Trauma of separation: the social and emotional impact of institutionalization on children in a post-soviet country.

BACKGROUND: In the former Soviet Union (fSU) region, which has the highest rate of institutional care worldwide, 'social orphans' -indigent children who have one or both parents living-are placed in publicly run residential institutions to receive education, food, and shelter. Few studies have focused on understanding the emotional effects of separation and life in an institutional environment on children who grow up with their families. METHODS: Semi-structured qualitative interviews (N = 47) were conducted with 8- to 16-year-old children with a history of institutional care placement and their parents in Azerbaijan. Semi-structured qualitative interviews were conducted with 8- to 16-year-old children (n = 21) involved in the institutional care system in Azerbaijan and their caregivers (n = 26). Trained interviewers collected narratives about children's experiences prior to being separated from their families while living in an institution, as well as the impact of institutional placement on their emotional well-being. We applied thematic analysis with inductive coding. RESULTS: Most of the children entered institutions around the school entry age. Prior to entering institutions, children had already experienced disruptions within their family environments and multiple traumatic events, including witnessing domestic violence, parental divorce, and parental substance abuse. Once institutionalized, these children may have had their mental health further impaired by a sense of abandonment, a strictly regimented life, and insufficiencies of freedom, privacy, developmentally stimulating experiences, and, at times, safety. CONCLUSION: This study illustrates the emotional and behavioral consequences of institutional placement and the need to address accumulated chronic and complex traumatic experiences that occurred before and during institutional placement, which may affect emotion regulation and the familial and social relationships of children who lived in institutions in a post-Soviet country. The study identified mental health issues that could be addressed during the deinstitutionalization and family reintegration process to improve emotional well-being and restore family relationships.

Narratives, masks and COVID-19: A qualitative reflection.

Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narratives contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one. This assumption drives our commitment to take seriously alternative narratives that do not conform to dominant ones in order to examine how structures of power might privilege particular types of 'truths' and with what consequences. We see this reflective piece as a re-articulation of social work's historic call to interrogate dominant ways of knowing, particularly the ways in which science obscures its own power and politics and sidelines other narratives in the process.

Reducing Opioid Mortality in Illinois (ROMI): A case management/peer recovery coaching critical time intervention clinical trial protocol.

Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.

A gender-focused analysis of structural and social precipitators to child institutionalization in Azerbaijan: A qualitative study.

Deinstitutionalization reforms in the post-Soviet region-the region with the highest rate of institutional care worldwide-are aimed at reducing the number of children in institutions. To develop context-specific gatekeeping strategies and prevent new cohorts of children from entering institutions, it is crucial to understand the local factors that contribute to institutional placement. Using a phenomenological approach, this qualitative study explores the contexts of institutional placement of children in Azerbaijan from their caregivers' perspectives. We conducted semi-structured qualitative interviews of the parents and primary caregivers (N = 26) of children placed in the institutional care system in Azerbaijan. Using systematic thematic analysis with inductive coding, we identified caregivers' reasons for placing children in the system, and inferred the life circumstances that led parents-women in particular-to be more likely to place their children in institutions. Our findings reveal multiple, gendered pathways that contribute to such placement. The majority of caregivers were single mothers, many of whom had divorced their husbands in response to domestic violence (often attributed to the husband's substance addiction). The strong stigma against divorce led women to be ostracized by close family members, often leaving them without economic and social support. Because of the limitations of public benefits available in the region, publicly-funded child institutions are often the only remaining way to provide education and care for their children. This qualitative study shows the importance of addressing the social and economic needs of parents, single mothers in particular, to prevent child institutional placement in the post-Soviet Caucasus region.