Children´s Forum, Dec. 2003

Children in Institutions: Prevention and Alternative Care

Bragi Guðbrandsson

General Director,

The Government Agency for Child Protection, Iceland

Outline

• The child's right to grow up in a family• Harmful effects of institutionalization on children

and society• Residential care in Europe• Prevention and preventive strategies• Examples of “Best practices”• Alternative care• Leaving care - pathways• The role of the professionals in the placement

process

The preamble to the Convention on the Rights of the Child

• “The family is the fundamental group of society and the natural environment of growth and well being of all its members and particularly children ….The child should grow up in a family environment, in an atmosphere of happiness, love and understanding.”

Harmful effects of institutionalization on children

• contributes to social exclusion and stigmatization

• deprivation of emotional nourishment and development of social skills

• hampers intellectual development and lasting relationship

• causes anxiety, personal uncertainty and passivity

• increases aggressiveness and inclination to antisocial behavior

• Russian research on orphans leaving care: every fifth develops criminal career, every seventh becomes prostitute and ten percent commits suicide

Harmful effects of institutionalization on society

Message from UNICEF:• “We are also coming to realize what institutional care

does to societies. It perpetuates discrimination, by providing tacit approval for the idea that certain groups of children, whether orphaned, abandoned, living with disabilities, from families affected by AIDS or by poverty should live apart from society….the use of institutional care also impedes the healthy development of communities and society as a whole”.

Harmful effects of institutionalization on society, cont.

The Stockholm Declaration of the Second International Conference on Children and Residential Care, May,

2003:

• “There is indisputable evidence that institutional care has negative consequence for both individual children and society at large”.

Residential care in Europe

• Existing data on the scope of residential care is fragmented and difficult to interpret

• At the risk of some oversimplification, three distinct categories of states can be identified, based on the rate of institutionalization, size and quality of institutional care, reasons for placement, alternative out-of-home placement and family support

Central- and Eastern Europe

• High level of institutionalization: 6 to 20 children per 1000

• Large institutions, up to few hundred children per unit

• High number of orphans and infants in institutional care

• Long duration of placement

• Quality of care often poor

• Poverty the most significant cause for placement

• Low level of alternative care

• Family support limited

South-Eastern Europe (incl. the Caucasus states)

• Low level of institutionalization: typically 1 to 3 children per 1000

• Large institutions, up to several hundred children• High ratio of infants and orphans in care• Long duration of placement• Quality of care often poor• Poverty and family breakdown significant cause for

placement• Low level of alternative care• Family support undeveloped

The more Affluent states in Europe (esp. Western Europe)

• Varied level of institutionalization: less than 1 up to 7 per 1000

• Significant progress in de-institutionalization • Small, family-type residential care is common• Low rates of orphans and infant care• Short-term placement common• Quality of care often satisfactory or good• Complex reasons for placement, conduct and substance abuse

treatment a significant cause• Generally a high level of alternative care, especially foster care• Range of services for families

Evolution of institutional care: three stages

• the specialization paradigm

• the normalization paradigm

• the paradigm of children’s rights

Defining Prevention

• Primary prevention: to stop significant harm to children before it occurs

• Secondary prevention: intervention to minimize the effects of significant harm once it has occurred

• Tertiary prevention: to prevent the reoccurrence of harm and further deterioration

Prevention strategies:

• Evidence of correlation between lack of family support and high rates of out-of-home placement

• Strengthening the basic provisions and services on the state level: health, education, housing, employment and social security

• Empowering local government - enhancing family support on the local level: day care services etc.

• Targeting vulnerable groups: single parent families, multiple children families, poor families, the disabled etc.

• Education, training, research and awareness raising: child abuse, sexual exploitation, substance abuse etc.

• Public family policy

Public Family Policy

• Family Policy as a Perspective

• Latent and Explicit family policy

• Assessing policies in terms of their family consequences

• Definition of responsibilities, coordination and collaboration

Child Protection Systems

• Vulnerable children and social intervention• The “Child Rescue” Model: investigatory,

policing and procedurally driven focus• The “Family Support” Model: supportive

intervention and partnership with families• CPS – Comparative analysis in Europe

CPS – Comparative analysis in Europe

• Comments on the UK System:– Limited understanding of family dynamic– Tension: investigation vs. theraphy– Conflict between families and professionals

• Comments on the Continental System– Risks with respect to the child´s safety– Lack of planning for course of action– Actions without evidence of harm or abuse

CPS – Cross Cultural Differences

• The Priciple of “Subsidiarity”

• Welfare pluralism

• The Concept of “rights”

Examples of “Best Practices”

• “Gatekeeping”

• Partnership with families

• Family Group Conferences - CFC

• Parent Management Training - PMT

• Multi-systematic Treatment (MST)

• Developing competence and family services

Gatekeeping 

• To ensure that services are provided only to those who meet specified eligibility criteria

• To ration and make effective use of scarce resources

• To focus on the child needs and targeting services

• Should raise thresholds for institutional or other out-of-home placement

Partnership with Families

• Empowerment: deprofessionalization, decentralization and anti oppressive practices

• Consumerism: power of choice, quality assurance and rights of the individual

• ATD Fourth World: – “Talk with us – not at us”

– “Work with families rather than work on families”

– “Don´t judge by crisis behaviour alone”

Family Group Conferences

• Radical alternative to traditional methods• Engages the wider family in decision-making with

regard to children at risk• Principle: Every family is unique – a valuable

resource• Four steps:

– Referral– Preparation– The Meeting– Reviewing the plan

Parent Management Training

• Adresses serious behavioural disturbances of children from a very early age

• Attempts to break a vicious circle of negative interaction between parent and child

• PMT consists of:– Directions and skill encouragement– Setting limits– Anger control and problem solving– Positive involvement

Multisystematic Treatment

• Community-based treatment of high risk young offenders, substance abusers and adolescents with anti-social behaviour

• A treatment package that focuses on:– Family theraphy and parental techniqes

– Interaction within the home, in school, with peers and neighbours

• Implemented nationwide in Norway – promising results

Developing Competence and Family Services

• Families with “multi-problems” can become “multi-agency families”

• The danger of “compartmentalisation” of professional intervention and of family life

• The importance of Multiagency and Interdiciplinary approach

Alternative Care – Foster families

• Foster family care most nurturing out-of-home placement for children

• Regulating foster care services by establishing guidlines: accreditation, monitoring etc.

• The right of the child to:– Be listened to

– Maintain contact to the biological family

– Have his/her developmental needs met

Foster Pride – an example of “best practices”

• Parent Resources for Information, Development and Education

• A Comprehensive Framework for Competence Building

• Pre-service: recruitment, preparation and assessment

• In-service: training, enhancing general skills and children with special needs

Existing Forms of Alternative Care – Eastern Europe

• “Family-type ophanages” and “family like boarding schools”

• “Family upbringing groups”, “replacement families”, “patronage families”

• Guardianship

• SOS Children´s Villages

• Adoptions

Leaving Care - Pathways

• Post placement care is crucial for the well-being of the child

• The Pathway plan, based on assessment of needs:– Family and social relationship

– Skills for independent living

– Accomodation

– Education, training and employment

– Health and development

– Financial arrangement

The Role of the Professional in the Placement Process

• Professional roles as articulation of values, perceptions, knowledge and ethical beliefs

• Important ground rules:– The rights of the Child

– Family support and respect

– Care Plans – the child´s development and autonomy

– Social intergration

– Minority Ethnic Groups

– Code of Ethics