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Background to special issue
Colton, M. & Williams, M. This special issue of the International Journal of
Child and Family Welfare reproduces some of the keynote
presentations from a conference that was held at University of Wales
Swansea on 17-18 September 2001. The conference was entitled
Residential Care: Last Resort or Positive Choice? Lessons from Around
Europe. The event brought together leading commentators from various
European countries and policy makers and practitioners from Wales and
England. The conference was organised by Prof. Dr. Matthew Colton and
colleagues at the University of Wales Swansea in association with
officials from the National Assembly for Wales and the European
Scientific Association for Residential and Foster Care (EUSARF). The
conference was funded by the National Assembly for Wales and the opening
speakers included the Minister for Health and Social Services of the
National Assembly for Wales, Jane Hutt, and the Children’s Commissioner
for Wales, Peter Clarke. The office of the Children’s Commissioner for Wales was
established following a recommendation by the ‘Waterhouse report on the
abuse of children and young people in care homes in North Wales (House
of Commons, 20003. The purpose of the conference was to provide policy
makers and practitioners in Wales with an opportunity to learn about
encouraging developments in residential care in other European
countries. The papers presented at the conference and included in this
special issue explore residential care in Belgium, the Netherlands,
Norway, Poland and Spain. Issues in residential care Residential care for children and young people in Europe
can be traced back to the middle ages. However, contemporary approaches
have their immediate origins in the 19th century. Large residential
institutions were established in many countries to care for children who
were orphans or had been abandoned by their parents, usually because of
poverty. Institutions were also erected to protect society from a
perceived threat to social order posed by so-called ‘dangerous
children’. Churches and charities played a major role in the running of
institutions in many countries. Rigid daily regimes were based on
discipline, training and religion. In this Special Issue, Tjelflaat
describes the mouldy mattresses, filthy urinals and regular beatings
that were part of the life of children in residential care in Norway in
the early I 900s. Residential Care as the Last Resort By the end of the 1960’s, residential institutions had
become places of last resort in some countries. Residential care was
criticised for providing out of date education and repressive regimes
that failed to meet the individual needs of children and young people
(Colton and Hellinckx, 1994). The last three decades of the 20th Century
saw the widespread decline of residential care in all European countries
and a corresponding growth in foster care. Hellinckx, writing in this
Special Issue about residential care in Belgium, has suggested five
reasons for the decline in residential care: the fact that children in
need of care now usually do have parents and, thus, a more
family-oriented placement may be preferred; a new attention to the
voices of children and their parents; the rise of ecological and systems
theories, which do not fit well with residential care; the often
negative impact of research studies; and, of course, the cost. In Poland, Stelmaszuk provides a fascinating insight
into the role of residential during and after the communist era of 1945
to 1989. She observes that the The trend toward the increasing use of family placement
is further advanced in the United Kingdom (UK) than in other EU
countries. Local authority social services in the UK look after some
65,000 children and young people, the majority of whom are placed with
foster carers. Currently, there are less than 10,000 children in
residential care in England. In Norway, the ratio of placement in
institutions to placement in foster homes is even smaller: 2 8. However,
in the Autonomous Region of Catalonia in Spain, Del Valle and Casas
report equal numbers of children in residential and family foster care
(about 13,000 in each type of care in 1997). In Poland, the ratio tilts
in favour of residential care: Stelmaszuk reports over 62,000 children
in residential settings, compared with 50,000 in non-residential care.
In the Netherlands, admissions into institutions are increasing despite
Dutch government policy which is directed towards decreasing the use of
residential care. Normalisation as it affects Residential Care There has been a move away from large-scale institutions
towards small-scale homes with an average of ten child-care places per
home. Hellinckx remarks that, in Belgium, not only have the large
asylum-like facilities been replaced by smaller houses or flats but the
location takes into account the needs of the target group, placing
adolescents for example in flats in the inner city. This attempt to
ensure that residential facilities resemble family environments as
closely as possible is part of the process of normalization. Del Valle
and Casas comment that, in Spain, normalisation efforts also encourage
the use of community resources so that, rather than providing education,
medical assistance and so forth on site, children are integrated into
community life through obtaining these services within the community. In
Norway, a white paper issued in 2000 has emphasised that young people
should not be exported Out of their communities but should receive
services close to home. Professional Development of Residential Care Staff Professional development of residential staff has also
advanced in Spain. At the beginning of the I 990s a new ‘social
educator’ qualification was introduced, involving three years of
university study and leading to a career in residential child care or
other community programs. Tjelflaat similarly remarks that Norwegian
residential homes are staffed by highly professional caregivers.
However, in Belgium, Hellinckx observes that professionalism in
residential care has been neglected for a very long time and specialised
training is now very much needed. Similarly in the UK, despite having
exceptional needs requiring highly skilled intervention, young people
placed in residential care are looked after by largely unqualified and
untrained adults. An estimated 15,000 staff work in children’s homes in
England. In London, for example, it was found that around 80% of care
staff and 40% of heads of homes in the local authority sector have no
relevant qualification (Warner, 1997). In the UK residential work with
children and young people is the poor relation of a developing
profession whose legitimacy is subject to ongoing challenge. The
education and training, salaries, supervision and support, for
residential care workers have, on the whole, all compared unfavourably
with that given to field social workers. Abuse by Care givers Extensive research undertaken in the I980s showed that
the child-care system in the UK was failing badly when judged against
the outcomes for children and young people. All aspects of their
development were found to be more problematic than those of children
cared for by their own families or adopted at a young age (Department of
Health, 19913. Moreover, public confidence in the care system in the UK
has been shaken by numerous highly publicized controversies surrounding
the physical, sexual and emotional abuse of children and young people,
especially those in residential institutions. A succession of official reports chronicle with
disturbing similarity how the residential care system in all parts of
the UK has failed to protect vulnerable youngsters in residential homes.
Most recently, the Waterhouse inquiry into child abuse in residential
institutions in North Wales revealed a dreadful pattern of sexual abuse
by paedophiles operating alone or semi-organised ‘rings’ (House of
Commons, 20003. Police forces in every part of the country have launched
investigations into historical cases of abuse in children’s homes. The following have been identified by Wardhaugh and
Wilding (19933 as factors that contribute to the abuse of people in
residential institutions. The neutralisation of normal moral concerns — those
who are abused come to be seen as less than fully human. Children and
young people in care are perceived as less than fully sentient beings
because of their age, and are thus subjected to forms of behaviour and
treatment that would be unacceptable with those not so stigmatised. The balance of power and powerlessness in
organisations — those responsible for highly vulnerable groups such as
children and young people have almost absolute power over them. Particular pressures and particular kinds of work —
children in residential care lack value and worth in the eyes of
society; they are easily stereotyped, and this affects the resources
made available for their care. Management failure — across most responsibilities at
all levels of management. Enclosed, inward-looking organisations — that serve to
stifle complaints, criticism, and new ideas, and encourage routines
and patterns of practice that are rigid and conservative. The absence of clear lines and mechanisms of internal
and external accountability — thus frontline staff are, in effect,
unsupervised, and the organisation comes to judge itself by its own
internal standards. Particular models of work and organisation — this
includes mistaken notions of professionalism, hierarchical structures,
the concentration of those regarded as the most troublesome clients in
one place, large size of some institutions; and bureaucracy. Thus, although improved education and training,
supervision, selection systems and registration can all make an
important contribution to improving standards, it is clear that
professionalism is not a panacea for the problems of the UK child and
youth care system. Indeed, the professional’s ability to make decisions
in the ‘best interests’ of the child may override any concept of
children’s rights and natural justice. Attention has also been drawn to issues of masculinity
in relation to sexual abuse by men who work with children and youth.
Woolmer (2000) has argued that the fundamental cause of abuse in
residential care homes in the UK was the gradual replacement of women
caregivers by men that appears to have occurred since the end of the
1960s. Given that most perpetrators of sexual abuse in residential care
homes are men convicted of offences against boys, some may feel that
only women should be employed. However, Woolmer (2000) contends that
this would compound the tragedy, and that it is essential to employ good
male social workers to look after teenage males with effective
safeguards before and after men are employed. Others believe that we have failed to take on board the
scale of the paedophile problem and the potential sources of harm they
represent to children in residential settings of all kinds, not just
children’s homes. The National Criminal Intelligence Service has a list
of about 4,500 convicted or suspected paedophiles in the UK, and there
are some 200 paedophile rings with roughly five members each. Research
suggests that, on average, an abuser will have attempted or committed
238 offences before he is caught. A survey of 232 abusers found that
they had committed 55,000 offences between them on 16,400 children
(Warner, 1997) Thus, it appears that the nature and scale of potential
offenders, and the attraction to them of residential childcare settings,
makes it vital to have effective checks in place for children’s homes
and to change their cultures. From this perspective, it is encouraging
that the UK government has established Care Councils in England,
Northern Ireland, Scotland and Wales with responsibility for setting
standards and for the registration of those working in the services,
including residential social workers. Another welcome development is the
UK Government initiative called ‘Quality Protects’. This is a major
programme designed to transform the management and delivery of social
services and is accompanied by the injection of substantial financial
resources to help local authorities improve the quality of services. Children’s Rights Significantly, at least half of the factors referred to
in the previous section concern the transgression of human rights. It is
evident, therefore, that any serious effort to improve the quality of
residential care for young people must involve increased emphasis on
their rights. The Children Act 1989 which relates to England and Wales
did seem to take children’s rights more seriously than previous
legislation, and provided new opportunities for advancing the wishes,
autonomy and independent actions of children and young people. However,
the Act does this in a very qualified way. A broader, more creative,
approach is required. In the same context, Hellinckx observes that the term
‘child care’ as used in the Convention on Children’s Rights originally
referred to child protection not protection of children’s rights, and
particularly not protection of children’s rights from the child’s
perspective. The emergence of the ecological perspective in residential
care marks, among other things, an important shift from the idea of the
child as a passive object to be protected to the idea that it is
necessary to involve children, as a group, in the identification of
their interests. Allied to the idea of children’s rights is the broader
concept of client empowerment. Hellinckx remarks that in Belgium the
attitude of child welfare professionals towards parents was, for many
years, blaming and patronising. More recently, the voices of children
and their families have been heard, not only through the media but also
in scientific publications. Nevertheless, partnership with parents, though widely
lauded as an admirable goal, continues to be imperfectly achieved.
Knorth remarks that parents of children in residential care in the
Netherlands are usually involved in admission and after-care decisions
but not in decisions about daily care within the institution. Youth,
similarly, are rarely involved in decisions about treatment issues. Organizational Issues in Residential Care The other factors contributing to abuse referred to
above appear to be related to bureaucracy. Many residential institutions
in the UK are both formal organisations in themselves and also a part of
larger formal organisations. But whilst bureaucratic organization may
help residential institutions to control heterogeneous groups of young
people, it prevents them from fulfilling their officially avowed caring
function (Colton, 1988). Hellinckx makes the point that residential care
that does not address a clearly defined target group is doomed to
failure because the target group and the care components are inseparably
linked. A facility for child prostitutes addicted to heroin, for
example, should be quite different from a facility for adolescent boys
with conduct disorder. In the Netherlands, there are indeed categories
of residential care, funded by different government departments. One of
these is for youth with psychiatric disorders funded by the health
department. Hellinckx avers that even a classification based on a
psychiatric diagnosis is not enough, but it is certainly an advance on
the ‘one size fits all’ system that presently holds sway within the
United Kingdom. In Norway, the Youth Care Bureau is responsible for all
placements of children and youth and the direct placement of a child
into a care setting is no longer possible. The Youth Care Bureau
assesses the needs of every child through screening and makes decisions
about desired outcomes in consultation with the client. The child is
then placed in the programme best suited to achieve these outcomes.
Hence, services in Norway are tailored to fit the child rather than the
other way around. Discrimination and Oppression It is hoped that the UK Government’s actions signal that
the welfare of children and youth in public care is at long last
receiving the priority it deserves. However, the appalling abuse
suffered by children and young people in residential homes throughout
United Kingdom ultimately reflects deeply embedded social attitudes and
associated structures of inequality. Although generally sympathetic
towards child victims of abuse, there is long-standing anxiety about the
threat to social order represented by troubled and troublesome youth.
Ambivalence is fuelled by the social class background of the young
people concern, by racism and by negative attitudes towards disability. Research shows that the number of black children placed
away from home is disproportionately high, that black children are more
likely to he placed in residential care than foster care, and stay in
care longer than white children. A 1993 survey of European Organisations
by the European Forum for Child Welfare showed that few children from
ethnic minority groups are placed in families of the same ethnic origin
(Ruxton, 1996). Knorth reports that in the Netherlands more than half of
the residents in juvenile custodial care institutions (funded by the
justice department) come from an ethnic minority group whereas ethnic
minorities comprise only 21% of youth under 25 in the general
population. Europe-wide data are required on the extent, reasons, and
consequences of differential rates of admission to care from different
ethnic groups, and how best to recruit and support caregivers from all
ethnic and religious groups. Sexual orientation is a second area of concern for
anti-oppressive practice. In the UK the special problems of young
lesbians and gay men placed away from home have been highlighted (Ruxton,
1996). Much of the evidence appears anecdotal and further research is
required. Research is also required to shed light on the controversy
surrounding the placement of children with homosexual carers. Integrating services for disabled children constitutes a
further challenge to care agencies across Europe. Disabled children face
discrimination in all countries: they lack access to buildings,
transport, health and social care; their opportunities for education,
training and work are severely restricted; and, they suffer stigma and
abuse. Alarmingly, the number of disabled children in Europe remains
unknown. Current classifications of disability reinforce medical
approaches, and fail to recognise the impact on disabled children of
wider discriminatory and oppressive attitudes and social structures (Ruxton,
1 996). Alternatives to Residential Care In Belgium, as in other European countries, the decline
of residential care was concurrent with policies intended to stimulate
the expansion of foster care. Many new types of foster care were
developed (Colton and Williams, 1997) and increasing numbers of children
previously considered unsuitable for family placement were placed with
foster families. Day care is also seen as a desirable alternative to
residential placement. Day-care centres which support the child and
family and co-operate with the child’s school have become a vital link
between the family and child welfare in many European countries.
However, as Hellinckx remarks, day care is not a valid alternative for
young people with extremely difficult behaviour or children at risk of
being abused. The I980s saw the rise of family support and family
preservation programmes both in Europe and in the United States. Despite
criticism of these programmes in the I990s, it is still generally agreed
that they represent a significant step forward in the advancement of
children’s welfare. Nevertheless, it is also apparent that no one form
of care can meet the needs of all children and families with their very
different problems in their range of circumstances. We might give
reasoned consideration to the ‘care to measure’ principle advocated by
Hellinckx, in which a continuum of care alternatives, including
residential care, is flexibly tailored to meet needs of the individual
child. Research In most European countries research on residential care
is funded by central and local government and, to a lesser extent,
private and charitable agencies. Research is usually carried out at
Universities, or at research units affiliated to Universities. Indeed,
much research is completed in pursuit of academic qualifications in a
range of disciplines. Governments usually only fund research on an ad
hoc basis. Consequently, funding is often only given to projects
reflecting policy concerns of governments; and research centres cannot
plan long-term programmes. Moreover, the funds for research are limited;
indeed, research is often commissioned to identify how spending on
services can be redirected and/or reduced. A more coherent approach has been followed in the UK,
which has a well-established tradition of child welfare research. Yet,
whilst the high level of central control has resulted in an abundance of
policy relevant empirical studies, there is a conspicuous lack of
support for theoretical research, academically relevant empirical work,
and for critical research. Funded research often reflects the
government’s interpretation and construction of social problems. In this
context, it is not surprising to find a manifest failure to develop new
methodologies and widen the focus of research. Further, whilst research
findings have been disseminated effectively and incorporated into policy
and practice in the UK, the lack of follow through has meant that the
necessary changes in philosophy, structure and practice have, all too
frequently, not occurred. Welfare interventions themselves can also generate
problems for clients. Tjelflaat comments on research showing that young
people can become more disturbed and disaffected during their stay in an
institution and that even when benefits are achieved, they are not long
lasting. Hellinckx quotes Melton, Lyons and Spaulding’s (1998)
conclusion that "there is little evidence of the effectiveness of
residential treatment, especially relative to well-conceptualised
non-residential alternatives". However, Hellinckx also remarks that this
conclusion might be challenged on a number of counts, not least the
over-simplified way in which research results are sometimes presented to
policy makers. There is a need for more research which exposes
bureaucracies to external scrutiny, and which seeks to redress the
emphasis on issues proposed by policy makers with studies that begin
with problems identified by other groups, not least young people.
Equally, if research is to make a greater contribution to practice as
well as policy, residential practitioners have to be convinced that
research can be helpful, contribute to the formulation of research
questions, and command some degree of purchasing power. In the same
vein, researchers must be willing to respond appropriately to practice
needs. Despite the big differences between European countries
in the level and scope of research on residential child-care, there is
room in all countries for more emphasis on evaluative studies of both
the processes and outcomes of intervention and residential placements.
There is currently a lack of adequate data on the most basic questions,
such as: How many children enter and leave residential care
each year? How many children from ethnic minorities are placed in
residential care? How many young people with disabilities are looked
after in residential settings? In addition to such basic data, we also require: the
systematic collection of reliable information to identify needs and
priorities; comparative research about different legal and policy
frameworks and their effects; research comparing the outcomes of
particular types of service; and comparative studies on children’s
perceptions of their circumstances. In this Special Issue, del Valle and Casas describe some
of the very few research studies on residential child-care in Spain. One
outcome evaluation found that 87% of a sample of young people discharged
from residential care were doing well in terms of socio-economic
situation, health, employment, family relations, and social integration.
Other studies, however, are far more negative, pointing to deficiencies
in process as well as inadequacies in outcome. There are, in short, many
thousands of studies in the field of residential care, using different
populations and methodologies, producing results which are often
contradictory, and contributing less than they might to policy and
practice because researchers often prefer to conduct their own studies
rather than focus their attention on review, synthesis and summary.
Grietens has tried to address these difficulties in the area of
correctional treatment for juvenile delinquents by producing a paper for
this Issue on a review of designs and findings from statistical
meta-analyses. He draws attention to three considerations to be taken
into account when trying to interpret findings with respect to their
significance for policy. The first consideration concerns measures of outcome or
change. For example, some studies use recidivism as an outcome measure
while other studies use behavioural or attitudinal changes on the part
of the offender. Recidivism is a very conservative outcome, measuring
the generalization of treatment effects over time. Conversely,
behavioural and attitudinal changes measured during treatment offer
information on the direct effects of a treatment programme. Grietens
remarks that measuring the direct effects of a treatment programme and
measuring the generalization of effects should be carefully separated in
evaluation research. The second consideration is the size of the change. For
example, Grietens’s secondary analysis showed that treatment of juvenile
offenders produced an average reduction in recidivism of about 9%. This
is quite low compared to the general effects of psychotherapy for
behaviourally and emotionally disturbed young people. On the other hand,
it is quite similar to some effects of treatment in the medical field:
heart bypass surgery, for example, and some cancer treatments. Hence
optimism or pessimism about the outcomes of treatment for juvenile
offenders depends on the reader’s knowledge of the effects of treatment
in different fields and his or her interpretation of what 9% means in
that context. The last consideration is geography. Grietens found a
remarkable difference between continents in that recidivism effect sizes
are substantially lower in North America than in Europe. He warns that
this difference may have to do with differences in the juvenile justice
system or different criteria for police intervention rather than actual
differences in rates of reoffending. Comparisons between countries are
often suspect because of the large numbers of variables that need to be
taken into account. In sum, this Special Issue, provides a fascinating
exploration of the present state of residential child-care in five very
different countries within Europe together with identification and
discussion of current issues and suggestions for future improvement. References COLTON, M. (1988). Dimensions of substitute child
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