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

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1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

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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

Thank you!!www.grupogifi.comjvalle@uniovi.es