God omsorg i barnevernsinstitusjoner
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Background The study was initiated in 2014 by the Directorate for Children, Youth and the Family. The main objective was to generate knowledge that can be used in the ongoing work to develop the quality of care in residential settings, in non-specialized units as opposed to those specializing in coping with emergency placements or severe behavioural problems. Four part projects were defined. Two were directly related to children and young people, namely good care as associated with participation and good health. Two could be seen as more institutional, and concerned the composition of groups of children and young people and continuity in relation to good care. However, it is difficult to imagine professional development within any of these areas without seeing them in relation to structural preconditions. Thus, a chapter was added discussing four such preconditions. These are the intended reduction in the number of places, that there will always be changes in the composition of those living in the institutions during the year, how best to differentiate the total offer of residential care, and the question of children up to 12 years old in residential care. This has been an important project, not in the least because we have seen a clear tendency to see residential care as a last resort during later years (cfr Backe-Hansen et al, 2011). Thus we see a new trend when this project is directed towards finding out how residential care can be a positive experience for children and young people. Methods The project has utilized several different methods. Besides a literature review (Storø, Backe-Hansen & Løvgren, 2017), focus group interviews have been done with young people and professionals from a sample of institutions. In addition leaders and staff nationally have filled in an electronic questionnaire, and some leaders and responsible for intake in the regions have been interviewed individually. Last, but not least, fieldwork has been conducted over time at one residential unit for children, toegether with interviews with employees in another residential unit for children. In addition the publicly available child welfare statistics was used in relation to the analyses of structural preconditions. Results The literature review showed that not much research exists about the themes that were identified in the four projects – a result which in itself points to the need for further research. Consequently it was deemed necessary to supplement the data generated in the project with other, relevant research. With regard to participation and research, one important conclusion is that participation must be seen as relational and contextualized processes, thus it is not sufficient to use a formal perspective. On the contrary, participation is an integrated part of the daily life in an institution, where the children’s formal rights are necessary, but not sufficient to realize their participation rights. One important point of departure will be how participation in small and big questions in daily life takes place in families, which then has to be weighted against considerations that need to be taken with regards to the other children and young people, and the adults working there. In addition participation may be understood as the possibility to influence the way the institution as such is organized, not just at the individual level (chapter 5). Since care is a relational activity and value, the analyses of the fieldwork underlined the significance of bodily expressions, and showed how participation became an integrated part of the care of the children, rather than formalized procedures (chapter 6). The survey to the employees investigated to types of health-related work. One concerned pro-active work, in the guise of rules and follow-up of diets, bedtimes, tobacco, alcohol, drug use etc. This is an integrated part of the activity of the institutions, but it seems as if rules for health-promoting activeties were less integrated than rules against unhealthy activities. Second, the survey investigated the use of dental, somatic and mental health services. While control by dentists was something that the institutions tried to ensure on a regular basis, action in regard to somatic and mental health depended on the employees’ initiatives either based on an observed need or when the children and young people asked for such services. In other word, the employees functioned as gatekeepers for these services. One solution is that the institutions employ health personnel directly (chapter 7). There is a need for better knowledge about how groups of children and young people in residential care function together, since the project addressing this issue underlines that this in a complex theme with many dilemmas. Children, understood as actors here and now as well as future grown-ups who will use their experiences from residential care afterwards, should be at the center of this. They live together in rich, relational interchanges, resulting in positive and negative influences. At the best they develop lasting friendships, but they may as well be exposed to what they least need – introduction to negative circles influencing their development in unwanted ways. If a group is to function well, space needs to be created between the individual in order to enable attention being paid to individuals as well as the group as a whole (chapter 8). Continuity and care was the project with the least available material. While continuity has to do with continued contact with family and friends, and maintenance of school and leisure time activities after a move, most of the available research concerns working hours for the employees in residential care. When young people are asked directly about their opinion about this, a large majority prefers long stints where the same employees are present over time. When the analyses take as their point of departure questions about children and young people’s situation in residential care, and see the responses in relation to different ways of organizing working hours, it might, however, seem as if these in themselves become less significant. This means that the organization of working hours needs to be seen in relation to a range of characteristics of residential care if one wants to elaborate more on children and young people’s safety and well-being. In addition, more knowledge is necessary about how it is possible to maintain continuity at an individual level, within the context of short-term stays, geographical distance, the possibility of the employees to follow up, etc This pertains to contact with the family, but as well to leisure time activities, friends and school (chapter 9). Conclusion Good quality care in residential care is a many-faceted activity, since it is natural to see the concepts of treatment, care and home/family in relation to each other. Treatment may be seen as specific methods, care is a phenomenon in the intersection between being an interpersonal activity and professional work, while the last reminds us that even if a residential unit is not a home or a family in the traditional sense, it is supposed to model qualities that exist in the family from the outset. One cannot se the contents of residential care independently of the structural preconditions for this part of out-of-home care. In Norway one such condition is a planned reduction in number of residential places during more than ten years. Not in the least this pertains to residential care for children up to 12 years of age, where there are hardly any places left. Too few places may impact on the freedom of choice when individual children and young people need placement. In addition the fact that more children and young people are in residential care during the year than on a single day, together with a relatively large rate being new (i.e. not in the system the previous year), necessitates that institutions ensure that the newcomers are sufficiently assessed, and that they are integrated into the existing group living there in a positive way. At the policy level the most important conclusion from the project is that residential care must be seen as a necessary and desirable alternative among existing out-of-care options for children and young people. At the individual level our analyses imply that residential care must be holistic and take care of the children and young people’s needs to see the unit as a home, albeit short-term, where their everyday needs are met, and where they feel at home, not only as recipients of a service.Prosjektet «Barnevernsinstitusjoner som arena for omsorg» ble initiert av Barne-, ungdoms- og familiedirektoratet i 2014 for å fremskaffe kunnskap som kan bidra til arbeidet med å utvikle god og kunnskapsbasert omsorg i barnevernsinstitusjoner. Vi har sett nærmere på omsorg i barnevernsinstitusjoner knyttet til temaene medvirkning, helse, beboersammensetning og kontinuitet. Arbeidet har også blitt sett i sammenheng med den pågående reduksjonen i antall institusjonsplasser og den utskiftingen som foregår i institusjonene i løpet av et år. Rapporten konkluderer med behov for ytterligere forsknings- og utviklingsarbeid på en rekke områder, og mer overordnet med at institusjonstilbudet må ses som en nødvendig og ønskelig del av barnevernets omsorgstilbud.