Institusjonsplassering - siste utvei?

Abstract

Evaluation of a comprehensive reform In 2004, the State took over the responsibility for the part of the child welfare services which had formerly been administered by 19 counties. A new unit was established, consisting of a central directorate and five regions. The reform had several ambitious goals, and was expected to result in equal child welfare services in all regions, proper monitoring of both costs and professional activities, improved collaboration between State and municipalities, good quality services and professional development. In May, 2010 the Ministry of Children, Equality and Inclusion asked for a comprehensive evaluation of whether the reform has reached its objectives, divided into five different tenders. This report presents results from the evaluation of the residential care services, which was one of the five evaluations commissioned. The evaluation has been conducted by NOVA and Fafo. Elisabeth Backe-Hansen has been the project director. Objectives The objective of the evaluation was to ascertain whether the State taking over the responsibility for residential care has ensured sufficiently differentiated, high-quality residential care services in all five regions. Three further questions were posed, concerning the quality of residential care, economic development in relation to residential care and collaboration between services when children or young people need residential care. These questions were further specified in a series of ways, which will be discussed below. Two analytical dimensions Reduced use of residential care, and an increased use of home-based services and foster care, was one important objective of the reform. This was partly justified on the basis of knowledge showing poorer outcomes for those who have been in residential care. It was also justified by a strongly felt need to gain control over ever rising costs. Thus foster care was to be the preferred out-of-home placement alternative, and the number of available places in residential care was to be reduced. While working with the evaluation, two analytical dimensions emerged. The first one was residential care as a last resort. Structurally this is the case because the Child Welfare Act directs that home-based services is to be the primary intervention. If children and young people need out of home placement, foster care is then the preferred alternative. In addition residential care becomes the last resort for children and young people if they are placed in residential care after several foster care placements have failed, or because their problems are judged to be too severe for a foster home to cope with. On the other hand public documents underline that residential care is a preferred alternative for some, without, however, discussing who these are in any great detail. This way of thinking parallels what is argued in countries like Sweden, Denmark, Great Britain and the US. In 2010 a working group was appointed by the Directorate for Children, Young People and the Families to look at quality in residential care. The report underlined that one reason for the proposed changes within the residential care system was to move away from residential care as a last resort. We will add that this also presupposes proper efforts directed at improving residential care, with regard to content as well as funding. The second analytical dimension concerns the significance of costs and economy. We conducted a documentary analysis covering the years between 1995 and 2010. The analysis shows how economic concerns have been prominent throughout, and actually has gained more prominence over the years. Since residential care is a very costly alternative compared to home-based services and foster care, it might be that a need to gain control over increasing costs in combination with knowledge about poorer outcomes is instrumental in positioning residential care as a last resort. Methods A mixed method design was utilized. The evaluation started with the documentary analysis mentioned above, amongst other things including a huge amount of public documents, White Papers, and working papers from the Ministry and the Directorate. Second, child welfare statistics from Statistics Norway were analysed, covering the period from 2000-2010 whenever possible. Going back to before the reform was implemented gave us the possibility to see developmental trends since 2004 in relation to several major concerns that had existed since before the reorganization as well. Third, two surveys were done including professionals working within the state regions and directors of public and private residential units to elicit their views about important issues related to the reform. Fourth, a case study was done in order to gain insight into negotiations and processes related to the decision to apply for residential care. The system is such that the municipal child welfare makes the decision to apply for a place in a residential unit, while the state employees decide which unit. Finally a literature study was completed. Unfortunately there was no possibility of including children and young people directly within the time frame and funding available for the evaluation. We tried to compensate for this through adding a separate chapter where research describing the content of residential care was presented, including two recent user surveys and a recently published "White Paper" developed by young people with experiences of public care. The evaluation was approved by the Privacy Ombudsman for Research. Who are in residential care in Norway? As in many other countries, residential care in Norway primarily concerns young people, not children. Around ten per cent are 12 years or younger, while about two thirds are between 13 and 17 years old. Slightly above half are boys, and about three in ten of those staying in residential units during the year have ethnic minority backgrounds. Around half are now placed in residential care because they have behaviour problems or drug abuse problems, while the remaining half are placed because of a variety of other reasons. Residential care units usually care for a small group of children and young people at a time, like 5-6 individuals. If institutions are larger, they will be subdivided into several smaller units. Just above half of the available places are commercially owned or owned by NGOs, the rest are owned by the State or some municipality. Results concening the main objective of the evaluation The main objective of the evaluation was to elicit knowledge about whether the reform has led to high-quality and sufficiently differentiated residential care in all the five regions. Our first conclusion was that residential care is not sufficiently differentiated. Second, it is actually difficult to conclude with regard to the quality of residential care. Results depended on how quality was defined. In addition those working in the regions and directors of the residential care units gave diverging answers about the quality of residential care which are partly difficult to explain. The quality of Norwegian residential care With regard to the quality of Norwegian residential care, four questions were to be answered, first to what extent the development of residential care since the reform mirror the goals for the State Child Welfare. Here the results were; The goal of reducing the use of residential care has been achieved, andwe have seen a large increase in the use of foster care. A high degree of stability is still present on some indicators. The proportion of children and young people in residential care compared to foster care has remained at around 20 per cent during the last teten years, and the number of children and young people being placed in residential care during the year has been around 2.000 during the same period of time. The amount of variation between the regions seems to be reduced, at least partly. There has been an increase in the rates of young people who are placed in residential care because of behaviour problems and drug abuse. In 2009 this pertained to around two thirds of those who received services because of behaviour problems, and almost 90 per cent of those who received services because of drug abuse. This adds up to almost half of those placed in residential care during 2009. The instability in care is cause for worry. During 2010 the average number of placements in residential care was 1.7 times as high as the number of children and young people being placed. Second, the evaluation was to assess whether the introduction of systems for approving the institutions and uniform quality regulations had led to higher quality and inceased equity. The comprehensive work done with necessary routines and regulations has probably led to increased equity in residential care. However, there are different views on the quality of care which are difficult to explain. Thus it is difficult to assess whether the increase in quality regulations has led to a higher-quality service, particularly since a systematic definition of quality did not exist at the outset. Third, the evaluation was to assess whether children and young people receive equally available and high-quality residential care services in all regions. Children and young people needing residential care do not receive equal services in all regions. In addition some groups are scantily mentioned or not mentioned at all in public documents, like those with different ethnic backgrounds, children and young people with disabilities or youth with different sexual orientations. Residential care services are not sufficiently differentiated as yet. Work has been done to improve the situation, but this is not sufficient. The economic basis for residential care The second area included in the evaluation concerned economy. Here again four questions were posed, first to what extent the capacity in our state-owned institutions is sufficiently utilized. It seems as if mos

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