E uropean p e r sp e c tiv e s
Caring for people with learning difficulties in Czechoslovakia Anni Telford, Birmingham Polytechnic/Andy Farrington, Sheffield and North Trent College of Nursing and Midwifery, Sheffield In June 1992 a massive step forward was made in Czechoslovakia when the first school for people with learning difficulties was opened. This article examines the problems facing this school and the background to its creation.
w
* W hen exploring the history of care for people with learning difficulties in Czechoslovakia, two main historical legac ies need to be considered. First, under the communist regime mothers in Czechoslo vakia were encouraged after the birth of a child with learning difficulties to place it in one of the large institutions, forget about it and simply go away and have a healthy child. The focus of care was therefore insti tutional, rather like the system in operation in Britain up until the last 20 years. Second, children in Czechoslovakia are given a form of intelligence quotient test between the ages of 6 and 8 years and, depending on the results, are then categorized in one of three ways: Teachable: children who are classified as teachable are seen as normal and enter the regular education system.
Unteachable: children who are classified as unteachable arc sent to institutions where only basic skills arc taught and no attempt is made to promote reading and writing or numerical skills. Uneducable: the uncducable arc placed in institutions, many of which are psychiatric hospitals, where in the words of one psy chologist, they are ‘locked away and for gotten about’. Although their basic physical needs are cared for they are given no train ing or education.
Ms Telford is Senior Lecturer in Psychiatry, Birmingham Polytechnic; Mr Farrington is CourseTeacher and Senior Behavioural Psychotherapist, Sheffield and North Trent College of Nursing and Midwifery, Sheffield
Thus, children born with a learning diffi culty or those classified as uncducable have no chance of developing to their full poten tial as human beings. The director of the school is Milanu Remarovou and it is with this group of children and adults that she works. Milanu Remarovou became interested in the plight of people with learning difficult ies when her own son was born with prob lems. She spent the next 5 years studying
British Journal ofNursing, l992,Vol l,N o5
teaching methods and attempting to raise her son at home so that he could benefit from her studies. To establish a school in the communist climate that existed at the time was a diffi cult task. However, she was very determin ed and in June 1991, the hunt for a suitable building started; finally a disused primary school in the district of Modrany on the outskirts of Prague was found. Money to convert the school was raised and the re construction work was able to start in O c tober 1991, the first students moving in on 6 April 1992. Sleeping accommodation mainly comprises four bedded rooms which are bright and colourfully decorated, as are the living and teaching areas. The standard of accommodation and furnish ings are far in advance of anything seen within the state institutions. A therapeutic pool is under construction, as are other therapy areas, and the residents themselves are helping to reconstruct the garden. The school, named Blue Key, caters for 35 people, 10 in residential care and 25 who attend on a daily basis. It takes both child ren and adults, the ages ranging from 7 to 39 years. The school is funded from many different sources, including the state, the city of Prague, the parents’ support group, local people and donations from individuals and industry.
Organization The structure of the day at Blue Key is simple but varied, providing the students with stimulation and relaxation (Table /). There arc usually four staff on duty, the director, two teachers and one sister (Brit ish staff nurse equivalent). With the support of a consultant paediatric neurologist from Prague staff are trained by visiting potential students in institutions, discussing the na ture of learning difficulties and special needs education and visiting similar institu-
259
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Caring for people with learning disabilities in Czechoslovakia
tions in neighbouring countries. One of the teachers is a speech therapist and other staff act as occupational therapists. There is one sister who covers night duty. Milanu Remarovou is aware of the low staffing levels and eventually wants to increase the ratio of staff to students to 1:5 when more money becomes available.
Lack of training Finding suitable staff is a problem as nurses undergo physical nurse training and there is no specific course in caring for people with learning difficulties (Telford, 1992). When the school first opened its doors to students the nurses were unsure of what to expect as the majority had never come into contact with this client group before and were unaccustomed to people with com munication problems, challenging behav iours or who suffer severe epileptic fits. It was felt that some of the clients with more severe problems should not be allowed to attend the school. As this is the very group that Milanu Remarovou champions it is understandable that she has become somewhat suspicious of the professional stance of nurses. One can understand this when one remembers that there are no equivalents in Czechoslo vakia to the British RNM H and while this may not be the cause of the problem, it certainly appears to be a factor in slowing down its resolution. It is to be hoped that the current review of nurse education within Czechoslovakia will look more to the British system of sep arate registration for mental health and learning difficulties nurses. The generic type of training dominant in some Euro T a b le 1. S tru c tu re o f s tu d e n ts ’ day 8 .1 5 -9 .0 0 : 9 .0 0 -1 0 .0 0 : 10.00-11.00:
Breakfast fo r residents Day students arrive Teaching groups Break Students help in food preparation
11.00-12.00:
Various activities: gymnasium, workshops, rehabilitation, gardening
12.00-1.00:
Lunch Various groupwork: drama, drawing, singing
1.00-2.30: 2 .3 0 -3 .0 0 : 3 .0 0 -6 .0 0 :
Break Leisure time O lder students help w ith household chores
6 .0 0 -7 .3 0 :
Dinner Day students leave before dinner
7.30:
Younger students retire O lder students’ leisure time
260
pean countries may be financially more cost-effective but evidence from the institu tions in Czechoslovakia shows it to be less effective in terms of patient care, advocacy and the notion of social role valorization. The method of nurse training in Czechoslo vakia must stand as a salutary lesson to British nurses who are keen to see the de mise and abolition of the RM N and RNM H , viewing these two fields of nurs ing as specialisms of physical nursing. These problems are partially a reflection of societal attitudes. The idea of integrating people with learning difficulties into the community is unheard of in Czechoslo vakia as many people feel that learning dif ficulties are somehow infectious. There is a need for community support and Milanu Remarovou has had to spend a great deal of time talking to local groups on the nature of the students’ problems. Most of the staff who work in the school are now drawn from the local community and integration is progressing albeit slowly. There are plans to encourage local children to visit by open ing a community farm in the grounds, rather like the city farms found in inner city areas in Britain. An important break through was made when local factories of fered some of the older students part-time employment. The wide age range at the school does cause problems as the students have differ ing needs, e.g. the soft play area and other children’s facilities are obviously not suit able for the adults, who require education in independent living, the expression of sex uality and socialization into group homes or sheltered accommodation, none of which are available at the moment. How ever, the school will continue to accept all those who need its help, and relatives are more than happy to have their loved ones at the school, saying that the alternatives are unthinkable.
Future goals There are plans to acquire more buildings within the district to accommodate differ ent age ranges. As the number of schoolage children has fallen dramatically in the surrounding area this would seem to be a strong possibility as two adjoining primary schools are standing empty. Such expansion will require extensive funding for equip ment, staff salaries and training. As the pro ject is funded mainly from charity Milanu Remarovou may have to move into the do main of fundraiser and organizer, a role that will take her away from Blue Key itself. British Journal ol Nursing, l992,Vol l,N o5 Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Carin8 for people with learning disabilities in Czechoslovakia
Milanu Remarovou’s long-term goals are to establish four schools for different age ranges, provide work for the older students in Modrany through the farm and a small factory and also found a whole senes of similar schools across Czechoslovakia. Her ultimate aim is to initiate the gradual emptying of the large psychiatric institu tions of people with learning difficulties. However, the reality is that Czechoslovakia
is a country that is attempting to rebuild its economy after the collapse of commu nism and the funding of the healthcare sys tem is still being debated. The funding of the original Blue Key School, relying so heavily as it does on charity, is not yet as sured. In order for the potential of every person with learning difficulties in Czech oslovakia to be realized there is a need for financial support, resources and adequate staff training.
KEY POINTS •
Care for people with learning difficulties is institutionally based.
Telford A (1992) The winds of change: psychiatric nursing in Czechoslovakia. Br ] Nurs 1 (3): 157-9
•
Nursing staff are not specifically educated to work with this client group.
•
The Blue Key School is the first of its kind in Czechoslovakia and is funded mainly from charity.
•
More money and resources are needed to finish the present project.
•
The Friends of the Blue Key hope to support this vital work.
If you would like to become a Friend of the Blue Key School please contact Anni Telford, Department of Nursing and Community Health, Cox Building, Birm ingham Pofytechnic, Perry Barr, Birming ham B42 7AU
British Journal of Nursing SUBSCRIPTION FORM 0 Y e s l I would like to subscribe to the new fortnightly British Journal of Nursing with effect from June 1992. I wish to pay by: 0 Cheque
DIRECT DEBIT MANDATE Mark Allen Publishing Limited, Croxted Mews, 288 Croxted Road, London SE24 9DA To the Manager......................................................................................................
0 Credit Card
0 Direct Debit
Full Postal Address of Bank Branch.......................................................................
Please complete the details as required Signature....................................................Date., Reference Number
FULL NAME......................................................... ADDRESS..............................................................
........................................................ TEL NO............................................... JOB GRADE................................................................................... CLINICAL SPECIALITY........................................................................ NHSOR INDEPENDENT?............................................................ MONTH & YEAR OF REGISTRATION............................................ SIGNED.................................................. DATE..........................
Now post this form along with chequa to: Sue Duffin, Subscription Manager, BJN, Robjohna Farm, Finchingfiald, Essex CM 1 4 U .
CREDIT CARD SUBSCRIBERS Please charge my Access, Barclaycard, Visa or American Express C... My credit card number is
on
1.r I I I I I I I m
E xpiry............................................. Signed..................................................... Date......................................................
Note: |f you want to make uaa of our special FREEPHONE Service, please phone 0800 220427 between 9.30am end 5.00pm Monday« to Fridays.
British Journal of Nursing, !992,Vol l,N o5
l/We authorise you until further notice in writing to charge to my account with you, variable annual amounts which may be debited thereto at the instance of Mark Allen Publishing Ltd, by direct debit in respect of my/our subscription to the British Journal of Nursing. Date of first payment on or within one month fro m ............................................. Name of account to be debited.............................................................................. Account number Banks may decline to accept instructions to charge Direct Debits to certain types of account other than current accounts
BJN SUBSCRIPTION RATES (with effect from April 1992 — 22 issues UK Personal Annual Subscription (Direct Debit) Personal Annual Subscription (Cheque/Credit Card) Personal Quarterly Subscription (Direct Debit) Institutional Annual Subscription* Pre Registration Annual Students (Direct Debit) Pre Registration Annual Students (Chequa/Credit Card) Pre-Registration Quarterly (Direct Debit)
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Cl 00 C125 C120 f 140
261
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Caring for people with learning difficulties in Czechoslovakia Anni Telford, Birmingham Polytechnic/Andy Farrington, Sheffield and North Trent College of Nursing and Midwifery, Sheffield In June 1992 a massive step forward was made in Czechoslovakia when the first school for people with learning difficulties was opened. This article examines the problems facing this school and the background to its creation.
w
* W hen exploring the history of care for people with learning difficulties in Czechoslovakia, two main historical legac ies need to be considered. First, under the communist regime mothers in Czechoslo vakia were encouraged after the birth of a child with learning difficulties to place it in one of the large institutions, forget about it and simply go away and have a healthy child. The focus of care was therefore insti tutional, rather like the system in operation in Britain up until the last 20 years. Second, children in Czechoslovakia are given a form of intelligence quotient test between the ages of 6 and 8 years and, depending on the results, are then categorized in one of three ways: Teachable: children who are classified as teachable are seen as normal and enter the regular education system.
Unteachable: children who are classified as unteachable arc sent to institutions where only basic skills arc taught and no attempt is made to promote reading and writing or numerical skills. Uneducable: the uncducable arc placed in institutions, many of which are psychiatric hospitals, where in the words of one psy chologist, they are ‘locked away and for gotten about’. Although their basic physical needs are cared for they are given no train ing or education.
Ms Telford is Senior Lecturer in Psychiatry, Birmingham Polytechnic; Mr Farrington is CourseTeacher and Senior Behavioural Psychotherapist, Sheffield and North Trent College of Nursing and Midwifery, Sheffield
Thus, children born with a learning diffi culty or those classified as uncducable have no chance of developing to their full poten tial as human beings. The director of the school is Milanu Remarovou and it is with this group of children and adults that she works. Milanu Remarovou became interested in the plight of people with learning difficult ies when her own son was born with prob lems. She spent the next 5 years studying
British Journal ofNursing, l992,Vol l,N o5
teaching methods and attempting to raise her son at home so that he could benefit from her studies. To establish a school in the communist climate that existed at the time was a diffi cult task. However, she was very determin ed and in June 1991, the hunt for a suitable building started; finally a disused primary school in the district of Modrany on the outskirts of Prague was found. Money to convert the school was raised and the re construction work was able to start in O c tober 1991, the first students moving in on 6 April 1992. Sleeping accommodation mainly comprises four bedded rooms which are bright and colourfully decorated, as are the living and teaching areas. The standard of accommodation and furnish ings are far in advance of anything seen within the state institutions. A therapeutic pool is under construction, as are other therapy areas, and the residents themselves are helping to reconstruct the garden. The school, named Blue Key, caters for 35 people, 10 in residential care and 25 who attend on a daily basis. It takes both child ren and adults, the ages ranging from 7 to 39 years. The school is funded from many different sources, including the state, the city of Prague, the parents’ support group, local people and donations from individuals and industry.
Organization The structure of the day at Blue Key is simple but varied, providing the students with stimulation and relaxation (Table /). There arc usually four staff on duty, the director, two teachers and one sister (Brit ish staff nurse equivalent). With the support of a consultant paediatric neurologist from Prague staff are trained by visiting potential students in institutions, discussing the na ture of learning difficulties and special needs education and visiting similar institu-
259
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Caring for people with learning disabilities in Czechoslovakia
tions in neighbouring countries. One of the teachers is a speech therapist and other staff act as occupational therapists. There is one sister who covers night duty. Milanu Remarovou is aware of the low staffing levels and eventually wants to increase the ratio of staff to students to 1:5 when more money becomes available.
Lack of training Finding suitable staff is a problem as nurses undergo physical nurse training and there is no specific course in caring for people with learning difficulties (Telford, 1992). When the school first opened its doors to students the nurses were unsure of what to expect as the majority had never come into contact with this client group before and were unaccustomed to people with com munication problems, challenging behav iours or who suffer severe epileptic fits. It was felt that some of the clients with more severe problems should not be allowed to attend the school. As this is the very group that Milanu Remarovou champions it is understandable that she has become somewhat suspicious of the professional stance of nurses. One can understand this when one remembers that there are no equivalents in Czechoslo vakia to the British RNM H and while this may not be the cause of the problem, it certainly appears to be a factor in slowing down its resolution. It is to be hoped that the current review of nurse education within Czechoslovakia will look more to the British system of sep arate registration for mental health and learning difficulties nurses. The generic type of training dominant in some Euro T a b le 1. S tru c tu re o f s tu d e n ts ’ day 8 .1 5 -9 .0 0 : 9 .0 0 -1 0 .0 0 : 10.00-11.00:
Breakfast fo r residents Day students arrive Teaching groups Break Students help in food preparation
11.00-12.00:
Various activities: gymnasium, workshops, rehabilitation, gardening
12.00-1.00:
Lunch Various groupwork: drama, drawing, singing
1.00-2.30: 2 .3 0 -3 .0 0 : 3 .0 0 -6 .0 0 :
Break Leisure time O lder students help w ith household chores
6 .0 0 -7 .3 0 :
Dinner Day students leave before dinner
7.30:
Younger students retire O lder students’ leisure time
260
pean countries may be financially more cost-effective but evidence from the institu tions in Czechoslovakia shows it to be less effective in terms of patient care, advocacy and the notion of social role valorization. The method of nurse training in Czechoslo vakia must stand as a salutary lesson to British nurses who are keen to see the de mise and abolition of the RM N and RNM H , viewing these two fields of nurs ing as specialisms of physical nursing. These problems are partially a reflection of societal attitudes. The idea of integrating people with learning difficulties into the community is unheard of in Czechoslo vakia as many people feel that learning dif ficulties are somehow infectious. There is a need for community support and Milanu Remarovou has had to spend a great deal of time talking to local groups on the nature of the students’ problems. Most of the staff who work in the school are now drawn from the local community and integration is progressing albeit slowly. There are plans to encourage local children to visit by open ing a community farm in the grounds, rather like the city farms found in inner city areas in Britain. An important break through was made when local factories of fered some of the older students part-time employment. The wide age range at the school does cause problems as the students have differ ing needs, e.g. the soft play area and other children’s facilities are obviously not suit able for the adults, who require education in independent living, the expression of sex uality and socialization into group homes or sheltered accommodation, none of which are available at the moment. How ever, the school will continue to accept all those who need its help, and relatives are more than happy to have their loved ones at the school, saying that the alternatives are unthinkable.
Future goals There are plans to acquire more buildings within the district to accommodate differ ent age ranges. As the number of schoolage children has fallen dramatically in the surrounding area this would seem to be a strong possibility as two adjoining primary schools are standing empty. Such expansion will require extensive funding for equip ment, staff salaries and training. As the pro ject is funded mainly from charity Milanu Remarovou may have to move into the do main of fundraiser and organizer, a role that will take her away from Blue Key itself. British Journal ol Nursing, l992,Vol l,N o5 Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
Carin8 for people with learning disabilities in Czechoslovakia
Milanu Remarovou’s long-term goals are to establish four schools for different age ranges, provide work for the older students in Modrany through the farm and a small factory and also found a whole senes of similar schools across Czechoslovakia. Her ultimate aim is to initiate the gradual emptying of the large psychiatric institu tions of people with learning difficulties. However, the reality is that Czechoslovakia
is a country that is attempting to rebuild its economy after the collapse of commu nism and the funding of the healthcare sys tem is still being debated. The funding of the original Blue Key School, relying so heavily as it does on charity, is not yet as sured. In order for the potential of every person with learning difficulties in Czech oslovakia to be realized there is a need for financial support, resources and adequate staff training.
KEY POINTS •
Care for people with learning difficulties is institutionally based.
Telford A (1992) The winds of change: psychiatric nursing in Czechoslovakia. Br ] Nurs 1 (3): 157-9
•
Nursing staff are not specifically educated to work with this client group.
•
The Blue Key School is the first of its kind in Czechoslovakia and is funded mainly from charity.
•
More money and resources are needed to finish the present project.
•
The Friends of the Blue Key hope to support this vital work.
If you would like to become a Friend of the Blue Key School please contact Anni Telford, Department of Nursing and Community Health, Cox Building, Birm ingham Pofytechnic, Perry Barr, Birming ham B42 7AU
British Journal of Nursing SUBSCRIPTION FORM 0 Y e s l I would like to subscribe to the new fortnightly British Journal of Nursing with effect from June 1992. I wish to pay by: 0 Cheque
DIRECT DEBIT MANDATE Mark Allen Publishing Limited, Croxted Mews, 288 Croxted Road, London SE24 9DA To the Manager......................................................................................................
0 Credit Card
0 Direct Debit
Full Postal Address of Bank Branch.......................................................................
Please complete the details as required Signature....................................................Date., Reference Number
FULL NAME......................................................... ADDRESS..............................................................
........................................................ TEL NO............................................... JOB GRADE................................................................................... CLINICAL SPECIALITY........................................................................ NHSOR INDEPENDENT?............................................................ MONTH & YEAR OF REGISTRATION............................................ SIGNED.................................................. DATE..........................
Now post this form along with chequa to: Sue Duffin, Subscription Manager, BJN, Robjohna Farm, Finchingfiald, Essex CM 1 4 U .
CREDIT CARD SUBSCRIBERS Please charge my Access, Barclaycard, Visa or American Express C... My credit card number is
on
1.r I I I I I I I m
E xpiry............................................. Signed..................................................... Date......................................................
Note: |f you want to make uaa of our special FREEPHONE Service, please phone 0800 220427 between 9.30am end 5.00pm Monday« to Fridays.
British Journal of Nursing, !992,Vol l,N o5
l/We authorise you until further notice in writing to charge to my account with you, variable annual amounts which may be debited thereto at the instance of Mark Allen Publishing Ltd, by direct debit in respect of my/our subscription to the British Journal of Nursing. Date of first payment on or within one month fro m ............................................. Name of account to be debited.............................................................................. Account number Banks may decline to accept instructions to charge Direct Debits to certain types of account other than current accounts
BJN SUBSCRIPTION RATES (with effect from April 1992 — 22 issues UK Personal Annual Subscription (Direct Debit) Personal Annual Subscription (Cheque/Credit Card) Personal Quarterly Subscription (Direct Debit) Institutional Annual Subscription* Pre Registration Annual Students (Direct Debit) Pre Registration Annual Students (Chequa/Credit Card) Pre-Registration Quarterly (Direct Debit)
C48.00 C49.50 C13.00 C80.00 C36.00 C38 00 C10.00
OVERSEAS AND EIRE Personal Surface Mail Personal Airmail Institutional Surface Mail Institutional Airmail* •Hospitals/Libraries
Cl 00 C125 C120 f 140
261
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 19, 2019.
