Fatjona R. Lubonja, Teachers College, Columbia University, New York: USA/
Introduction
Children with intellectual impairment are “at-risk” when there is an inequality between their education, policy, and needs. Such a population needs strong interventions and treatments alongside quality education that allow the disability to survive in a difficult environment and society (O’Connor, Notari Syverson, & Vadasy, 1996). Albanian policy, health, education, and social institutions have gone through many changes in the last years, following the country’s political and economic reforms (Zogaj, 2014). Since, Albanian have a centralized health and education system controlled by the state (Fshazi, 2004), such changes had influenced policy, education, health services, and directly the children with intellectual impairments. In addition, lack of specialized staff and education in the behavior field targeting children with intellectual disability such as attention -deficit/hyperactivity disorder (ADHD), schizophrenia, autism, and general cognitive impairment had a direct effect on the development and life of children with intellectual impairment.
The report reviewed the situation of children with intellectual impairment in Albania, and the directly related policy. Such a report gave an overall historical review about the country’s children with intellectual impairment and the Albanian policy. Empirical research suggested that education expectations, which form the basis of learning ability, can have a powerful impact on children with intellectual impairment and their development (Gentile, J. & Gillig, P. 2012).
The report developed an overall guidance with the goal of describing and understanding the reality of the Albanian institution environment and its direct effects on children with intellectual disabilities. The researcher gathered relevant data from the specified archive documents and historical documents available at the Institute of Statistics (INSTAT), Albanian National Library, Education Ministry public data, Health Ministry, Ministry of Work and Social Affair, independent nonprofit organizations, and interviews with professionals. Time frame for this report stretched through the months of June and August of the year 2017. The data collection began in Albania during the academic school year 2016 – 2017. In order to collect data and in a timely manner, the researcher visited the country with the request asking for information collaboration with Albanian non-governmental and nonprofit organizations dealing with child health and social issues in Albania.
Intellectual Disability in Albania: An Historical Perspective.
Albania had a diverse history in relation with intellectual impairment and as like in many cultures (Ragurman,. et al., 1996) situations involving mental illness were often hidden from the community or health services. During the early 1900 hundred, there were no hospitals or any institution that took care or treated mentally ill children. Religious institutions (monasteries, mosques, churches) were mostly the only host of children or individuals with mental illness.
During the communist totalitarian regime, between the years 1950-1990, there was restriction in data collection and there were no public discussions targeting mental health. Based on statistics, although few, in Albania the number of children suffering from intellectual disabilities or mental problems is higher compared to other pathologies of children (WHO-AIMS Report, 2006). According to the City of Berat Hospital historical patient record data, during the years 1970-1980 there was a “high” number of infant deaths or impairment, with a larger number of cases detected in the rural area (Central State Archive, 1971).
Albanian laws during the 1950-1990, prohibited any independent research or data collection either from Albanian doctors or foreign researchers (Central State Archive, 1961;1963;1971).
The year 1991 brought the regime change and internal revolution that re-structured all government and its policy. The change in government structure and political structure brought a change also in mental illness approach. The economical difficulties and the absence of structure in mental healthcare providers brought poor services to children with intellectual impairment and overall to mental health issues. There was and still is a low number of doctors and specialists in the field of mental health medical field. During the transition years many specialists emigrated on western democratic countries. In addition there was not even one graduate in the field of behavior or applied behavior science from the University of Tirana, studies that specifically targeted mental health (WHO-AIMS Report, 2006). According to an interview with pediatrician Dr.Gjylameti, based on dates obtained over the last 20 years through visits of registered children in the city of Tirana, there was an increased number of children diagnosed with autism spectrum disorder or general intellectual impairment throughout the years. As cases increased, children with intellectual disabilities were “at risk” when there was an imbalance between the understanding of these disorders, their treatment, education and basic needs. Society needed direct intervention of treatments that allowed children with intellectual impairment to survive in a difficult environment (Bow, D. H., & Woolley, R. S., 2011).
Albanian Policy and Services
Albanian education services – (Article 39 & 40, #7952, date 06.21.1995) Education services were provided for free in the school setting or special school. Services provided in school include relatively generic support, such as teachers. The curriculum was written for the entire year or in some cases pre-designed for the entire school K-12 curriculum. Such curriculum was designed by the Ministry of Education for the entire general Albanian education system, and it is unchangeable by schools.
Albanian social care services – (Article 23, 309. # 8092, date 03.21.1996) Services associated with social care were centrally funded government services overviewed by the Ministry of Health and Ministry of Work and Social Affair. There were two major Central Residences in the city of Shkoder and Lezhe. The centers provided help for children with disabilities for the entire country. Their maximum capacity of 250 children was not enough for providing to the entire population of children with intellectual impairment in the entire country of Albania.
Policy – In addition to specific areas of support, policy played a role in shaping Albanian education and children with intellectual impairment. Albanian policy in relation to education had changed categorizing it from pre-1990 policy to post-1990 policy. Prior to 1990 children with intellectual impairment were under the law (Article 23, 306), designed and supervised by the Ministry of Health. After the changes post-1990, the children with intellectual impairment law was revised with the goal of integration of such a population in the society and general education environment. Furthermore, in post-1990 laws, other than the Ministry of Health, also the Ministry of Work and Social Affair began playing an important role in shaping the policy toward children with intellectual impairment. Changes for mental health legislation were taken during 1996. The issues taken into consideration in mental health legislation were the care, the rights of individuals and members of the family, competency and capacity, voluntary and involuntary treatments, guardianship, and judicial issues. During the years 2003-2005, further changes were made to the legislation focusing mainly on policy and development of mental health services by adding the deinstitutionalization of the psychiatric hospitals. For the first time the law included human rights promoting social inclusion of intellectual impairment individuals.
Only 3% of the government health care budget was used for mental health. Overall, from this percentage, 97% of the finance went to the mental hospitals. The essential list of medicines, revised and approved by the Ministry of Health, included at least one psychotropic drug. Only 1% of mentally ill population had free of cost access to psychotropic drugs. (WHO-AIMS Report, 2006).
Mental health facilities were composed of 2 mental hospitals, 34 outpatient facilities (2 of them for children and adolescents), 2 psychiatric wards in general hospitals, 5 day treatment facilities (3 of them for children and adolescents). The number of beds in mental health facilities during the years 2003 -2005 was 30.3 / 100.000 sample population. Children and adolescents represented 8% of patients treated yearly in outpatient facilities, 25% of those in day treatment facilities and 3% of admissions in general hospitals. The highest number of children suffering from mental illness was schizophrenic disorders including the spectrum of autism (70%), followed by mental retardation (17%) and mood disorders (13%). (WHO-AIMS Report, 2006).
Most of the information of children with intellectual impairment derived from the mental health hospital, children’s pavilion, department of psychiatry and neurology. The children were usually treated as outpatients. There were only two hospitals that had psychiatric and neurology patients, in the city of
Tirana and Berat. The first psychiatric hospital was opened in the year 1968 in the city of Berat, previously used as an orphan place and a hosting house for intellectual impairment children. Another hospital specialized in neuro psychiatric treatment of children ages 2-20 years old was the Mother Teresa Hospital in the city of Tirana. There were no behavior clinics targeting children’s intellectual impairment.
Citation: Lubonja, F. R. (2022). Report: Children with intellectual impairment in Albania. Academia Letters, Article 4550. https://doi.org/1020935/AL4550
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