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“I have always had to behave ‘like a girl’ and I am not used to being asked for my opinion, but you ask me to say what I think during these workshops.” A 13-year-old girl from Syria describes the impact of empowerment workshops in Serbia Boy is drawing a picture. UNICEF-supported activities for children on the island of Lesvos, Greece The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children over the past year. As a result, they and their families have learned about key health issues, about the health services available to them, and how to demand health services as their right. Through its support for health literacy – the ability to find, understand and use information to take care of your own health – the initiative has helped to dismantle some key barriers to health services for refugee and migrant children and their families in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 27-month, €4.3 million co-funded initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works alongside young refugees and migrants to ensure that they have accurate health information in their own languages – information that reaches them via the channels they use and the people they trust. Importantly, the initiative makes them more aware of their right to health care in these European countries – welcome news for those who have fled from countries where good quality health care is either unaffordable or unavailable. With support from the initiative, UNICEF and its partners first worked with young refugees and migrants to identify gaps in the information available to them and in their own knowledge. This informed the health literacy packages that have been rolled out in all five countries over the past year, spanning a wide range of topics from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The packages themselves have been backed by detailed plans to ensure that their messages reach their audiences and gain real traction. Great care has been taken to ensure that information materials are culturally appropriate, gender sensitive and child-friendly, and that they are suitable for the ages and backgrounds of their audiences. Cultural mediators and interpreters have helped to overcome language and cultural barriers, while materials have been made available in, for example, Arabic, Farsi and Pashto. Activities have often been led by trusted professionals, such as nurses, physicians and psychologists who are already familiar with the needs of refugee and migrant children and their families. Materials have been shared through channels and locations that are well-used by refugees and migrants, including asylum offices, temporary reception centres, health centres, Mother and Baby Corners (MBCs), workshops and discussion sessions, during outreach activities and via social media. As a result, health literacy is now embedded into existing activities with refugee and migrant children and parents across all five countries, and is based firmly on their views and needs. In Bosnia and Herzegovina, information workshops have been tailored to the needs of different groups of children, including those who are unaccompanied and separated. Topics over the past year have included personal and oral hygiene, drug and alcohol use and its impact on health, the importance of immunization, early childhood development, medical referrals and the proper use of medicines and the risks of self-medication, as well as COVID-19 risks and prevention and services for those with symptoms. Health literacy on immunization, for example, has been strengthened through close cooperation with the Institutes for Public Health and local primary health centres, helping to ensure that refugees and migrants are aware of the national immunization calendar and protocols. In all, 1,428 refugee and migrant children and their parents have received vital information on immunization, 840 have received information on mental health and psycho-social services, and 580 (nearly double the target) have received information on maternal and child health care and nutrition. In Bulgaria, the initiative has supported group sessions that have exceeded their targets, with 99 sessions held for refugee children and mothers – more than three times the 28 sessions envisaged. There were more than twice as many information sessions on gender-based violence as originally planned: 107 rather than 48. In all, 600 refugee and migrant children and their parents have received information on immunization, 600 on mental health and psycho-social services, and 600 on maternal and child health, with every target for these areas met or surpassed in terms of the numbers of children reached. “Guiding people from refugee and migrant backgrounds on health-related procedures in their host country is a way to empower them to find solutions to health issues.” Yura, a social worker with the Council of Refugee Women in Bulgaria (CRWB) In Greece, support from the initiative has enabled UNICEF and its partners to equip refugee and migrant children with information on health risks, entitlements and services through its non-formal education programme in urban areas and on the islands. In the first full year of the initiative, 1,796 children and 464 parents have received crucial information to help them safeguard their own health. In addition, information on mental health risks, entitlements and services has been shared with 587 refugee and migrant children on Lesvos through existing psychosocial support activities at the Child and Family Support Hub (CFSH), including counselling, information sessions, parent sessions and more. Refugee and migrant women and children using the UNICEF-supported Safe Space in Athens and the CFSH on Lesvos have had access to information on GBV, with 1,313 women and 687 children reached to date. Another 1,183 mothers and 596 children have received information on maternal and child health via the CFSH on Lesvos and at child-friendly spaces within the Asylum Service Offices in Athens and Thessaloniki. In Italy, there has been an emphasis on peer-to-peer health literacy over the past year. Young refugees and migrants have shared critical health messages through, for example, the U-Report on the Move platform – a user-friendly, cost-effective and anonymous digital platform with more than 6,000 subscribers, where they speak out on the issues that matter to them. Brochures on immunization, mental health and GBV have been translated into seven languages, and a live chat on reproductive health and the concept of ‘consent’ has been conducted in partnership with the United Nations Population Fund (UNFPA). ‘Q&A’ publications have provided clear answers to burning questions on immunization, mental health and GBV, with short videos explaining, for example, what to do if someone you know has been subjected to violence, and how to protect yourself from online abuse. In the first full year of the ‘RM Child-Health’ initiative, more than 10,887 refugees and migrants in Italy have benefited from critical information on health-related risks and services. The health literacy package supported by the initiative is being shared beyond refugee and migrant communities to reach local communities and key stakeholders, with human interest stories aiming to increase public awareness of the lives of refugees and migrants. The initiative’s targets for health literacy in Serbia have also been exceeded, with 1,094 refugee and migrant children and parents receiving information on mental health (original target: 500) and 722 receiving information on GBV (original target: 600). Looking beyond the sheer numbers of beneficiaries, those taking part in health literacy workshops, in particular, have voiced their appreciation. One woman from Syria who took part in a GBV workshop commented: “I think that women, especially in our culture, do not recognize violence because they think it’s normal for men to be louder, to yell, that they have the right to have all their whims fulfilled even if their wife wants or needs something different. It is a form of inequality we are used to. That is why it is important to talk about it, as you do, to have more workshops on these topics with women from our culture, so that we realize we should not put up with anything that is against our will or that harms us and our health.” Another woman from Syria, who participated in a workshop on mental health and psychosocial support, said: “If it weren't for these workshops you’re organizing, our stay in the camp would be so gloomy. I notice that women are in a much better mood and smiling during the workshops, more than in our spare time. You have a positive impact on us.” Materials have been available in six languages and have covered access to health services, mental health issues, GBV, breastfeeding and infant and young child feeding, breastfeeding during the COVID-19 pandemic, recommendations for parents of children aged 1-6 months, recommendations for children aged 7-24 months, and substance abuse. To reach key stakeholders beyond refugee and migrant communities, a project information sheet and human-interest stories have been widely shared via social media and other well-used channels. Work is now underway in Serbia, with support from the ‘RM Child-Health’ initiative, to develop a new information package and tools to prevent and respond to sexual violence against boys. This will be rolled out in 2021 in close partnership with key actors in child protection, including those who work directly with boys from refugee and migrant communities. The first full year of support from the ‘RM Child-Health’ initiative shows what can be achieved when refugee and migrant children, women and parents are all treated as champions for their own health, rather than the passive recipients of health care. Once equipped with the right information, including the knowledge of their fundamental right to health services, they are more likely to demand the health care to which they are entitled. Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe This story is part of the Project ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe’, co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative). It represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.

Basis for a European Child Guarantee Action Plan in Lithuania PH OTO : DA NIJ EL SO LDO iBasis for a European Child Guarantee Action Plan in Lithuania When citing this report, please use the following wording: UNICEF, Basis for a European Child Guarantee Action Plan in Lithuania, UNICEF Europe and Central Asia Regional Office (ECARO), 2022. Authors: This policy brief has been prepared by a team led by Alina Makareviien, Project Manager and Lead Expert at PPMI. Haroldas Broaitis, PPMI Research Director, contributed to the report as a scientific advisor. The following experts have provided content on their areas of expertise: Greta Skubiejt (early childhood education and care and education), Agn Zakaraviit (health and housing), Aist Vaitkeviit (nutrition, material child poverty and social exclusion), Loes van der Graaf (administrative coordinator). Project management: Daniel Molinuevo, together with Kristina Stepanova (European Child Guarantee National Coordinator in Lithuania) and the rest of the Steering Committee of the third preparatory phase of the European Child Guarantee in Lithuania. Acknowledgements: Thanks are also due to James Nixon, language editor at PPMI, and many other experts who have shared their knowledge. UNICEF, 2022 The information and views set out are those of the authors and do not necessarily reflect the official opinion of the European Commission and the Commission cannot be held responsible for any use which may be made of the information contained therein. More information on the European Union is available at www.europa.eu. The material in this policy brief was commissioned by UNICEF ECARO in collaboration with the Lithuanian National Committee for UNICEF. UNICEF accepts no responsibility for errors. The findings, interpretations, opinions and views expressed in this publication are those of the authors and do not necessarily reflect the policies or views of UNICEF. Contents 1. Introduction 01 2. Free and effective access to ECEC 03 3. Free and effective access to education 07 4. Free and effective access to health care 11 5. Effective access to healthy nutrition 15 6. Effective accesss to adequate housing 18 7. Social services and benefits in cash 21 iiBasis for a European Child Guarantee Action Plan in Lithuania PH OTO CR ED IT: U NIC EF, SA MIR KA RA HO DA 1. Introduction Child poverty has an immediate and long-term effects on both individuals and society. Due to particular needs of children, and the limited coping capabilities tied to their specific life stage, children are impacted more acutely by poverty, particularly at an early age. Poverty and deprivation during childhood impact an individuals health, educational attainment, employability and social connections, and increase the risk of future behavioural problems. Thus, poverty and social exclusion at a young age often extend into later stages of life, perpetuating intergenerational poverty and inequalities. Childrens experiences of poverty and social exclusion depend not only on the extent of income poverty and material deprivation, but are also highly influenced by their immediate caregiving environment (e.g., family composition, foster care) and the characteristics of the local community (e.g. the level of access to public services). This policy brief contributes to the drafting of the Lithuanian National Action Plan on reducing child poverty and identifies the key challenges to achieving the goals of the European Child Guarantee in Lithuania. It provides an overview of the policies currently in place and provides recommendations ranging from improving access to free early childhood education and care (ECEC), to education, health care, healthy nutrition, , and adequate housing. This policy brief is based on the findings and recommendations identified in the deep-dive analysis and consists of five parts, each covering a different policy area. Each part comprises three sections, dealing with the main access barriers to access, policy responses and recommendations for ECEC, education, health care, nutrition and housing services for children. 1 2Basis for a European Child Guarantee Action Plan in Lithuania Key messages Effective access to quality ECEC services is one of the most important factors in ensuring equality in childrens further development and academic achievements, as well as to ensuring childrens safety. Meanwhile, in Lithuania, access to ECEC remains one of the biggest challenges especially for the youngest children. Not enough places are available in public centres, and private for-profit services are very expensive. In addition, hidden costs (such as meals and transport) exist even in the public sector, thereby rendering access to ECEC especially problematic for the most vulnerable children, such as children from low-income families and families at social risk. Due to the large group sizes in public ECEC centres and a lack of learning support specialists, there is also a lack of inclusion with regard to children with SEN (Special Education Needs), disabilities, and children from minority groups. Effective access to education, first and foremost, requires equality among schools and regions within the country, which is currently lacking in Lithuania. Vulnerable children, such as children from low-income families, children from families at social risk, children in rural areas, and children from national minorities within Lithuania, receive a lower quality of education. The reason for this is that schools in rural areas and in certain parts of cities, as well as schools for national minorities, lack qualified teachers, necessary learning equipment, up-to-date books and methodologies. The issue of hidden costs also applies, particularly in relation to access to non-formal education. Meanwhile, children with SEN and disabilities do not receive quality education due to teachers lack of knowledge about working with such children, as well as a lack of adapted methodology, and a lack of learning support specialists. To reduce these barriers, all schools should be equipped with laboratories, IT equipment, highly qualified teachers, all necessary learning support specialists, up-to-date books, and adapted methodologies. Schools should also provide children with universal benefits and represent cultural diversity. Meanwhile, with regard to non-formal education, children must be provided with a wide range of activities that correspond to their individual needs and capacities, and transport should be provided for children with SEN and disabilities as well as children living in distant areas. Socio-economic disadvantages negatively influence childrens access to the healthcare system in Lithuania due to families inability to afford treatments, long waiting lists, long travel times or no means of transport, a lack of time due to parents working commitments, etc. Effective access to free healthcare requires improved access to healthcare services for the most disadvantaged groups such as children in low-income families and precarious family situations; a greater focus on children with disabilities and special needs, as well as Roma and migrant children; the development of mental health services and the improvement of after-school opportunities for childrens physical activity. A lack of effective access to healthy nutrition during infancy contributes to a range of poor health outcomes in future life, as well as impacting physical and mental well-being and cognitive functioning, and contributing to lower learning outcomes. The most vulnerable children in Lithuania are those from low-income families, families at social risk, and children living in remote rural areas. Parents with low incomes cannot afford healthy foods as these are often more expensive than less healthy alternatives. In addition, parents at social risk may lack knowledge regarding the importance of nutrition, and parents raising children in remote areas may face additional barriers of access due to a lack of transport or its cost. The most vulnerable period for children is during infancy, when they should be breastfed, and their nutrition relies on mothers awareness as well as their eating habits. Tackling barriers to access such as the affordability of healthy foods, as well as addressing unhealthy eating habits by promoting and enabling healthy eating and ensuring that all children have at least one full healthy, balanced meal per day, are therefore particularly important in tackling food insecurity for AROPE children. Housing deprivation is a much bigger issue for children living in low-income families compared with other income groups of children in Lithuania. Effective access must be ensured to adequate housing and access to housing support services needs to be improved for the most disadvantaged groups in Lithuania: children in low-income households, children of single parents, children from large families, children with disabilities, Roma and migrant children. A greater focus should be placed on improving the income situation of families in Lithuania. Social services and benefits in cash significantly improve access to ECEC, education, health care, nutrition and housing. In Lithuania, some of these benefits include universal child benefits, social benefits, the family card, and one-time COVID-19 benefit and benefits for pregnant women. Other important programmes to improve the overall situation of the most vulnerable children include the action plan for complex services for families, the child well-being programme, case management and the policy of deinstitutionalization. 3Basis for a European Child Guarantee Action Plan in LithuaniaP HO TO C RE DIT : UN ICE F 2. Free and effective access to ECEC Main challenges experienced by children regarding ECEC in LithuaniaAccess to ECEC services remains a challenge in Lithuania. As in most post-Soviet countries where policies have been shaped to support stay-at-home mothering and nuclear families, and where a clear division of gender roles exists between men and women, insufficient attention has been paid to expanding the ECEC system. Policy in Lithuania has traditionally focused on supporting the aforementioned gender roles, and inattention towards developing the ECEC system has led to a lack of available ECEC services and a lack of flexibility in those services that do exist (both in terms of working hours and the types of ECEC providers), particularly with regard to children aged 0 to 3 years old. In addition, there is insufficient inclusion and access to ECEC services for children with Special Educational Needs (SEN) and disabilities, children with migrant backgrounds and children living in families at social risk, especially when such children live in rural areas. Due to a lack of public services, parents have to rely on private for-profit services, which are very expensive. Most vulnerable families, such as single-parent families, cannot afford them. For single-parent families, the situation is extremely complicated: they may face long waiting lists for enrolment into ECEC, as most municipalities in Lithuania give priority in enrolment into ECEC to families in which both parents are registered in the same area. On top of this, even in public ECEC centres, hidden costs constitute a great burden for low-income families. Meanwhile, in many cases, families with children living in rural areas cannot afford transport to and from ECEC services. Inequality between children in the education system is therefore present from a very early age. 3 4Basis for a European Child Guarantee Action Plan in Lithuania Table 1 . Number of children requiring free and effective access to ecec Vulnerable group Estimated size of the group Data source and year Children in low-income families 21.6% (38, 000) of children up to 6 years old are at risk of poverty Eurostat, 2020 Children living in families at social risk 17,430 (children of all ages) Official Statistics Portal, 2018 Children living in rural areas 50,232 Education Management Information System, 2020-2021 Children with special needs and disabilities 24,962 Education Management Information System, 2020-2021 Children with migrant backgrounds Returnee children: 976Immigrant children: 1,007 Ministry of Education and Science, 2018Official Statistics Portal, 2020 The policy responses to improve access to ECEC To improve the availability of ECEC services, the Lithuanian government has established mandatory pre-primary education. Other tools include recognizing different forms of ECEC provision, providing children with transport, free meals and more. The National Education Development Programme 2021-2030 foresees that by 2030, 95% of children between ages of 3 and the age of compulsory primary education will attend ECEC services, while 75% of children from families at social risk will attend ECEC. It is also foreseen to improve the inclusion of children with SEN. The main tools to achieve these goals include the creation of new ECEC sites (including modular kindergartens and family kindergartens), and the improvement of teachers competences via various courses and peer learning. Modular system kindergartens are flexible spaces, generally made from light construction modules, which can be easily remodelled if necessary. Family kindergartens, meanwhile, are formed when a child-raising parent takes care of other children for a certain fee, using the facilities of his or her own home. Nevertheless, while the goals of current policies are promising, there is a lack of concrete steps that need to be taken, together with a lack of financial distribution. In the current situation, access to ECEC among the most vulnerable children remains a challenge, as priorities regarding enrolment into ECEC remain based on the strengths of families, rather than their vulnerabilities, such as raising children alone, and there is a lack of transport, learning support specialists and other resources. The Description of the Requirements for Teachers qualifications foresees that at least one teacher in the childrens group should have a BA qualification; all teachers should have attended courses of at least 40 hours on working with children with SEN, disabilities, and other vulnerable backgrounds, and at least 40 hours of courses on teaching the Lithuanian language. Nevertheless, there is still a shortage of workforce in ECEC due to the professions lack of attractiveness and the lack of financing in this area. Although salaries for pre-primary teachers have been raised, ECEC teachers and learning support specialists remain among the lowest-paid professionals. To help ensure the quality of services, all ECEC centres are also provided with methodological recommendations. These recommendations include topics such as identifying childrens individual needs and improving childrens academic, artistic and social skills. Moreover, they provide information on how to approach and work with children with SEN, disabilities, migrant backgrounds, as well as children from low-income families and other vulnerable backgrounds. Meanwhile, mandatory pre-primary education for all children, and mandatory ECEC education for children from families at social risk, as well as a minimum of 5 hours mandatory provision of Lithuanian language courses for migrant children of all ages while attending ECEC, seek 5Basis for a European Child Guarantee Action Plan in Lithuania to ensure childrens safety and equality. The aim of these measures is to provide children with an equal starting point when they attend primary school; however, such measures are not always carried out due to a shortage of workforce and the competences of teachers, as well as the large sizes of childrens groups. Other tools include the provision of transport, increasing the number of ECEC centres, and assessment tools for children. In addition, children from families at social risk are also provided with free meals, learning equipment, family monitoring by The Child Welfare Commission, and counselling parents regarding the benefits of ECEC. Recommendations for improving access to ECEC Make ECEC universal for children from 0 years old to the age of compulsory primary education, with priority being given to children from disadvantaged backgrounds. The current goal is to achieve universal ECEC for all children between the ages of 2 and primary education by 2025. Progressive universalism could help to reach these goals. Progressive universalism means that children from vulnerable backgrounds are given priority in terms of access to ECEC. Financial allocations could also be raised to help children from vulnerable backgrounds to access ECEC. More attention to parents and their needs. It is important to inform parents about the benefits of ECEC via families social workers and health care specialists. Outreach mechanisms could provide significant benefits in terms of involving children from vulnerable backgrounds. It is also crucial to help parents with bureaucratic processes, and to simplify these processes as much as possible. Improve the inclusion of children with SEN. Although quality ECEC has a dramatic impact on the development of children with SEN, currently only around 20% of such children attend general ECEC in Lithuania. Improving the inclusion of children with SEN requires extended training for the ECEC workforce, both during their initial studies and while working in ECEC. There is currently a lack of teacher training in this area, mainly due to a lack of financing. This should be improved. In addition, it is important to reduce the sizes of childrens groups, and to determine the number of children per teacher. Where teachers work with groups including children with SEN, those groups should contain a smaller number of children. Address issues of gender inequality and reconciliation of work and family life. ECEC services are important for removing obstacles to the employment of women, particularly single mothers, and for single parents in general. Access to ECEC contributes to gender equality by allowing greater flexibility to manage family and work-life balance for both mothers and fathers. It is important that more flexible ECEC services are made available, with different working hours, and that single parents are given priority with regard to enrolment in ECEC. Address geographical disparities. Lithuania is currently unable to ensure equal enrolment into ECEC across the country. First and foremost, increasing access to ECEC, means developing infrastructure and increasing the number of teachers. The level of provision is lower in rural areas than in urban areas, and in urban areas, fewer high-quality ECEC resources are available in poorer neighbourhoods. Clear guidelines regarding structural quality and financing must be set at national level, to avoid children suffering inequalities in conditions depending on where they are born. It is also necessary to ensure equality among ECEC providers regarding the quality of services provided to children with SEN and disabilities, and to ensure that these children receive high-quality services close to their homes. Support the ECEC workforce. As previously mentioned, more time and money should be invested into the continuous professional development of working teachers as well as teachers training. The strong connections with teacher training institutions for ECEC could be further expanded to include on-site training or mentoring for working teachers. Moreover, professional development should be embedded into the process of quality monitoring, creating a system that focuses on measuring quality, reflecting on the results, and supporting teachers in making improvements. Every teacher should receive continuous professional development training continuous training and supervision in class, as well as training on special education, psychology, and IT; teachers should be able to attend qualification courses abroad and to receive video 6Basis for a European Child Guarantee Action Plan in Lithuania feedback. More attention should be focused on improving teachers salaries and the status of the teaching profession, as well as increasing diversity among teachers in ECEC centres. Set clear requirements for curriculum. Curricula need to be planned within an open framework that acknowledges and addresses the diverse interests and needs of children holistically. This should include addressing differences between boys and girls; children with SEN; children from national minorities; and children from families at social risk. While planning curricula, it is important to take into account global challenges, technological advancement, topics relating to everyday life challenges, and the identities of various ethnic minorities. Children, especially those from families at social risk, should be provided with facilities to meet their hygiene requirements, and centres should pay extra attention to the nutrition and health of such children. With regard to children with SEN and disabilities, recommendations provided by doctors and other services should be followed carefully at all times. It is also important to involve children and their parents in the process of creating curricula. Ensure that policy goals are oriented towards improving access to and the quality of ECEC. Strong public policy commitment to ECEC is important, and must be backed by a bold vision, strong plans and adequate funds. Promoting ECEC as a central priority in national education strategies and plans including clear targets, indicators and ministerial leadership can make a significant difference in terms of the political and financial importance given to the sector. Robust governance and accountability mechanisms across decentralized levels are also important in ensuring the efficient allocation and use of ECEC resources. Develop comprehensive quality monitoring. To ensure success, the monitoring and assessment framework should cover structural aspects of quality (child-staff ratio, qualification levels of staff); process quality (e.g., interaction with children, the content of activities); and outcome quality (looking at the benefits for children, families, communities and society). Monitoring needs to include assessments of the accessibility of ECEC for children living in rural areas, children from low-income and single parent families, for families at social risk, and for children from ethnically non-Lithuanian families. Furthermore, the quality of staff, price of services, curricula, governance and funding should also be monitored. General quality criteria need to be set at the highest possible levels, but should also encompass regional and local levels, and should ideally align with the EU ECEC Quality Framework. The ECEC workforce, the children themselves and their parents should all be empowered and included into the quality monitoring process. Information from both self-assessment and external evaluations regarding the quality of the ECEC system should be used as the basis for improvement. Information about the quality of the ECEC system should also be made available to the public. PH OTO CR ED IT: U NIC EF 3. Free and effective access to education Main challenges experienced by children in Lithuania in relation to education Although education is free and universal for all children in Lithuania, many barriers to access and other challenges still remain. First and foremost, great inequality exists between schools in terms of the quality of services, with the greatest disadvantage evident in schools in rural areas, certain areas of cities and in minority language schools. Such inequality exposes children living in rural areas and less well-off urban areas, as well as the children of non-Lithuanian ethnic groups, to low-quality education. Many of the schools attended by these children suffer a lack of laboratories, IT equipment, learning support specialists, up-to-date books and methodologies and highly qualified teachers, and a lack of transport to and from non-formal education activities as well as a lack of choice in such activities. The lack of learning support specialists and lack of choice in free-of-charge non-formal education activities, especially among children with SEN and disabilities, is major and prevent problem in all schools. Moreover, although education is considered free of charge for all children, hidden costs remain a great issue. Despite school tuition being free, the families of school students have to pay for certain school materials, activity books, transport, food and various extra courses and activities that contribute to their learning. This can be extremely problematic for low-income families, especially those living in remote areas, where hidden costs limit access to both formal and non-formal education. Immigrant children, returnee children and children of migrant origin are also insufficiently included in the educational system. There is a lack of teachers from different cultural backgrounds in schools, Lithuanian language is not sufficiently well taught to non-native-speaking children, and teachers lack the skills to work with children with different languages and cultures. A lack of learning support specialists is also a major problem in this context. 7 8Basis for a European Child Guarantee Action Plan in Lithuania Table 2. Number of children in need of free and effective access to education Vulnerable group Estimated size of the group Data source and year Children in low-income families 24.8% (100, 000) of children between ages of 6 and 19 are at risk of poverty Eurostat, 2020 Roma children 1,036 (children of all ages) Overview of Roma situation in Lithuania, 2016 Migrant and returnee children Returnee-children: 412 Immigrant children: 3,303 Ministry of Education and Science, 2018OSP, 2020 Children from non-Lithuanian ethnic backgrounds 31,502 Education management information system, 2020-2021 Children living in rural areas 53,510 Education management information system, 2020-2021 Children with special needs and disabilities 4,873 Education management information system, 2020-2021 Policy responses to improve access to educationThe Lithuanian government recognizes the issue of low academic achievements among Lithuanian children and its link to the lack of quality of education in Lithuanian. The government recognizes issues such as inequalities between schools and the lack of inclusion of the most vulnerable children such as children with SEN and disabilities and children of migrant origin. To reduce these inequalities, it proposes to equip all schools equally with highly qualified teachers, learning support specialists, laboratories, IT equipment and the necessary methodologies. The National Education Development Programme 2021-2030 foresees that by 2030, 97% of children with SEN and 75% of children with disabilities will attend general education schools; 75% of all children will attend non-formal education; 50% of children with SEN will attend non-formal education; 65% of teachers will be employed in schools after graduation; and 40% of teachers will have MA degree. In addition, it is expected to improve pupils PISA results to reach 16th place among all participating countries by the year 2025. To achieve these goals, the government has allocated a budget of EUR 550 million. The Strategic Action Plan of the Ministry of Education, Science and Sport for the year 2021-2023 seeks to improve teachers qualifications; implement the monitoring and assessment of students, schools and education as a whole; develop infrastructure for inclusive education; and to integrate formal and non-formal education. Tools to achieve these goals include courses to improve teachers competencies; increases in teachers salaries; online self-assessment programmes for schools; monitoring indicators for education; purchasing additional school buses and laboratory equipment; modernizing school infrastructure; modernizing non-formal education facilities; increasing support to Lithuanian schools abroad; providing coordinated support to immigrated and returnee children and their families; expanding the number of all-day schools; and increasing funding for student benefits. Nevertheless, teaching remains among the lowest-paid professions, and teachers do not receive any of the financial and educational support necessary to motivate them when working with children with SEN and disabilities, or with children from minority backgrounds. The Political Programme of the XVIII Government of Lithuania also sets similar goals. In addition, it foresees the establishment of national education quality standards and improvements in the quality of education in minority schools. Although most of these goals are similar to those set in previously mentioned documents, the Political Programme of the XVIII Government of Lithuania foresees the use of different tools to achieve these goals. These include modernizing the curricula (including a multilingual reading and maths programme, as well as updated history programmes that recognize the importance of minorities in Lithuanian culture), reduced class 9Basis for a European Child Guarantee Action Plan in Lithuania sizes, additional financing for learning support specialists, more up-to-date books in minority languages, and the digitalization of minority schools. According to data from interviews, the issue of schools lack of autonomy still remains, as they are not given the power to make their own decisions regarding financial allocations and various aspects of curricula, despite the schools themselves being best placed to know what is missing, and what is necessary for their children. Educational tools of the largest scale will include mobile school staff teams and millennial schools. Mobile school staff teams will consist of teams of teachers and other learning specialists that will go to schools facing issues and work there temporarily to improve the situation. Millennial schools will be located in different regions in Lithuania and will benefit from better teachers and STE(A)M laboratories, and modern curricula for formal and non-formal education. All children from the surrounding region will be able to use the facilities and courses provided at these schools. These schools are intended to reduce inequalities between regions, and to provide equal opportunities for all children irrespective of their living place, as well as to improve overall academic achievements. Nevertheless, some of the experts interviewed as part of this research expressed concern that these schools might even worsen equality among regions and children, as millennial schools would absorb all of the best resources in the area and become elite institutions. Children learning in other schools in the area would thereby receive an even lower quality education, as not all of them would have access to these elite schools. The inequalities between schools and regions with regard to quality therefore remains an issue. More detailed, focused tools and more integrated solutions are required to break the cycle of poverty by providing every child with the highest-quality education at all educational levels. Meanwhile, the Law Amending the Law on Education of the Republic of Lithuania and The Description of the Procedures for Organizing the Education for Pupils with SEN, seek to improve the inclusion of children with SEN, those with disabilities and those from other vulnerable backgrounds (migrants, at social risk, from low-income families etc.), as well as to reduce the number of school dropouts. The tools provided include continuously working with childrens parents, pupil self-care plans (provided for children who have various health issues), and individual learning plans. Other tools include the provision of special classes, transport, school meals, school supplies, and improved inter-institutional cooperation. Municipal administrations are encouraged to work more effectively to ensure the well-being of the child, to remove interdepartmental barriers between educational assistance, municipalities, state institutions and establishments, organizations and non-governmental actors, to ensure inter-institutional co-operation. Improved inter-institutional attention to vulnerable children and their parents should reduce social exclusion, dropouts from schools, as well as improve parents skills and involvement in their childrens education, in addition to improving childrens psycho-emotional well-being while attending educational institutions. Inter-institutional co-operation means that all of a childs needs must be identified and dealt with through cooperation between all of the necessary services and support providers. Nevertheless, the inclusion of children with SEN and disabilities, in general, remains a great challenge due to the aforementioned lack of competencies and motivation among teachers, as well as a lack of learning support specialists and the physical appropriateness of schools buildings. Other smaller-scale programmes also exist, such as quality baskets, all-day schools, day care centres and financial baskets for non-formal education. Quality baskets seek to improve pupils academic achievements. EUR 30,324,2001 were allocated to this programme across 270 schools. The programme includes the evaluation of schools, provision of improvement plans to the schools and the monitoring of their success. Meanwhile, financial baskets for non-formal education seek to improve childrens attendance in non-formal education by providing every child with a monthly allowance to purchase non-formal education activities. All-day schools are settings in which children are provided with educational activities after official school hours. The main goals of these schools are to improve the inclusion of children from vulnerable backgrounds and to reduce conflicts between parents family life and work commitments. Day care centres are social care settings in which children from the most vulnerable backgrounds (such as families at social risk) gather after school and receive help with their homework, participate in various educational and cultural activities, and receive free meals. These centres also seek to work with childrens parents to improve their parenting skills and to ensure that children receive all the support they need. Despite improved financial allocations and more attention being given to the parents, the hidden costs of education remain, and there is a lack of universal provision of school supplies and other necessary materials. 10Basis for a European Child Guarantee Action Plan in Lithuania Recommendations for improving access to education There should be universal and inclusive education for all children: geographical and socio-economic disparities should be addressed, as well as differences in levels of inclusion and quality among schools. Universality and equality in the education system would reduce inequality between children from families of different socio-economic status. It would also improve academic achievement and decrease school dropouts. It is necessary to provide all children with school supplies, transport and meals to reduce hidden costs and bullying in schools. It is also important to address such differences as the unequal distribution of learning support specialists, laboratories, IT infrastructure and high-quality teaching staff among schools, and to reduce differences between elite and rural as well as minority schools. Reducing inequalities between schools would also improve the inclusion of children with SEN and children with migrant backgrounds. Targeted interventions should also take place to improve boys academic achievements. Update curricula and provide greater flexibility in the selection and design of programmes. It is crucial to enrich learning experiences while supporting the effective use of digital technologies and encouraging activities that link learning with real-life experience. It is also necessary to improve the curricula in vocational schools so that they effectively combine strong basic and job-related skills. Regions, cities and schools should be allowed to choose from a list of validated activities and programmes that best meet the needs of their children. Greater investment in measures that reduce early school leaving. Interdisciplinary communication is crucial to ensure that children who are not well included in schools are identified and worked with, to reduce the risk of dropouts. It is also necessary to improve communication with childrens parents, to ensure that they receive all the necessary information and that their individual needs and those of their children are met. Preventive and tailored interventions that involve multiple actors (such as families, schools, and so on) are identified as being more likely to succeed. Developing early warning systems for pupils at risk could help to ensure effective measures are taken before problems become manifest. The availability of various routes back into mainstream education and training is also important. Expand all-day schools and non-formal education opportunities across Lithuania. The lack of teachers and other staff, as well as additional transport costs, learning supplies, additional school meals and the necessity to adapt methodologies, are all concerns that must be addressed in order to ensure the expansion and quality of all-day schools and non-formal education across Lithuania. It is also important to address the issue of access to non-formal education for children living in rural areas, as well as for children with SEN and disabilities. Also important is the need to ensure that a variety of after school activities options are available for these children. Strengthen the teaching workforce. It is important to attract teachers with different backgrounds, genders and ages. All teachers should have a BA degree and at least some should have a Masters degree. Initial teacher education also needs to be improved, and greater flexibility should be provided in terms of the ways in which people can acquire a teaching degree. It is important to ensure that new teachers can work in a well-supported environment and receive frequent feedback and mentoring during the early years of their careers. In addition, all teachers should be provided with qualification courses, and teachers opportunities to network and exchange knowledge and experiences at school should be strengthened and improved. There should be a more coherent career pathway for teachers that rewards teaching excellence. The methods used to recruit teachers should be improved, and salaries should be raised. Set national quality standards and implement monitoring. It is important to prioritize education at policy level as part of the overall solution to social exclusion and poverty throughout the integration process. Any strategy should therefore provide clear timelines, targets, baselines and indicators to monitor progress, as well as adequate financial, material and human resources. External evaluation must be carried out, as well as the provision of methodology and tools for internal evaluation by schools. General quality criteria need to be set as high as possible, while minimum quality thresholds are also required to avoid a lack of balance between regions and avoid a situation in which the quality of a childs education depends on the region in which they are born. Funding on a larger scale should also ensure consistency between richer and poorer regions, to avoid a situation in which municipalities with a higher prevalence of low-income families lack the means to serve the needs of those families. The possibility should be considered of assigning higher weights in the funding formula to socio-economically disadvantaged students. More attention should be devoted to improving efficiency in the allocation and use of school maintenance budgets. PH OTO CR ED IT: U NIC EF - VA KH TAN G K HET AG UR I 4. Free and effective access to healthcare Main challenges experienced by children in Lithuania in relation to healthcare Socio-economic disadvantages negatively influence childrens access to the healthcare system in Lithuania. Childrens medical and dental needs may remain unmet due to various reasons, such as families inability to afford treatment, long waiting lists, long travel times, or no means of transport, as well as a lack of time due to parents work or their responsibility to care for other family members. Children in low-income or single-parent families, Roma families and children living in precarious family situations are at a high risk of not receiving necessary health treatments due to travel costs, lack of time to take children to the doctor, and also due to some necessary and continuous treatments not being entirely free of charge and, in the case of and Roma families families in precarious situations, due to a lack of education and interest in childrens health on the part of parents. One of the most obvious issues is the insufficient level of vaccinations. Vaccination rate among children in Lithuania are lower than the 95 per cent recommended by the WHO, and the issue of non-vaccination is particularly common among Roma children. Another important issue relating to healthcare is a lack of physical activity by children, often determined by the absence of interest by parents and financial reasons. The children who experience the highest risk of low physical activity are those from low-income families, families at social risk, single-parent families and Roma families, as the main reasons for low levels of physical activity include the inability to afford after-school sports activities and/or transportation, lack of time to take children to these activities or to supervise childrens activities on a daily basis, as well as the previously mentioned lack of parents education and interest in their childrens health in the cases of families at social risk and Roma families. These same groups of children do not always have access to mental health services when needed, due to long waiting lists and parents lack of time or transport to take children to consultations, especially when they live in remote rural areas, far away from clinics. The lack of availability of psychological counselling is especially problematic for children from low-income and single-parent families, as their parents often cannot afford private consultations and are even more time-poor than wealthier families. Families raising children with disabilities or special needs report having limited access to certain treatments their children need, as well as a lack of specialists, long waiting periods, and so on. Migrant and refugee children may experience limited access to free healthcare. 11 12Basis for a European Child Guarantee Action Plan in Lithuania Table 3. Number of children in need of free and effective access to healthcare Vulnerable group Estimated size of the group Data source and year Children in low-income families 24% (138,000) of children between birth and the age of 19 are at risk of poverty Eurostat, 2021 Roma children 1,036 Overview of the Roma situation in Lithuania, 2016 Children living in precarious family situations 17,430 Official Statistics Portal, 2018 Migrant and returnee children 4,310 Ministry of Education and Science, 2018OSP, 2020 Children with disabilities 14,289 NGO Confederation for Children, 2017 Children with mental illness 701.05 per 10,000 children The Institute of Hygiene, 2018 Children in single-parent families 26% of all families150,000 children Eurostat, 2017Lithuanian Population and Housing Census, 2011 Policy responses to improve access to healthcareEnsuring childrens health and social well-being is an important part of the national health system in Lithuania. Access to, and the quality of, healthcare services, health literacy, mental and physical health and sex education are at the heart of the National Progress Programme 2021-2030, the Programme of the XVIII Government of the Republic of Lithuania, and the Public Healthcare Development Programme for 2016-2023. Physical activities and mental health services are not currently accessible for all children and their families in Lithuania; thus, the national focus is on spreading awareness of the importance of mental and physical health, increasing access to sporting activities, and improving childrens health monitoring. The National Progress Programme 2021-2030 strategically aims to increase social well-being inclusion within Lithuanias population, and strengthen its health. To achieve this goal, the following measures are planned: improved adaptation of the environment for people with disabilities, including children (e.g. transport, infrastructure, services, information); increased attention to childrens psychological state and access to mental health services; improved access to physical activities for children; high-quality health care services; improved health literacy; an efficient health system with focus on stronger primary care; and improved access to outpatient care. Moreover, issues such as long waiting lists to receive treatment, the high cost of drugs and high levels of corruption are also addressed. However, some healthcare programmes such as continuous rehabilitation services and treatments for certain developmental disorders, as well as transport services, remain among the biggest barriers to accessing healthcare provision for the most vulnerable children in Lithuania. The Programme of the XVIII Government of the Republic of Lithuania plans to improve access to sporting activities and mental health services. The main tools to achieve this include promoting more equal distribution of qualified sports specialists across the country; introducing up to three physical education lessons per week in all general education schools; updating the physical education curriculum; providing swimming lessons to all children in primary schools; improving sex education; and improving access to mental health services. The National Public Healthcare Development Programme for 2016-2023 also seeks to promote physical and mental health, as well as encouraging a healthy lifestyle and culture, by promoting health literacy and ensuring the sustainability of the public health care system. To achieve these goals, awareness will be raised with regard to physical and mental health, with an emphasis on the prevention of illnesses in schools; updating sports 13Basis for a European Child Guarantee Action Plan in Lithuania equipment and facilities in schools; monitoring physical activity and childrens mental state; increasing the availability of high-quality public health care services and improving the management of the public health care system overall. The key mechanism currently used ensure childrens health needs are met is preventive annual health inspections and the National Immunization Programme 2019-2023. The latter provides that all recommended vaccinations included in the national immunization scheme are free of charge. The Programme aims to ensure at least 90 per cent of children are vaccinated (in the case of measles and rubella, not less than 95 per cent) across the country and in each municipality. Meanwhile, preventive annual health examinations at health care institutions include consultations with family doctors and dentists, and are compulsory for all children attending pre-primary and general education. However, a lack of attention is paid to the health of children who fall outside formal care and education systems. Attending to the medical needs of these children depends solely on their parents who, as previously mentioned, may lack interest or knowledge about their childrens health. A grey area also exists with regard to refugee children, who have different rights to the nationals in terms of access to healthcare. Meanwhile, children with disabilities receive financial assistance and various free services. These include a social assistance pension; targeted compensation for assistance costs for children with disabilities; and universal and free early rehabilitation for children with developmental disorders. The mechanism for integrated family services includes the provision of positive parenting training, psychological counselling, ECEC services, transport and more. Nevertheless, many issues still remain for children with SEN and disabilities, who face additional challenges in addressing everyday medical needs such as dental treatment. They also lack access to special, targeted treatments and integrated assistance that could help to meet all of their needs and reduce the burden on their families. Recommendations for improving access to healthcare Consistent coordination between central and local institutions is necessary in order to ensure

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