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Chapitre 1 Etat des lieux by xiuliliaofz

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									                                                                   1




                                                       Report

     Current Situation in the Re-
 socialisation facilities dedicated to
 persons addicted to psychoactive
substances and other dependencies
       in the Slovak Republic

                     Twinning project SK/06/IB/SO/02




                                                              Authors:
                                                              Marianne Storogenko (Coordinator)
                                                              In alphabetical order:
                                                                   Sibel Bilal de La Selle
                                                                   Jean-Pierre Demange
                                                                   Valerie Dorso
                                                                   Yvan Grimaldi
                                                                   Sylvie Gomes
                                                                   Ruth Gozlan
                                                                   Philippe Lagomanzini
                                                                   Anneli Pienimaki
                                                                   Olivier Romain
                                                                   Dominique Terrasson

                                                              Project Leaders:
                                                                  Chantal Gatignol (FRE)
                                                                  Minna Sinkkonen (FIN)
                                                                  Zuzana Jelenkova


                                                              Twinning team:
                                                              Matthieu Chalumeau
                                                              Jana Novotová


                                                     Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                    psychoactive substances
                                                                   2



                                                              Bratislava, 30 October 2007




Acknowledgements
Our first thanks are dedicated to the General Secretariat, notably Ms Zuzana Jelenkova, Slovak
Project Leader, the representatives of the Ministry of Labour, Social Affairs and Family, the
representatives of the 8 Higher Territorial Units and all the interviewed persons.

We thank all the directors of the Resocialisation and rehabilitation Centers, their teams and the clients
for their welcome and availability.

This analysis would not have been possible without the professional approach and promptness of our
group of translators: Mária Paľová, Roman Gajdoš, Jana Hönschová.

Especially, we would like to thank our drivers, who were at our disposal during the five missions:
Milan, Bohuš and Ivan.




                                                     Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                    psychoactive substances
                                                                   3


                                                          Contents




Introduction ......................................................................................................................... 2
1. Current Situation Analysis.............................................................................................. 3
   1.1 General Framework ................................................................................................... 3
   1.2 Funding ...................................................................................................................... 5
   1.3 Premises and Infrastructure ..................................................................................... 7
   1.4 Type of Clients ........................................................................................................... 8
   1.5 Personnel ..................................................................................................................10
   1.6 Care and Facility Functioning ..................................................................................13
Chapter 2 Stakeholders and Partners of Re-socialisation Facilities...............................17
   2.1        Partners ...............................................................................................................17
   2.2 Clients .......................................................................................................................20
   2.3 Personnel ..................................................................................................................20
   2.4 Directors....................................................................................................................21
Chapter 3            Comments, Opinions, Proposals, Suggestions ........................................23
   3.1 Comments and Opinions .........................................................................................23
   3.2 Proposals and Signals .............................................................................................26
Conclusions ........................................................................................................................29
Conclusions of the Senec seminar (November 5th and 6th 2007) ....................................30
Charts and Graphs .............................................................................................................33
List of Experts ....................................................................................................................37
Annexes ..............................................................................................................................38




                                                     Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                    psychoactive substances
                                                                   2




Introduction


This analysis of the current situation in the re-socialisation facilities in Slovak Republic was done
during the first phase of the French-Finnish-Slovak twinning project "Improving and Broadening the
Care for the Re-socialisation and Rehabilitaion of Persons Addicted to Psychoactive Substances"
(SK/06/IB/SO/02) The analysis is the activity 1.1 of the project.

Key goal of this national level assessment was to draw an overall picture of the re-socialisation
facilities functioning and to understand and analyse methods applied in the current Slovak addictions
context.

To be able to implement this, we met with and spoke to the representatives of state institutions at
national and regional levels, institutions with specialised care (psychiatric clinics, care facilities),
organisations playing a role in the minimisation of risks, as well as with other stakeholders.

Finally, we analysed the key legislation, as well as National policy documents on social policies.

Methodology, tools and goals were developed jointly by European and Slovak experts. Their
discussion led to the selection of two data collection procedures, which were applied in the
development of this report (see annexes):

-    Guide to interviews in re-socialisation facilities used by experts with the aim to collect standardised
     quantitative and qualitative information.
-    Short form to be completed by the directors of the re-socialisation facilities.

The report is based on the qualitative data collected during the interviews and the short completed
forms. The data presented reflects the interpretation of the situation by the people interviewed.

This analysis was prepared between 13 August and 5 October 2007 during five 5 day missions.




                                                     Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                    psychoactive substances
                                                                      3


1. Current Situation Analysis

As of the last quarter 2007, there have been 22 re-socialisation centres for drug, alcohol and other addicts in
all eight Slovak regions. Altogether there are 26 facilities; four centres manage two re-socialisation facilities

Article 63 of Act No. 305/2005 on Social-Legal Protection of Children and Social Guardianship and on
change and amendment of certain acts defines re-socialisation facilities as facilities aiming to activate
internal capacities in children and adult individuals with the goal to overcome psychological, physical and
social effects of drug addictions and to participate in life in their natural environment. For this purpose, re-
socialisation facilities are obliged to provide services and perform activities described in Article 47 of the
above act: housing, social work, establishment of conditions for inclusion into everyday life, psychotherapy,
re-socialisation programs and rehabilitation activities, psychological support, provision of care, etc. and this
for a minimum period of eight months.

This chapter aims to present the observations of the French and Finnish experts made during their visits to
the re-socialisation facilities.


1.1 General Framework
Twenty centres and 24 facilities were visited and in addition 2 directors of the centres not visited were
interviewed,.At the time of our visit, one of the facilities was in design phase and another operates under a
centre not visited, which does not enable their inclusion into this analysis

In terms of accreditation, 18 facilities are managed by state accredited NGOs. Two are municipality and
region dependent and do not need to apply for accreditation according to the law. Overall, there are 350
beds, of which - 326 accredited.

Out of the 20 facilities, 13 were opened prior to year 2000, 5 between 2000 – 2005 and 3 were in 2007.


The founders of the facilities are:


                               Founder of facility
                                                2                         2



                                                                                              4



                        6

                                                                                         2

                                                            4
                  Only doctors                                  Church organisations
                  Health care professionals,                    Psychologists and social workers or
                  citizens and former users                     teachers
                                                                Citizens with strong relation to this
       :          Only former users                             issue, social workers, teachers,
                                                                etc.



These 24 facilities are in the following geographical locations:

                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                      4




                                Geographical Location of Facilities
                         6                                            4




                                                                                           City centre
                                                                                          Suburban
                                                                                          Peripheric
           3                                                                              Isolated




                                                                11



Four centres manage facilities that are located both in city centre and and in a peripheric location, in two
cases they are only few kilometres apart and in the other two, tens of kilometres.

Public transportation provides easy access to seven facilities, 3 are significantly isolated and a car is needed
to reach them. To reach the remaining 14 facilities, it is necessary to have good knowledge of bus
schedules, be able to ride a bike or organise individual transport.

All facilities openings were followed with concerns from the neighbourhood, however, they calmed down
quickly. Except for one, the facilities have excellent relations within the locations (neighbours, municipality,
etc.); they communicate, cooperate and provide mutual services to each other. Fifteen facilities have very
close partnerships with the municipal office, which allocates them material and/or financial aid. Seven
facilities receive strong supports sides the church. Two facilities help their inmates find accommodation
within the municipalities. This way they become citizens of that municipality, they vote …, which significantly
simplifies the integration of inhabitants and the facilities.

All facilities submit financial and summary reports with quantitative data to the state and their funding
subjects. Non-compulsory summary reports with quantitative data are prepared on a more occasional basis.

Fourteen facilities state to have cooperation with other Slovak re-socialisation facilities. Ten of them
cooperate with foreign partners, 3 only with such partners and two informed of no cooperation.




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   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                                                                                     5


1.2 Funding
Except for two facilities, which are not NGO managed, but rather 100% funded from accredited beds
through annual subsidies, the share of co-financed and accredited beds varies significantly from 100% in the
best case to 44%. Thirteen of 20 facilities are funded from accredited beds, whereby the average co-
financing represents 67%.




                                                                       Scope of accredited beds financing

                                                       8



                                                                                           Average extent of covered beds
                                                       7

                                                       6

                                                       5
                       Počet centier




                                                       4

                                                       3

                                                       2

                                                       1

                                                       0
                                                   40-49 %           50-59 % 60-69 %                                        70-79 %         80-89 %           90-99 %                             100 %

                                                                                          Miera financovania




When comparing this financial coverage method and the number of occupied beds during our visits, the
level of financial coverage increases from 10 to 133% with an average of 84% (when disregarding extreme
values).


                                                                                  Level of occupied beds financing

                                                   6




                                                   5
                                                                                                                                                              Average financial coverage
                          Number or facilities




                                                   4




                                                   3




                                                   2




                                                   1




                                                   0
                                                       %



                                                                %



                                                                           %



                                                                                     %



                                                                                                                            %



                                                                                                                                     %



                                                                                                                                               %



                                                                                                                                                         %



                                                                                                                                                                                           %



                                                                                                                                                                                                   %


                                                                                                                                                                                                           %
                                                       9



                                                                 9



                                                                            9



                                                                                      9



                                                                                                9



                                                                                                                                      9



                                                                                                                                                9



                                                                                                                                                          9



                                                                                                                                                                                9



                                                                                                                                                                                                    9
                                                    -1



                                                              -2



                                                                         -3



                                                                                   -4



                                                                                             -5



                                                                                                                                   -6



                                                                                                                                             -7



                                                                                                                                                       -8



                                                                                                                                                                             -9



                                                                                                                                                                                                 10



                                                                                                                                                                                                          10
                                                                                                                                                                                                        •
                                                 10



                                                           20



                                                                      30



                                                                                40



                                                                                          50



                                                                                                                                60



                                                                                                                                          70



                                                                                                                                                    80



                                                                                                                                                                          90



                                                                                                                                                                                              0-



                                                                                                                                                                                                        1
                                                                                                                                                                                           10




                                                                                                Level of occupied beds financing
                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                                                         6




Five facilities receive financial resources on the basis of a stabilised system of annual subsidies and the
other 5 on the basis of beds occupied in the previous year. For 10 facilities, the amount changes from year
to year depending on the higher territorial unit budget.
                                                                                                                      1
As a result, 14 facilities receive funds equalling SKK 150 000 per bed and year, one facility receives only
SKK 120 000 and another one SKK 447 000 per one bed and year. According to the law of 1998 modified in
2005 the sum is 150 000


                                                                                                    Amount per bed


                                                           14
                                                           13
                                                           12
                                                           11
                                          Number of facilities




                                                           10
                                                            9
                                                            8
                                                            7
                                                            6
                                                            5
                                                            4
                                                            3
                                                            2
                                                            1
                                                             100              150       200      250     300     350          400   450
                                                                                               In SKK th./bed/year



The level of client financial participation varies between the facilities, whereby the average value represents
SKK 2 600 per month and client.


                                                                                              User Payments



                                                                 ≥ 5000

                          Adjusted to minimum social
    Payments Modulation




                                          allowances
                              (SKK 3 600 per month)

                            Adjusted to clients family
                           circumstances and clients
                                  financial resources

                                            Adjusted
                                     according to the
                                        phase of the
                                       mprogramme
                                               rehab
                                             None



                                                                          0         2           4       6           8         10    12    14   16
                                                                                                             Number of facilities


1
    Euro Exchange rate as of 23/10/2007:1 euro = 33,73 Slovak Crowns
                                                           Draft assessment report
      EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                          psychoactive substances
                                                                        7


One facility agreed for clients with no financial resources to pay nothing, 8 facilities require a payment of
SKK 2 500 per moth, 5 require payments ranging from SKK 2 600 to 3 000 per month, 3 require payments
ranging from SKK 3 100 to 3 600 per month and 3 require SKK 3 600 per month.




                             User Payments




                      3 600 and
                      more

                  from 3 000 to 3 599
        Payment




                  From 2 500 to2 999


                      from 1 to 2 499


                                    0


                                        0        1       2          3           4         5          6          7         8

                                                               Number of facilities


All facilities receive private donations, both financial and tied, 6 are striving for self-financing through the
sale of own products and the provision of services and one is trying to enter economic sphere with the goal
to become independent from its funding institutions.


1.3 Premises and Infrastructure
Two facilities have premises in one joint building, whereby the others dispose of own premises: 6 buildings
and 16 detached houses, 14 own land, which enables them to carry on with one, or several trades and/or
agricultural work.


                                            Ownership of Facilities


                                                                            6


                                                                                     Full owners
                                                                                     Partial owners and tenats


                                                                                     Tenants
      11



                                                                        3




                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                        8


In the position of lessor, we usually encounter the municipality, in which a facility is located (8/14), private
sector (3/14), higher territorial unit (2/14), or the state in one case. Except for one case, the rental fees ares
quite low, or even symbolic, whereby lease agreements are signed for periods ranging from 5 to 35 years.

It seems that making such premises available releases the lessor from the duty to maintain them, since such
duty is transferred onto the facility, which sometimes causes financial problems.

Floor space per client ranges from 8 m² to 37.5 m². Except for some cases, clients have own rooms
available, or are in one room with 15 others. The average is 4 beds per room. In terms of sanitary equipment
(showers, toilets), 12 facilities have 1 per 5 clients, the remaining 12 facilities have differing numbers.

All visited facilities were clean, tidy and maintained. One facility seemed to be at the limit.
Except for two facilities, all have equipped kitchens authorized to prepare food. The mentioned two facilities
receive two daily deliveries of cold food.

Nine facilities state the possibility to admit physically disabled people, or even have admitted such persons
already. Other facilities are not prepared for such situation.

Except for 4 facilities, all facilities have well equipped sports rooms and/or sports equipment for: volleyball,
football, basketball, table tennis, etc.
All facilities have TV sets, some also audio-visual equipment.


1.4 Type of Clients
1.4.1 Capacity and Occupation Rate

With the 350 officially available beds, the number of accommodated persons significantly varies between the
facilities. In the course of our visits, we counted 408 accommodated clients. The rate of occupation ranges
from 66% to 900%. The average value represents 98% when disregarding the two extreme values.

Out of 20 facilities, 4 are 100% occupied, 8 exceed the number of authorised beds and 8 accommodate less
clients than they have accredited beds and still have some free beds available.

In 8 facilities the rate of occupation is below 90% and in 10 higher, or equal to 100%. In two facilities, the
rate of occupation reaches extreme values: 140% and 900%.


                                                                Facility Occupation Rate

                                  4

                                 3,5

                                  3
          Number of facilities




                                                                                          Priemerná miera




                                 2,5

                                  2

                                 1,5

                                  1

                                 0,5

                                  0
1.4.2 Age et sexe des personnes accueillies
                                                                                                                                 4
                                       9


                                             4


                                                    9


                                                           4


                                                                    9


                                                                            4


                                                                                      9


                                                                                                               4


                                                                                                                        9


                                                                                                                              11
                                     -6


                                             -7


                                                    -7


                                                           -8


                                                                   -8


                                                                          -9


                                                                                   -9


                                                                                                            10


                                                                                                                     10
                                   65


                                           70


                                                  75


                                                         80


                                                                 85


                                                                        90


                                                                                 95




                                                                                                                              0-
                                                                                                0-


                                                                                                                     5-


                                                                                                                            11
                                                                                              10


                                                                                                                   10




                                                                    Rate of Occupation


                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                      9


Six facilities admit only men over 18 years of age, 4 admit men over 16 years of age under the condition of
completed compulsory school attendance, 7 facilities admit both men and women over 16 years of age
under the condition of completed compulsory school attendance, 3 facilities admit clients up to the age of
16.

All facilities admit men, 50% admit men and women, 50% admit youths below the age of 16. In the last case,
40% of these facilities admit only men and 20% of facilities are mixed with no age limitation. There is no
facility exclusively for women.

When admitting clients, there is a maximum age limit (40, 55 and 56 years of age).

In terms of clients’ average age, Slovakia could be categorized in 3 zones:
     – In the west, with 8 facilities, the youngest clients are between 23 and 24 years of age
     – In the central part with 10 facilities, 25 - 35 years of age
     – In the east with 3 facilities, 35 - 45 years of age and 3 facilities with an age limit of 45 years and
        more.

Thirteen facilities admit persons of various age categories. This causes problems to 3 of them due to
generation differences: creation of clans inside the group, various problems, different future expectations,
etc.


1.4.3 Character of Client Addictions

In terms of addictions character, it is necessary to differentiate between Eastern Slovakia (in this region,
addictions are almost exclusively alcohol related, less solvent related) and other parts of Slovakia, where
polytoxicomania with methamphetamine prevalence is common (methamphetamine – alcohol and heroin...).
6 facilities admit almost only former alcoholics, 3 admit pathologic gamblers and 18 admit former
methamphetamine, alcohol, heroin users and multiple drug abusers.

The estimation provided by some of the RC directors states that there are very few HIV positive clients (< 1
%); and hepatitis C positive clients represent 25%.


1.4.4 Socio-economic Background of Clients

5 facilities state their clients are from various socio-economic backgrounds, ranging from analphabets to
university graduates. It is possible to conclude that 4 facilities admit clients with good financial standing and
7 with average situation (officers, workers). 4 facilities admit clients with difficult and very difficult social
situation.




                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                     10


1.5 Personnel

1.5.1 Staff


The facilities are “managed” by their directors supported by a full time team (2-24 persons) and external staff
(1-10). All facilities employ minimum one woman, often in a man/woman tandem “with more or less family
type relation”. At this stage, it is necessary to point out the systematically repeated presence of a competent
expert, who is either the member of management or employee in a position close to the director with a real
position of authority in the team.



Except for one facility employing staff through a selection procedure, the directors employ staff in the other
facilities. In 5 cases, the management board or work team opinions are considered.

With respect to the given number of staff, ten facilities state to have no need for a formalised organisational
structure. Nevertheless, all facilities defined tasks of the respective personnel, even though they are often
varied.
In eight facilities of nineteen (one was opened recently and cannot be included), the staff has been
employed for several years, whereby fluctuation, which takes place in three year cycles, is below 10%; in
three facilities, the three year fluctuation is higher, or equal 40%. In one facility, it reaches 60%.

The number of staff members (full time or external), regardless of position, per one admitted client (see
following scheme) suggests there is one member of staff per 5 admitted clients in 5 facilities, one staff
member per 2 clients in 6 facilities and more than one member of staff per one client in one facility.




                                            Members of Staff per One Client

                                    6
             Number of Facilities




                                    5

                                    4

                                    3

                                    2

                                     1

                                        0
                                                            29

                                                          39

                                                         49
                                                         0,




                                                       59
                                                       0,




                                                                                                                  Nombre de structures
                                                      69
                                                      2-




                                                      0,




                                                    79
                                                    3-




                                                    0,
                                                   4-
                                                   0,




                                                  89
                                                   0,
                                                 0,




                                                 5-




                                                99
                                                 0,
                                                0,




                                                6-




                                              09
                                               0,
                                              0,




                                              7-




                                             19
                                             0,
                                             0,




                                            8-




                                           1,
                                           0,




                                          9-




                                          1,
                                         0,




                                        0-
                                       0,




                                       1-
                                     1,


                                    1,




Number of client staff members ranges from 3 to 22, disregarding accountants, economists and
administrators.

See also table 5 in annex



                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                              11


1.5.2 Work Organisation

One facility employs no overnight staff. Responsibility for the facility is left with the “group leader” and
director living 100 m away from the facility. All other facilities have minimum one person that is present 24
hours a day and 365 days a year basis.

One facility has both day and night personnel working 37.5 hours per week; one has guards available; other
facilities have the following work organisation:



                                                  Supervision Provided by the Personnel




                                Unsupervised nights              24h supervision by 1 person
                                Night or day shift               24h supervision - 2 persons
                                Nightwatch                       2 persons working 4 days d'affilée
                                3x8                              2 persons working an entire week




Work organisation in terms of personnel allocation is as follows:


                                                      Work Organisation by Facility

                                                              Graph. 2 : RCs accreditations year deadline
                   1 full week of 5
                   1 full week of 2

                                  4 days of 8
   Workload




                      1 supervisor per 9 days
                                                                                              1
                      1 supervisor per 7 days                                                      1
              1 supervisor for 24h every 5th
              day                                                                                        2
              1 supervisor for 24h every 4th
              day                                                        14
              1 supervisor for 24h every 3rd
              day
                  24 h permanent shift does not                                                     4
                  exist
                                                  0       1          2              3         4              5          6   7
                                                                         Number of Facilities




                                                              2011   2009          2007   Not required       unknow n




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   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                     12



1.5.3 Personnel Qualification

In 15 facilities, full time staff is assisted by volunteers (family members of management, neighbours, former
clients), whereby their activities range from office work to client assistance.

Only 5 facilities stated they accepted to trainees due to lack of time necessary for their training.

The character of jobs in these facilities varies and is not necessarily qualification or degree based:
receptionist, dietician, economist, accountant, theologist, educator, ergotherapist, psychotherapist, nurse
assistant, social worker, pedagogist, psychologist, nurse, and doctor. See also table 6 in annex.

The following chart shows the number of facilities employing such personnel:

                                              No. of facilities providing full              No. of facilities providing part
     Position/qualification
                                                    time employment                               time employment
Nightwather                                                    1                                             /
Receptionist                                                   1                                             /
Qualified dietician                                            1                                             /
Administrator                                                  5                                             3
Qualified accountant                                           2                                             /
Qualified theologist                                           4                                             /
Qualified educator                                             3                                             /
Unqualified ergotherapist                                     14                                             /
Qualified ergotherapist                                        5                                             2
Qualified psychotherapist                                      5                                             3
Nurse assistant                                                4                                             /
Uncertified social worker                                      4                                             /
Qualified social worker                                       16                                             /
Qualified pedagogist                                           6                                             1
Qualified psychologist                                         8                                            12
Diploma nurse                                                  4                                             /
Doctor                                                         2                                            11

Except for two facilities with infrequent work team meetings, other facilities state to organise meetings of
client care personnel once per week (3 facilities), once every two weeks (6 facilities) and once per month (9
facilities) with the aim to assess clients’ progress, discuss problems encountered, find solutions and develop
care standards.

In 14 facilities, personnel participate in training. Five facilities state to finance such training from own
sources or via partners, 4 facilities provide partial funding with staff co-financing and in 5 facilities, training is
fully staff financed.




                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
                                                                     13


1.6 Care and Facility Functioning
1.6.1 Client Admission

In 14 facilities, clients are transferred from psychiatric clinics following detoxification treatment. In the
remaining six cases, clients hear about the facility from other people, via internet, during outpatient care,
from family, etc.

It is standard to admit clients following the detoxification treatment. One facility is equipped for detoxification
treatment and 4 facilities admit clients without this condition. These facilities have strong partnerships with
psychiatric clinics and physicians.

In two regions (4 facilities), preference is given to clients with permanent address in that region. Clients from
other regions are admitted on a bed availability basis.


1.6.2 Admission Conditions and Method

In 5 facilities, there is a formal requirement to write a motivation letter with the community agreeing with the
admission. In the other 15, the client is admitted following a simple interview and on a “who comes first”
basis.

There is no waiting list for admissions to the facilities. In case of full occupation, 11 facilities refer the user to
another facility. This procedure is also applied should the client have problems.

All facilities sign an agreement with the user, what is to be performed, whereby both parties confirm to
understand all relevant conditions.

Only two facilities do not have an internal operating order. In other facilities, clients study it on admission; it
is also presented inside the facility.

On arrival of a new client, 8 out of 20 facilities state to be informed of the persons' medical record and 10
also of the social background. In ten cases, the facility learns about the clients' social background gradually
throughout the clients' stay.


1.6.3 Medical Care

Subject to conditions, hepatitis C positive patients are supervised by experts. In case of other diseases, 11
facilities employ externally a general practitioner and 9 cooperate with a physician on an informal
partnership basis. Four facilities are under permanent monitoring of a cooperating dentist, whereby 3
facilities have partnerships with a gynaecologist (total 10 facilities admit women), 11 facilities cooperate with
a psychiatrist.


1.6.4 Social Care

All facilities support their clients in the renewal of social contacts and recovery of their identity cards. 4
facilities declare to have informal partnership with a lawyer, which enables them to provide legal aid to those
clients that have legal problems. Even though the request for annulation of debt towards the health
insurance company is possible (this information was provided by the regional branch of one health
insurance company), 9 facilities are not aware of this option.

Similarly, even though the new penal code has an alternative to drug user imprisonment under the
supervision of probation and mediation officer, 5 facilities are not aware of such a new measure. However, it
is necessary to point out that this penal code provision does not explicitly mention any re-socialisation
facilities, only treatment of addictions and education programs.

                                                        Draft assessment report
   EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                       psychoactive substances
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1.6.5 User Resources and Participation

Except for 2 facilities, individuals with no financial resources are entitled to social benefits of SKK 3 600. In 6
facilities, clients may not take on work against remuneration, or receive remuneration. In 18 facilities, clients
dispose of their own funds (salary and social benefits). In terms of the social benefits, 15 facilities leave 20 –
45% of this amount with the client, if their income exceeds SKK 3 600 per month, it is more. 8 facilities do
not allow clients to manage their funds alone, or with assistance. Their financial funds are managed by the
facility, or the group having the client consent. In 10 facilities, clients manage their funds with the assistance
of one facility staff member, or with the help of the group, whereby such help, or assistance gradually
decreases as the stay progresses.


1.6.6 Reasons for Exclusion

Drug consumption represents the key exclusion motive in all facilities. In 9 facilities, exclusion takes place
with no warning following the first violation, in 11 facilities a second chance is granted by the group, or the
management. Further reasons for exclusion are physical and verbal violence, or love and sexual relations in
mixed gender facilities. With respect to the last case, the facility may isolate the couple, should it have two
facilities. Otherwise, the client, who has spent more time in the facility, leaves.

In 8 facilities, drug consumption is tested regularly (alcohol and urine tests).

In three facilities, smoking is prohibited; in 2 facilities, tobacco may be used under supervision, in 11
facilities, use is controlled (defined hours and number of cigarettes) and 4 facilities have no limitations.



1.6.7 Therapeutic Approach

In fact, therapeutic approach is behaviour based. Group piers, spirituality, or religion, family and work play
key roles.

The facilities work on the principle of a therapeutic community, community of residents living together,
working for the community under the supervision of one staff member sticking to strict rules developed by
the residents themselves and developing depending on their requirements coming up during the group work.
5 facilities have a system of rewards and sanctions. Their system is often defined by the community, acts,
approaches, residents are marked.

They meet within a community therapy 1 to 3 times per day. It is managed by an employee or speaker, or
“boss” appointed by equal group members. Only two facilities do not have the appointed representative or
speaker. Further, clients are monitored by individually qualified psychologists depending on their individual
needs and progress made in the facility. In 5 facilities, clients are obliged to write diaries forming part of their
individual work with a therapist.

Except for 5 facilities with no pets, pets accompany the residents (dogs, cats, birds, fish, and turtles),
participate in their life and support them in the form of “zoo therapy”. In 13 facilities, residents look after
livestock (cows, pigs, poultry, goats, horses, etc.).

One facility does not have free movement of residents, five have limited movement (doors are locked). In 19
facilities, clients may access all facility premises, except for the director office and/or drug storage.

Thirteen facilities organise walks, trips and meetings with former facility clients.




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1.6.8 Duration of Stay and Organisation

On the average, clients stay 15 months in the facilities; this period may be extended by 12 to 36 months.



                                            Duration of Client Stay (months)

                                             >24                                            < 12
                                               15%                                            15%




                       18-24
                          20%



                                                                                                 12-17
                                                                                                    50%


The stay is distributed among four structured phases (3 to 8). Their description is often defined and
presented in the internal house order; in these phases, the client learns tasks for the community and learns
about own rights and duties.

These phases are characterised as follows:

  - Phase 1: Adaptation. Most commonly, the client is isolated from the outside world, be it through
    prohibition of any contact (including intimate realtionships), or prohibition of any outings. It is necessary
    to adjust to the new environment and adhere to the community life rules.
  - Phase 2: Own development. The client re-establishes contacts with own family, the outside world, starts
    assuming responsibilities and performing duties within the community.
  - Phase 3: Stabilisation. The client has an increasing volume of rights, tasks and responsibilities with
    respect to the community, independence starts to set in.
  - Phase 4: Independence. Client needs to find job and accommodation. The client is almost independent
    in own actions, responsible for oneself and accepts responsibility for piers in the group, who are in
    phase one.

Phase one is considered to be critical, 20 to 25% clients leave prior to progressing to the next phase.

Providing the client agrees, work with family starts in the second phase. Family inclusion into the client
therapy is very important, not only due to material (the family very often participates in the funding of the
client stay), but also psychological aspects. The aim is to identify the first impulse leading to drug
consumption and to help the family accept the “new client”, who no more is an abuser. Despite the seeming
simplicity of this work in 8 facilities, 12 facilities have small or more significant problems.

In 24 facilities, clients are responsible for household work (cleaning, kitchen, shopping, etc.), in 17 facilities,
they participate in construction, restaurant work, cabinet making, wood chopping, farming (garden, animals),
sewing, ironing, car washing, baking, etc., In 11 facilities, there are the necessary equipment and material
available for professional work. Further, there is also work in the exterior: forest maintenance, restaurant
work for the municipal office, house and neighbouring gardens maintenance, etc.

In 7 facilities, tasks are allocated by staff, in 6 by staff and residents and in 7 by the residents themselves.

It is necessary to point out that only two facilities provide their clients practical work experience possibly
helping them to re-enter the labour market, despite it not being considered qualifying training.

8 facilities consult and train their clients in the fields of nutrition, hygiene, budget management.

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In 11 facilities, clients may re-enter school and minors may finish their compulsory school attendance. 9
facilities do not offer this possibility, whereby some facilities do not admit clients with incomplete compulsory
school attendance.

In 3 facilities, employment outside the facility is seen from the second phase onwards; the remaining
facilities allow this from phase 4.

7 facilities have partnership with industrial sector, businesses and shops, and this with respect to financial
contributions for the facility and support in client job placement. The remaining facilities rely on cooperation
with neighbours, who provide them with jobs, which in turns establishes good local relations. 15 facilities
state to have cooperation with the local labour offices.

13 facilities significantly support clients in their departure preparation (support in job and accommodation
search). 5 facilities continue monitoring clients also following their departure.

18 facilities offer former clients the possibility to return for one or several support meetings; 5 facilities see
such returns seldom, but 6 others stress developed relations and their regular up keeping.

Ten facilities state certain detachment problems encountered at the end of stays. They are demonstrated
through settlement in the same region, regular returns, etc. 5 facilities dispose of transition homes, and 7
would like to open them to solve accommodation problems and support slow, but safe client detachment
from the facility.




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Chapter 2 Stakeholders and Partners of Re-socialisation Facilities


2.1      Partners
To better understand the given environment and conditions the re-socialisation facilities function in, we
considered it necessary to meet various partners and managers, experts, officers and institutional workers
to understand their perceptions, expectations and opinions with respect to the facilities and their work.

For this purpose, we met health care professionals working in hospital environments, labour office staff,
health insurance company representatives, etc., as well as representatives of municipal offices and higher
territorial units.

These meetings helped us establish contacts and collect the following wishes.

2.1.1 Health Care Professionals

First of all, general practitioners do not largely participate in drug addicts’ treatment, their medical practice
does not deal with drug addictions, and it is rather related to psychiatric practice.

Even though all psychiatrists agree on toxicomania being a pathologic phenomenon, schematically, they
could be divided into three categories:

         -    Those, who consider toxicomania, but especially addiction to be a pathologic phenomenon in
              the competency of psychiatry. This pathologic phenomenon cannot be coupled with social
              problems. Just as with any pathologic phenomenon, we encounter recovery and relapse, so
              social care could not support “recovery”, or support relapse prevention.

         -    Those, who appreciate and acknowledge the fact of re-socialisation facilities and abstinence
              clubs providing such support following detoxification treatment. Some doctors inform their
              patients on the existence, functioning and purpose of such facilities, but only few provide them
              with addresses.

         -    Those, who consider the coupling of this pathologic phenomenon and psychiatry to be too
              strong, which supports excessive hospitalization. In their opinion, treatment is missing openness
              and diversity. The drug withdrawal period may and/or must take place in a hospital environment,
              whereby outpatient treatment could be suggested for detoxification treatment instead of the
              currently used three month treatment or for after-treatment. This method of care would be less
              costly and more efficient; the patient would not be isolated from his/her natural environment.
              According to this group, re-socialisation is interesting for instable patients, who also have
              psychological, social and family problems. They highlighted the need to introduce, or even
              support the cooperation between the health care and social facilities in the provision of true care
              for individuals with addiction.

Some departments feel the obligation to train social workers, who are considered undertrained in the field of
addictions care. Training on addictions and relevant care could improve their cooperation in these cases.

Further, significant lack of psychiatric departments truly specialised in addictions treatment was underlined,
just as the lack of beds and personnel.
Similar problem was suggested in the treatment of individuals with mental disorders and addictions.

Finally, the need to involve medical services in addictions prevention was highlighted.




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2.1.2 Labour Offices

The staff of regional labour offices is totally overloaded.

Despite having identified strong prevalence of toxicomania in the clients within their competency, they
cannot identify specific clients as drug addicts, whereby their social problems are identical to others:
unemployment, housing.

They do mention close cooperation with re-socialisation facilities.


2.1.3 Municipal Offices

Municipal offices and the Federation of Cities and Villages in Slovakia (ZMOS) identified the toxicomania
problem and highlighted their intense participation in primary prevention at schools and universities.

With respect to social care provided to addicts, there are two opinions:
        - One entrusting such care to re-socialisation facilities. In such cases, municipal offices are ready
           to participate in these facilities financing, which in turn obliges the facilities to provide the
           services and be accountable;
        - And another one based on true partnership. These municipalities closely cooperate with the
           facilities, especially their directors, who are well known and established in the community; they
           support their projects and facilities operation.


2.1.4 Higher Territorial Units

It seems, social policy of higher territorial units focuses especially around children, elderly-, people with
disabilities, re-socialisation of disadvantaged individuals and drug control. These rights are defined in social
laws. Social department has to be able to provide clients with customised help depending on individual
needs.

With respect to the current competencies transfer, situation is very sensitive. The process of social laws
implementation was initiated, however, it is not completed yet and the same applies to regional
decentralisation. Currently, re-socialisation facilities are in the competency of the central government
(definition of general tendencies, accreditation, etc.), as well as higher territorial units and municipalities to a
limited extent (establishment, funding, etc.).

Coordination between the state and higher territorial units and in between the units is insufficient, they work
in isolation. Laws only define general guidelines for the facilities, just as minimum qualification requirements.
Each region has its own policy depending on its budget with not enough regard to the overall national
context.

In this respect, two higher territorial units require the re-socialisation facilities to preferably admit individuals
with permanent address within the given region. Person from other parts of Slovakia are to be admitted only
to the remaining beds.

There is no document summarising minimum requirements for personnel, qualification, etc. criteria for re-
socialisation facilities, or an investment budget, which leads to differences in the quality of care in different
regions.

Some higher territorial units have had enough of funding the facilities without having tools and methodology
to supervise the quality of care

Without tools for the estimation of the number of beds needed there are two contradictory approaches by
the higher territorial units: one assumes hat there is a sufficient number of beds because of the non-
existence of a waiting list for admission to these facilities; the second approach looks at the number of beds

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occupied during the detoxification treatment in hospitals and considers the social approach to be
underdeveloped, which leads to the conclusion that beds are lacking.

Further, the method for calculation of funds allocated by the higher territorial units to the re-socialisation
facilities also varies. Some higher territorial units base the calculation on the number of its inhabitants
admitted to all facilities throughout Slovakia, or the number of addicts within their territory. Others consider
the material capacity of a facility to admit clients and the quality of the NGO running the facility integrating
the aspects of quality and recognition of certain autonomy expressed in a figure. Some base the calculation
on the total social policy budget of the higher territorial unit and the granted contribution.

         Key requirements of higher territorial units expressed within our meetings:


 - Most higher territorial units we visited would appreciate the introduction of a medical-social approach
   and complex addicts care. The current situation, where heath care is responsibility of the state and
   social field partial responsibility of the higher territorial unit, leads to deviations/mistakes of economic,
   medical and social character impacting the users at the grass-root level. It is necessary for the health
   care and social services to cooperate, since they are complementary, not competitive. Some higher
   territorial units even believe re-socialisation should start in the hospitals with the detoxification treatment,
   to reduce the volume of relapse through the inclusion of this care into the overall longterm treatment.
   Some regions think that access to medical care is easier nowadays (more information, more place, etc.)
   than acces to social care, which in turn would be less costly and support re-inclusion into society.

 - Some higher territorial units plan to open their own re-socialisation facilities for addicts after
   detoxification treatment to get out of the current observer position, which precludes them from
   influencing facilities they finance, but do no manage. They would like to assume a leading role, define
   material conditions, number of staff and staff qualification, length of stay, philosophical approach and
   care approach (special individual project). With respect to the best proven procedures, they plan to
   adjust the necessary financial resources to the implementation of such projects and monitor quality of
   provided services.

 - Others contemplate the addicts care take over at national level, whereby, they would like to minimise the
   existing differences between the facilities established by NGOs, municipalities and higher territorial
   units.

 - There are many higher territorial units with true need for participation in cooperation and coordination
   with the state in the development of legislative texts and with other higher territorial units and
   municipalities in increased implementation coherence at local level. A requirement has been voiced for
   the development of evaluation tools applied to medical and social services with the purpose of national
   policy and its local implementation improvement.

 - Further, a need for the development of cooperation with re-socialisation facilities at both regional and
   national levels has been expressed, which should take place via the relevant representatives. This
   would not only enable the development of social policy strategic plans, but also the implementation of a
   clearly defined set of tasks guaranteeing quality, financial resources and investments, as well as the
   development of evaluation and control charts.

 - When considering the existence of very distinct differences between various social services and the lack
   of cooperation, which weakens the effect and efficiency of their work, it is desirable for these services to
   better cooperate with the aim of better coherence, funding and efficiency.

 - Prevention development is often desirable when considering it in a complex and transversal context with
   the various partners, both active and inactive.




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2.2 Clients
During the visits to the re-socialisation facilities, it seemed important to also provide some space to the
clients to get an insight on their lives, wishes, expectations and fears.

There are to client profiles: former methamphetamine users, often poly-addicts, 20 – 25 years of age, who
started abusing drugs at a very young age (11 – 12 years of age); former alcoholics, 30 – 35 years of age,
who started drinking later.

Most often, these people have a background in socially disadvantaged families that gives them the legacy of
bad life experiences (breakdown, death, divorce…), they all identify problems and painful turning points in
their lives.

Family is very important, both at material and emotional levels (conception of family, position, support,
responsibility, remorse, hope). All clients mentioned family and positioned themselves in relation to it.
Most clients state to have repeatedly passed through detoxification treatment and to have had repeated
relapses, but for many it is the first time in the re-socialisation facility. Many never had a job.

Clients state they needed help to identify and accept themselves. Despite support from older clients, many
feel lonely. The “older brother” principle (having and being one) is important for receiving understanding,
support, social attachment and solidarity. However, not even this environment erases the feeling of being
different than others, outsider from the world coupled with confrontation problems and fears.

Both organised and informal meetings with former clients are a source of guidance and hope. The survival
of the former clients clearly prove it is possible to find a way out of the situation and the support and help
received from them is considered trustworhy

Open return policy based on the clients' wish or need, helps the clients common worry about their departure
from the facility. Some complain about the state failing to support them as individuals and transferring the
responsibility onto the family. For some families, it is really complicated to provide any help; they often
blame the client, which does not strengthen family relations.

Most clients are worried about their facility departure, they are afraid of the future – both financially (debts,
lack of education, or education leading to no job option, no accommodation) and emotionally (family, return
to the original environment, detachment from the past…).

Many clients state, they would not like to return to their previous address following their departure, since
there are the old memories and friends. They would like to start new life elsewhere, some even in the
proximity of the facility and older brothers, with whom they sometimes find joint accommodation.

Often, the clients mentioned training possibilities, the option to study or continue in studies, since the level of
their education and work experience were low. They would expect help and preparation for future job
interviews.



2.3 Personnel

As far as the operation of facilities and client care are concerned, it was also necessary to meet the
personnel, learn about their system of work, their perception of that work and problems encountered.
The personnel is interested in this work, they like it, but are quite isolated. It is caused by the low number of
employees (due to services distribution, they do not have a chance to work in a group), lack of more
extensive network of professionals, continuous training and training cost problems (often, staff pays for
training) and work organisation. However, it is also the result of limited information exchange with the
management, which fails to communicate with the staff and considers staff merely as work executors.

Mostly, regardless of qualification, people perform several work tasks and feel unprepared for such tasks.
Some practice various “methods”; others use their own work and personal experiences.


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Despite few directly expressed complaints, practically all mentioned strained work rate and effort, the feeling
of isolation, lack of acknowledgement and financial remuneration for their work. Many mentioned lack of
specific professional training, different from medical, for the work with addicts. Therefore, their training is the
“passing days”, their practical activities, since there is lack of specialised expert work available in the Slovak
language. The presence of former clients opens a more realistic approach.

Need for communication, relations, discussions, exchange of experiences with other facilities was
mentioned very clearly in almost all cases. Just as the need for company (those working alone would
appreciate the possibility to work at least in two-man teams) and participation in the facility management.
And since a diploma guarantees higher salary, many would like to study or participate in qualification
training schemes.


2.4 Directors
In all visits, we communicated with the facility management on their perception of their work, its mission and
problems, as well as their wishes. Some topics were urgently repeated, others were mentioned several
times.

Determination and confidence characterised all 21 directors we met. Some seem a bit “out of breath” and
they regret the volume of energy necessary to reach average results.


2.4.1 Funding

All directors mentioned financial problems coupled with everyday operation, or facilities improvement. Lack
of regular and stable funding prevents the implementation of multi-year projects, prevents the improvement
and extension of services provided, and prevents the employment and proper remuneration of qualified
staff. This forces them to function from year to year without any expectations for the future. Many believe
their facilities are “surviving” and are threatened due to the instable environment.

Legislative changes are expected. They should reflect everyday reality and true needs. Till now, such
legislation was drafted by theoreticians, so the drafts were inaccurate, stiff, or inapplicable.

Many questions are raised in relation to the ongoing accreditation. From their point of view, it does not solve
much: it is not coupled with funding, more precise rules, or quality or sustainability guarantees… The current
transition status in the implementation of laws and ongoing changes in the higher territorial units cause
unclarity. The facilities are within competency of higher territorial units (financially, supervision) but also
state competency (accreditation). It is necessary to solve this hybrid position as soon as possible, since it
leads to problems with communication, mixed requirements, pursuit of different goals, and application of
own, often contradicting criteria… One example documenting this situation is the disagreement between the
number of accredited beds and number of beds with a subsidy of the higher territorial unit.

The need for financial remuneration clearly exists, however the need for partnership, definition of standards,
evaluation, supervision and control resounds, of course under the condition of financial support securing
good functioning of facilities.
Clarification of state and higher territorial units’ tasks and competencies, as well as the harmonisation of
financing is desirable. It would avoid the “help yourselves” situations, or application of differing solutions.


2.4.2 Client Care

The existing gap between the health care providers and social facilities was evaluated to have a negative
effect on the clients, since clients with addiction problems have a need for both medical and social support
services. Despite possible perfect access to them, the separation of medical and social care leads the
clients to failure, be it due to lack of social attendance, or insufficient medical care.

The establishment of complex medical-social client care seems to be a human and economic necessity.
Medical-social care would be cheaper and would generate better results.

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It would be truly desirable for the law to define transversal approach to addicts care. Re-socialisation
facilities must be recognised as an equal partner to providers of medical-social addiction care.

Further, the directors realise certain deficiencies in the admission of and social attendance provided to
clients. They would like to improve their standard of living through the extension, or reconstruction of
premises and to support the “re-socialisation program” for it to lead to increased client independence.
They are aware of the difficulties the clients have with detachment from the facilities and society integration
following the end of stay. Therefore, some directors suggest the establishment of qualification professional
training for clients, opening of transition homes standing half way between re-socialisation and normal life
and supporting the effects of various social support services.

2.4.3 Cooperation and Partnership between Facilities

Many directors regret the lack of an impartial platform enabling the facilities to exchange experiences,
listening, supporting, helping in project development and representing them democratically towards the
public administration.

Several directors cooperate with foreign facilities providing care to individuals with addiction in the USA,
Poland, Hungary, the Czech Republic, Austria … They expressed the desire for more openness to
international cooperation.

2.4.4 Personnel

The directors are worried about the lack of personnel, especially qualified, experienced in work with addicts,
since they are unable to offer them permanent and well paid jobs in the instable conditions. Therefore, it is
very hard to finds such professionals. Qualified staff requires higher remuneration and the directors cannot
afford to employ a larger number. This leads to a situation with a low number, or low qualification of staff.
Therefore, it is desirable to establish a national remuneration chart reflecting qualification and experience
levels, which would be applied regardless of who the facility reports to provided, of course, there will be
sources allocated for such remuneration.

Similar approach needs to be adopted in the definition of qualification requirements and personnel – client
ratio.

Except for difficulties with recruitment, there is also a vacuum in training and preparation for work with
clients cumulating medical and social problems. The existing education formats are quite general and do not
offer the possibility to develop skills necessary for work with this type of clients. It would be advisable to
open training programs on the provision of care to individuals with addictions. These should enable
individuals with sufficient practical experience and those wishing to work in this field to graduate with a
diploma.




2.4.5 Development

Many directors hope they will be able to perform research, implement new, untrialed forms of work and
further develop the existing once. Except for the already mentioned problems with project development,
directors are also faced with misunderstanding sides the superior authorities in the approval and funding of
development activities. They would expect them to show more courage and will to act.




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Chapter 3 Comments, Opinions, Proposals, Suggestions
The previous parts endeavoured to provide detailed and true description of all observations and opinions.
The visits and meetings led the French and Finnish experts to comments, reactions and surprises, which
resulted in a set of suggestions and proposals. We will try to introduce them in this chapter.

3.1 Comments and Opinions
All visited facilities welcomed us very amicably. Meetings, sometimes marked by initial curiosity, or
concerns, took place in a relaxed atmosphere. Therefore, the work was constructive and rich in mutual
exchange of information. We would like to express our sincere thanks to all our hosts, who devoted their
time to us to describe and explain all necessary issues.

Experts could not help, but notice the engagement of all involved, both in health care and social services,
caring for individuals with addictions. Further, they noticed the problem was identified at the regional and
municipal levels and search for solutions was underway.

Significant social and economic differences between western and eastern Slovakia did not escape their
attention. In the field of drug addictions, the differences are represented in the drug abuse schemes; alcohol
prevails in the east, methamphetamine and other drugs in the west. However, differences are also in the
field of re-socialisation (finding a job, accommodation). These have economic background: in the west,
unemployment rate represents 4 – 5%, in the east, 20 – 23%.


3.1.1 Missing Global View on Addiction Issues

Missing regular statistic data, electronic data, and qualitative evaluations in facilities may lead to the
problems observed in the application of health care and social policies.
What is missing is certain detachment of all relevant stakeholders from their own practice, but also the
mentioned data, which complicates the opinion on the currently provided services and needs. Further, it
contributes to isolated opinions on financing, innovation of drug addiction care and fight against undesirable
addiction related activities.
This may be a source and result of insufficient horizontal work and partnership, insufficient links among the
ministries at state level: ministries of health, interior, justice, education, …, but also at the level of higher
territorial units and municipalities; at local level, links between higher territorial units and the municipalities
are missing, as well as between the respective social services.

However, it is necessary to point out the strong desire for data and transversal and partner approach in re-
socialisation and health care services, as well as within municipalities, local government and state
administration.


3.1.2 Fractioned Provision of Care to Individuals with Addictions

Low offer of out-patient care, irregular work of psychiatrists and general practitioners often lead to care
segmentation and insufficient continuity.

The fact that addiction is treated and considered to be “pathologic” regardless of its cause (gambling, heroin,
marihuana, alcohol…) raised justified or unjustified surprise of experts. But for some exceptions, both
medical and social care related rather to the addiction manifestations.

The addiction origin and its medical and social etiology remain in the background, or so it seems. Significant
separation, to avoid the term fractioning, between medical and social fields in the care for individuals with
addictions is undesirable. It almost prevents the provision of global care.

From our point of view, this fractioning is based on the conviction of certain physicians, that the care is
responsibility of health care professionals, more precisely psychiatrists and their underevaluation for the
work of re-socialisation facilities. Some believe the social dimension in drug addictions to represent some

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kind of unproved hypothesis both in the fields of etiology and care. Only few are convinced of the need to
provide global care.

Urgent appeals on this separation are heard from subjects responsible for the implementation, or funding of
social integration of individuals passing through one or several detoxification treatments. With respect to
their number and rate of failed integration efforts, they raise questions on the efficiency of the pure health
care approach and stress its financial and human counter efficiency. They call for closer partnership based
on the acknowledgement of all partners performing complementary work.


3.1.3 Re-socialisation Facilities in Reform

It seems the laws on social care provision and the role of higher territorial units within it is in the drafting
phase. This situation raises questions on the roles of state and local institutions and on the current
accreditation method. It is a source of problems and differences in the re-socialisation facilities functioning.

All higher territorial units consider drug addictions to represent an important issue. However, the state
considers their role to be the one of an “implementation body”, which is unsatisfactory and unclear for the
higher territorial units and the facilities.

Such unclarity applies to both the position and funding, and results in differences in the subsidies provided
to the facilities, in their calculation method, in allocation depending on the higher territorial units opinion,
even to differing subsidies to respective facilities within the same territorial unit. The feeling of uncertainty
prevails in the facilities despite partner relations with the higher territorial unit authorities, which some
directors describe as good. This ambiguity results in significant differences in the facilities functioning, which
applies to premises, qualification and number of staff and services provided and introduces sometimes
counterproductive competitiveness between the facilities, or just as undesirable “withdrawal and isolation”.


3.1.4 Re-socialisation Facilities – and Yet They Do Operate

Certain harmony, sometimes even cosiness and fellowship is felt in the facilities.

Work teams are dynamic, composed of people devoted to their jobs despite low financial remuneration
(salaries are very low) and appreciation for their work. For some of them, it is more a mission, rather than a
job.

Many directors have opened the facilities themselves, they participate in the work actively, for some the
facilities are part of their lives. They do not hesitate to involve their families and friends, be satisfied with
lower salaries in case of difficulties, establish more or less formal contact network, fight and find help for the
facility to survive.

Experts appreciated this personal investment, since the directors manage to keep the facilities up and
running. However, it also raised certain concerns for their further functioning, which is often based on just
one person with limited number of staff support, whereby this person is subjecting oneself to possible
“burnout”.

Such a strained functioning is coupled with the feelings of separation, isolation; they would like to share their
experiences. However, it also prevents them to detach themselves from their work; experts concluded they
simply had no time and power to think, ask questions, analyse results.

In some staff, the missing detachment may lead to certain stereotypes possibly preventing further
development of care, since progress is based on the questions asked, on critical review of existing
theoretical approach and practice.

In some facilities, skills and practical abilities exist, but only a few are aware of them. Except for the
immediate neighbourhoods, where most facilities have very good neighbour, or even partner relations, only
limited information leaks through to the general public. Probably due to lacking time and tradition, only some
facilities promote their activities beyond the framework of institutions. They try to generate more extensive
awareness, create partnerships and upgrade client work. It is surprising and detrimental for the situation,
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since there is a need of social appreciation, formal partnerships, financial resources and significant human
and material potentials are at stake.


3.1.5 Suitable Care Provision

As far as premises go, we visited truly wonderful facilities providing nice living conditions, but also facilities
lacking space and failing to meet safety requirements (several staircases need immediate repair, sanitary
facilities need to be reconstructed or newly constructed: one shower per twelve persons does not provide for
necessary hygiene). Only very few facilities are accessible. It is necessary to say the directors are aware of
these problems; however, they are not able to deal with them due to lacking funds.

There are big differences between client payments (from 2 000 to 5 000 per month and more) and this
observation rises the question, if there are facilities for the privileged and for others.
Further, there is no method to estimate the need for the number of beds on state or local levels. This way,
there are free beds in some facilities and others have to decline clients.

The experts consider emphasis on work with family and client work to be significant and complex.

The variety of staff qualifications, titles and functions reflecting or not the obtained diplomas caused trouble
to the experts in terms of understanding who was doing what, when, how and where. This should be
considered in the drafting of training programs.

In several facilities, there is the family model established: a couple, father …; with constantly applied man
and women model, which is very positive with respect to the important position a family holds in Slovakia.
However, in expert opinion, this family model, sometimes coupled with a system of sanctions (transfer to a
lower phase, refusal of second dinner, points…) and rewards (extra dinner, sweets…), puts clients into the
position of children, which is against the re-socialisation idea of social learning and assumption of an adult
person responsibilities, which assumes improved conscious decision making with its consequences, without
any influencing and material or oral guidance of another person.

Clients told us about their concerns coupled with their departure from the facility. There are several theories
possibly explaining their personal unease; it may be caused by excess protection in facilities, which are not
open enough and are not exposing clients to sufficient social environment pressure; further, it may be
caused by lacking generation of anticipations for the future (lack of training, support, preparation for
departure); it may be a new dependence on the facility… In any case, these concerns deserve attention and
analysis.




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3.2 Proposals and Signals
With respect to the recorded development dynamics in the given area, prepared analysis, expressed
concerns and our conclusions, we suggest to focus on the following priorities:


3.2.1 Initiate the Establishment of Mutual Links, Partnerships and Horizontal Approach

Proposal 1: Joint development of national standards

Within a short period of time, a work group composed of RF directors and other staff (since they work in
various environments, are of different size and legal form) should be established. The work group should
also include representatives of state administration, self-governing regions, municipalities responsible for
addicts care, physicians. Together, such stakeholders should develop conditions for the operation of re-
socialisation facilities.


Such operation conditions should define the following aspects and be flexible to allow for possible
development:

      -   What is a re-socialisation facility
      -   Where can such facility be established
      -   Client target groups
      -   Method of client admission, free beds administration
      -   Average stay duration
      -   Facility departure requirements
      -   Client rights and responsibilities
      -   List of provided services (accommodation, supervision, care, social consultancy, organisation and
          coordination of activities …)
      -   Number and required qualification of staff (depending on the number and type of client target group)
      -   The supervision function and qualification required for this position
      -   Facility, or founding organisation functioning and organisation
      -   Financial needs
      -   Funding (including client financial participation), overview of collected financial sources distribution –
          what is covered and what is not
      -   Overview table with annual qualitative and quantitative evaluation – key item of financial report and
          report on re-socialisation process effects.

Principal advantage of this initiative is the fact that it gathers the most varied re-socialisation stakeholders
around one table, where they may define standards of their activities. Of course, forced standards will be
hard to accept by the RF representatives, especially where internal standards already practically exist in the
respective facilities. However, they need to pass through a long and demanding process or modification to
be adjusted to the national and local situation in this area.

Another advantage is the definition of roles for all engaged stakeholders. State administration and local
government will clarify their competencies: is the addictions issue a state, local or municipal competency?
Why? How? To what extent? Using which means?

The third, but just as important positive aspect of conditions definition is the alignment of RF functioning and
funding throughout the country, introduction of regular evaluations helping all facilities to define sustainable
and flexible goals and procedures answering the clients’ needs with respect to their addictions. Further,
conditions for constructive cooperation between respective RFs will be established.




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Proposal 2: Introduction of a monitoring and evaluation process

It will be necessary to establish external independent control for the initial phase of a facility
establishment, as well as for its functioning. In line with the standard conditions, an inspection may discover
non-compliance (or compliance) with the defined standards, as well as needs and limitations of the provided
care scope.

A national information system supported by reference facilities at national level (NMCD) could be
established in line with key European indicator TDI. This would provide regularly updated information from
national and local levels that would enable evaluation and adjustment of the professional approach to the
given requirements.

Proposal 3: Development of interdepartmental cooperation and other actors

Prevention and medical and social care of addictions calls for interdepartmental cooperation. It is important
to approach the issue horizontally and vertically – including the relevant ministries (ministries of health,
justice, interior, education, etc.) and all levels of administration and other actors in the field (NGOs, regions
and cities) to clearly identify the existing problems and call on the relevant ministry contribution within its
competencies. This would define political, legislative, administrative and financial priorities. If such priorities
are to be reflected in field, it will be necessary to prepare training on the issue of addictions, medical and
social care for individuals with addictions and possibilities of stakeholder networking. State administration
and local government staff would represent the target group of such training.

3.2.2 Improved Care for Individuals with Addictions

Proposal 4: Introduction of a global care system for individuals with addictions

It is necessary to work on the preparation of a global care system for individuals with addictions.

Statistic data on the number of detoxification treatments, relapses, out-patients and beds offered in the re-
socialisation facilities raise many questions.

Without precise price definition for a day of treatment in a psychiatric facility, follow up out-patient treatment
or re-socialisation facility stay it seems a large volume of money is spent to reach very average overall
results.

Except for the above mentioned financial losses, it is necessary to also consider social and human aspects
of an addict’s situation facing unsuccessful recovery attempts. These individuals are confronted with the
feelings of failure, and the longer this status prevails, the longer and more costly the withdrawal and re-
socialisation process.

Even though HIV seems to have missed Slovakia so far, several subjects spoke about changes in the
addicts’ behaviour and procedures with all health risks such behaviour represents for the entire population.

Following the consideration of options, health and social care professionals need to take real measures and
react to such target group needs through joint approach:

       - Provided care diversification (low threshold, harm reduction, street work, detoxification treatment,
         ambulatory or residential care…)
       - Establishment of a care flow without the omission of any stage (possible hospitalisation followed by
         out-patient care and supervision, prescription of reliable substitution treatment, participation of
         general practitioners in the process, etc.)
       - Development of a parallel and complementary system of social care existing alongside medical
         care. They play a key role together with other social care institutions.




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Proposal 5: Improved procedure preparing for the end of re-socialisation facility stay

The mentioned system of social services provision suggests the need to consider the services the re-
socialisation facilities provide their clients, especially in the phase leading to the end of their stay. Even
though the clients need some time “to clarify issues”, long-lasting exclusion from real life may cause worries,
or even lead to failure. Except for physical work, such as wood cutting, growing of vegetables, or cleaning of
the facility, it is also necessary to devote time to mental activities – client training, improvement of their
qualification, preparation for work process inclusion following their departure from the facility. These
activities are a prequisite for sustainable clients’ inclusion into the society.

In this respect, re-socialisation facilities need to open up to the economic sphere, businesses and mutual
cooperation. Support of client employment and their professional inclusion could form part of legislative
measures in the field of social services for addicted individuals.

Extended possibility of social housing or the development of half-way homes should help clients depart from
the re-socialisation facilities and to gradually integrate into society.

The easiest and fastest path to improved and simplified access to the services of the re-socialisation
facilities leads via all free beds administration, which would help to refer clients to facilities based on free
capacities. Provision of funds necessary for investments would enable the re-socialisation facilities to
perform reconstruction work, reconstruct their premises to the basic safety specifications and purchase all
missing equipment.


3.2.3 Improved Staff Performance, Reaching Certain Independence Level

Proposal 6: Invite professionals to mutual exchange of experiences on local, regional and national
levels

With the aim to provide for the necessary exchange of information and experiences between the staff of re-
socialisation facilities and to improve their work conditions and care provided to clients, we select the
following proposals:
                 - Support meetings. Introduce a tradition of 4 regular meetings per year, topical
                       weekends, etc. Distribution of minutes from such meetings would minimise the feelings
                       of isolation, the re-socialisation facility staff mentions.
                 - Improve information exchange on the relevant legislation and inform on key web pages
                       and other information sources.
                 - Improve access to the most important books, which seem to be missing in Slovakia so
                       far (only foreign language mutations of such books are readily available).


Proposal 7: Improved staff training in re-socialisation facilities

As far as staff training in re-socialisation facilities is concerned, it seems necessary to introduce basic
training ending with a diploma on reached qualification for the provision of services to individuals with
addictions. This will be first possible following the definition of precise work descriptions and relevant
required skills and capabilities. To support the already existing dynamics leading to significant diversity of
facilities, it seems necessary to introduce accessible training activities in specifically oriented modules
providing staff with new qualifications. Training activities should reflect and use the previous experience and
job assignment and offer new knowledge.
Further, development of liberal sciences and society needs to be reflected in the introduction of a life-long
learning process adjusted to the current needs and open to all stakeholders. This way, care provision would
continuously adjust to the current needs.




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Proposal 8: Inclusion via economic activities

Outside the framework of public funding, re-socialisation facilities could reach certain level of independence
via client work.
In the scope and framework defined in cooperation with the ministry (to avoid the risk of black work),
independent workshops (similar to sheltered workshops) could be established. Their existence would enable
re-socialisation facility clients to perform work, sustain their work habits and even provide the possibility for
qualification extension. Re-socialisation facilities could generate financial resources sufficient for the
satisfaction of their needs.



Conclusions

«And yet they do function!». Hopefully, Galileo will pardon us for this small theft. However, this quotation
sums up the observations of French and Finnish experts in the 24 re-socialisation facilities.

Equipped with energy and enormous determination fighting financial problems and working in unenviable
conditions only with minimum acknowledgement, the re-socialisation facilities are able to provide services
and care to a very vulnerable client target group in the time of abstinence and help them cope with the re-
socialisation process.

With highly critical thinking, calm assessment of weaknesses, paradoxes, deficiencies, and the re-
socialization staff is able to keep up the re-socialisation process day by day. They have all the prerequisites
necessary to improve the level of their care.

Furthermore, the Ministry of Labour, Social Affairs and Family, the General Secretariat and the Slovak
Association of the Resocialization centers have decided to tackle up the challenge and have been very
involved in the process of improving and enhancing the resocialization and rehabilitation facilities when
initiating the Twinning Project.

First of all, mutual communication and exchange of experiences is crucial. It will be important to forget about
the stereotyped procedures, competitiveness and join and rely on those ready to participate in the process
of addicts care improvement in Slovakia.

Improvement may only be reached through horizontal and vertical approach and establishment of
partnerships.




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Conclusions of the Senec seminar (November 5th and 6th 2007)

The following conclusions were made by the foreign expert group based on the workshops in the seminar 5-
6 November in Senec. In all workshops of the seminar the National report was discussed and agreed by the
Slovak participants. The instructions of the workshops were to discuss more in depth of four most important
proposals in the National Report (under the recommendations proposed in the Chapter 3.2 of the National
report). Based on the workshop summaries these four proposals seemed to be prioritized by the Slovak
participants. The foreign expert group is in accordance with the prioritized themes.

Furthermore, some issues concerning the finance were also discussed in the workshops and well as in the
foreign expert group. Financing issues impact the following four key proposals:
- to maintain the RCs in the long run
- to enhance new services
- to improve the facilities of the RCs by e.g. training, supervision, incentive measures, equipment.


Proposal 4: Introduction of global care system for individuals with addictions

1. To encourage and improve the co-operation between medical and social care.

It was underlined in the workshops that improved co-operation between social and medical care could help
to guarantee a “continuum of the comprehensive treatment and rehabilitation” for the client, to recognize
social and medical competencies of the RCs and to improve the access to the RCs and it would increase
the visibility of the RCs in the current network of the other services (GPs and hospital, psychologists in
school, specialises institutions psycho- pedagogical under the Ministry of Education). The collaborative
network of different actors could be strengthened. It was also mentioned in the summary of one workshop
that it would be usefull to consider opening of the detoxification units in general hospital.

The expert group sees this as a long duration process, and recommends that the relationship between
Ministry of Health and MLSAF should be strengthened.

2. To introduce low threshold structures and outpatient drug related services.

It was mentioned in the summaries of the three workshops that low threshold and ambulatory services
options should be developed in order to catch hidden populations and to facilitate access to RCs and\or
medical care, e.g. to be provides the first diagnosis, orientation, a companionship and counselling. The
foreign expert group discussed that it would be important to recognise the background organisation which
could initiate the development of low threshold structures in all over Slovakia. It was mentioned in some of
the workshop summary that this kind of structure already exists in some areas, but it is not general
approach.

It was also emphasized in the summaries that there is a need to to develop outpatient facilities in order to
offer different forms of care and widen the panel of care. It was discussed by the foreign group whether that
would be a taks of the RCs or e.g. of the regions. Some of the RCs already offer out patient services.
However, many of them might be more related to follow-up.

3. To differentiate services for adults and minors

The question concerning the service provision for minors and adults was also raised in the workshops
although it was not mentioned in the international report. The foreign expert group concluded that it would
be good to differentiate between the two kinds of facilities for minors and adults separately. Moreover, it is
important to provide and enhance specific care to minors, who might be more drug abusers than drug
dependent. Furthermore, it would be useful in order to guarantee the continuum of care when growing up.



Proposal 1: Joint development of national standards

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The creation of the standards was discussed in the foreign expert group from two perspectives: the process
and the content.

1. Process of elaboration

There was agreement coming from the workshop summaries that the approach to create the standard
should be bottom up methods. The participants of workshops showed strong interest in participating in the
process from the very beginning. The following actors were mentioned who would be needed along the
process: MLSAF, Ministry of Justice, Ministry of Education, Centre of LABOUR, Cities, HTUs, GS, Health
Services, GP, Health Assurances, RCs (clients, staff and families).
Harm reduction NGOs could be also the part of the actor-group. Also the question of the leadership was
raised in the workshop.

The foreign expert group underlines that creating standards is a long-term process. It is important to decide
in the beginning of the process whether the aim is to create binding standards or recommendations. The
foreign expert group raises the concern that strictly binding standards might lead to decreased motivation to
participate in the process, as well as the consequence might be decreased diversity of the services. The
foreign expert group suggests that two parallel processes could be carried out simultaneously: one targeting
at few minimum level standards for administrative purposes and another process creating qualitative
recommendations for RCs to improve the daily based practices.

Concerning the process, it is important to consider the time and the means for implementation, as well as
monitoring and evaluation of the standards.

2. Additional criteria

In addition to the aspects mentioned in the national report, the following additional criteria were proposed by
the workshops:
- philosophy of RC
- evidence-based programme
          - e.g. individual and group therapy
- standard cost per a bed taking in account of the kinds of clients and related to the type of qualified staff
- qualifications of the supervision - however, the concept of supervision needs further clarification
- equipments (e.g. furniture)

Proposal 6 and 7: Invite professionals to mutual exchange of experiences on local, regional and
national levels & improved staff training in re-socialisation facilities

The importance of experience exchange and training was emphasized in workshops.

1. Forms of sharing experiences

It was suggested that RCs could have regular thematic meeting 2-4 times a year. There could be also
professional meetings among the same professional groups (e.g. psychologists, social workers).
Furthermore there could be meetings also meetings between RCs and others institutions. These kind of
meetings were not mentioned in national report.

It was suggested in one of the workshops that the RCs could organise the meetings spontaneously.
However, the foreign expert group discussed also whether there could be other initiatives to organise this
kind of regular meetings. Anyhow the expert group strongly supports the idea of networking. The networking
can be used e.g. for disseminating information and acquiring knowledge, as well as setting up joint projects.




2. Training

Both basic training and specialised training was discussed in the workshops. In specialised education there
are two levels: 1) basic education for each kind of job function in RCs (academic, professional education or
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self-education) and life-long professional training. There should be basic training for any no-qualified
personal. It was stressed in the foreign expert group that training is needed for any RC staff member.

It was also discussed in the foreign expert group that there should be training for external partners
concerning drug addiction, e.g. GPs, HTUs, Labour Agencies.

Also the question concerning the organisation which could deliver such education was raised in the foreign
expert group.



Proposal 5: Improved procedure preparing for the end of re-socialisation facility stay

The importance of the work life for ex-drug addicts was discussed and emphasized in one of the workshops.
Two proposals were introduced: there should be incentive measures for the employers to hire RCs clients,
and in terms of employment policy it would be useful to get sheltered jobs also for RCs' clients. The both
initiatives could help the ex-addicts to access the labour market.

It was discussed in the workshop, in which phase of the rehabilitation process the work could be started. No
conclusions were made. The foreign expert group strongly supports the idea of improving ex-addicts
chances to enter the labour market.




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Charts and Graphs



Graphs and charts presented above are based on the information provided by the re-socialisation facilities
via a brief questionnaire (see annex)
The analysis focused three aspects:
- Network of re-socialisation facilities in Slovakia and their condition
- Budgets and partnerships
- Staff qualification

Twenty questionnaires were returned to the twinning team.

There are discrepancies between our data and information collected in the re-socialisation facilities;
however, they are not significant.
The results are comparable with the results of previous two Slovak researches organised by Slovak
institutions (The reintegration client and program report – NMCD, 2006 and Ministry of Labour, Social
Affairs and Family, 2006).




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                      Graph 1: Year of Re-socialising Facility (RF) Establishment
                                        (22 RF in October 2007)


                 5
                 4
                 3
    Number of RF
                 2
                 1
                 0
                             1995      06       07       08      09     2000      01       02       03      04       05      06     2007




                    Chart No.1 Review of Slovak Re-socialisation Facilities (RF)*
                                                           Total       Average No. per
                                                                              RF
                                                                          (min.-max.)
             Number                                         22                 -



             Number of beds                                                       360                       18
                                                                                                          (2-56)
             No. of accredited beds                                               342                       17
                                                                                                          (8-56)
             No. of beds in 2006                                                  580                       32
                                                                                                         (12-94)
             Average stay duration in months                                        -                      10.5
                                                                                                          (5-24)
                                     * Data based on 20 completed questionnaires




                                    Chart No.2 Minors/Adults/Gender*
                No. of RF with underaged clients (under the age of 18)                                      7
                No. Of RF including underaged clients (under the age of                                    13
                18)
                No. Of RF with female clients                                                               8
                                * Data based on 20 completed questionnaires




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                                          Chart No.3 Key Partners*
               Self-governing region                                              20
               Municipalities                                                     12
               Hospital psychiatric departments                                   12
               NGOs**                                                             10
               Drug Addiction Treatment Facilities                                9
               Doctors                                                            8
               Private businesses                                                 5
               Others (church, refuges, schools, universities, health
               insurance companies…)
                                * Data based on 20 completed questionnaires
        ** Understanding guide: 10 of 20 re-socialisation facilities regularly cooperate with other NGOs


                               Chart No.4 Budget and Income Sources*
                                                               SKK 3.3
   Average annual budget of 1 re-socialisation facility (RF)
                                                                million
                        in 2006
                                                             (€n 88 000)
   RF funding:                                                                                               No. of RF (out of 20),
                                                                                                            having obtained funds
                                                                                                           from the stated sources
            Self-governing regions                                                    67%                           19/20
                                                                                   (0%-100%)
            Clients                                                                   16%                            20/20
                                                                                    (8%-42%)
            Sponsors                                                                   4%                            12/20
                                                                                     (0-23%)
            Anti-drug fund                                                             6%                             9/20
                                                                                     (0-25%)
            Own economic activities                                                    2%                             6/20
                                                                                     (0-13%)
* Data based on 20 completed questionnaires
(1) One RF is financed solely by the municipality and receives no subsidy from the higher territorial unit.


                                                    Graph No. 2: Submission of Accredition by Re-socialisation Facilities




                                                                                   1
                                                                                         1
                                                                                              2
                                                             14
                                                                                          4




                                                    2011    2009     2007     Not required        No informaotion


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Chart No.5 Composition of RF Teams*
                                                     Total         Average / RF
Internal staff (1)                                    124              6.20
External staff (1)                                     53              2,65
Total                                                 177              8,85
* Data based on 20 completed questionnaires
(1)Average value calculation is based on 20 facilities. It is not always full-time employment; the chart does
not express the number of hours worked.


Chart No.6 Qualification of RF Staff (external and internal)*
Job Allocation and/or Qualification                                                       Total

Qualified social workers                                                                    43
Unqualified ergotherapists (without the relevant education )                                22
Psychologists                                                                               20
Unqualified social workers (without the relevant education)                                 14
Teachers (pedagogists)                                                                       9
Psychiatrists                                                                                8
Sisters and nurses – university graduation                                                   8
Theologists                                                                                  7
Psychotherapist                                                                              5
Nurses with secondary school graduation diploma                                              5
Special pedagogists and educators (special and treatment                                     4
pedagogists)
Doctors                                                                                      2
Others (cleaner, lawyer, guard, …)                                                          23

* Data based on 20 completed questionnaires



Scheme No. 1 Proffesionalisation


                                                                                     Qualified personnel (social
                                                                                     workers, psychologists,
                                                                                     nurses, doctors)
               14%               4%                                                  Unqualified staff


                                                                                     Others
      21%                                                          61%
                                                                                     Qualified theologists




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List of Experts
Marianne Storogenko (Coordinator)
Ministry of Labour, Social Cohesion and Housing – Ministry of Health and Solidarity
General Directorate Social Services
Department of Inclusion Policy and Social Exclusion Prevention

Others in alphabetical order:

Sibel Bilal de La Selle
ANGREHC National Physicians Association (hepatitis C research) – National Coordinator. Social
Management (criminology). Social change management, re-socialisation strategies and social action
strategies.
Jean-Pierre Demange
T3E (Drug addiction Europe Exchange Training) President. General Director of Sato Picardie. French
network of facilities for addicts. Services provided: health care, substitution programs, housing issues,
therapeutic communities, out-patient care, psychological and social consulting, re-socialisation programs
and specialised training, etc.
Valerie Dorso
ESPACE Association. Consultant for job inclusion – Head of CAARUD unit (Consulting centre for the
minimisation of addiction related risks). Re-socialisation projects management for disadvantaged groups
and drug abusers.
Yvan Grimaldi
Aurore – Head of job inclusion services department. Department for marginalised groups, addicts and other
mental disorders.
Sylvie Gomes
Aurore – ESF. Project head in the field of employment services. Head of Equal projects.
Ruth Gozlan
French interdepartmental delegation for drug control (MILDT) – Medical and social department. Expert for
prison care (Chief Prison Physician).
Philippe Lagomanzini
Director: Drogues et societe: French organisation dealing with addicts. Services provided: health care,
substitution programs, housing issues, therapeutic communities, out-patient treatment, psychological and
social consulting, re-socialisation programs and specialised training…
Anneli Pienimaki
Development manager: Finnish Blue Ribbon. Expert for qualitative standards implementation in facilities for
drug addicts.
Olivier Romain
Director of WADS: Specialised medical centre for drug addicts (health care, substitution programs, housing
issues, therapeutic communities, out-patient treatment, psychological and social consulting, re-socialisation
programs and specialised training, prevention, etc.). Managing board member of national professional
networks: ANIT (National Association of Professionals in Addicts’ Care) and FFR (French Addictions Union).
Dominique Terrasson
Ministry of Labour, Social Cohesion and Housing – Ministry of Health and Solidarity
General Directorate Social Services
Professional training for social workers (needs, requirements, establishment of curricula and training
implementation).

Twinning team:
Matthieu Chalumeau (Resident Twinning Consultant) and Jana Novotová, Assistant




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Annexes
                                                                           Chart No. 1 – Detailed Activity Chart
Activity                                           Period                                                  Agenda                                                                       Experts
                                                                                                    Visits and Meetings

Activity 1.1.1 Preparatory meetings for        9 -10 August        Agreement on activity 1.1 Preparation of a detailed analysis of current                       EU Experts
the evaluation phase                                               Slovak RF situation                                                                           Mr LAGOMANZINI
                                                                   Bilateral meetings with key stakeholders in drug control:                                     Ms GATIGNOL
                                                                   General Secretary                                                                             Ms SINKONNEN
                                                                   Jelenková, Head of twinning project on behalf of Slovakia                                     Ms BILAL
                                                                   Slovak drug monitoring centre                                                                 Ms STOROGENKO
                                                                   Lucia Kiššová                                                                                 Mr DEMANGE
                                                                   Health care                                                                                   TW Team
                                                                   Ivan Novotný (AT Sanatorium in Bratislava)                                                    Mr CHALUMEAU – RTA
                                                                   Psychiatry                                                                                    Ms NOVOTOVÁ –RTA Assistant
                                                                   M. Halmo                                                                                      Slovak Expert
                                                                   Third sector                                                                                  Ms JELENKOVÁ
                                                                   Katarína Jirešová, Odyseus CA and Špáleková Marta, Prima CA
Activity 1.1.2 Evaluations visits in the       13-17 August          - RF Sanatorium AT                                                                          Mr LAGOMANZINI
Bratislava region                                                    - RF Road n.o (Petrţalka and Borský Svätý Jur)                                              Ms STOROGENKO
                                                                     - Bratislava Magistrate, Department of Social Inclusion                                     Mr DEMANGE
                                                                     - RF Retest                                                                                 TW Team
                                                                     - Higher Territorial Unit Bratislava– Department of Social Services                         Mr CHALUMEAU – RTA
                                                                                                                                                                 Ms NOVOTOVA –RTA Assistant
                                                                                                                                                                 Slovak Expert
                                                                                                                                                                 Ms JELENKOVÁ

Activity 1.1.3 Evaluation visits in Prešov     27-31 August        Prešov region                                                                                 Ms STOROGENKO
and Košice regions                                                   - RF Dom Boţského Srdca Jeţišovho /House of Godly Jesus Heart                               Ms BILAL
                                                                     - RF Dom Boţieho milosrdenstva / House of God’s Mercy                                       Ms DORFO
                                                                     - OZ Rizen, Centrum zniţovania rizík / Risk Minimisation Centre                             TW Team
                                                                     - Higher Territorial Unit Prešov                                                            Mr CHALUMEAU – RTA
                                                                     - RC Dom Charitas / Caritas House                                                           Ms NOVOTOVÁ –RTA Assistant
                                                                     - Regional branch of State Insurance Company                                                Slovak expert
                                                                   Košice region                                                                                 Ms CZUCZOROVÁ
                                                                     - RF Resocia
                                                                     - Regional Authority
                                                                     - RF Centre for critical intervention
                                                                     - UPSVAR Košice III
                                                                     - Regional UPSVAR
                                                                     - Higher Territorial Unit Košice
                                                                     - RF Šanca



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                     EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to psychoactive substances
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Activity 1.1.4 Evaluation visits in Nitra        3-7                   -   RF Nádej                                                                                Ms STOROGENKO
region                                           September             -   RF Nelegál o. z.                                                                        Ms GOZLAN
                                                                       -   CPLDZ f Nové Zámky                                                                      Mr. ROMAIN
                                                                       -   RF Komunita Ľudovítov, n.o.(both facilities)                                            TW Team
                                                                       -   Higher Territorial Unit Nitra                                                           Mr. CHALUMEAU – RTA
                                                                       -   RF Pahorok n.o.                                                                         Ms NOVOTOVA – RTA Assistant
                                                                       -   Ministry of Justice, Department of Penal Probation                                      Slovak expert
                                                                       -   Establishment for punishment execution Nitra – Drug Free Unit                           Ms JELENKOVÁ

Activity 1.1.5 Evaluation visits in Trenčín      17-21                 -   RF Bethesda o.z. - Teen Challenge,                                                      MS STOROGENKO
and Trnava regions                               September             -   ZMOS                                                                                    MS GOMES
                                                                       -   RF Čistý deň n.o.                                                                       M. GRIMALDI
                                                                       -   Trnava Self-governing Region                                                            TW Team
                                                                       -   RF Adamov                                                                               M. CHALUMEAU – RTA
                                                                       -   Higher Territorial Unit Trenčín                                                         MS NOVOTOVA –RTA Assistant
                                                                       -   DSS Dolný Lieskov Slovakia                                                              Slovak expert
                                                                       -   RF PROVITAL o. z. Dom ţivota bez drog/House of Drug-free Life                           MS JELENKOVA
                                                                       -   ORCHIDEA

Activity 1.1.6 Evaluation visits in the          1-5 October         Region of Banská Bystrica                                                                     MS STOROGENKO
regions of Banská Bystrica and Ţilina                                 - RF Návrat - RDZO                                                                           MS PENNIMAKI
                                                                      - OLÚP Predná Hora                                                                           MS TERRASSON
                                                                      - RF COR – Centre                                                                            TW Team
                                                                      - Higher Territorial Unit Banská Bystrica                                                    M. CHALUMEAU – RTA
                                                                                                                                                                   MS NOVOTOVÁ –RTA Assistant
                                                                     Ţilina region                                                                                 Slovak Expert
                                                                     RF Manus                                                                                      MS JELENKOVA
                                                                     Higher Territorial Unit Ţilina
                                                                     RF Z – Návrat centrum




                                                                                       Draft assessment report
                       EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to psychoactive substances
                                                                        40




                                    Re-socialisation Facility (RF) at One Glance
                                                   Questionnaire

   Name of facility:
   Názov organizácie:
   Facility foundation (year):
   Deň, mesiac, rok zriadenia RF:
   Name of founder:
   Meno zriaďovateľa:

   This very short presentation of your facility will provide us with a first impression of your organisation. Thank you for your
   participation. Ďakujeme Vám za Vašu spoluprácu pri vyplnení tohto dotazníka, ktorý nám umoţní vytvoriť si prvotnú
   predstavu o Vašom zariadení pred uskutočnením oficiálnej návštevy vo Vašom zariadení.

Name and position of the             Name: M./Ms                                                         Position :
person completing this               Meno, priezvisko                                                          Prac. zaradenie:
questionaire
Meno, priezvisko a pracovné          e-mail:                            @
zaradenie zamestnanca, ktorý
vyplnil tento dotazník
Facility address                     Address/ Adresa :
Sídlo zariadenia

                                     Tel:
                                     Fax:
                                     Web site and e-mail/ Webová stránka a e-mail:

RESIDENTS (clients)                        -    Maximum bed capacity:
Klient                                     Maximálny počet postelí:
                                           -    Number of beds with accreditation:
                                           Počet postelí schválených akreditáciou:
                                           -    Number of patients in 2006:
                                           Počet pacientov za rok 2006
                                           -    Do you received residents under 18 years of age (minors)                     yes/ áno        no/ nie
                                           Prijímate pacientov mladších ako 18 rokov
                                           -    Stay average duration (in months):
                                           Priemerná dĺţka trvania pobytu (v mesiacoch)
                                           -    Main admission systems:
                                           Hlavné spôsoby prijímania klientov:




                                           -   Does a “personal resident admission file” exist?                            yes/ áno       no/ nie
                                           Existuje prijímacia osobná karta klienta?
                                           -   Does a resident’s file exist?                                              yes/ áno      no/ nie
                                           Existuje pracovná zloţka (dokumentácia) klienta?

                                           -   Main “after stay” orientations:
                                           Aké sú hlavné sluţby (činnosti) poskytované klientov po ukončení pobytu v RF:


                                                           Draft assessment report
      EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                          psychoactive substances
                                                                          41



STAFF                                  Nb of staff members (internal staff):
Zamestnanci                            Počet zamestnancov (interní zamestnanci):

                                       Nb of external staff members:
                                       Počet externých zamestnancov:

                                       Presentation of the crew (position and professional background) including the external
                                       employees
                                       Prezentácia zamestnancov (pracovná pozícia a profesijné zázemie) vrátane externých
                                       zamestnancov
                                                 Position in the facility                           Education
                                                  Pracovná pozícia v RF                             Vzdelanie




ACTIVITIES                             Main Activities Hlavné aktivity (činnosti) RS:
Aktivity (činnosti)                    -
                                       -
                                       -
                                       -
                                       -
                                       -

PARTNERS                               Main external partners (health care facilities, social services, NGOs, cities, …) :
Partneri                               Hlavní externí partneri (zdravotnícke zariadenia, sociálne zariadenia, neziskové organizácie,
                                       mestá, samosprávne kraje a pod.)
                                       -
                                       -
                                       -
                                       -

FUNDING                                2006 annual budget (SKK):
Financovanie                           Výška rozpočtu RF za rok 2006
                                       Main funding origin (State, HTU, city, residents, other…) in % :
                                       Hlavné finančné zdroje (štát, samosprávny kraj, mesto, klient a pod.) v %:
                                       -
COMMENTS                               Please use this box for any additional remarks and comments:
Poznámky                               Prosím vyuţite tento priestor pre Vaše odporúčania a doplnenia:




    For any additional questions please contact:
    Contacts:
    Matthieu Chalumeau, RTA
    02/ 572 95 761
    matthieu.chalumeau@government.gov.sk

    Zuzana Jelenková
    02/ 572 95 764
    zuzana.jelenkova@government.gov.sk

    Ms Jana Novotová –RTA Assistant
    0905 233 260
    jana.novotova@goverment.gov.sk

                                                             Draft assessment report
        EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of persons addicted to
                                                            psychoactive substances
                                                        42

                                     QUESTIONNAIRE/ DOTAZNÍK
                                    Guide d’entretien pour les experts
                                        Experts’ interview guide

  1. Date de création de la structure/ Dátum vzniku/ Date of establisment
  2. Date de l’accréditation:/ Dátum získania akreditácie/Date of accreditation
  3. Qui a créé la structure : usager, travailleur social, sanitaire:/ Kto založil túto organizáciu:
       bývalý užívateľ drog, sociálny pracovník, zdravotný pracovník/ Who founded the
       organisation : former drug addict, social worker, health professional:
  4. Nombre de lits accrédités et pour quelles prestations : Počet lôžok, na ktoré je získaná
       akreditácia (resp. ktoré môţu byť financované na základe akreditácie, keďţe akreditácia sa
       získava na lôţka, al. na osoby) a na aké služby:/ Number of accredited beds (or beds
       possibly funded on accreditation basis, since accreditation is obtained for beds, or persons)
       and type of accredited service :
  5. Nombre de lits total et pour quelles prestations : Celkový počet lôžok a na aké služby:/
       Total number of beds and their allocation to service :
  6. Taux d’occupation : Percento obsadenosti/Occupancy percentage
   - Lieu unique ou éclaté - Prevádzka na jednom alebo na viacerých miestach / Operations at
  one, or several sites
  7. Si éclaté où sont les sites et qu’y fait-on ? Ak áno, kde sú pobočky ostatných a čomu sa
       venujú / If so, where are the other sites and what do they deal with ?
  8. Date de la construction du lieu : Dátum postavenia budovy / Date of building construction
  9. Date des rénovations et réhabilitations : Dátum renovácie a rekonštrukcie budovy / Date of
       renovation, or reconstruction
  10. Qui est propriétaire des locaux : Kto je vlastník priestorov / Who owns the premises
  11. Public accueilli :           Klienti/ky / Clients
                               1. hommes : muži / men
                               2. Femmes : ženy / women
                               3. MineuRF : mladiství / minors
                               4. âge moyen : priemerný vek / average age
                               5. existence d’une limite d’âge pour être accueilli : vekové obmedzenie
                                   pri prijatí / age limitations appying to admission
                               6. handicapés physiques accueillis : počet klientov s telesným
                                   postihnutím/ znevýhodnení klienti / number of physically disabled
                                   clients
  12. Principaux motifs de sortie sauf fin de séjour prévu : Hlavné dôvody odchodu z
       resoc.pragramu okrem ukončenia liečby / Key reasons for re-socialisation program
       withdrawal, other than treatment completion
  13. Historique sanitaire et social des résidents connu : Zdravotná a sociálna anamnéza
       klientov/tiek / Medical and social history of clients
  14. Combien de HIV + : Koľko klientov/tiek je HIV pozit. / How many clients are HIV positive


                                           Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of
                                 persons addicted to psychoactives substances
                                                        43
  15. Hépatites + : Koľko klientov/tiek je                          pozit. na hep. C / How many clients are
       Hepatitis C positive
  16. Qui suit sanitairement les résidants : Kto sa stará o klientov zo zdravotného hľadiska /
       Who provides clients with medical care
  17. Critères d’admission et mode de recrutement : Kritéria prijatia a spôsob prijímania nového
       peRFonálu : /Admission criteria and recruitment method :
  18. Situation sociale moyenne des résidants : Priemerná/ najčastejšia sociálna situácia, v akej
       sa klienti nachádzajú / Average/most common social situation of clients
  19. Nature des drogues utilisées : Druh drog, ktoré klienti užívajú (li) / Type of drugs used
  20. Signature d’un contrat d’objectif avec le résidant : Podpis zmluvy, v ktorom sa obe strany
       (klient vs RF) zaväzujú k rešpektovaniu určitých práv a povinností + zmienka o cieli
       pobytu / Signing of a mutual contract (client vs RF) commiting the parties to respect certain
       rights and duties + definition of an objective of the contract
  21. Existence d’un règlement intérieur (demander un exemplaire) : Vnútorný poriadok
       (exemplár) / Internal regulation (provide one copy)
  22. Participation financière des résidants demandée : Finančná spoluúčasť klientov/tiek je
       žiadaná? / Do you require financial participation of clients ?
  23. Combien et comment est-elle défini : Koľko a ako je definovaná / What is the amount and
       how is the participation defined
  24. Ressource des usagers : Zdroje užívateľov drog / Sources of drug users
  25. Garde-t-il une part de ces ressources et quelle part en %: Nechávajú si časť svojich fin.
       Zdrojov, príjmov a aké v % / Do you leave part of the financial sources, income with the
       clients, what %?
  26. Les résidents disposent-ils d’une carte d’identité : Majú klienti/ky občiansky preukaz ? / Do
       clients have an ID ?
  27. D’une couverture sociale active : Platné zdravotné a sociálne poistenie ? / Valid health and
       social insurance ?
  28. Si non les aide-t-on à entreprendre les démarches pour les avoir : Ak nie, je im poskytnutá
       pomoc, pri vybavovaní ? / If this is not the case, do you offer them help in the necessary
       arrangements ?
  29. Les résidants peuvent-ils avoir une activité rémunérées : Môžu sa klienti/ky venovať
       činnostiam, ktoré sú finančne ohodnotené (práci za mzdu) ? / May clients perform
       financially remunerated activities (paid work) ?
  30. Nombre de personnes salariées par la structure : Počet zamestnancov v RC pracujúcich
       za mzdu / Number of salaried staff per RF


  31. Qualification : Kvalifikácia / Qualification
  32. Nombre d’heure de présence : Počet odpracovaných hodín / Number of hours worked
  33. Nombre de personnes intervenant au sein de la structure : Počet všetkých pracujúcich
       osôb v zariadení / Total number of persons working in the facility
  34. Qualification : Kvalifikácia / Qualification

                                           Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of
                                 persons addicted to psychoactives substances
                                                        44
  35. Nombre d’heure de présence : Počet                            odpracovaných hodín / Number of
       hours worked
  36. Personnels les WE et jours fériés : PeRFonál počas víkendu a štátnych sviatkov /
       Personnel working weekends and holidays
  37. Qui recrute les personnels : Kto prijíma peRFonál do zamestnaneckého pomeru/ Who
       recrutes personnel
  38. Intervention de bénévoles : Dobrovoľníci/čky /Volunteers
  39. Combien rôle : Koľko je ich a aká je ich úloha / Have many are there and what are their
       roles
  40. La structure accueille-t-elle des stagiaires : Stážisti/ky / Internships
  41. Formations initiales : Aké je požadované vzdelanie pri nástupe / What qualification is
       required for initial employment
  42. Le personnels peut-il ou a-t-il suivi une formation continue, complémentaire: Majú
       zamestnanci možnosť zúčastniť sa ďalšieho vzdelávania? /Is there a possibility for
       personnel to participate in continuous training ?
  43. si oui de quel type : Ak áno, akého typu / If so, what type
  44. Les postes sont-ils définis: Je zadefinovaná náplň pracovného miesta ? / Do you have job
       description ?
  45. Existence d’un organigramme (le donner svp) : Organizačná štruktúra / Organisational
       structure
  46. Depuis quand le personnel travaille-t-il dans le centre : Odkedy súčasný personál v
       zariadení pracuje / Since when has the current personnel been employed in the RF
  47. Turn –over :Aaká je ich fluktuácia ? / What is their fluctuation rate
  48. Le code pénal permet des alternatives à la prison : connaissent-ils ces nouvelles mesures :
       Umožňuje trestný zákon alternatívny trest namiesto väzby/ poznáte tieto nové
       možnosti ? / Does the penal code enable alternative punishment to imprisonment/are you
       aware of these new alternatives ?
  49. accueillent-ils ce type de public :Prijímate takýchto klientov/ky?/ Do you admit such
       clients ?
  50. Les résidants peuvent-ils recevoir de la visite : Môžu klienti/ky prijímať návštevy ? / May
       clients receive visits
  51. rythme et délais après l’entrée en centre et de qui : Ako často a v akých hodinách sú
       umožnené klientovi návštevy rodiny po vstupe do centra a zo strany koho / How often
       and at what hours may the client family visit the client in the facility and authorises such visits
  52. Famille accueillie par les équipes: Stretol sa peRFonál s rodinou pacienta/ky/ Did the
       personnel meet the client family
  53. nature du travail avec les familles: Spôsob práce s rodinami/ Nature of family work
  54. Peuvent-il sortir : Môžu chodiť na vychádzky / Are outings permitted ?
  55. quand, pourquoi, où : Kedy, prečo a kam / When, why and where




                                           Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of
                                 persons addicted to psychoactives substances
                                                        45
  56. Le tutorat par les pairs existe-t-il :                        Existuje tutorát zo strany
       rovnocenných klientov (funkcia tzv. staršieho brata v skupine rovesníkov) / Is there a
       system of mentorship between piers (function of the so-called older brother in a group of piers)
  57. Existe-t-il un projet d’établissement (le fournir svp) : Má zariadenie nejaký projekt
       (exemplár) – vízia do budúcnosti, filozofia, smer, ktorým by sa malo RC uberať ? /Does
       the facility have any type of project (provide a copy, please) – future vision, phylosophy,
       direction in which the RF should move ?
  58. Activités proposées : Navrhované aktivity (ktorým sa klienti počas dňa venujú) /
       Suggested activities (the clients should do in the course of a day)
  59. Description d’une journée type : Opis bežného dňa / Common day description
  60. Répartition des taches : Rozdelenie úloh / Distribution of tasks
  61. Formation en hygiène, nutrition, gestion du budget est-elle donnée : Školenie ohľadom
       hygieny, výživy, spravovanie vlastného rozpočtu / Hygiene, diet, budget management
       training
  62. par qui : Kto je školiteľom / Who trains
  63. Comment est préparée la sortie des résidents : Ako sú klienti pripravovaní na odchod zo
       zariadenia / What preparation do clients receive for the moment of facility departure
  64. Travail trouvé : Našli si prácu ? / Job found ?
  65. Logement trouvé : Našli si bývanie ?/ Accommodation found ?
  66. Suivi après la sortie ? Sledovanie/ kontakt po odchode zo zariadenia / Monitoring, or
       contact after departure from the facility
  67. Un bilan d’activité est-il réalisé chaque année : Každoročné vyhodnotenie činnosti (ročná
       správa) / Annual activity evaluation (annual report)
  68. Quantitatif : Kvantitatívne / Quantitative
  69. Qualitatif : Kvalitatívne / Qualitative
  70. A qui est-il donné : Komu sa odovzdáva / Who is it submitted to
  71. Une évaluation – audit interne est-il réalisé : Uskutočnenie vnútorného auditu/
       vyhodnotenia pre vlastnú potrebu / Internal audit/evaluation for own needs
  72. Partenariats : Partnerstvá / Partnerships




                                           Draft assessment report
EU Twinning project SK/06/IB/SO/02– Improving and broadening the care for the re-socialisation and rehabilitation of
                                 persons addicted to psychoactives substances

								
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