Post on 12-Mar-2020
Residential Child Care in Spain: Current Challenges and Advances
Jorge F. del Valle
Principality of Asturias
Founded in 1608
Content
• Child welfare system in Spain
• 4 projects to face 4 main challenges by our GIFI Research Group
Challenge ProjectAddressing behavioral and emotional disorders
HEALTHINCARE research project
Outcomes assessment in residential care SERAR project
Quality evaluation of residential care ARQUA project
Leaving care and transition to adulthood PLANEA project
46 million inhabitantsFertility Index: 1.33 (EU average: 1.58)
Decentralized government17 Autonomous communities
Civil War 1936-1939Dictatorship 1939-1978Democratic Constitution 1978
Child Welfare background (1940-1987)
• Charity Law 1869 (until 1991)
• Big Institutions as the main resource
• Mainly for orphans and children from poor and deprived families
• Run by religious orders
• Paternalistic intervention
• Non professional intervention
• social work disappears as a profession during dictatorship till 1970
• also psychology till 1968
Current Child Welfare Legal Framework
• 1987 Law on Foster Care and Adoption (reforming the Civil Code)
• Introducing family foster care in Spain
• Facilitating adoption
• Family preservation as a main priority
• Autonomous governments as regional authority for child care (regional laws…)
• No need for court intervention in case of clear cases of abuse or neglect, regional government can make a protection order
Child Welfare Current Legal Framework
• 1996 Constitutional Law on Child Protection
• Developing main ideas of 1987
• Introducing the Convention on the Rights of the Child
• Introducing the need for intervention also in cases of risk
• Reform of Constitutional Law in 2015• Prohibition of residential placements for children under 6 years old• Obligation to develop services for young people leaving care (before and after)• Detailed regulation of the use of therapeutic residential care (specialized residential
care) in terms of process, court supervision, etc. (not in terms of models of intervention….)
Residential care evolution: From institutions to family model (late XXth Century)
– Children’s homes, small family units– Based on normalization theory
• Community integration• Family environment and routines
– Professionalization• Social educators: university degree (4 years)
–Not allowed for children under 6 years old
Comparing residential care vs foster careReferrals per year
0
2000
4000
6000
8000
10000
12000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Residential care Family foster care
0
5000
10000
15000
20000
25000
30000
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Residential care Family foster care
Comparing residential care vs foster care
Family foster care vs. residential care
39.6
Kinship care vs. non-relative foster care
Out-of-home care in Spain. 31st December 2016
Residential care42%
Kinship care38%
Foster care20%
Out-of-home care 2016
Evolution of Adoption in Spain
0
1000
2000
3000
4000
5000
6000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Adoption
National International
Current challenges• Expanding foster care as a real alternative for out-of-home care placements
• Reviewing the vast use of kinship care• Using ordinary guardianship for informal kinship care in cases without abuse or neglect
• Supporting properly kinship carers in terms of funding, counselling, services…
• Defining the role of residential care as a specialized service for adolescents with emotional and behavioural problems
• Family intervention• Lack of figures despite being the more frequent intervention (family preservation and family
reunification)• Different models of intervention depending on local authorities (counselling, social
education, therapy, social work…)• Lack of program evaluation
Behavioral and Emotional Disorders of children in residential careHEALTHINCARE project
• Three-year National Project 2013-2015:– Mental health of children in residential care.
Prevalence, coverage and effectiveness of therapeutic services
• Objectives– Prevalence of children under treatment– Types of treatment received– Longitudinal outcome evaluation
Sample
• Children 6-18 years old in residential care in 6 Autonomous Communities and SOS Children’s Villages
• N= 1,216 – Age (25% 6-11) (75% 12-18)– Gender: 57% boys– Unaccompanied asylum seekers: 7.8%– Roma children: 12.3%– Immigrant family: 13%– Time in residential care: M= 42.3 months
Age distribution
0
10
20
30
40
50
6-8 9-11 12-14 15-18
8.2
16.8
29.9
45.1
Perc
enta
ge
Family Risk Factors
39.3
30.6
11.4
4.9
28
28.1
44
12.6
0 5 10 15 20 25 30 35 40 45 50
Alcoholism
Substance abuse
Mental Health
Suicidal behav.Mother Father
%
n = 20116.4%
• Enormous prevalence
• 72% receive mental health treatment
• Scarce visibility in child care research
• Special needs in residential care
• (Sainero, Del Valle, López y Bravo, 2013)
Intellectual disability
n = 585
49%
Children in treatment
0
10
20
30
40
50
60
6-8 9-11 12-14 15-18
35.1
47.6 51.2 49.9
Perc
enta
ge49.9% boys 47.2% girls
Percentage* of children in treatment
21
23
40.7
0 10 20 30 40 50
Pharmacological
Psychiatrist
Psychologycal
*A single child could receive more than one treatment
TYPES OF TREATMENT
PSYCHOLOGIST50%PSYCHOL&PSYCHIA
T34%
PSYCHIATR13%
ONLY PHARMAC
3%
30,6%
51,2%
46,5%
0 10 20 30 40 50 60
Internalizing
Externalizing
TOTAL
Broadband scales
CBCL: Clinical range
61,1%(externalizing, internalizingand/or total)
Children in clinical range by scales
103
127
71
170
105
154
189
222
250
368
365
25
71
31
45
21
64
104
112
111
237
185
0 100 200 300 400 500 600 700
Anxiety/Depres
Withdrawal
Somatic
Social
Thougth
Attention
Disruptive
Agressive
Internalizing
Externalizing
Total
Treatment NO Treatment
Monitoring intervention and outcomes in residential care
Evidences
- Children remain in residential care for a long time- Life events and crucial developmental steps happen during
that time- Information about family relationship, academic
performance and school integration, social network, health, etc., is managed
- Children change of facilities frequently and the information can be lost
- Children should improve in many aspects
• Recording relevant information systematically
• Assessing the individual needs of children in care
• Planning specific intervention for each child (individual educational plan)
• Collecting data to evaluate children evolution
• Engaging children to participate in assessing and planning individual intervention
• Making structured follow up reports to make decisions
• Promoting teamwork
• Preserving every child’s history
SERAR is a tool for:
SERAR method of intervention
Assessing children needs
Designing individual
plan
Recording intervention
Outcomes evaluation
SERAR SYSTEM COMPONENTS
•Recording background•Recording changes and events1•First needs assessment•Planning individual objectives•Assessing objectives outcomes2•Periodical report•Systematised information3
ESTRUCTURE OF MONITORING SYSTEM
Case and personal data
Family context
School and training context
Residential context
Community context
Work context
Developmental and health data
Monitoring System: Health and development
– First medical examination– Medical history– Growth: weight and stature– Vaccines– Sight, hearing and denture disease– Record of sicknesses– Record of treatments and therapies
• Assessment:- 115 items divided into the five main contexts- Observation made by social educators
• Validated by factorial analysis (Bravo y Del Valle, 2001)
• First month assessment and continuous assessment every month
Assessing needs and outcomes
FAMILY CONTEXTChild – family relationshipFamily cooperationParental skills
SCHOOL CONTEXT
WORK CONTEXTWorking skillsLabour insertion
RESIDENTIAL CONTEXT1. Personal autonomy forDuties and self-care FeedingHomework Managing social resources
2. Residential integration
Social integration Motivation and participation
COMMUNITY CONTEXT
Monthly objectives evaluation
Child-family relationship
Family cooperation (*)
Parental skills
Autonomy on duties and self-care
Feeding
Homework
Managing social resources
Social integration
Motivation and participation
Community relationships
School integration (*)
Working skills1 2 3 4 5
Boys
Girls
COM
Res
iden
tial
Con
text
Fam
ilyco
ntex
t
SCHOOL
LABOUR
Achievement level on individual objectives (Individual Educational Plan): differences between boys and girls
(*) Significant differences between groups p<0.05
SERAR in use: 9 autonomus communitiesAbout 6,000 children
Quality evaluation system
Interviews
Evaluators collect data during their stay in the residence by means of:
ObservationEnvironmental check list
Document reviewResidential care project,
Individual plan…Questionnaires
social support, burnout…
Method: formative approach
Young persons11-186-10
Social educators
Other staff
INTERVIEW FORMSQuantitative and qualitative approach
The shared vision
Manager
Evaluation contents
Resources
Basic processes
Children needs and wellbeing
Organization and management
Standards Resources
E1. Location, home design and equipment
E2. Human resources
Standards
E3. Referral and admission
Basic Processes
E4. Individual need assessment
E5. Individual program planning
E6. Leaving care
E7. Family support
Standards
E8. Safety and protection
Needs and wellbeing
E9. Children rights
E10. Basic needs
E11. School and training
E12. Health
E13. Normalization and social integration
E14. Development and autonomy
E16. Contingency management
E15. Participation
Standards
E17. Planning and evaluation
E18. Leadership and social climate
E19. Labour organization
E20. Professional coordination
Management and Organization
TRANSITIONS TO ADULTHOOD SUPPORT:PLANEA PROGRAM
CONCLUSIONS• Improving residential care quality by mean of tools and proper method
• Helping practitioners to carry out their main activities with technical solutions
• Addressing children needs and implementing specific resources and methods– Unaccompanied immigrant children– Severe behavioral problems: therapeutic residential care– Transitions to adulthood