infants and young children with serious disabilities
are often advised by medical staff to institutionalize
their children because, they are told, it will be difficult
to care for them within the family environment.
Furthermore, families are discouraged from being
involved in the rehabilitation services of their children.
In this “expert model,” the participants depend on
“professional expertise” to solve problems for the
children, rather than taking the needs of the entire
family into account. (Please refer to the second
Bulgarian case study on page 13.)
During the first implementation period of the Early
Intervention Programme in the Municipality of Varna,
it became clear that there is very little awareness
about early intervention services as such. Moreover, it
became necessary to establish an Early Intervention
Programme that helps children to overcome develop-
mental challenges, since both parents and medical
authorities tended to ignore the need for targeted
support for the development of young children with
disabilities aged from zero to four years.
Another significant problem was the lack of higher
education and other training programmes on early
childhood intervention and the application of fami-
ly-centred practices in Bulgaria.
THE DEVELOPED SOLUTION:
A family centred approach
is introduced
Unlike institutional care and medical-based services,
this model works to support and strengthen par-
ent-child interactions and relationships as well as
child outcomes, and offers parents considering child
abandonment an alternative to institutionalisation.
Through early assessment coupled with interven-
tion, there are increased chances that children with
disabilities can participate and flourish in inclusive
mainstream educational settings. One crucial element
of early intervention is breastfeeding support, given
its important role in preventing abandonment and its
strong influence on better developmental outcomes.
THE MODEL:
The child’s home becomes
the focal point
The Early Intervention Programme includes home
visits, parent-toddler playgroups, family-support net-
works, and breastfeeding support. Because the home
is considered the natural environment of the child, the
core service is the home visit. During home visits, the
specialist works with the family on assessment of the
child, setting of goals, and preparing an individual plan
for a six-month period. Through a series of follow-up
visits, the specialist gives practical demonstrations to
the parents on how to teach their child various skills
through play or such routine activities as dressing,
ABOUT BULGARIA
Struggling to advance in the
World’s Mothers Report
• Bulgaria, a country of 28 provinces, is a
parliamentary republic with a high degree
of political, administrative, and economic
centralization. It is a member of the Euro-
pean Union, NATO, and the Council of Eu-
rope. Bulgaria’s population of 7.4 million is
predominantly urban. Most commercial and
cultural activities are centred in the capital
and largest city, Sofia. The strongest
sectors of the economy are heavy industry,
power engineering, and agriculture, all of
which rely on local natural resources.
• The 2015 Human Development Index
ranks Bulgaria 59th, with a gross domestic
product) of $15,596 per capita. Median age
is 43.4 years (data from 2014), with approx-
imately 300,000 children under five years.
According to Save the Children, Bulgaria
ranks 43rd in the State of the World’s
Mothers Report – one of the last among EU
countries, followed only by Malta, Hungary,
and Romania.