Together on the right track

16 April 2020, Nis, Serbia - “Packs the car!” This sentence, spoken by five-year-old Lazar brought on a big round of applause and praise from the entire Milic family – mom Anastasija, dad Milos and three-year-old sister Milica.

For them, this is a huge success. Maybe the biggest.

And it all started three years ago when they noticed that Lazar was not communicating. He wasn’t responding when called, wasn’t playing and exploring the world around him. Worried, Milos and Anastasija sought help from a paediatrician who referred them to the Development Counselling Unit (DCU) at the Primary Health Care Centre in Nis.

In February 2018, Lazar was included in the early intervention system, involving a psychologist helping Lazar to develop his speech, play and motor skills, but with intensive involvement and training of Lazar’s parents. Since last year, this work has continued at the Milic home.

The whole idea is for the expert not to work with the child one-on-one, but rather to support the parents who will implement the intervention plan themselves. A parent is the best expert for their child.

“I immediately realized why. He behaves differently when we go to the Primary Health Care Centre, to the Development Counselling Unit, because it's an atypical environment for him and he probably has some brakes, some barriers in his head, he doesn't act naturally”, says Milos.

Milena Petkovic Milenovic, psychologist at the DCU, and now also a family friend, has been working with the Milic family for two years now. By coming to their home, she says she can have a better picture of their priorities and needs.

“The whole idea is for the expert not to work with the child one-on-one, but rather to support the parents who will implement the intervention plan themselves. A parent is the best expert for their child. They know their child the best,” explains Milena.

Anastasija and Milos, like other parents in Nis, no longer have to search for the support they need. Now Lazar, and other children with developmental difficulties, have a team of experts from the Development Counselling Unit at the Primary Health Care Centre, the Pcelica Preschool, and the Centre for Social Work who work for them.

Together, experts and parents make a plan of support for a specific period of time. And the support is tailor-made: “one plan for one family/child”. There are no universal plans, each one is specific and made for each individual family. Such a plan was designed for the Milic family as well.

"We immediately started following the psychologist's guidelines, instructions and advice. We started with speech activities because Lazar’s speech was incoherent. We showed him imitation, echo, onomatopoeia. Within a few weeks we started noticing that he had the capacity to learn, to adopt what we were doing with him. After three months, he was able to say his first meaningful words - mom, dad, car, eye. Soon, he said his first sentence. That was amazing!” says Milos.

The Milic family now knows that in more than 70% of children development returns to the expected course if they are included in early intervention programmes in a timely manner.

"We play some functional games that develop communication. For example, I lie down on the floor because I have to be on the same eye level with Lazar. We then develop games that immitate real life – for example, how will Lazar iron his clothes, repair and wash his car”, Milos explains.

Through everyday routines, Milos and Anastasija are improving their own, as well as Lazar’s skills. The earlier this form of support begins, the better the outcomes.

“It was easier for us to have someone to guide us with what we have to do. It’s best to show daily routines at home, especially those related to food and hygiene”, says the boy’s mom, Anastasija.

Lazar now likes brushing his teeth with his dad, eating with his mom and playing with his sister.

“We practice all the skills that the family wants, the things the family wants to work on through the routine. If we work on feeding, then we practice fine motor skills, communication and speech. Our focus in not on individual skills, but on the routine and on the set of skills within the routine,” says Milena.

Grandparents often care for Lazar and Milica when they are not at kindergarten, because their parents work. This is why the psychologist coming to their home facilitates and accelerates their progress.

“We’ve made verbal progress, and I think his attention has also improved a bit. As for his sensory skills, he used to avoid touching anything or having any contact whatsoever, and that has changed. Now, he washes his hands on his own, takes something when he needs it, at bedtime he knows the routine. He's also trying to bathe on his own, so he’s showing more initiative,” Anastasija says confidently.

Milena is also there to help them with routines, such as going to the store or to the playground. Together, they make a plan whether to meet once or several times a week.

“It means a lot to me that we can find a time that works for everyone, sometimes it can be a Saturday. It’s not easy for me to take days off from work and take him to the DCU, and he needs continuous work”, Anastasija explains.

The family-oriented programme based on support through everyday routines and activities in the child’s natural environment, home or kindergarten, is adapted for Serbia based on the international experience, mostly relying on the model that has been applied in Portugal for the last fifteen years.

This programme in Serbia is jointly supported by UNICEF and the Open Society Foundations of the United Kingdom and Serbia in partnership with the Belgrade Psychological Centre, and with the financial support of the Austrian Development Agency.

Currently, 99 professionals from the health, education and social protection systems are being trained to implement it. 70 families in Leskovac, Kragujevac, Nis, Sremska Mitrovica and Belgrade are receiving support through the early intervention programme, including home visits.

The goal for the next two years is to increase the number of families and professionals taking part in the programme, modify existing regulations, integrate the knowledge of professionals at all levels, and actively advocate for the availability of improved early intervention practices at the national level.