| Healing the past, enjoying the present and anticipating the future - residential child care in action |
by Mrs Margaret Lindsay, Director of the Centre for Residential Child Care in Scotland
This paper was presented by Mrs. Margaret Lindsay, Director of the Centre for Residential Child Care in Scotland at the Conference on Children and Residential Care- Alternative Strategies 3-6 May, 1999, in Stockholm
Healing the Past, Enjoying the Present and Anticipating the Future- Residential Child Care in Action
What is the function of residential childcare?
Today I want to try to answer this question. But I do not want to answer it in terms of the pessimistic agenda about the function residential care has so often been forced to assume in society. Residential care has been used variously as a way of coping with the effects of poverty, as a means of punishment, as a method of removing disabled children from society, as a method of producing, cultural conformity. All these and more have been unacceptable uses to which the group care of children has been put. This, coupled with the models of care used, and the lack of resource poured into the support of these institutions, has led to the tragic stories so often heard of understimulated, underfed and certainly under-loved children Who -row into adults unable to feel they belong, in or can contribute to their society and culture.
A positive agenda for residential care
But the problem is that all of the above, now well researched and understood, has also served to deflect attention away from the need to define a positive agenda and function for residential child care. What should it be for? What is good enough residential care? How do we know it when we see it?
I have had many discussions with Western consultants going, for example to Eastern Europe, who talk as if their sole mission was to remove institutional care once and for all, because it is an evil of itself, whose total removal in every form is both desirable and achievable.
Is the removal of residential care achievable?
I have visited many such large institutions for children and indeed for adults also. I have seen the misery, suspected the abuse, which goes on behind their walls. I've seen the silent children who put little hands across their eyes when anyone approaches, or who cling with desperation to the limbs of any passing adult. But I have also been involved in closure programmes for large institutions, and I know it will not happen overnight. Even in the Wealthy West, it takes years of work. We cannot achieve the total removal of institutional care quickly. Therefore, many of the institutionalised babies I saw in Eastern Europe last autumn will still spend their entire childhood there, however determined 'we are or fast we work. Their future will be an institutional one, whether we wish it or not. Will it be a good one? What is good institutional care and how do we achieve it?
Is the removal of residential care desirable?
And secondly, if we could achieve total removal of all residential care from our systems, would this be a good thing? Residential care comes in many forms, and many attempts have been made to define it. Today, I will use a loose term which we find a helpful enough working definition - 'residential child care is anywhere where children and young people are looked after in groups away from home, by paid staff'. There are many and various ways in which this takes place. We have spoken already of the huge institutions, which are each home to several hundreds of children. But I can also think of one authority in Scotland where there are six residential establishments with no more than two children or young people in each. Some of the young people who live there have chosen to do so because their previous experience of family life has been such an agony that they cannot face either returning or being placed in any other family setting. Others are there because they have behaviour problems, which can best be addressed by intensive work by a team of staff. I visited one of these homes on a hot summer's day. It was an ordinary suburban house amongst many others in a typical street in a Scottish town.
Two young people and staff were sitting in the back garden having their lunch in the sun. The pet rabbit nibbled the grass nearby. One was a young lad delighted to show me his new bike, which was in the garden shed. The traumas of the appalling family life that had been his were being carefully unpicked daily by the skill of the staff he lived with. For some young people, residential care will be the best option. But it has to be the right care, and it has to be for the right child. Residential care will continue to form an essential component in any integrated child care system. Will it be a good one? What is good residential care and how do we achieve it?
In order to develop this theme, I want to move to talking, about the Scottish experience, and then to reflect on a recent study, in which we were involved, which compared residential care in four European countries. From this I will move on to consider the need for clear principles and an explicit and positive philosophy of care, which will enable us to move the agenda forward in a constructive way.
The Scottish experience
Scotland is a small country with a long history, and one, which is particularly interesting right now, as the country, goes to the polls to elect its first Parliament for nearly 300 years. Since 1603 when the Scottish king inherited the English throne on the death of so called 'Good Queen Bess' (Queen Elizabeth of England), the same monarch has ruled both countries. In 1707, the parliaments were tinted, but Scotland retained her own ancient legal system, her own national church (Presbyterian) and her own culture. This has meant that Scotland approached the care of her children in a different fashion from her larger neighbour to the South (England). During the 18 Th and 19 Th centuries, most of the solutions to Scotland's social problems were local ones. The Church, in the reformed tradition, had disseminated much of its power to local communities, and the 'Kirk Sessions' - the ruling courts of the local churches, made up of local men - took responsibility for the care of those in need in their neighbourhood. Thus if a child lost her/his own family, another family in the parish would be invited to take over her/his care. Thus there was little residential care, and indeed, this so contrasted with the English situation, that a delegation was sent from England to study the system. However, by the 19 Th century, industrialisation and compulsory population movement (the 'Clearances') to the New World, meant that local communities were so decimated that they could no longer 'care for their own', and residential care began to develop rapidly, in the shape of farce institutional care, children's villages, and industrial schools. This pattern has been replicated in many countries in the world.
In the later 20 Th century, dissatisfaction with the large institutions increased. This resulted partly from a developing awareness of children's needs for individual attachment and care, as a result of research. Innovations in the field of family work, to support parents to retain the care of their children, and developments in foster and adoptive care were initially so impressive, that professionals began to believe that it would be possible to dispense with residential care entirely. The result of this was less than helpful. Resources and staff enthusiasm was targeted on these developing areas of work. While these developments were much to be welcomed, unfortunately and unwisely, while this was underway, investment in residential services was seen as unnecessary. Staff remained largely untrained, building were inappropriate and often poorly maintained, and the study and understanding of the residential task did not progress. The result was that, as happily more and more younger children were able to stay with their own families or move to alternative ones, older and more damaged children and young people continued to arrive in residential care. Staff were faced with a new and much more difficult task in helping these young people, but they were ill-prepared to deal with it, and felt undervalued as well. Problems resulted, and poor publicity became commonplace. Morale fell, as did quality of staff recruited - who wants to work in an underfunded, undervalued service with difficult and unhappy young people, and be pilloried in the press for doing so?
Such was the situation in 1992, when the Scottish Office (the arm of the Government in Scotland in predevolution days) produced its report 'Another Kind of Home - A Review of Residential Child Care (Skinner 1992). This report recognised again the essential role of residential childcare, and outlined eight principles for defining good practice - these will be referred to below. This report also led to the birth of The Centre for Residential Child Care, of which I am the Director. The vision for The Centre was that, although small in itself, it would act as a catalyst for the sharing and exploring of good practice, so that the quality of residential care could be raised throughout Scotland. The Centre does this via consultancy, networking, dissemination of information, publications, seminars and conferences, research, and anything else we can think of. After five years, The Centre now has extensive Scottish UK wide and international networks.
A European Overview
One of these networks led us, alone with a local residential establishment, into comparative research into residential childcare in four European countries - Finland, Spain, Scotland and Ireland. Funding had been supplied by the 'Youth for Europe' programme of the European Union, and topped up by local resources in each country. The group was unusual in that each country team comprised both practitioners and researchers. This ensured the relevance of the study to the real life within residential care settings - a relevance too often lacking in social science research.
The study planned to set the context of residential care, and to consider the nature and views of the young people within it, and those of their staff. To do this, it traced the history of residential care in each of the countries, and then made comparisons along certain key statistical measures. The degree of trauma and difficulty faced by the young people was measured using, the Child Behavioural Checklist (University of Vermont, 1991) (50 per country), alone with a brief questionnaire for keyworkers. The views of the young people themselves (20 in each country) were gathered using face to face, semi-structured interviews. The views of workers, managers and policy makers in each country were obtained using a variety of techniques, including individual and group interviews and written comment. The resultant report - ''Care to Listen - A Report on Residential Child Care in Four European Countries'' (EUROARRCC, 1998) was delivered to the European Union, in May 1998.
The Development of Residential Care in the Four Countries
The histories of residential childcare in the four countries show a picture of convergence of styles and types of care. Whereas Finland and Scotland had moved from heavy reliance on 'boarding out' - early forms of fostering - towards later development of institutional care, Ireland and Spain, star-tine from an institutional base, had subsequently developed foster care. The reasons for such different patterns are unclear. It is possible that they may have their origins in the effects of the reformation, reformed countries relying less on the patterns of group care common in Catholic tradition, and more on greater control by the local community, typical of the reformed tradition. Whatever the historical influences, by the 1990's, all four countries provided out of home care in a variety of ways, from foster care with related and non-related families, through to croup care in a variety of settings, even thou-h the balance between the two kinds of care varied.
It is since tile 1940's that the divergence in styles of care can be seen between Western and Eastern Europe. In the 1940's, all Europe was similar in having a dependence on larger scale residential care, albeit with different decrees of development of family based alternatives. By the 1990's, Eastern Europe's pattern of institutional provision had increased, whereas Western Europe was exhibiting a range of models of family support and out-of-home care, and a reduction in the size of the residential sector.
Other trends in the four countries studied were similar - by the 1990's, all countries were in the process of reducing'- the size of their residential units. The process was more advanced in some countries than in others - Children's Homes in Finland and Scotland have reduced to an average number of beds of eight whereas Spain has recently reduced from average capacities of sixty down to thirty to forty. Likewise, the overall population of children in residential care was reducing and the length of time they stayed in these settings was getting shorter. Again, the degree of this varied from country to country - in Ireland, the majority of the young people admitted (76.3%) stay for more than 2 years, whereas in Scotland 66% and in Finland, 54% stay for less than one year. This tendency can be taking to mean that while a reduced number of young people are in residential settings at any time, the young, people who have had at least one experience of residential care is larger, and some will have had several such experiences.
Profile of Young People in Residential Care
Tile profile of the young people entering. residential care also shows similar patterns of change across the four countries studied. The age of young people in residential care is such that many of them are in their early to mid teens, and in each country, there are more boys than girls in residential settings. There is however variation from country to country. In Scotland, most young people in residential care are aged between 14 and 16 years, in Ireland, between 12 and 16. In Finland approximately half are under 13 years whereas in Speain, under 11 years.
Again this contrasts with Eastern Europe, where most admissions are made as babies, often direct from in maternity hospitals. Thus the population of children in institutions covers the whole i.e. spectrum, and are not banded with a bias towards older children and young people as seems to be the case in Western Europe.
The reasons for young people's arrival in residential care were also similar country to country, showing the expected pattern of family disruption, abuse, single parenthood and poverty. The reasons for admission to care in Eastern Europe are more difficult to isolate. Abandonment plays the predominant part, but what causes abandonment in each individual case is less clear. Certainly it can be considered that the current fragile economic condition of these countries is likely to mean that poverty itself will play a relatively larger part, but this may also mask the other effects of abuse, single parenthood etc.
What Do the Young People Think?
A questionnaire was designed in Scotland by young, person who herself had experience of residential care. This, translated into the relevant languages, was completed by 20 young, people in each country with the assistance of an interviewer. Questions ranged over the eight quality principles identified in ''Another Kind of Home'' (Skinner 1992) - individuality and development, rights, good basic care, health, education, child centred collaboration, partnership with parents, and a feeling of safety. This elicited a vast amount of information - only a small part can be summarised here.
Most of the voting people were satisfied with the standard of care they received and only 8% described it as,'poor''. Ninety-two percent of the young people knew why they were in residential care, and 76% of the young, people felt they were listened to by staff, while 82% said they were encouraged to do well in education and 78% had clear goals for their future in their minds, some very specific - ''I'd like to be a professional footballer. If 1 can't do this, I'd like to go into catering'' (Scots boy); ''I'd like to have all doors open for my life, and try to live a good life '' (Finnish girl).
Eighty-seven percent could describe a good range of hobbies and activities they were undertaking- and 72% felt that the staff encouraged them in these. However, the hobbies described seemed to be skewed towards sporting activities, and young people expressing an interest in music and art were less likely to be encouraged. Of those expressing, an interest in religion, only 36% felt themselves to be encouraged in this. The amount of choice that young people had was variable, Scottish young people feeling they had the most choice and Spanish young people the least. 64% of young people overall had no say in the daily routines of their home and 61.5% had no say in the choice of food that they ate. Thus there was some evidence that, while efforts were being, made to supply a varied lifestyle, there was some evidence of regimentation, varying, between countries. As one Irish girl said ''The staff snake the choices, butt they do listen to us. But at the end of the day it's the staff who are the bosses.
Questions were asked about contact with families. Eighty-one percent of the young people said their families had offered them support while they were in care. when asked who they felt ''knew best'' for them, 78% of the young people named themselves or their families. This emphasises how important it is to involve families and young people themselves when plans are being made. However, 43% of the young people mentioned that they felt they had been under pressure from their families when they first entered care and had found this distressing (''My aunt was threatened by my father, because she was the one who took me to the centre'' ? Spanish girl). Twenty-six percent had lost touch with their family on entering care. Interestingly, in some cases this seemed to be despite regular contact. 'Loosing touch' seemed to be interpreted as loss of emotional contact. It was -general for young, people to report that their family were riot involved in the normal life of the home, and this may also contribute to this emotional 'loss of touch'.
As regards friendships, 70% found it easier to make new friends while in care. While this may be positive, 40% also reported loss of original friends on entering, care and this does indicate that the peer group of the young people was shifting from one in the wider community to one of other young people with experience of residential care - this may not be the best thing for their future adaptation. Some comments indicated that the actual experience of residential care made maintaining original friendships difficult - ''I stopped seeing friends because the staff don't know them '' (Irish boy).
There has been considerable concern recently over the safety of young, people in residential care. Eighty-eight percent of the young people felt they were safe with the staff who cared for them and 74% had felt this from the outset, whereas for others this had developed as their experience of the staff grew - ''At first I felt uneasy but little bv little, I felt more comfortable '' (Finnish girl). Ninety-five percent felt that they were safe with the peer group with whom they lived, but 56% of them did not feel that their possessions were safe with their peers and gave examples of items being stolen or broken.
A concerning finding was that 59% of the young people were unwilling to or did not know how to complain - ''I should tell my manager, but she never listens so I did not tell her'' (Spanish boy). Given that many abusive situations within children's homes happen as a result of an enclosed culture, it is very important that children know how and to whom to complain, including to someone outside the children's home.
Much of the risk to young people in residential care derives from their difficult and even violent behaviour, which results from their anger and pain - as described above these are traumatised young people. Asked how they coped with their anger, only '3% felt they were able to do this by talking to staff, whereas 43% used withdrawal and 52% acted out - ''I don't know how to deal with it - 1 go bersek. 1 always feel confused'' (Irish boy). The young people recognised that the staff preferred to deal with such incidents by talking to them (74%) or by giving the young person ''space''. There was therefore a gap between staff and young people's ways of handling these difficult issues. Further work would be beneficial in finding how the voting person's ways of coping can be matched to the staffs' techniques for managing, these emotional outbursts, which given the emotional difficulties these young people have, are likely to be frequent.
Therefore, these young people's views of the quality of care they were receiving were not uniformly negative - indeed, many felt valued, happy and safe. However, the contact they had with their families, although substantial, was less than they would have wished, and their individuality was not always recognised as it right have been. If it is so difficult to achieve complete success in children's homes as small as these, it is easy to see why difficulties arise in both of these areas in the much larger institutions of Eastern Europe. None the less, the young people's views showed that, survivors of considerable trauma, and suffering from significant measurable mental distress as the were, they were more than able to express their views and to make sensible and balanced assessment of the quality of care they were receiving. Young people after all are the key experts in residential care - they are on the receiving, end of the service adults offer, and their views are therefore in some ways of more value than any others when the quality agenda is being discussed. These results show powerfully that these young, people, although acutely hurt and damaged by their previous experiences both at home and their movements within residential care, can make very valuable comment about quality of care they receive. Further, while there is much room for improvement, in all countries, most of the young people valued the care they received, and felt safe. In view of the negative publicity the service often receives, this is important. Overall, the children's views about residential care in all four of the countries were surprisingly positive.
The Need for a Clear Philosophy of Care
So where does all this led us? Basically, we can conclude that residential care needs to chance and develop, as does any form of care. When it does so, it can and does form an essential aspect of the pattern of childcare resources in any country. But to be good, those who live and work in it need to have a clear understanding, of what makes residential care good - what are the principles that mark out quality care? Above we referred to the eight principles outlined in the Scottish Office report, 'Another Kind of Home', In Scotland these have proved useful in focusing the debate about quality.
The 'Eight Principles'
Individuality and Development
Young people and children in residential care have the right to be treated as individuals who have their own unique relationship, experiences, strengths, needs and future, irrespective of the needs of other residents. They should be prepared for adult hood and supported until they are fully independents.
Young people's can easily lose their identity when they live in large groups, away from their families and home communities. Identity is far more than a name on a piece of paper - it is about your whole history, what you like and dislike, what you enjoy and what you hate. It is medical details, educational details. It's all the little thin-s that make you the person you are. In my experience, these are precisely the things that -et lost. Institutions quickly make people anonymous. I once worked to assist children who had lived in a large hospital to move to smaller group homes. They were teenagers with very severe learning and physical disabilities, and most had lived there all their lives. 1 went to the hospital to find out about them. They had files, full of information, but it was all in the form of little notes about their health ''26.5.81. Constipation; headache. 2 paracetamol administered''. There was nothing about them as individuals, as people with thoughts and feelings. The real child was lost, and a medical dossier had replaced him. Gradually, over the months that followed, we pieced to-ether who they were. Workers searched for family history, and cot to know the children. Gradually, working together with each one, they began to build up folders of information - life story books. They were nothing special - just rim binders. with paper on which they stuck photos of family, friends, home; of the hospital where they had lived for so long, of a pet do- they had loved; of a day out they had enjoyed. The children added their own drawings and things that they liked - a bit of pink paper - ''Because 1 like pink''. A scrap of furry material - ''I like to cuddle soft things when I am frightened''. Even mementoes of times or places they had not enjoyed appeared - photos of institutions they had been unhappy in perhaps. We all have sad or unhappy memories as well as good ones, but sometimes when we care for children, we act as if any unhappiness they may display is somehow an insult to us. By using these books, even children who were not able to speak could share how they were feeling. They could grieve as well as rejoice. Details of their own culture, religion and race could be described and treasured here too.
Rights
''Young people, children and their parents should be given a clear statement of their rights and responsibilities. They should have a confidential means of making complaints. They should be involved in 7 decisions affecting them and the running of the home. Their rights should be consistently respected''.
There will be much talk about children's rights throughout this conference. I do not intend therefore to add much to it directly at this stage. I will however point out that one of the keys to ensuring that we handle this issue thoroughly is to listen to the young people themselves. They, better than anyone else, can tell us how they feel about living in a children's home, and they can show us what we need to put right. In Scotland, we have a powerful group of young people who have lived or are living in residential care. Called Who Cares? Scotland, they have expanded from a small group which started 21 years ago to an extensive network funded in part by central and local Government. They take part in conferences and training events for staff, they comment on all documents that are issued relevant to child care from the government or other agencies, they recently supplied advice to the government in the forming of our new Children?s Act of 1995. Most areas have a Development Officer, also a young person from this agency who visits children's homes and schools in their area, getting to know the young people, and hearing of any worries that they have. When the report ''Another Kind of Home'' to which I am referring, was published, a young person's version was produced with the help of young people, to ensure that the children in the homes understood the principles of care that they were entitled to expect. This organisation of young people is one of the four organisations that manages The Centre for Residential Child Care.
Good Basic Care
''Young people and children in residential care with or without education should be given a high standard of personal care. They should be offered varied and positive experiences of life, and should be included in the wider community ''
It matters how children live - what they wear, what they eat, how comfortable they are; the amount of time that staff can spend with them as individuals or in small groups. It is possible to give good basic care even when children are living in very large institutions. One of the senior figures in childcare in the UK himself grew up in care. As he is in his 40?s now, the sort of institution he was in was such as we no longer have it housed several hundred children at once. They were subdivided into groups of 20 or 30, and cared for by one ''housemother''. He recalls these as the happiest days of his life. Why? Because the care and love that that individual lavished on him made him feel special. He felt, he says, that he ''was the most important person in the world'' to her; and all the other children who lived with him felt the same. Even in large institutions, we must find ways of enabling children to get to know their carers as individuals, who care about them. This is essential. It may mean splitting the children up into groups, and perhaps one member of staff taking on some activity - a game or whatever - with the majority, while a small -group or individuals spend time with individual staff. The amount of time may be small, but it is the quality of what happens within it that is significant.
Education
''Young people and children should be actively encouraged in all aspects of their education, vocational training or employment and offered career guidance. Their individual educational needs should be identified and met''
Research tells us that the key correlation with success in adult life is good education. This is the critical point. In our country, we also know that for children in children's homes to get this, they need extra help from both teachers and care workers. Unfortunately, often they have not had it. Often they have been educated separately, in residential schools. At other times, when in ordinary day schools in the community, they have found that other children and even their teachers may be prejudiced against them, and may not understand how hard it is for them, for example, to do homework when they are living with a group of other children. Teachers and care staff need to work to-ether, and to do this, we need to training them. At home, at The Centre for Residential Child Care, we have a training course which we offer to student school teachers. We teach them about children in residential care - how it feels, how teachers can help - or hinder - their process. We have started in a small way giving these student teachers placements in children's homes and residential schools so that they can see what goes on, and meet the children. We hope that in this way, they will be more understanding when they have children in their classes in future, and that they will spread this understanding among their colleagues. We must work to create greater awareness of the importance of education for these children.
Health
''Young people's and children's health needs should be carefully identified and met, they should be encouraged to avoid health risks and to develop a healthy life style''
There is evidence to suggest that the children in residential care have more health problems that their peers. This may be because of stress and poor quality care in infancy, exacerbated by poverty. Whatever the reason, we do not always mitigate it as we could. We do not always keep careful enough records of their health status, and so symptoms of disease may be missed and not dealt with early enough. Keeping really accurate records is essential. It is also vital to educate young, people in keeping, themselves healthy. We have tried all sorts of health education programmes for them, but sometimes they seem reluctant to take in what we are trying to teach. It's no wonder really. They are tired of having adu
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