UNICEF UKRAINE
TERMS OF REFERENCE
International Consultancy for Assessment of
the Early Intervention Services1 in Ukraine
Country: Ukraine
Assessed period: January 2010 – July 2014 & January 2002 – December 2006
Duration of assessment: 34 days, November – December 2014
1. Background and Context
Of over 8 million children living in Ukraine, 167,000 children are registered with disabilities, with more
than 40,000 of these children living in institutions. Of those children with disabilities2, it is estimated
that in 2012 there were more than 12,000 children under 3 years with disabilities (83.2 per 10,000
child population of 0-3 years of age) and more than 33,000 children between 3-6 years (179.6 per
10,000 child population of 3-6 years of age).3 There is strong stigma and discrimination against children
with disability and hence inclusion of children with disabilities in the society and their right to access
essential services in healthcare, schooling and social support for them and their families are yet to be
realized. Eliminating the placement of children in institutions has not yet clearly become a regular
practice regarding support and care for children with disabilities, as medical professionals still advise
parents with children having more severe disabilities to place them into institutional care from birth.
Furthermore, parents of children with disabilities have limited knowledge about options available or
on the advantages of keeping the children at home, and there is lack of mechanisms and
comprehensive services to support families with children with disabilities.
At the same time, early intervention services have been developing in Ukraine for more than 10 years.
NGO partners from Lviv and Kharkiv have developed their services based on international early
1
In this research, “early intervention,” is meant as a system of coordinated services that promotes the child's ageappropriate growth and development and supports families during the critical early years (from birth to 6 years). The age
for intervention can vary from 0-3 years to 6 years, but a critical part is starting intervention early and before 3 years.
Development of these services sometimes has been targeted to children with developmental disabilities or delays, but
early intervention is not limited to children with these disabilities. Early intervention services often address needs of young
children who have been victims of, or who are at high risk for child abuse and/or neglect, or where the child or family faces
other vulnerabilities to enabling development growth.
2 The term ‘a person with disability’ shall be defined here according to the Convention on the Rights of Persons with
Disabilities whereupon ‘persons with disabilities include those who have long-term physical, mental, intellectual or sensory
impairments which in interaction with various barriers may hinder their full and effective participation in society on an
equal basis with others.’ In this document the term ‘a child/children with disabilities’ is used to define a person with
disability under the age of 18. Given the context of the Ukrainian legal framework, the notion ‘a child with
disabilities/children with disabilities’ used throughout this text is an equivalent to the term ‘disabled child/children‘ used
in the Ukrainian legislation. According to the Law of Ukraine ‘On Rehabilitation of People with Disabilities in Ukraine’, a
‘child with disabilities’ is a person under 18 years (majority) with long-tern disorder of the functions of the organism, which
under the interaction with external environment may lead to limitation of the person’s life; therefore the state shall
establish conditions for realization of the person’s life on a par with other citizens and ensure his or her social protection.
3
UNICEF, Creating a Good Start for Children with Special Needs & their Families: Early Intervention, p1
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intervention standards, leading the development of early intervention approaches among other
colleagues from different agencies (including NGOs, baby homes, and rehabilitation service centers).
These initiatives are now at a stage where their experiences could be disseminated to a national level
to enhance early intervention responses throughout Ukraine. UNICEF’s strategy to assess the impacts
and cost the work of organizations conducting such services assumes that establishing a Ukrainian
evidence-platform for early intervention will serve as the tipping factor for taking the approach to
scale.
This process requires a more systematic analysis, which can provide insight into the effectiveness of
the services, approaches, or strategies as well as the outcome or impact that the services are
contributing to with regards to children and families. Findings from this research will become the
factual basis for policy advocacy, as well as for future expansion and enhancement of early intervention
services in Ukraine. Furthermore, political commitment for this process exists, with the priority
expressed by the government on 27 February 2013 at a Cabinet of Ministers meeting within the
presidential social initiatives to enhance rehabilitation services for children with disabilities, modelling
services such as those in Kharkiv.
Children with disabilities are a key focus for UNICEF’s equity response4. In UNICEF Ukraine’s Country
Programme 2012-2016, there is a commitment expressed to strive towards a 25% decrease in the
number of children in institutions due to disability or development delays. UNICEF believes that
interventions at the earliest age for children with disabilities or at risk of disabilities have the largest
impact, providing a strong foundation for children and their families to address the needs of children
with disabilities and be more socially included. A theory of change document on early intervention
has been drafted by the UNICEF-Ukraine office and is attached to this Terms of Reference. Research
findings will also establish a knowledge base for UNICEF’s equity focused evaluation5 scheduled at the
end of its country programme in 2016.
2. The Programmes to be assessed
In this research, “early intervention,” is meant as a system of coordinated services that promotes the
child's age-appropriate growth and development and supports families during the critical early years
(from birth to 6 years). The age for intervention can vary from 0-3 years to 6 years, but a critical part
is starting intervention early and before 3 years. Development of these services sometimes has been
targeted to children with developmental disabilities or delays, but early intervention is not limited to
children with these disabilities or delays. Early intervention services often address needs of young
children who have been victims of, or who are at high risk for child abuse and/or neglect, or where the
child or family faces other issues to enabling development growth (e.g. poverty, families facing
dependencies, pre-mature birth etc.).
4 For UNICEF, equity means that all children have an opportunity to survive, develop, and reach their full potential, without
discrimination, bias or favoritism. This interpretation is consistent with the Convention on the Rights of the Child (CRC),
which guarantees the fundamental rights of every child, regardless of gender, race, religious beliefs, income, physical
attributes, geographical location, or other status. This means that pro-equity interventions should prioritize worst-off
groups with the aim of achieving universal rights for all children. This could be done through interventions addressing the
causes of inequity and aimed at improving the well-being of all children, focusing especially on accelerating the rate of
progress in improving the well-being of the worst-off children.
5 An equity-focused evaluation provides assessment on what works and what does not work to reduce inequity, and it
highlights intended and unintended results for worst-off groups as well as the gaps between best-off, average and worstoff groups.
2
Key principles of early intervention, which are found in the different programmes to be assessed, are
having: (1) a family-centred approach; (2) coordination of services, using a multidisciplinary team of
specialists; and (3) individualized interventions, which are accessible and provided on a regular
(continual) basis.
Early intervention services have been extensively developed in Kharkiv’s Institute of Early Intervention
as well as Lviv’s Dzherelo NGOs. Both organizations are NGOs with greater flexibility in structuring. In
Kharkiv, early intervention approaches have been disseminated to other institutions building
capacities to enhance access of more inclusive medico-social services for families.
In addition to the assessment of the two NGO services, the research should analyse how early
intervention principles have been incorporated into other state agencies and the capacities to build on
these initiatives to make early intervention principled services more accessible. For the baseline of the
assessment, the assessment will also cover state residential institutions for children with disabilities or
developmental delays.
In this context, assessment will be three-fold:
(1) Assessment of the work of Kharkiv/Lviv NGOs work over the last 5 years and whether outputs and
programme activities are leading to expected outcomes;
(2) Assessment of the “pathway” of children (now adolescents/ adults) and their families who worked
with Kharkiv/Lviv NGOs in early intervention services;
(3) Assessment of state agencies that provide medical and social/rehabilitative support to young
children with disabilities; and
(4) Analysis of whether the early intervention models in Kharkiv and Lviv substantiate UNICEF
Ukraine’s theory of change (hypothesis, assumptions, linkages and expected outcomes) on early
intervention with evidence of envisaged change.
Organisations to be assessed:
1). Kharkiv: Institute of Early Intervention
Established: 2000
Main objectives of the services:
 Provide assistance with both a child’s cognitive and developmental delays, as well as support
advancement of self-help and social skills during a child’s early years;
 Family-oriented support for families and children with disabilities and/or developmental delays or
health impairments by interdisciplinary teams.
Early Intervention Team:
Director; psychologist, speech therapist; physical therapist; coordinator.
Age Group: 0-4 years
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Geographical Coverage: Involves day services for families from the city of Kharkiv
Strategy:
The services of Institute of Early Intervention has the parents as key partners in providing psychological
and pedagogical support to young children with disabilities and/or developmental delays – focused on
rehabilitation and abilitation of children while normalizing lifestyles for families and working toward
social integration and inclusion
Project Interventions:
 Development evaluations of children
 Monitoring of children’s development
 Case management approach to services: profile of the child’s development and an individual plan
with involvement of family members, realizing the plan through individual and group therapy
 Home visits
 Counselling for family members; informational support for parents; parent clubs
 Play therapy, involving caregivers in the process
 Provision of crisis groups that counsel parents in maternity wards
 Accompaniment of children to transition from early intervention programme in pre-school to other
development programmes
Key Stakeholders:
The end beneficiaries are children with disabilities, development delays or risks of disability, and their
families.
Other partner organizations in Kharkiv applying components of early intervention:
(1) Children’s Polyclinics #2 and #14: EI service since 2012
(2) Kharkiv Oblast Baby Home #1: EI service since 2007
Objective: Accompany children with disabilities and their families to provide support and multi-profile
rehabilitation.
Age group: 0 up to 4 years
Provide support to children with:
 Nervous system impairments (neurological impairments)
 Congenital disorders (abnormalities of structure, function, or body metabolism that are
present at birth)
 Genetic disorders with psycho-physical delays/disorders
 Children with autistic spectrum disorder
Intervention Components:
 Medical diagnosis (EKG, ultrasounds, etc.)
 Medical monitoring
 Correctional/ rehabilitation therapy
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


Medical treatment for convulsive disorders (Institution is licensed to provide medical
treatment)
Services for medical rehabilitation
Psychological-pedagogical rehabilitation
2). Lviv: “Dzherelo” Rehabilitation Center
Established: 1993, as a grassroots association.
Early intervention services - since 2002.
Since 2008, part of the Center is a communal organization (Lviv City Rehabilitation Center).
Main objectives of the services:
 Provide a complex of services to families with young children with disability, health problem or risk
of developmental disorders, focused on early identification, treatment and prevention of disorders
in child’s development and of issues in a family.
 Further overall development of children with disabilities, their self-fulfilment and full social
integration by providing - in close cooperation with the family - integrated rehabilitation to children
and ensuring child’s full participation in the society.
Early Intervention Team:
Paediatrician, child neurologist, speech therapist, physical therapist, psychologist, psychotherapist,
medical registrar.
Age Group: 0-5 years
Geographical Coverage: Lviv and Lviv Oblast, as well as all Western Ukraine
Strategy: Like IEI in Kharkiv, Dzherelo’s services have parents as key partners in providing psychological
and pedagogical support to young children with disabilities and/or developmental delays – focused on
rehabilitation and abilitation of children while normalizing lifestyles for families and working toward
social integration and inclusion. At the same time, Dzherelo’s work extends to support children with
or at risk of disabilities and their families throughout the life cycle (schooling, integration, support with
work opportunities etc.)
Project Interventions:
- Development evaluation of children (motor, psychological, speech, and social development).
- Identification of key issues and goals of EI.
- Integrated individual rehabilitation program.
- Family support, incl. psychological.
- Feeding therapy.
- Consultations on social and legal issues.
- Peer support family group meetings.
- Referral to other specialists.
- Hydrotherapy.
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-
Kindergarten.
Social accompaniment.
Key Stakeholders:
The end beneficiaries are children with disabilities, development delays or risks of disability and their
families.
Partner organizations in Lviv:
Lviv city children polyclinics; Lviv Genetics Center; Departments of Intensive Care for Newborns.
3). State institution: Specialized Baby Home focused on children with disabilities (concrete baby
home to be chosen after agreement with the Ministry of Health).
Specialized baby home is an institution for medical and social care for orphan children and children
deprived of parental care, with physical or mental disorders (III to V groups of health) aged 0 to 4 years,
as well as children:
 with organic lesions of the nervous system and mental impairments;
 with organic lesion of the central nervous system, incl. cerebral palsy without mental
impairments;
 with dysfunction of the musculoskeletal system and other disorders in physical development,
without mental impairments;
 with hearing and speech impairments;
 with vision impairments;
 TB- and HIV-infected children.
4). State institution: Social Rehabilitation Center for Children with Disabilities
Social Rehabilitation Center for Children with Disabilities is a rehabilitation facility for children with
disabilities under the Ministry of Social Policy and social protection authorities. It provides
rehabilitation services aimed at correcting disorders and/or impairments of and developing children
with disabilities, teaching them core social and personal skills, and establishing conditions for their
integration into society. It also provides training to parents of children with disabilities for their followup rehabilitation in family environment after the service has been provided at the center. Some of
these rehabilitation centers have already established specialised “mother and child” sections that
focus on rehabilitation work with young children (and in some cased, depending on the center
management the age level has been reduced to 6 months rather than 2 years).
3. Rationale
Early intervention services have been developing in Ukraine for more than 10 years. NGO partners
from Lviv and Kharkiv have developed their services based on international early intervention
standards, collaborating with European (e.g. Holland), North American (e.g. Canada, US) and Australian
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colleagues, as well as partners from St. Petersburg’s Institute of Early Intervention. These NGO
partners have led development of early intervention approaches among other colleagues from
different agencies (including NGOs, baby homes, and rehabilitation service centers). Through these
efforts, there is an “informal” early intervention network from more than 10 regions of Ukraine’s 27.
In 2013, UNICEF conducted a mapping of existing early intervention practices, which revealed a
growing movement of state and NGO colleagues applying portions of early intervention practices.
These initiatives are now at a stage where their experiences could be disseminated to a national level
to enhance early intervention responses throughout Ukraine. UNICEF’s strategy to evaluate the
impacts and cost the work of organizations conducting such services assumes that establishing a
Ukrainian evidence-platform for early intervention will serve as the tipping factor for taking the
approach to scale. As lack of information affects the government’s ability to design appropriate
services and measures for children with disabilities and their families both on a normative level
(including finance, standards, guidelines, and protocols) and on a service delivery level, there is a need
to document and assess the results of the model services along with evidence of outcomes.
Assessment is undertaken when the government is increasingly interested in ensuring and enhancing
services to children with disabilities and their families. Ukraine has politically made a commitment to
move from institutional care to family-based care, including for children with disabilities. The
government called for transformation of baby homes by 2017 (Order of the Ministry of Health #70 of
02.02.2010 On Activities to Develop Baby Homes). In addition, a presidential order was made in 2013
to enhance rehabilitation services for children with disabilities modeling services such as those in
Kharkiv.
It is expected that the assessment results will reveal the extent to which the early intervention services
are contributing to: reduction of young children (0-4 years) entering or staying in residential care (baby
homes); increase in the health/ development abilities of young children with disabilities; and increase
in the capacities of these children’s families to manage their children’s needs.
It is also expected that the assessment results will provide understanding about the ability for early
intervention services to be replicated throughout Ukraine.6 Government ownership in the expansion
and incorporation of early intervention practices and transformation of baby homes is crucial for
national scale up. Throughout the process, there will be documentation on implementation of early
intervention approaches with agreement by the national state partners.
4. Objectives
The objectives of the formative assessment are as follows:
1. To analyse whether outputs and activities within the project are leading to expected outcomes
and goal of the project;
2. To assess and analyse the bottlenecks and barriers, including policies, practices and other
structural barriers in service model implementation;
3. To document lessons learned and good practices of the service model activities, along with
evidence of outcomes;
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UNICEF’s 10 criteria for successful modelling shall be used to assess the replicability or scale-up of the models.
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4. To demonstrate, based on evidence, whether or not a nation-wide scale up of the service model
approach and practice is possible and whether a scale up will effectively lead to closing of equity
gaps in the area of work;
5. To assess the validity of UNICEF Ukraine’s theory of change on early intervention and revise the
theory of change according to the findings; and
6. To develop strategic, policy and implementation recommendations of how the on-going service
model, if achieved its key outcomes, will be efficient and sustainable in future, thus informing
policy development and framework of the national scale-up of the pilot.
End-Users of Assessment Findings:
The primary user of the research findings are the Ministry of Health, the Ministry of Social Policy, the
Ministry of Education, Kharkiv and Lviv local authorities, partner NGOs implementing the early
intervention services in Lviv and Kharkiv, UNICEF, and local organizations involved in the development
of policies and services related to young children with disabilities and families.
It is expected that the assessment results will help the primary users, such as national and regional
authorities as duty bearers, to inform the way forward in the enhancement and national scale up of
the service model of early intervention services for children with disability. It will help to identify, based
on evidence, what the essential steps, strategies, and environment are in order to achieve the intended
results. NGOs providing various services for vulnerable groups such as children with disabilities will use
the results of assessment as advocacy instrument for expansion of the service model in the country as
well as to adjust or enhance the services and approaches, based on the findings. UNICEF will also use
findings for evidence-based advocacy and to provide evidence to the donor community for the
effectiveness of investment. All stakeholders are expected to use the findings, conclusions and
recommendations to further develop policy and framework to achieve positive impact for children and
women, in particular children with disabilities and their families.
5. Scope
The assessment will comprise two approaches:
1). Review and analysis of the early intervention services in comparison to conventional medical
approach services provided in state care institutions.
2). Assessment of children and families who received early intervention services in 2002-2005 in
‘Dzherelo’ Rehabilitation Center or the Institute of Early Intervention, their health, participation in
education, social inclusion, relations inside the family, quality of life, in comparison to children who
resided and received services in state care institutions in 2002-2005.
The assessment will review early intervention practices/services in the first years of introducing the
services as well as during the last five years until the present (July 2014). For the different agencies,
the time line will be the following:
o ‘Dzerelo’ (Lviv) and the Institution of Early Intervention (Kharkiv): 2010-2014 & 2002-2005
retrospectively.
o Children’s Polyclinics in Kharkiv: 2012-2014.
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o State child care institutions: current practices 2010-2014.
The scope of the assessment will focus on the effects of the early intervention services for children and
their families (impact level) as well as identify the lessons learned about “what worked” and “what did
not work” (outcome level) and to answer particularly the question of feasibility for replicating these
practices on a regional or national scale. In the baseline assessment of state care institutions, the
assessment will focus on the effects of conventional social and medical services on children and their
families.
Overall, each service provider should be assessed and analysed for its approach, innovation, evidence
of impact on children’s development capacity and family’s coping mechanisms, standards to be used
in developing regional or national policy, and costing.7
The assessment should be conducted in line with UNICEF’s determinant analysis (Annex 2). The
assessment should identify whether there is evidence that the key elements of the UNICEF theory of
change, i.e. the hypothesis, assumptions, linkages, expected outcomes and strategies, hold true and
demonstrate that expected change is happening, or whether there is a need for adapting elements of
the theory of change. Example of questions to be considered in the assessment, may include:
A. Relevance:
 What is the profile of children and families in the early intervention service provision?
o Ages the children enter the service
o Types of impairments and/or disabilities or other risks they have in entering the
service
o Status of the family
o Average timeframe for services
 How did the family hear about the service provision? Who made the referral?
 Was the service model design relevant within the Ukrainian context: was this
intervention in line with national priorities, strategies and goals?
 To what degree has the project objectives been relevant to the priorities and needs of
women and children, particularly the most vulnerable groups of children in Ukraine?
B. Effectiveness:
 To what extent has the underlying theory of change been valid at this point? To what
extent are the expected results chain occurring as planned?
 To what extent has the design of the service model and its evolution, including type of
intervention, the choice of beneficiaries, funding, and stakeholder/beneficiary
involvement enabled to achieve the project’s defined objectives?
 To what degree has the project contributed to removing bottlenecks hampering the
improvement or expansion of early intervention services in Ukraine?
The Programme will be assessed and analysed according to the 10 ‘sine-qua-non’ criteria as specified in the Annex to the
present ToR.
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7
 To what extent has the resources, including human resources and funding been used
effectively and contributed to or hindered the achievement of results?
 Did the project result in better coverage, quality and uptake of services for children with
disabilities and their families in selected sites?
 To what extent has capacity building activities for service providers resulted in service
quality improvement?
C. Efficiency:
 How cost effective are the service model activities compared to similar activities in
Ukraine?
 Has the initiative used resources (funds, expertise, time) in the most economical
manner to achieve the results?
D. Impact:
Primary beneficiaries:
 What evidence is there to prove that there is increased number of children with
disabilities staying with families?
 To what extent have the primary beneficiaries (families with children with disabilities)
experienced increased capability and confidence to take care of children at home or
increased ability to demand/seek support?
 To what extent have the primary beneficiaries satisfied with the quality of services
available for them up until now?
 To what extent have the primary beneficiaries perceive that their unique needs and
sensitivities are reflected in the established services?
 To what extent have the primary beneficiaries been able to take up (use) on the
available services?
 To what extent has gender, human and child rights8 and capacity-building issues been
taken into account in the service model and to what extent have they have contributed
to achieving of the results?
 To what extent has the equity gap closed in the number of children in institutions? If it
has not closed, what is the likelihood that it will? If it did not close, what are the most
prominent barriers for the lack of forward movement?
Local and national authorities:
 How has the project influenced or affected local and national authorities and the wider
community to establish early intervention services?
 To what extent has the service model changed (or likely to change) behaviours and
attitudes of local and national authorities as well as families of children with disabilities
on taking care of children with disabilities in a family environment?
E. Sustainability:
[1]
Indicators were developed based on review of indicators in the following documents: New Jersey Early Intervention
System, County Performance and Determination Report, NJ Dept. Health and Senior Services, Division of Family Health
Services, State Fiscal Year 2010-2011;Texas Department of Assistive and Rehabilitative Services, Division for Early Childhood
Intervention, Annual Performance Report, FFY 2011-2012.
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 To what extent have partnership and stakeholders’ involvement at different stages of
the service model been decisive for the project in attaining its expected results up until
now?
These questions are intended to give a more specific and accessible form to the evaluation criteria and
articulate the key issues of concern to stakeholders, thus optimising the focus and utility of the
assessment.
INDICATORS TO BE USED IN THE ASSESSMENT:
Impact Indicators:


# Children ‘at risk’ of separation who remained with families
Status of children’s health/development[1]:
- % children who demonstrate improved positive social-emotional skills (including social
relationships)
- % children who demonstrate improved acquisition and use of knowledge and skills (including
early language/ communication)
- % children who demonstrate improved use of appropriate behavior to meet their needs
 Status of children’s families to manage their children’s special needs:
- % families participating in early intervention services who report that early intervention
services have helped the family know their rights.
- % families participating in early intervention services who report that early intervention
services have helped the family effectively communicate their children’s needs.
- % families participating in early intervention services who report that early intervention
services have helped the family help their children develop and learn.
Outcome Indicators:

# service providers/ # regions providing early intervention counseling
(based on principles: family-centred, using multidisciplinary team, outreach occurring on regular
basis and in child’s/family’s regular environment)
# service providers providing home consultations, regular counseling (not in sessions)
 Existence of normative provisions establishing legal/ regulatory framework for early intervention
services:
- Protocol/ instruction defining inter-sectoral coordination
- Standards on screening, diagnostics & early intervention service
 Existence of Early Intervention Professional Network:
- # regions/ service providers participating in network
- level of regularity of communication/ information exchange among members
[1]
Indicators were developed based on review of indicators in the following documents: New Jersey Early Intervention
System, County Performance and Determination Report, NJ Dept. Health and Senior Services, Division of Family Health
Services, State Fiscal Year 2010-2011;Texas Department of Assistive and Rehabilitative Services, Division for Early Childhood
Intervention, Annual Performance Report, FFY 2011-2012.
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
Existence of higher education modules on early intervention/ Approval by Government and
incorporation in academic institutions/ Ministry continued learning programmes.
 Existence of communication outreach package (developed)
- # regions incorporating communication outreach proposed
- # general population reached (is informed) through public information campaign via TV and
radio channels
- # internet users mobilised to support changes for children with disabilities and their families
Limitations to the assessment – Evaluator will have access to all sources of information, available at
the time of assessment, including state statistics, research and study data and data related to the
service model budget and implementation. The service model clients in all sites, as representatives of
the target groups, will be involved during the in-country phase of the assessment to the possible extent
for interview and meetings as well as national and local stakeholders. The availability of key informants
(i.e. those directly involved in the service model) for interview and clients for focus group discussions
during the in-country phase of the assessment could be limited due to the summer holidays season.
Other limitations for assessment related to the methodology, source of information and baseline will
be identified and documented by the evaluator during the preparation phase of the assessment while
developing desk review and methodology.
Data quality, reliability, and validity – All data provided for evaluator for desk – review and further
analysis, are from the official sources and validated by the authorities, thus reliable. This includes state
statistics, and the information bulletins of the Ministry of Health, Ministry of Social Policy, and Ministry
of Educations. Ukraine’s state authorities have a wealth of statistics and data relating to the project
both within the service model sites as well as nation-wide, which would be useful for the evaluator. In
addition, data will be collected through the partner NGOs implementing the service model in the 2
regional sites.
Approach
While designing the assessment methodology, and implementing the assessment, the following
approaches should be applied: i) Keep assessment procedures (e.g. interviews) brief and convenient
to minimize disruptions in respondents work process; ii) Ensure that potential participants can make
an informed decision about the process and duration of face to face interview; iii) Follow the principle
of confidentiality; iv) Accurately and impartially analyse information and findings.
Elements of a successful modelling
The service model should be assessed and analysed according to the 6 elements of modelling 9,
specified as following:
1. An equity-based hypothesis (H) to describe the pathways from model to the national system of
care and treatment for vulnerable to HIV groups of pregnant women, in particular drug-addicted;
2. Expected equity-based Overall Results formulated as Child Rights Realisation and which meet
international HR standards, technical protocols and guidance;
3. Baseline as a basis for (H) above, including equity-increasing impact indicators;
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Fulfilling these elements would be a prerequisite to a national scale up of the ‘model’.
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4. Set Sustainability/Exit Strategy and Termination date agreed with partners;
5. Monitoring mechanisms, including for process indicators; and
6. Strategies and budget to disseminate results of assessment (communication, advocacy).
Cross-cutting Issues
Based on available data, the assessment will assess how the project and the strategy that it employs
affect the gender equity, if there is one. The communication for social change component will be
assessed as well, in order to identify to what degree (and how) communication efforts have been
able to change social norms, social and cultural practices and beliefs in the area of early intervention
services and stigma/discrimination against children with disabilities/developmental delays.
National Consultant
As the assessment will require obtaining data retrospectively, a national (local) consultant will be hired
in each region to conduct a statistical data collection based on the agreed indicators for the
assessment. This consultant can also serve to support the international consultant in obtaining
additional primary information required and, if needed, support could also be considered to the
international consultant in his/her field trips.
6. Tasks and Deliverables
In close consultation with the supervisor, the International Consultant will:
Work Assignments (Tasks)
1. Conduct desk review of secondary data and relevant legal
framework/policies for the national level as well as the provincial level
from existing sources available within UNICEF (retrieved from project
officers; method to be decided upon) and partner organisations,
analyse data and define data gaps and need for data updates related
to the area of early intervention services.
Deliverables
Summary of (desk
review) data
available and
information gap
analysis
# of Days
6 days
2. Develop methodology, framework, tools and indicators for the
assessment in consultation with UNICEF programme officers and
partners.
Report on
methodology,
framework, tools
and indicators
Interview records
and summary
report of field
work conducted
Analysis report
2 days
3. Conduct field work to collect primary data from with key
stakeholders.
4. Analyse data and information collected.
5. Present preliminary finding and analysis to UNICEF and key
stakeholders.
6. Prepare a draft version of the assessment.
Presentation of
preliminary
finding/analysis
1st draft of the
assessment
12 days
5 days
1 day
3 days
13
7. Review and validate the contents with UNICEF programme officers
and UNICEF partners through a participatory approach (method to be
decided upon in consultation with Programme Officer).
Documentation of
comments and
review
2 days
8. Produce final version of the assessment report.
Final assessment
report
Summary
presentation of
final assessment
report
2 days
9. Produce summary presentation of the final assessment report.
Total # of days:
1 day
34 days
All deliverables to be submitted to UNICEF in electronic form for feedback and assessment. The
evaluator should be available for follow-up clarification and revisions of the report until its finalization.
7. Methodology
The assessment methodology should be comprised of a mixed-method assessment design, which
includes of site visits and observations, face-to-face interviews of key informants, including with
families with children with disabilities, service providers and stakeholders. Qualitative and quantitative
components are conducted in parallel.
The assessment combines collection and analysis of quantitative data, from both surveys and
secondary data, with more in depth quality methods. The principal data collection methods are a
sample of focus groups selected in the service delivery sites, combined with structured interviews and
direct observation of services provided at health/community facilities. The primary data will be
complemented by an analysis of the extensive secondary data available from national record and other
sources. Secondary data will be used as an independent source to triangulate with primary survey data
in order to test for consistency.
Assessment approach and data collection to be human /child rights based and gender sensitive.
Assessment methods should include analysis of both qualitative and quantitative data, including
baseline indicators and established targets.
Data collected during the in-country stage of the assessment (interviews, meetings etc.) will be
complemented by a desk review of all data that has been collected during the implementation of the
pilots, including official sources of information, administrative records and state statistics as well as
budget and records of expenditure of the project.
While the overall approach is that the assessment should be the result of a collective contribution by
relevant stakeholders, project staff, decision makers, donors and beneficiaries, the Consultant shall
develop the methodology based on the background resources provided to the Consultant by the
UNICEF and key parties.
8. Structure of the Assessment Report
14
The assessment report to be produced must be compliant with the UNICEF Evaluation report
standards:
http://intranet.unicef.org/epp/evalsite.nsf/0/2BDF97BB3F789849852577E500680BF6/$FILE/UNEG_
UNICEF%20Eval%20Report%20Standards.pdf and the GEROS Quality Assessment System
The final pilot report produced and presented to UNICEF should be presented in the following format:
Executive Summary
Detail information on the purpose of the assessment, approaches and the process of
assessment.
 Assessment methodology and limitations;
 Overall overview of state policies and issues in early intervention, social protection and child
care sphere.
An overview of the government’s current policy and priorities in the sphere of early
intervention, social protection and child care, including a review of key strategic
documents. An overview of the key problems identified at national and local levels and
the link with local practices.
 Key findings
 Conclusions and Recommendations (plan of follow up actions)
Based on evidence, whether or not a nation-wide scale up of the pilot approach and
practice is possible and whether a scale up will effectively lead to closing of equity gaps
in the area of work. Recommendations for enhancing the effectiveness of early
intervention services for children with disabilities and their families within the country.
Strategic, policy and implementation recommendations of how to ensure the model’s
efficiency and sustainability in future and inform policy development and framework of
the national scale-up of the pilot.
9. Performance indicators for evaluation of results:
The evaluation of the results will be based on:
1. Technical and professional competence (quality of the product delivered to UNICEF as indicated
in part 6 above);
2. Scope of work (No. of meetings with the partners);
3. Quality of work (Timely submission of the assessment draft and final report to UNICEF);
4. Quantity of work (completing the assignments indicated above);
5. Frequency and quality of communication with UNICEF and key partners throughout the process.
In addition, such indicators as work relations, responsibility, and communication will be taken into
account during the evaluation of the Consultant’s work.
10. Ethical Issues
All interviewees, including children, should be provided the “UNICEF Principle Guidelines for the Ethical
Reporting on Children and Young People under 18 years old” and should be informed about the
objectives of the analysis and how findings will be used; they also should be informed that collected
data and any statement about the programme will be kept confidential and respondents will not be
named or identified in the reports with regard to their statements.
15
All interviewees should agree without coercion to take part in the analysis and be given the option to
withdraw or not to participate at any time during the process. All gathered data should be confidential
and names of individuals deleted from the data and replaced by codes in the analysis notes.
Ownership of all data/information/findings gathered, databases and analysis prepared for the analysis
lies with UNICEF. The use of the data/information/findings for publication or any other presentation
or sharing can only be made after agreement with UNICEF.
11. Qualifications/specialised knowledge/experience required to complete the task
1. At least a Master’s Degree in public health, sociology or other relevant discipline;
2. At least 7 years of experience of disability, early childhood development, and social policy
issues at the national level with government departments, development partners inter alia;
3. Solid and demonstrated knowledge and understanding of early intervention services and
approach, as well as social protection thematic areas;
4. Specific knowledge of issues related to children with disabilities and/or developmental delays;
5. Extensive experience in conducting analytical surveys and sociological assessments or
evaluations;
6. Demonstrated ability to conduct qualitative and quantitative analysis/evaluation;
7. Demonstrated knowledge and understanding of issues related to disability as defined in the
UNCRPD;
8. Proven experience of managing multiple, complex tasks being undertaken concurrently;
9. Proven experience of conducting key informant interviews and focus group discussions;
10. Proven ability to analyse, interpret and synthesise information from a number of sources;
11. Proven ability to work in a team;
12. Excellent and proven communication skills;
13. Demonstrated experience with completing assessments, reviews, and evaluations;
14. Proven and demonstrated experience in writing analytical reports.
15. Excellent and proven command of English. Command of Ukrainian and/or Russian would be an
asset.
12. Definition of supervision arrangements
Consultants will be supervised by the Child Protection Specialist, UNICEF Ukraine and work in close
coordination with the UNICEF Ukraine Monitoring and Evaluation Specialist.
13. Description of official travel involved
Travels are envisaged to the 2 sites within the in-country Programme assessment mission. The local
travel will be paid separately. No travel shall be undertaken prior to completing the UN Basic and
Advanced Security in the Field Courses as well as Landmines and Explosive Remnants of War Safety
Training. The links to the electronic courses will be sent to the consultant separately.
14. UNICEF recourse in the case of unsatisfactory performance
16
In the event of unsatisfactory performance, UNICEF will terminate the Agreement. In case of partially
satisfactory performance, such as serious delays causing the negative impact in meeting the
programme objectives, low quality or insufficient depth and/or scope of the assessment completion,
UNICEF will decrease the payment by the range from 30 to 50%.
15. Support provided by UNICEF
Day-to-day support for the assignment will be provided by the Child Protection Specialist and will
include relevant information sharing via e-mail, briefing and de-briefing sessions, and facilitation of the
evaluator’s meetings with UNICEF counterparts when necessary.
The deadline for submission of applications is 27 November 2014.
Only short-listed candidates will be contacted.
Applicants that fulfil the above requirements are requested to complete the United Nations
Personal History Form (P. 11) available at www.unicef.org/employ and submit it together
with a CV and a cover letter describing your professional interests in working for UNICEF.
Applications should be sent to:
UNICEF Office, 1, Klovskiy Uzviz, Kyiv, Ukraine
Fax No. 380-44-230-2506
E-mail: recruitment_kiev@unicef.org (Please indicate ‘Assessment of
the Early Intervention Services10 in Ukraine
’ in the subject of your application)
UNICEF does not charge any fees or request money from candidates at any stage of the selection process, nor
does it concern itself with bank account details of applicants. Requests of this nature allegedly made on behalf of
UNICEF are fraudulent and should be disregarded.
Annex 1
Theory of Change on Early Intervention
Early Intervention in Ukraine
Theory of Change
10
In this research, “early intervention,” is meant as a system of coordinated services that promotes the child's ageappropriate growth and development and supports families during the critical early years (from birth to 6 years). The age
for intervention can vary from 0-3 years to 6 years, but a critical part is starting intervention early and before 3 years.
Development of these services sometimes has been targeted to children with developmental disabilities or delays, but
early intervention is not limited to children with these disabilities. Early intervention services often address needs of young
children who have been victims of, or who are at high risk for child abuse and/or neglect, or where the child or family faces
other vulnerabilities to enabling development growth.
17
1. Problem and Context
Problem Statement:
Children with disabilities are one of the most vulnerable child groups in Ukraine. Of over 8 million
children living in Ukraine, 168,280 children are registered with disabilities11, with more than 40,000 of
these children living in institutions12. Of those children with disabilities, it is estimated that in 2012
there were more than 12,000 children under 3 years with disabilities (83.2 per 10,000 child population)
and more than 33,000 children between 3-6 years (179.6 per 10,000 child population). These numbers
don’t even start to consider those children who have special needs or are at risk of disabilities but are
not addressed due to their lack of “status” of a disability.
Global research has proven the critical role that caregivers play in developing children’s social and
cognitive abilities13, particularly in early years when the plasticity of the mind provides the greatest
opportunities for development.14 Early attunement and empathy shared between child and parent
play key roles in the child’s overall physical and psychological development..
Frequently, families who give birth to children with special needs or disabilities are significantly
affected by the situation. Many families feel isolated or depressed15 which can prevent them from
being able to respond to their children’s heightened needs.16 Studies have shown that maternal
depression is a prime factor in the pathway to behavior problems for many children, even leading to
limitations in brain development.17 External vulnerabilities of families (e.g. poverty, dependencies, or
violence) can also be factors that inhibit their ability to respond to their children’s development needs,
especially when the children are at risk of developmental delays or children at risk of or with
disabilities. Heightened stress and psychological distress due to Ukraine’s current crisis may further
limit parents’ and families’ abilities to respond to their children’s needs and subsequently their ability
to be socially integrated.
At the same time, children born at biological risk or with established disability have less resilience to
parents’ reduced abilities to provide stimulus or interaction, leading to potential deficits in
development18. At times, these delays or disabilities are even hidden and children are fully dependent
on their parents to recognize the first signs of special care needs.
11
Data as of the beginning of 2013. Figures for children with disabilities by region from State Statistical Service,
СОЦІАЛЬНИЙ ЗАХИСТ НАСЕЛЕННЯ УКРАЇНИ, 2014. Available via
http://www.zp.ukrstat.gov.ua/index.php?option=com_content&view=category&layout=blog&id=95&Itemid=100034 .
12
According to the Presidential Commissioner for Children’s Rights, in 2013 there were 41,700 children living in special
boarding schools for children with disabilities. Presidential Commissioner for Children’s Rights, Protection of the Rights of
the Child in Ukraine, 2014, p. 99.
13
Why Early Intervention Works, A Systems Perspective, Michael J. Guralnick,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083071/
14
Investing in Our Children: What We Know and Don’t Know About the Costs and Benefits of Early Childhood
Interventions, Chapter 1, p. 2.
15
Research of CEECIS countries showed that families often feel ashamed about having a child with disabilities and are
frequently told to forget them and continue with their lives (Burhanova 2004), FAMILY MATTERS: A Study of
Institutional Child Care in CEE & FSU, Every Child, p. 22. http://p-ced.com/reference/Family_Matters_summary.pdf
16
Investing in Our Children: What We Know and Don’t Know About the Costs and Benefits of Early Childhood
Interventions, Chapter 2, p.63.
17
Ibid, p.65.
18
Why Early Intervention Works, A Systems Perspective, Michael J. Guralnick,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083071/
18
While the intervention needed is to establish or restore parents’ interaction with their children, the
traditional response in Ukraine has been application of an outdated medical approach to addressing
delays or disabilities. Existing responses have focused on medical needs of children with disabilities
with a view to “cure” the child rather than enabling the environment for the child and his/her family.
Focus has been on “diagnosing” the child’s ‘problems’, branding the child with a disability and
establishing an environment where the response is in a separate and isolated, specialized medical
response. Under these conditions, medical services address only the needs of the child and leave
parents and families completely outside the response. Furthermore, this medical approach prevents
“non-doctors” (e.g. parents) from challenging the response as “only doctors can diagnosis.”
This situation is complicated by the fact that often there are only limited social services available to
support these families. Responses are often fragmented19 with social aspects of a child’s and families’
needs frequently not being addressed or segregated from a child’s medical support. These conditions
leave the onus on parents to search for different specialists to address varying needs of their children20
and do not allow for synergy among specialists’ interventions. Placing such responsibilities on parents
is particularly difficult as in most cases parents do not participate in rehabilitation processes for their
children, leaving them uncertain about how to identify or address their children’s special needs.
At the same time, medical professionals still frequently advise parents with children having more
severe disabilities to place them at birth into institutional care21, either proposing that they are “still
young enough” to have other children or proposing residential care for “rehabilitation”. 22 European
research on the consequences of institutional care for children 0-4 years revealed that children placed
in residential care before 6 months experience long-term developmental delays and difficulties with
social behaviour and attachments may persist, leading to a greater chance of antisocial behaviour,
delinquency and mental health problems. 23 These risks of harm from institutional care exist for any
child; for those children at risk of or with disabilities or developmental delays, the consequences can
be even more dire as they have limited abilities to compensate for limited stimuli.
Context for Intervention:
To address these bottlenecks, UNICEF believes that there must be a paradigm shift where building
families’ nurturing resources is at the center of responses. Responses need to have a comprehensive
and inter-sectoral coordination approach, addressing needs of both the child and the parents.
For young children, early intervention principles address these challenges. Specifically, early
intervention is a system of coordinated services that advances the child's age-appropriate growth and
development and supports families during the critical early years (from birth to 6 years). Early
Mapping of Ukraine rehabilitation programmes for young children was described as “cabinet” approaches, where parents
had to go to individual specialists who addressed issues and then referred to other offices. UNICEF consultancy by Natalia
Dobrova-Krol, 2013.
20
Case study of parent from Sevastopol Center, UNICEF Mapping Exercise, “Early Intervention: Key Aspects, international
and Ukrainian Experience,” (2013).
21
Research by Dr. Kevin Browne in 2003 showed that the reason for children under 3 years being in residential care was
disabilities for 4% of those institutionalized children in EU member state countries, whereas 23% in central and eastern
European countries participating in the research. http://www.unicef.org/ceecis/02-5_Kebin_Browne_UK_ENG.ppt
22
Parent testimony from NGO, Dzherelo, Lviv, Ukraine, Building Futures: The Dzherelo Children's Rehabilitation Centre
in Lviv, Ukraine, https://www.youtube.com/watch?v=Qwkmylzs5XI.
23
Presentation by Dr. Kevin Browne, “Transforming services for children without parents: A decade of EU Daphne projects
in collaboration with the WHO Regional Office for Europe,” slide 15, http://www.crin.org/docs/The_Risk_of_Harm.pdf.
19
19
intervention services require multidisciplinary, inter-sectoral coordination, where a team of different
specialists24 works together with the child and the parents to develop an individual plan. Parents are
key partners in developing solutions for their children, enabling them to build their understanding and
skills to care for their children’s special needs. This approach, in turn, contributes to decrease the risk
of abandonment or placement in residential care for rehabilitation purposes as parents have
alternatives in their communities and see ways to support their children themselves. Global research
has found early intervention to be effective25 and cost efficient26, as it can reduce the long-term effects
of some disabilities and also decrease the overall cost of providing care to children with disabilities,
even considering the client cost for each alternate care service.
Models of early intervention services in Ukraine have been developing among NGO providers for more
than 10 years. Through these efforts, there is an “informal” early intervention network with NGO and
state providers from more than 8 regions of Ukraine’s 27. These initiatives are at a point where
assessment of their impacts for children and families and exploration of how different venues (e.g.
NGOs, baby homes, medical clinics and rehabilitation service centers) could be used to disseminate
early intervention practices under existing budgetary resources could provide the evidence framework
for active advocacy for family-oriented service approaches within the Government’s on-going reform
processes.
In particular, two NGO partners from Lviv and Kharkiv within this network have services which have
been developed based on international early intervention standards27, striving to have parents as key
partners in providing rehabilitation and habilitation of young children with development and health
impairments while normalizing families’ lifestyles and working toward social integration and inclusion.
Research over a ten year period (2003-2012), examining the effect of early intervention services for
363 children28 attending the Kharkiv Institute of Early Intervention, revealed a 100% improvement for
children with Down Syndrome, 95.05% improvements for children with central nervous system
impairments and 97.24% improvement for children with autistic spectrum.
Political priorities to enhance rehabilitation responses for young children and transform Ukraine’s baby
homes provide a ripe environment for advocacy of family-oriented responses such as early
intervention practices. Specifically, Ukraine committed to move from institutional care to family-based
care, including for children with disabilities (Order of the Ministry of Health #70 of 02.02.2010 On
Activities to Develop Baby Homes) and enhancement of rehabilitation services for children with
Specialist teams will vary upon the specific needs of a child and their families, but usually an “early intervention” team’
will comprise at least a physician, speech therapist, physical therapist and psychologist.
25
An American longitudinal research was conducted to evaluate the effect of early intervention services. The research was
conducted over a 10-year period and tracked the progress of 2,586 children with development impairments or at risk of
receiving impairments. At the time of leaving the early intervention services, 54-62% of the children in the study did not
have any delays or diversions from the “norm” in communication skills, reading or counting. (US Department of Education,
2011, Early Childhood Outcomes Center, 2011.)
26
Research by Barrett (2000) in the US showed economic savings from $30,000 to $100,000 for each child that went through
early intervention services or up to $48.3 billion at the national level. Research by James Heckman (2006) also showed that
return on investment in early intervention was 6 to 7 cents for every dollar invested.
24
27
The main target group for early intervention in Ukraine is children with disabilities, development delays, or special needs.
While it is recognized by Ukrainian colleagues that these other groups could benefit from such services, the outreach is still
largely to children at risk of or with disabilities or development delays.
28 The group comprised 242 children with development impairments, and 120 with development delays. Research by
Anna Kukuruza, PhD thesis, ….
20
disabilities modeling services in Kharkiv was highlighted as a priority in the presidential social initiatives
as stated at a Cabinet of Ministers meeting (27 February 2013).
2. Hypothesis:
This theory of change focuses on strengthening parents’ capacities to support their young children’s
development needs, including caring for parents’ own needs to fill their caregiver role. Parents’ ability
to provide stimuli and support to their children’s development is particularly critical for children with
vulnerabilities, such as at risk of or with disabilities or development delays.
Review of global research shows that early intervention principles and programmes advance familyoriented services that build the families’ resources and in turn these interventions enable families to
respond to children’s specific and often extensive developmental needs.
Furthermore, in Ukraine responses to family vulnerabilities, including disabilities or development
delays, have traditionally been outside of the families in residential care facilities rather than
community-based services with the child remaining with the families.
In this context, the hypothesis of this theory of change is that:
Provision of enhanced early intervention services for young children with disabilities or at risk of
disabilities and their families, access to and uptake of such services will:


Increase children’s development capacity and family’s coping mechanisms, enabling greater social inclusion in their
communities; and
Reduce the number of children with disabilities being placed in residential care (i.e. decreasing the “inflow” of children
into baby homes)
3. Expected Goals:
Families with children at risk of or with disabilities or development delays are able to care for their children’s specific
needs and to cope with challenges faced due to their children’s disabilities or vulnerabilities within the families through
their access to family-oriented, early intervention support and services in their communities.
4. Results Framework:
4.1 Expected Impacts:
Specific development needs of children with disabilities or development delays are met by their families, resulting in
an increase in these children’s overall development and greater integration into their communities and a reduction of
these children being placed in residential care.
 Young children with disabilities or development delays and their families have access to early intervention services
that are consistent throughout Ukraine and are conducted within their communities, including in more rural or
remote areas.
 Families with children with severe/complex disabilities gain the support to care for their children rather than send
them to residential care for rehabilitation.
Key assumptions behind the outcomes that lead to the impact are:
-
Early intervention responses, which are family-oriented, build parents’ skills to care for their children’s special
needs
o Key risk: The key risk is that limited capacity of professionals may not effectively involve parents as active
partners in solutions and thus not build parents’ caring skills.
o Key mitigation measures: Information outreach to parents will inform them about the principles of early
intervention and will provide them with knowledge about how they can participate. In this way, parents will
become capable to demand the services needed and advocate for their active role in the process.
21
-
Parents will care for their children with disabilities or development delays at home if they have access to support
and services. UNICEF assumes that if parents have the skills to care for their children’s special needs and receive
the necessary and effective support, then they will keep their child in the family rather than abandoning them or
placing them in residential care for rehabilitation purposes.
o Key risk: Families requiring early intervention services can be as a result of vulnerabilities within the family,
separate from children’s disabilities or development delays. In this context, parents’ own vulnerabilities may
inhibit them from seeing their children’s specific needs or being motivated to address their children’s specific
needs in the best manner, i.e. deciding that residential care is the “easier” response.
o Key mitigation measures: A strong focus on interdependent needs of children and parents to establish or rebuild parent-child relationships should provide the means to address parents’ own vulnerabilities.
4.2 Expected Outcomes:

Early intervention services are systematized through normative provisions, following international good practices
(legal provisions, protocol/ instructions for inter-sectoral collaboration and referral mechanisms; and standard(s)
for early intervention service)

Community-based, child-centred and family-focused early intervention services are developed and strengthened,
with services provided as close to child’s routine environment as possible.

Parents’, families’, professionals’, and the general public’s supportive behavior towards children with disabilities
and development delays as well as knowledge on available early intervention services are increased.
Key assumptions behind the outputs that lead to the outcomes are:
-
Rehabilitation responses for young children and transformation of Ukraine’s baby homes will remain a political
priority
o Key risk: While the reform planned in the social service and health sectors continues, competing priorities
related to programme and financial engagements could arise due to Ukraine’s difficult economic conditions
and limited local budgetary resources for service delivery. The fact that funding for children with disabilities
comes from varying budget lines could also complicate establishment of a comprehensive, consolidated
service response.
o Key mitigation measures: Efforts will focus on generating evidence about the social and individual benefits of
early intervention practices, while at the same time increasing participation of parents and family members
in the policy dialogue so they can advocate for early intervention practices.
-
Service providers are willing to shift from a medical to social response, but require the know how for taking specific
steps: Dialogue among professionals reflects their understanding about the need for more inclusive rehabilitation
responses for children with disabilities and special needs. There also is awareness among professionals about the
negative impacts of institutionalization of children, particularly young children.
o Key risk: Early intervention services stretch across several sectors (social policy, health and education). There
is the risk that coordinated responses required across the sectors to make changes may be more difficult than
planned, as professionals may have varying capacity or motivation to conduct such services.
o Key mitigation measures: UNICEF is working with national government partners to create policy changes and
ensure mutual buy-in. At the same time, multidisciplinary training teams will build understanding among
professionals from different sectors, seeing how their coordination will produce more effective responses for
children.
4.3 Expected Outputs:


Existing community-services based on early intervention principles through different agencies are documented
and strengthened to be applied in advocating for replication of the practice across Ukraine.
Recommendations for inter-sectoral coordination referrals, management and quality control mechanisms for
early intervention services for children with disabilities and development delays are established and submitted to
the government for approval.
22





Frontline professionals’ knowledge about early intervention services and capacity to provide immediate
information support and referral for vulnerable women and families for more extensive rehabilitation services are
enhanced.
Early intervention network is strengthened, providing opportunities for exchange among professionals and
parents on good practices, mentoring, and setting professional “standards”/criteria.
Early intervention approaches are integrated into higher education programmes for relevant professionals.
Outreach responses using early intervention practices are increased among families/children living in more
rural/remote areas and those being most vulnerable.
Communication outreach packages are developed and tested in 2-3 regions and shared across other regions for
replication, addressing stigma towards children with disabilities and enhancing families’ knowledge about early
intervention services (to increase demand for services).
Key assumptions behind the activities that lead to the outputs are:
-
Establishing a Ukrainian evidence-platform for early intervention will serve as the tipping factor for taking the
approach to scale: UNICEF’s experiences have shown that demonstrating good practices can serve as motivating
factors for government partners to initiate reform. This example was seen in the Ministries of Finance and Social
Policy’s agreement to work with UNICEF on development of a new funding approach for social services after
participating in a study tour to review Berlin’s social service system.
o Key risk: The risk is that different stakeholders have conflicting interests, causing resistance to a shift from the
current medical to a social approach for disability issues. Vested interests and resources held among the
different sectors could be jeopardized with the proposed changes, creating resistance to new approaches.
o Key mitigation measures: The evidence-base will be grounded in pragmatic assessments involving cost
analysis of different alternatives as well as rigorous documentation of results and impacts for key
beneficiaries.
-
Building professionals’ capacity through systematic exchange of knowledge on early intervention approaches will
enable them to develop effective early intervention services.
o Key risk: The risk is that without continued funding or technical support to capacitate the professionals, they
may not be able to implement the knowledge gained/transferred.
o Key mitigation measures: Extensive involvement and advocacy with government partners provide the means
for a more systemic and sustainable response, reducing the risks of lack of resources.
-
Raising awareness through enhanced information outreach will reduce stigma and encourage parents to demand
early intervention services. The perception is that stigma and discrimination exist due to lack of knowledge and
understanding.
o Key risks: A key risk is that information will not be believed by parents or the fear of “losing” the little they
have will be too great to change their behavior. Discrimination and stigma towards families with
vulnerabilities as well as towards children with disabilities may even persuade such parents to believe that
residential care is better for their child.
Another risk is that behavioral change may take a long time for it to happen, limiting abilities to advance early
intervention services in a systematic manner.
o Key mitigation measures: Information outreach to address stigma and discrimination will be a key component
targeted in responses of this theory of change.
5. Activities Required:
This theory of change contributes to UNICEF’s 2012-2016 programme indicator to strive towards a 25%
reduction in the number of children in institutions due to disability, by working on a decrease in
children’s entrance (“inflow”) to residential care facilities (baby homes). A key priority for UNICEF’s
country programme is advancing system responses to enable children to be protected and cared for
in their families, with a particular focus on enhancing the opportunities for the most vulnerable child
groups such as children with developmental delays or disabilities.
23
Within this theory of change, UNICEF’s role is to generate evidence that contributes to policy dialogue,
convening policy makers and ministry colleagues with civil society partners and parents of children
with special needs. Building on the existing promising early intervention practices in Ukraine
(particularly in Kharkiv and Lviv), UNICEF is assessing the impacts and costs of these services to explore
opportunities for harnessing their lessons learned for replication across Ukraine.
UNICEF also supports integration and cross-sectoral linkages among different government levels as
well as across sectors, which is critical to the early intervention approach. The process involves
enhancing both national and regional partners’ capacities to advance early intervention practices.
Information exchange and direction from the national level to the regions is also required to establish
a mutual understanding and commitment to the new approaches, for which there may initially be
some resistance.
Building support for early intervention practices requires changes both from the supply side, involving
policy-makers and providers, and the demand side, by parents and community members. In this
context, UNICEF is working to also focus on social change communication targeted at communities to
better understand disabilities and the importance that early intervention approaches can play in young
children’s development. This work will be conducted closely with partners such the National Assembly
of People with Disabilities.
Recognizing the need for capacity development to enable lessons from existing promising practices to
be disseminated broadly across different service providers and specialists in Ukraine, UNICEF partners
with national and international civil society organizations who have taken the lead in building capacity
among colleagues in Ukraine. UNICEF’s role is to support civil society colleagues in advocating with
government partners and academic institutions for established good practices to be incorporated
systematically into education programmes such as continued learning programmes of the Ministries
of Education and Social Policy, as well as programmes of higher education institutions.
It is recognized that the systemic changes described in this theory of change are ambitious and
significant, requiring time to be developed and accepted by communities. The timeframe for this
theory of change is at least 5 to 7 years. However, assessment of progress will be conducted at the
end of UNICEF’s current programme cycle to determine whether adjustments are needed.
By the end of UNICEF’s current programme cycle (end 2016), UNICEF strives to have established,
collaboratively with international and national civil society partners and government colleagues, an
evidence-based platform for early intervention practices, with an action plan for development of
normative provisions for early intervention and objectives for dissemination of the practices
submitted to the government.
Specifically, at the end of 2016 the following results are expected:


Early intervention practices among different service providers (NGO services providers, baby homes, etc.) are assessed,
documented and disseminated. These services are assessed in comparison to more “traditional” practices of baby
homes and socio-rehabilitation centers for young children to reflect the added value of the innovation of early
intervention approach.
Action plan is established for development of normative provisions for early intervention, with a clear understanding
of what legislative/ regulatory provisions are required and when they should be drafted.
24


Capacity building plans and approaches are documented in modules and agreed among early intervention providers
with plans set for integration into education programmes, with a goal to strive for expansion of early intervention
practices into at least 2 new regions.
Package of communication materials, promoting understanding about disability issues and early intervention
practices, are established and shared among network of early intervention service providers and government partners.
Under these conditions, the main activities will include:

Data collection & knowledge management: Working with Lviv and Kharkiv colleagues, UNICEF will evaluate the impacts
and results of and costs for early intervention services for children with disabilities or development delays and their
families. Assessment will review early intervention approaches established in NGOs, baby homes and agencies from
other sectors in comparison to more “traditional” services for children with development delays or disabilities.
Establishing an evidence base within Ukraine’s context will strengthen UNICEF’s advocacy stance with government
partners for systemization and replication of the early intervention practice.

Legal and regulatory development: Based on the proven success of early intervention services, UNICEF will convene
service providers (NGO and state agencies) and government colleagues to systematize early intervention practices.
Establishing normative provisions will provide the framework to enable early intervention’s multidisciplinary approach,
bringing specialists from different sectors to work together rather than in separate silo-responses.

Capacity building: While early intervention services are expanding, colleagues continue to have significant needs to
develop their professional skills and understanding about working in a family-centered, multidisciplinary approach.
Good knowledge exists among Ukrainian experts, but there must be the opportunities for exchange of experiences
and coaching or supervision support by experienced early intervention service providers for colleagues newer to the
early intervention approaches. Working with international and Ukrainian early intervention partners, UNICEF will
promote training approaches and information exchanges to be incorporated in a systematic way to government
continued learning programmes and higher education curricula.

Communication outreach: Communication initiatives will include “Communication for Social Change” interventions
and partnership building among families and communities. Communication outreach will focus on behaviour change,
challenging discriminatory responses from professionals and general public towards children with disabilities.
Outreach will also target families’ and communities’ awareness raising about early intervention services and social
mobilization.

Quality assurance: Development of quality mechanisms on the service itself, such as a service standard and potential
accreditation or criteria for early intervention service providers, and on education programmes will be critical to ensure
that responses are truly in the spirit of early intervention approaches -- i.e. a multidisciplinary approach, familyoriented, and interventions conducted on a regular basis within the daily settings of children and their families.
Hypothesis: Provision of enhanced early intervention services for young children with disabilities or at risk of
disabilities and their families, access to and uptake of such services will: (1) increase children’s development
capacity and family’s coping mechanisms, enabling greater social inclusion in their communities; and (2)
reduce the number of children with disabilities being placed in residential care (i.e. decreasing the “inflow”
of children into baby homes).
Programme Goal: Families with children at risk of or with disabilities or development delays are able to care
for their children’s specific needs and to cope with challenges faced due to their children’s disabilities or
vulnerabilities within the families through their access to family-oriented, early intervention support and
services in their communities.
Activity
Short-term Interventions:
Output
Existing
community-
Outcome
Underlying
Assumptions
Timeframe for
Outputs
End 2014
25
1.1 Survey of international good
services based on
practices on early intervention early intervention
services is developed, sharing principles
with key stakeholders.
through different
1.2 Mapping of existing EI
agencies
are
services/evolving practices in
documented and
Ukraine is conducted through strengthened to
different agencies (NGOs,
be applied in
baby homes, polyclinics &
advocating
for
social-rehabilitation centers).
replication of the
1.3 Recommendations are
practice
across
developed for action plan to
Ukraine:
advance EI service in Ukraine, - Concept on
based on mapping, to MOH/
early
inter-sectoral working group.
intervention
clearly defines
the “standard”
Short to Mid-term
for early
Interventions:
intervention
services in
2.1 Indicators for monitoring
Ukraine, with
results (impact) from EI services
agreement
are agreed among key
among key
practitioners.
stakeholders.
2.2 System is set up for
Evidencemonitoring agreed indicators.
based data on
2.3 Impacts/ outcomes of EI
effectiveness
services is assessed in 2-3 of the
and efficiency
more advanced regions.
of EI services
in Ukraine is
2.4 Costing of early intervention
established for
services is conducted in 2-3 of the
advocacy of
more advanced regions.
policy
provisions.
Mid-term Interventions:
3.1 Dialogue across sectors and
state/NGO partners on the
need for inter-sectoral
coordination for referral,
provision of services &
budgeting of services is
facilitated (shared across
sectors) in the form of
roundtables, study tours,
bilateral meetings, etc.
3.2 Together with colleagues from
different sectors/ state and
NGO partners normative
provisions are drafted to
Recommendation
s
for
policy
framework
for
early intervention
services
for
children
with
disabilities and
development
delays
is
established and
submitted
to
government.
Early
intervention
services are
systematized
through
normative
provisions,
following
international
good practices:
- legal
provisions
(e.g. rights,
benefits and
guarantees)
to allow
different
specialists
(from
different
sectors) to
work
together in
one facility
-
Protocol/
instructions
for intersectoral
collaboratio
n and
referral
mechanisms
-
Clear
standard(s)
for early
intervention
service
exists,
defining
what
specialists
to be
involved
and how to
interact
Documentati
on of existing
and/or
services,
practices,
strategies,
approaches,
and costing
are perequisites for
buy-in by
government
partners and
opportunities
for further
dissemination
.
Legislative
development
and
operational
coordination
will enable
efficient and
effective
implementati
on of multidisciplinary
and intersectoral early
intervention
services.
End 2015
End 2016:
Agreed action
plan for policy
development
End 2018:
establishment
of policy/
normative
provisions standard,
protocol/instr
uction.
26
systematize early intervention
services:
 Protocols/instructions or
methodological
recommendations for
coordination among
professional from
different sectors (e.g.
ability for doctor to be in
EI team, psychologist to
be polyclinic staff)
3.3 Establish working group
among leading EI service
providers and state agencies
to define key quality
assurance mechanisms for
service implementation:
- service standard(s) and
assessment tools: screening,
diagnosing, implementing
service (May need to be two
standards, depending on
whether there will need to
be two linking standards
among MOH &MOSP, or
whether there can be an
inter-sectoral standard)
- components for control
mechanisms and licensing of
early intervention
programmes, founded on
3.4 Conduct advocacy/policy
dialogue at national level with
government partners & key
academic and research
institutes
Mid-term Interventions:
Build knowledge and capacity of
frontline professionals for
referrals:
1.1 Conduct roundtables,
seminars and information
exchange on:
 importance of children
staying with families/
negative effects of
institutionalization;
Frontline
professionals’
knowledge about
early intervention
services and
capacity to
provide
immediate
information
support and
referral for
vulnerable
women and
Communitybased, childcentred and
family-focused
early
intervention
services are
developed and
strengthened,
with services
provided as
close to child’s
routine
Enhanced
capacity of
existing
service
providers to
conduct early
intervention
services will
enable
increased
access for
services by
End 2018
27


Ways to consult
mothers/families to
identify problems and
responses
role of early intervention
services in enabling
children to stay with
families
families for more
extensive
rehabilitation
services are
enhanced.
environment as
possible
the target
population.
(Potential professionals include:
neonatologists, social workers,
Psycho-medico-pedagogical
commission specialists, pre-school
specialists, NGO and parent peer
groups)
1.2 Develop and test information
materials for:
 professionals to better
understand how to consult
with vulnerable families and
where/how to make referrals
 mothers/families – on actions
to obtain support/ contacts
for early intervention services
and other service outreach
(e.g. brochures, “red flag” cards
for signals for support and
reference numbers, guides on how
to consult/ address vulnerable
families’ needs/concerns, mapping
of the referral process)
Mid- to Long-term Interventions:
EI Professional Network for
exchange of information and
quality assurance:
2.1 Dialogue among EI service
providers is facilitated through
roundtables, skype
discussions, questionnaires to
define needs and
opportunities for exchange of
information, coaching
2.2 Objectives, activities,
membership requirements
and secretariat for the
network are defined and
agreed among EI community
2.3 Information to donors,
international organizations,
Early intervention
network
is
strengthened,
providing
opportunities for
exchange among
professionals and
parents on good
practices,
mentoring, and
setting
professional
“standards”/criter
ia.
End 2016:
identification
of secretariat
for network in
more
“formalized”
manner
- Action plan
established
for
development
of network to
advance
information
exchange
28
private sector is coordinated
to leverage funding
opportunities and other
resources for network
(association).
2.4 A coordination forum with
participation of EI network is
established among donors,
international organizations,
private sector interested in
advancing early intervention
to ensure synergy of actions
and avoidance of duplication.
(Early intervention practices are
developing across different agencies –
both state and non-governmental.)
Mid- to Long-term Interventions:
Higher Education Programme on
EI Approaches:
3.1 Working group of existing EI
service providers to define key
criteria to be included in EI
education programme is
established.
3.2 Review existing higher
education programmes and
convene academic/research
colleagues to identify how EI
modules could be included.
3.3 Develop EI modules for higher
education/ continued-learning
programmes (including
technical assistance on
international standards; other
countries’ EI training
practices).
3.4 Advocate among ministry
colleagues (MOES, MOH,
MOSP) and academy higher
education provosts/ directors
among
members
End 20182019:
- Tools for
information
exchange/me
ntoring
among
network
members are
functioning
Early intervention
approaches are
integrated into
higher education
programmes for
relevant
professionals.
(e.g.
pediatricians,
psychologists,
speech therapists,
physical
therapists, social
workers)
End 2019:
- Professional
criteria for
conducting
early
intervention
services is
drafted and
agreed
among
members
End-2016:
- Assessment
of EI training
approaches/
exchanges
required
End-2018:
Development
of EI modules,
with advocacy
to higher
education
facilities &
government
partners
End-20192020:
Goal for
approval of EI
modules into
programmes
29
to incorporate EI modules in
existing programmes.
Mid- to Long-term Interventions:
End-2016:
Assessments
of situation
for needs of
rural
areas/remote
areas for EI &
home visiting
is conducted.
Outreach to more
remote/vulnerable families:
4.1 Conduct assessment of early
intervention needs among
rural areas and specific home
visit needs of most vulnerable
children/families, reviewing
effects of existing practices
(particularly home visits)
4.2 Review home visit practices in
Ukraine, examining the results
obtained, specialists involved
and contribution of this
component to overall early
intervention responses
4.3 Pilot mobile team outreach,
using different available
resources including NGO
services, baby home experts
and potentially other EI
experts.
Outreach for rural areas
where specialists aren’t
located or for children with
severe/complex disabilities
requiring high tech diagnosis
etc.
4.4 Establish working group
among specialists from
different agencies – baby
homes, NGO service
providers, social rehabilitation
centers, and MOH colleagues
to review assessment findings
and outreach practices
proposed/developed to
enhance access and to
develop recommendations for
normative provisions and
practices among
agencies/sectors that will
expand access, with
establishment of action plan
agreed with government
partners.
Outreach
responses using
early intervention
practices are
increased among
families/children
living in more
rural/remote
areas and those
being most
vulnerable:
 Existing EI
home visiting
practices
reviewed and
opportunities
defined for
strengthening
and
replication
 EI mobile
team practice
piloted and
documented,
End 2018:
Pilots of
mobile team
outreach/
home visits
are tested
and
documented.
End 20192020:
Recommenda
tions for
normative
provisions to
expand
mobile team
work
30
Mid-term Interventions:
1.1 Develop baseline study on
perceptions of public and
professionals’ towards
children with disabilities/
developmental delays; and on
knowledge of parents with
disabilities/developmental
delays regarding early
intervention.
1.2 Establish communication
outreach materials and
campaign
1.3 Pilot (in 2-3 regions)
information outreach to:
- families and community
professionals to break down
stigma towards children with
disabilities/ development
delays and dispel the belief
that children with disabilities
can only be properly cared for
in specialised institutions
- families know about the value
of early intervention services,
importance of family
participation in process
1.4 Evaluate effect of campaign,
comparing findings from initial
baseline and evaluation at
completion of campaign
Communication
outreach
packages are
developed and
tested in 2-3
regions and
shared across
other regions for
replication, with
the goals to:
- address
stigma
towards
children with
disabilities
-
enhance
families’
knowledge
about early
intervention
services (to
increase
demand for
services)
Parents’,
families’,
professionals’,
and the general
public’s
supportive
behavior
towards
children with
disabilities and
development
delays as well
as knowledge
on available
early
intervention
services are
increased:
-
Families
with
children
with
disabilities
know about
early
intervention
services and
feel
supported
by their
communitie
s.
End 2015:
Behavioral
change
among
families,
professionals,
and general
public will
enable
greater access
to and uptake
of services.
Baseline
study on:
perceptions
of public
towards
disability;
knowledge of
parents
regarding EI
End 2016:
Pilot
information
outreach with
information
package is
developed,
tested and
evaluated in
at least 2
regions
End 2018:
Roll-out of
more
extensive
31
1.5 Document campaign lessons
and materials, establishing a
communications package that
would enable dissemination of
campaign to other regions
-
General
public has
greater
solidarity
towards
children
with
disabilities
and
families,
supporting
initiatives
for
children’s
greater
social
inclusion.
information
campaign
awareness
Evaluation of
campaign
results
32
6. Partnerships:
The work will involve a coordinated circle of partners: government; civil society
organizations/think tanks; and the general public, including families and children themselves,
the private sector and media. Partnerships will be advanced at both the national level to
advocate for the systematizing of early intervention practices and at regional/local levels
exploring specific lessons learned from existing service providers for dissemination.

Ministry partners are key partners as they are ultimately responsible for developing the policy framework of
service responses for young children with disabilities. The key ministries include Ministry of Health, Ministry of
Social Policy, Ministry of Education and Science.

Parliamentarians are important stakeholders in setting the legislative foundation for early intervention services.
There is a Committee on disabilities Issues within the Parliament, with which UNICEF collaborates in advocacy.

Early Intervention Service Providers: Early intervention approaches have developed across different sectors (e.g.
NGOs, MOH’s polyclinics and baby homes, MOSP’s social rehabilitation centres), based on capacities and
available resources. Promotion of early intervention practices across diverse agencies should be encouraged
particularly as services must be based within available resources, given Ukraine’s tight fiscal conditions.
o Civil society organizations: NGO early intervention service providers play a critical role in setting the
standards for policies to address early intervention services. NGO colleagues, such as Dzerelo and Institute
for Early Intervention, provide the examples of successful early intervention responses within Ukraine’s
context. Documenting and costing these two experiences will provide the proof that early intervention
works for children with disabilities and development delays and their families in Ukraine. Furthermore, an
informal network of early intervention providers exists who can serve as critical resources for coaching on
and transmitting knowledge about early intervention practices to other colleagues and regions to ensure
that the service can exist throughout Ukraine. Another key NGO partner is the National Assembly of People
with Disabilities, which reaches across disability organisations and parent groups on disabilities throughout
Ukraine.
o
State agencies as early intervention providers: Colleagues developing early intervention services often have
collaborated with NGO colleagues from Dzerelo and Institute of Early Intervention, such as the
rehabilitation center in Sevastopol or the Kharkiv Oblast specialized baby home #1. Experiences of the
Kharkiv Oblast baby home portray approaches that can be used to shift from isolating, residential care to
family support options within communities. Strategies to expand early intervention practices need to be
main flexible, exploring different options for use of resources and ability to tap into specialists such as in
baby home facilities. In the case of the Kharkiv baby home, the specialists have started to serve as
important resources for development of “mobile teams” to reach more rural areas where specialists and
advanced equipment are not available.

Parents groups for children with disabilities play a critical role to challenge the system to advance and better
respond to the particular needs of their children. Early intervention approaches must be family-centred, where
parents have an active role in conducting the services. In this way, these groups play a critical role in shaping
the service and providing feedback to professionals on how to enhance responses.

International NGOs, like Soft Tullip, and other international organizations (e.g. OSI, World Bank) are also key
partners in advancing systematizing and expansion of early intervention services in Ukraine.

Think tanks and academic institutions, such as National Academy of Pediatricians and the National Medical
Academy of Postgraduate Education in the name of Shupyk, are important partners to advance policy
development as well as early intervention approaches within higher education programmes for professionals.

Active participation of the wider general public will also be required to build greater solidarity for children with
disabilities and their families to be active members in their communities, receiving services and participating in
mainstream activities.
33
7. Monitoring & Evaluation Framework
Monitoring and evaluation of established early intervention services within Ukraine is a key strategy in advocating
for expansion of the services across Ukraine. All monitoring and evaluation actions will be guided by the principles
of results-based management and human rights-based approach programming. Indicators to evaluate effectiveness
will be designed based on global standards and beneficiary perspectives. A cost benefit analysis will also be required
to display how existing resources could be redirected to produce better results for children and their families.
Indicators will be developed in agreement with NGO colleagues from Lviv and Kharkiv, and in consultation with
MOSP and MOH colleagues.
UNICEF will be working with partners at both the national and local levels. At the local level, UNICEF’s will conduct
monitor and document the effects for children and families and lessons learned from implementation of early
intervention services. Regular monitoring efforts will focus on the following areas:
 Monitor progress implementation through agreed indicators, working together with local government
counterparts and service providers.
 Conduct regular field/regional visits to support programme implementation and monitoring vis-à-vis the
regional authorities, service providers, including conducting progress reviews and preparing reports.
 Develop, collect, analyze and report on indicators based on available data. These analyses will support baselines
against which the effectiveness of the mechanisms proposed can be measured.
Documentation of the effect of early intervention services for children and their families will be
conducted at the beginning of the initiative in the two developed early intervention service
providers in Lviv and Kharkiv. At the same time, monitoring and assessment will be conducted
among those service providers still in the process of integrating early intervention practices.
Data indicators will be agreed and each provider will be collecting on a regular basis. UNICEF will
work with early intervention service providers to develop baselines for the providers’ monitoring
and assessment. Assessment will involve key stakeholders from both the local and national level.
The assessment framework will be guided by the UNEG criteria, organized along these criteria:
relevance, effectiveness, efficiency, inclusiveness and sustainability.
M&E Indicators:
Impact Indicators:



# Children ‘at risk’ of separation who remained with families
Status of children’s health/development29:
- % children who demonstrate improved positive social-emotional skills (including social relationships)
- % children who demonstrate improved acquisition and use of knowledge and skills (including early
language/ communication)
- % children who demonstrate improved use of appropriate behavior to meet their needs
Status of children’s families to manage their children’s special needs:
- % families participating in early intervention services who report that early intervention services have
helped the family know their rights.
- % families participating in early intervention services who report that early intervention services have
helped the family effectively communicate their children’s needs.
- % families participating in early intervention services who report that early intervention services have
helped the family help their children develop and learn.
29
Indicators were developed based on review of indicators in the following documents: New Jersey Early
Intervention System, County Performance and Determination Report, NJ Dept. Health and Senior Services, Division
of Family Health Services, State Fiscal Year 2010-2011;Texas Department of Assistive and Rehabilitative Services,
Division for Early Childhood Intervention, Annual Performance Report, FFY 2011-2012.
34
Outcome Indicators:

# service providers/ # regions providing early intervention counseling
(based on principles: family-centred, using multidisciplinary team, outreach occurring on regular basis and in
child’s/family’s regular environment)
# service providers providing home consultations, regular counseling (not in sessions)

Existence of normative provisions establishing legal/ regulatory framework for early intervention services:
- Protocol/ instruction defining inter-sectoral coordination
- Standards on screening, diagnostics & early intervention service

Existence of Early Intervention Professional Network:
- # regions/ service providers participating in network
- level of regularity of communication/ information exchange among members

Existence of higher education modules on early intervention/ Approval by Government and incorporation in
academic institutions/ Ministry continued learning programmes.

Existence of communication outreach package (developed)
- # regions incorporating communication outreach proposed
- # general population reached (is informed) through public information campaign via TV and radio
channels
- # internet users mobilised to support changes for children with disabilities and their families
8. Sustainability Strategy & UNICEF Exit Strategy:
At the end of the country programme (end 2016), UNICEF will conduct an assessment directed
by this theory of change and against the baseline indicators for the effectiveness of early
intervention services. The review will consider to what extent early intervention services are
contributing to: reduction of young children (0-4 years) entering in residential care (baby
homes); increase in the health/ development abilities of young children with disabilities; and
increase in the capacities of these children’s families to manage their children’s special needs.
Evidence of results according to the theory of change accompanied by costing and
documentation of implementation guidance is a requirement for a successful national scale up30.
Assessment results will provide understanding about the ability for early intervention services to
be replicated throughout Ukraine. Furthermore, it will define whether there is a further role for
UNICEF to take in this service process. Government ownership in the expansion and
incorporation of early intervention practices and transformation of baby homes is crucial for
national scale up. Throughout the process, there will be documentation on implementation of
early intervention approaches with agreement by the national state partners.
Assessment of UNICEF’s further role will need to be defined based on the inter-rim assessment
in 2016 and with a follow-up evaluation towards the mid-term intervention of this theory of
change.
30
UNICEF will follow its agency criteria for scale up of pilot (model) projects (i.e. “10 sine qua non”).
35
36