The Dutch decentralisation policy: Risks for child protection and child welfare?
Presentation Erik J. Knorth, Summer School University of Groningen, August 21-25, 2017
1. Introduction
It is a big honour for me to have a talk with such a highly interested audience.
Thanks for the invitation to give this presentation and for the perfect organisation!
I applaud the organizers: Mónica López, Hans Grietens, Lennart Nygren, Floor Middel + Helen Bouma
What am I going to talk about?
Main theme is the new Dutch policy on child and family welfare, especially the decentralisation of the power of control on youth care to the municipalities
Six topics are on the agenda:
- How many children receive support?
- Background, principles and rules of the new decentralisation policy and legislation
- Gateways to, and types of support & care
- Support with & without out-of-home placement
- Bottlenecks and risks of the decentralisation policy
- Conclusions
But first some outcomes from the latest Health Behaviour in School-aged Children study (2016), including data on children’s health and life satisfaction in 42 countries (Europe + North-America).
Dutch children are almost the most happy children in the Western world.
On average 93,5% of 11-year-olds report high life satisfaction, corresponding with the third place in the ranking of countries.
We see the same picture for the 13-year-olds: also the third place – although the scores are a bit lower (esp. girls)
And for the 15-year-olds the Dutch children score a fourth place in the ranking.
But – as a contrast – we have also much more alarming numbers.
We all know the family tragedies, like in our country, for instance, the dead of the 8-year-old Sharleyne (2015) as a result of the maltreatment by her mother
But they are the tip of the iceberg.
In the Netherlands yearly some 120.000 children (almost 3,5% of all minors) suffer from maltreatment.
In the group of 12-17-year-olds almost 10% reports maltreatment.
2. How many children receive support?
Now let’s broaden the scope and see how many children and young people in the Netherlands receive professional support or youth care, including child protection and youth rehabilitation
Here I have some numbers:
In a population of some 4,5 million young people (0-22 years of age) almost 400.000 receive psychosocial support, which comes down to 8.8 %.
More than 377.000 receive youth care.
Almost 40.000 receive child protection, mainly after the imposing of a supervision order.
And finally, more than 10.000 juveniles participate in a programme of youth rehabilitation.
Warning: there are ‘double counts’ in the numbers (for instance, children may receive child protection as well as youth care)
3. Background, principles and rules of the new decentralisation policy and legislation
Now we will have a look at the second topic on the agenda: the new decentralisation policy and legislation in our country.
A couple of unwanted phenomena in the youth care system gave rise to the preparation of a new law, the Youth Act 2015.
Which were these phenomena or characteristics?
First there is too much focus in policy on ‘youth with problems’ at the expense of attention paid to and money spent on the ‘normal’ raising of children.
Second there are many different provisions, legal frames, financial settlements, and responsible authorities – the last ones on the level of the central government, the provinces, and the municipalities. Also the field is partitioned in separate sectors like social work, preventive child healthcare, special needs education, child and adolescent social care, child protection, mental health care for children and adolescents, and care for children with mild impairments. Often they do not cooperate where they should.
Third, as a result of ongoing differentiation and professionalization of the system the clients have become more and more dependent (‘consumers’) on what the providers offer; this at the expense of the responsibility, the competences, and the power to find solutions by clients and their social networks themselves.
Fourth, there is an ongoing tendency to ‘moving or passing on’ children and young people to other services or provisions at the moment that the interaction with them becomes more difficult or stressful. This, in stead of finding solutions in the original child-rearing or living environment of the child.
Fifth, there is a growing ‘consumption’ of specialised youth care. Although the numbers are not very precise, it was estimated that during the last decade the number of users of specialised services showed a yearly increase of 6-10 %.
Sixth, evidence on the effectiveness of the system or parts of the system is limited, let alone the cost-effectiveness. That’s why the role of unsubstantiated assumptions and opinions, for instance on ‘what works’, is considered as too prominent.
What now are the principles underlying the new Youth Act?
I’ll present the most important ones in a rather staccato way.
- Child and family support should be as nearby (geographically) and as early as possible (early detection)
- Needs of the client (child, parents) are guiding (needs-led in stead of supply-led support and care)
- Children’s safety is crucial and comes first
- Keep the ‘normal’ life of children as much as possible (no unnecessary scaling up of services, de-medicalisation, timely scaling down)
- Empowerment of family members and more solution-focused approach
- Engaging social network in child and family support
- Integrated approach (cooperation between agencies if more than one is active)
- One family – one plan – one director (as little as possible ‘different faces’)
- Adequate and fast specialised treatment if indicated (timely scaling up)
- Less bureaucracy; more space and training for professionals
- Evidence-informed practice (monitoring & reflecting on outcomes)
In addition to these principles some practical-organisational rules were issued.
The most important one is that the municipalities – and we have almost 400 of them in our country – are responsible for all forms of care and support for children and families, including
- Preventive child healthcare*
- Social care
- Mental health care
- Care for children with impairments
- Child protection
- Youth rehabilitation
This is a real big change because until 2015 the municipalities only were responsible for preventive and light forms of social support. Children and families using more specialized services do need from now on a ‘disposal’ (beschikking) or decision by the municipality.
A second big thing is that the transition of responsibilities to the municipalities and transformation of the youth care system as a whole should go hand I hand with two directives:
1: Savings up to 15%
2: Reduction specialized services up to 30%
As you can imagine the impact of these directives was and still is enormous. I’ll come back to this later on.
4. Gateways to, and types of support and care
Now some words regarding the gateways to and types of support and care that currently are being offered.
Connected to the principle of serving children and families as nearby as possible to their own environment, main gateways to support can be found at the local level, including
- Local or district social teams
- Centres for youth and family (CJG)*
- Municipal front offices for youth care
In more and more cases these portals seem to be combined (Prakken, 2015).
Related to cases of child abuse and neglect or juvenile delinquency the next agencies, situated at a municipal and/or regional level, can serve as a gateway to care:
- Advice and Reporting Centre for Domestic Violence and Child Maltreatment (AMHK), mainly indicated as ‘Safe Home’ (Veilig Thuis)
- Child Protection Board (CPB)
- Juvenile Court
- Police Public Prosecution Department
I won’t go into the details of these agencies; the paper by Helen Bouma and colleagues (2016) you received is recommended here.
Finally children can enter support services while problems become manifest at school or during a visit to a general practitioner. Especially family doctors are frequent referrers to specialized services, most of the time to child and adolescent mental health care.
The youth care system and the types of support it comprises can be modelled like a continuum with three levels.
At the first level – the level that according to the current policy should be the most dominant in terms of ‘handling’ psychosocial needs of children and families – we see free accessible services offered by generalistic professionals like social workers, district nurses and GPs.
At the second level we find the ambulatory or outpatient specialised services, delivered at the office of the provider, at school or at home.
At the third level we see specialised services, whereby the child is (temporarily) being placed out of home in a foster family, a family home or a residential care centre.
Important is that these levels are strongly connected and that the child and family receive an appropriate level of services all the time, which might imply
- Scaling up, or
- Scaling down
I’ll come back to the issue if this works in practice in a minute.
5. Support with and without out-of-home placement
The next question is what type of support children and families actually receive. I’ll give you the most recent data.
The total number of children and young people receiving youth care is: 377.320 – a number that already came across.
Interesting to see now is that almost 95% receive community-based support, so support without a stay in care. However, I must add that also children in care quite often make use of this type of services, but then as an ‘extension’ to being fostered.
Most children and young people (71%) receive support by visiting the office of a care provider.
Only one in six (16,3%) of the young clients is supported by a local or district team.
In this slide we can see that more than 11% of the young people in the youth care system receive care out of home. This corresponds with nearly 1 % of the population of 0-22-year-olds.
(N = 43.770 , i.e. 0,98% of 4.448.400 0-22-year olds)
Almost 7% receive family-like care.
And nearly 6% receive residential care.
For reasons of comparison I’ll show you the rates of children in out-of-home care in some other countries as well.
As you can see the Netherlands has a placement rate that is more or less comparable with countries like France and Denmark.
Lower rates can be found in countries like Italy, England, Sweden and Germany.
Higher rates can be seen in some eastern European countries.
Concerning the Netherlands’ data it should be remembered that all kinds of care are included; they not only cover social child and adolescent care but also, for instance, child and adolescent mental health care.
6. Bottlenecks and risks of the decentralisation policy
After this snapshot presentation on current types of support and numbers of children receiving them two years after the Youth Act 2015 became guiding and the power of control on the system was decentralised to the municipalities, it’s time to take a look if the system is functioning as it was intended to do.
Just a few months ago a first evaluation study was published by the so-called ‘Transition Authority Youth’, a national board that was installed to critically follow the implementation of the new policy, especially the transition of youth care and the responsibilities concerned to the municipalities.
I will present a selection of findings. They are based on interviews with 51 providers of youth care services and 12 certified agencies in charge of the execution of child protection measures and youth rehabilitation trajectories.
They were asked to report on their experiences concerning topics like
- The available time to address all the changes asked for
- Their being contracted by municipalities
- The existence of concrete plans for implementation of the new policy
- The presence of visions or documents on youth care in the municipalities
- The expertise in the municipalities
- The budgets that were made available
- The cooperation between agencies and organisations in the region
- And the sensitive topic of conflicting interests between organisations
Here are the results, as presented by the services providers.
Significant to huge bottlenecks were reported on nearly all the topics mentioned, with on top:
- the missing of concrete transformation plans,
- the insufficient regional cooperation,
- the inadequate budgets,
- the conflicting interests of organisations, and
- the shortage of time to give shape to changes asked for.
On the next slide the experiences of the certified agencies are presented. Their biggest problems relate to:
- the shortage of time to implements necessary changes
- the short term contracts with the municipalities (with as a result that they have to negotiate with a multitude of municipalities every year anew)
- the inadequate budget, and
- the absence of concrete plans for transformation of the services.
Not a very positive picture, I think.
The next theme was if according to the interviewees progress has been made on a couple of issues that are seen as crucial in the transformation process.
Here are the combined results of both groups of respondents.
On four topics there is consensus that hardly or no progress at all has been made concerning
- Reducing the administrative burden
- Scaling up timely
- Scaling down timely, and
- Making use of the expertise of well-educated professionals
A bit less of consensus we see with regard to three topics
Certified agencies are very critical on two topics:
- The innovation of level 1 and level 2 services (so the community-based and ambulatory support services)
- The waiting time before being able to start support and treatment trajectories
Service providers are more critical on
- The innovations necessary to offer integrated services for those children and families who are in need of them
So 2 ½ years after the new Law the progress that has been made is – to put it mildly – not impressive.
My almost last slide summarizes the Commentary of the Dutch Ombudsperson for Children on the developments in Dutch youth care in 2016. Since April 2016 this prestigious institute is chaired by our Groningen colleague prof. Kalverboer, who will give a lecture on Friday.