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Meaning of 'quality of care'?

2014

What is meant by “quality of care?” I have attended many forums and meetings and I realize that in most cases, there have been heated debates and there has been no common understanding of what “quality of care” means. I live in a country which has a clear piece of legislation (The Children’s Act 38 of 2005) regulating the CYC field. One would think that Acts like these would provide a base on which to understand what “quality of care” means. Of course CYC organizations have diverse target groups of young people they serve and might have their own quality standards that determine what quality of care is. That I do understand, but given this context of “diverse target groups of young people”, how can one explain in simple terms what the provision of “quality care” means.

Vincent Hlabangana
South Africa
...

Vincent,

In my view, 'quality care' is care that is provided in a safe nurturing environment which aims to meet the social, emotional, intellectual, physical and spiritual needs of the child. 'Quality' care should address barriers to social mobility and enable each child to maximize their life opportunity so that they can eventually live as 'normal' and 'independent' a life as possible. It's kind of like professional parenting.

The problem is, that the interpretation of some of these terms can be somewhat subjective. I once worked with a woman who allowed children to verbally abuse one another. When I asked her about it, she tried to convince me that it was culturally normal for children with their 'socio-demographic profile' to behave this way! (In truth, I suspect that she was just no good with confrontation).

The provision of 'quality care' is further complicated by political agendas. In Ireland, child protection is (in the first instance) very little to do with the best interest of the child. It is more to do with politics and economics. High profile kids who make the system look bad frequently get lots of money thrown at them while very many others fall through the cracks and receive less than adequate care, or no state intervention at all.

When kids do get a service, the care is often aimed at containment and control of problematic behaviour. For example, when I ask staff how they meet the spiritual needs of the kids in their care, they look at me like I have ten heads! It is clear to me that managers in Irish res care rarely (if ever) explore that question with their staff.

In summary. When I work with a kid in care, I provide the very same quality of care that I provide to my own kids and just like my own kids, sometimes I get it right and sometimes I don't. Either way, I sleep well at night knowing that I have done my very best to help them all to get on in life.

With best wishes,
John Byrne
Ireland
...

Hallo Vincent.

It might be an idea to research the minimum norms and standards . Here is your opportunity to start formulating friendly *definitions* for concepts such as quality of care.

Antoinette Meyer
Cape Town.
...

You make an excellent point. The world is so diverse, so what one country claims to be quality of care might be different from another. These are the types of ideas that should be questioned on a regular basis by people in the field. We take so much for granted because it is being taught to us by teachers or staff, but even the people in higher positions take these basic truths for granted. It pains me to say that I do not think high quality care happens very often. Just because people do the job given to them does not mean they are providing quality care; what it really means is they are good at being robots.

Braden Freeman
...

Hi Vincent,

This an interesting question. The concept “quality of care” is linked to a number of factors. If we start with legislation, the Children’s Act, contains norms and standards. When CYCC comply with the norms and standards than that in itself can ensure “quality of care”. The second aspect for me is that the field of Child and Youth care have practice principles, again if CYCC’s apply the practice principles in their operation this will lead to quality of care. The last area that one must look at in terms of “quality of care “ is whether the CYCC employ staff with the correct qualification. It used to be an accepted practice to employ staff who do not have the correct qualification. Vincent for me these are the elements that leads to quality of care.

Alfred Harris
Cape Town
...

There is a great deal of synergy to be had from crossing the boundaries between children and young people’s services into other fields of practice. From my work in the field of adult learning disabilities I would expect to see a person centred approach that seeks to promote quality of life outcomes. Have a look at the work of John O’Brien, for example

http://thechp.syr.edu/wp-content/uploads/2013/10/whats-w.pdf

Ni Holmes
Scotland.
...

Whilst legislation and quality controls do provide some guidelines, we must always ensure that care is not about mere compliance with requirements and reduced to a list of ticked boxes. Care is about the essence of the experience of young people in terms of human elements such as warmth, understanding and compassion in relationship with others. Care cannot be quantified and measured, which of course, means that much of our work does not appear in audits and reports, and so it remains invisible to many. However, care (or the lack thereof) may be felt.

Jackie Winfield
Durban, SA
...

Hi Vincent,

I am heartened to hear that you have participated in heated debates concerning the definition of ‘quality of care’. If you have access to a journal database, these are two articles that I consider to deepen the conversation about quality of care:

Barnes, V. (2007). Young people’s views of children’s rights and advocacy services: A case for ‘caring’ advocacy. Child Abuse Review, 16, 140-152.
Holland, S. (2010). Looked after children and the ethic of care. British Journal of Social Work, 40, 1664-1680.

I am a frontline youth worker in Calgary, AB, Canada and over the past decade or so have experienced alongside youth many social policy changes that attempt to define ‘best practices’ and provide ‘evidence based practice’ guidelines for ‘giving’ quality care. As you and other participants in this discussion have mentioned, it is difficult to quantify the quality of care that we engage in. I believe that we each have our own framework for practice that is shaped by the contexts that we work and live within. At times ‘best practices’ that come down from the top of a hierarchy such as federal or local governments take into account economic and socio-political state goals rather than children and youths’ self-determined needs and goals.

In Alberta the lack of government and systemic weight given to qualitative, youth-voice-and-action informed research in comparison to a plethora of quantitative stats research on ‘this many youth have this disorder’ or ’this many youth did this crime’, causes a dynamic in care giving that is more worker ‘doing to’ than ‘doing with’. Funding is most often delivered to agencies that agree that ‘quality of care’ is defined by what workers and agencies do to children, youth, families, and communities.
As a result, it becomes challenging for agencies and workers to determine and genuinely participate in a quality of care model that that is child, youth, family, and community centered. In response to experiencing this both as a ‘former-youth-at-risk’ and as a current youth worker, when defining ‘quality of care’ to individuals and systems that inquire I emphasize that care is relational, and its quality is defined by ongoing collaboration of the agents engaged.

The following book is an excellent resource:
Pence, A. & White, J (Eds.). (2011). Child and youth care: Critical perspectives on pedagogy, practice, and policy. British Columbia, CA: UBC Press.

Thank you all for an excellent discussion,

Stef Bolianatz
...

Dear friends in CYC work,

Your replies on the aspect of quality care were indeed remarkable. Having looked at everyone’s response, I am now able to articulate what quality care means as I work with children and should I get further questions about it. Thank you all. I am now a $1 richer….

Vincent Hlabangana
...

Yes I agree, quality care is not easily defined, especially the qualitative side. Many systems of care focus on more quantitative issues than can easily be measured, such as the material/environmental support.

However, that is also part of care. Children do need a containing environment in which to grow, and that involves that certain basic material things are provided. It is disturbing when organisations start to redefine their definition of care towards more qualitative aspects (which would normally be good) because they are looking for an excuse to skimp on the quantitative and material aspects. Ultimately, the most reliable way to “measure” care is to ask children and youth whether they feel cared for, and I suppose there are many ways to do this. And it’s a pity that organisations (almost never) ask employees whether they feel cared for! How do you provide quality care if you do not feel valued (cared for) as well? I think an important aspect of quality care is the degree to which the organisation cares for staff. Too often there is a focus on caring for children, but staff needs remain unmet. Compare the principles of trauma-informed care for organisations and models like Sanctuary, and you get an idea that quality care for children goes far beyond just “quality care for children”. If an organisation is not a “quality organisation” with “quality staff”, you are unlikely to have quality care.

Well, that’s my perspective…
Werner van der Westhuizen
...

I totally agree. The essence of the work we do is invisible. I am surprised when I was in school learning about the field nobody taught this truth. The young people are the measure of the quality of the work we do. And when you look at the young people today, at least in my city, they are not feeling loved or warmth. At one of the group homes I saw only one child in the history of the program graduated from high school. It seems we are just not doing good enough. I think unfortunately this message is not being spread to the masses. I know the people online are not the people who need to let this sink in.

Braden Freeman
...

I want to agree with Jackie, our work with young people is relational based and this is not something you can simply tick in the correct “box”. Legislation is “broad guiding principles” to create uniformity within a particular sector of society. If “quality care” is merely a compliance exercise than we’ve missed the bus completely.

Charles Harris
...

Whilst legislation and quality controls do provide some guidelines, we must always ensure that care is not about mere compliance with requirements and reduced to a list of ticked boxes. Care is about the essence of the experience of young people in terms of human elements such as warmth, understanding and compassion in relationship with others. Care cannot be quantified and measured, which of course, means that much of our work does not appear in audits and reports, and so it remains invisible to many. However, care (or the lack thereof) may be felt.

Jackie
Winfield
Durban, SA
...

I agree with Jackie. You know I have been to many organisations, some in rural settings and some in urban. In rural focus is more on cultural values and societal standards and basic needs are no preference as such, as long as the child responds well in the teachings on cultural matters, the carers (elders would praise each other) and say Mr so and so is providing quality care to his children. There is no consideration of how the young people themselves experience or feel about the type of care they receive.

Barrington Makunga
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