Listen to thisIn many jurisdictions around the world, child and youth services have always existed as a combination of public and private services, sometimes as distinct service systems (one public and one private) and sometimes as an integrated system in which private services augment public services. In countries like Canada, Australia and perhaps also the UK, we have been somewhat complacent about this co-existence, likely because we simply assumed that the political cultures in these countries generally value public services and have given rise to fairly large public service systems and associated institutions that extent from health care and education to post-secondary institutions, child protection, welfare and social assistance, universal pension plans, and more. In the United States, private services are much more obviously prevalent and somehow no one is surprised because we tend to associate private service with the political culture of that country.
What is of concern is the degree to which we misunderstand and make assumptions about the role of public service in child and youth services. We erroneously believe that much of our system is public, with some aspects featuring private actors sometimes to positive effect and often to negative effect. This is simply not true. In fact, in some countries associated with very strong public service systems, such as Canada, child and youth services are overwhelmingly private. What is of even greater concern is that almost all the literature related to child and youth services, whether it is research-based literature or grey literature focused on policy frameworks and implementation sciences, continues to be based on the general assumption that we are talking primarily about a public service sector. Our critiques of child welfare systems, for example, make extensive demands of governments to change the day-to-day operations of specific services and procedures as if governments actually operated these services or control these procedures. At the moment, the only relatively holistic work taking a closer look at private service (in the specific context of residential care and treatment) is that of Lisa Holmes and her teams in the UK; outside of that, we are engaged in discussions about a sector of service while mislocating that sector in the public sphere. Inadvertently, our lack of attention to private service has opened the door for more private service to creep into our child and youth services, and for the concept of private service to become firmly established as the norm.
One concern is that we seem to misunderstand the difference between private and public service and label private services as public when in fact they are not. In Ontario (where I live), for example, the child protection system is operationalized through Children’s Aid Societies. Many people believe these to be public entities. They are not. Children’s Aid Societies are private, incorporated entities, albeit not for profit (often charitable) and governed by a Board of Directors (but run by professional employees). We often see them as public entities because they are mandated by government legislation (The Child, Youth and Family Services Act, 2017) and regulated by an expansive network of governmental bureaucratic departments. They are also funded almost entirely by government, which again makes them seem like public entities. Given the deep involvement of government in Children’s Aid Societies through legislation, regulation, and funding, we might be excused for mistaking these entities as public ones and dismiss my point that they are in fact private as simple semantics. What does it matter that they are private entities when everything they do is enabled and closely monitored by government. For all intends and purposes, they are public entities even if legally they remain firmly embedded in the private sector. Well, it does matter.
For example, as private entities, Children’s Aid Societies evolve not in lockstep with public discourse, culture, and ideology, but as a function of the professionalized and highly insulated world of child welfare professionals about whom the general public knows very little. In fact, it is a world that is largely inaccessible to the general public, and one that therefore is also not accountable to the general public. When bad things happen in child welfare, we blame governments for the work done in private entities and we leave the private entities largely alone. In any other private sector context, when a company fails miserably, the leadership gets fired and replaced immediately. In child welfare, when children die unnecessarily, we instead look to the leadership of the organization in whose care the children died to make it better. In other words, when mistakes are made, we direct blame at those who did not make the mistake (government) and we demand solutions from those who did make the mistake (the private entity). Hopefully I am not the only one who finds that a little strange.
In reality, this uneasy relationship of public mandates and regulation on the one hand and service through private entities on the other hand has never really resulted in a transparent and accountable system of child and youth services. For the past few decades, we have continuously watched private service creep deeper and deeper into this sector. From the 1970s to the 2010s, for example, private service, mostly of the for-profit type, has been the primary vehicle for service provision in the out of home care sub-sector. It is important to note that private for-profit residential care providers are also subject to legislation and the regulatory processes of government and are almost entirely funded indirectly through governments (by having government funds given to Children’s Aid Societies be passed along as payment for placements in private group homes or privately operated foster homes – it is public money paying for those placements). We have seen the devasting impact of allowing care to unfold through private, for-profit entities. That impact is now subject to class action lawsuits and widely recognized as having deeply and adversely altered the life course of many sub-groups of young people, most notably Indigenous and Black young people.
Although there is much more recognition today than there was in the past that private group homes run for profit are very much a problem, and there is even a crackdown on such places on the part of government licensing divisions, the reality is that much of the group home system in Ontario and elsewhere continues to be a privately, for-profit operated system, even if some private companies have been shut down or are subject to enormous criticism, lawsuits, and even criminal investigations. More disturbingly, whereas for many decades, private for-profit out of home care was largely based on group home models, such care is now based on private, for-profit foster care models, which has been one of the fastest growing sub-sectors in child welfare in Canada, and from what I can tell, also in Australia and the UK, and this despite multiple preventable child deaths in such settings. And things get considerably worse.
Today, one of the greatest challenges facing child protection sectors at least in the global north is the emergence of large numbers of young people with what is commonly referred to as “complex needs”. These are young people with multiple developmental and mental health challenges that manifest through difficult behaviours, including extreme violence, self-harm and suicide. The emergence of this trend comes at a time when much of the public discourse has shifted away from group care settings and has endorsed, almost fanatically, the concept of family-based care. We assume that because governments are echoing (or parroting) the rhetoric about family-based care that this is in fact the direction we are going in. But it is not at all the direction we are going in. To the contrary, the private child protection sector described earlier has already privatized the care for children and youth with complex needs and is looking to private for-profit entities to meet the placement needs for these children. That insulated world of the child welfare professional elite does not reflect the political cultural shifts in public discourse. To the contrary, it aims to continue the decades of the privatization of care it already enabled and is comfortable with. The result is that the family-based care we often talk about is actually private, highly institutionalized (or carceral - take your pick) care offered by the very same for-profit entities that previously operated the private, for-profit group homes that we have collectively shunned as horrific places. For these private for-profit entities, family-based care is simply a new product line they developed in response to new consumer (Children’s Aid Societies) demand.
Privatization is creeping into child and youth services through other channels as well. For decades now we have been valorizing the concept of treatment in child and youth services, which has given rise to an industry promoting and selling evidence-based practice models. This industry is itself a for-profit and private industry selling its goods to the highest bidder through licensing fee models. It is accompanied by a training and consultation industry, also private and for-profit, that is sweeping child and youth service sectors in unprecedented ways and that is in fact reinforcing the necessity and value of the products being marketed for profit. Beyond that, to the extent that children and youth involved in child welfare services are actually exposed to treatment services, such as counselling or psychiatric services, these too are predominantly offered by private individuals or by private, for-profit entities promising to match children and youth with counsellors and psychiatric services they secure through contracts with appropriately credentialed professionals.
Even inside of seemingly public agencies (such as not for profit and charitable agencies offering services and placements to children and youth), privatization is creeping in at profound levels. For example, yet another sector that has grown exponentially in child and youth services is the agency-based staffing sector. Here, private, for-profit companies contract with individual professionals (usually at the bottom of the professional hierarchy, such as child and youth workers and personal support workers, sometimes nurses) and provide staffing to programs and services operated by the seemingly public agencies. Never mind that in so doing, almost everything we know about high quality service provisions goes out the window; agency staff are temporary, often appear just for a single shift or for a week or a month, which negates relationships and meaningful child and youth care practice altogether. This sector is growing because in true private sector style, seemingly public agencies avoid making commitments to hiring permanent staff and having to manage those staff, pay them benefits, and assume risks and costs associated with potential workplace injuries and the like. In other words, the staff who work in group homes, support foster carers, provide treatment in family-based care or intensive treatment settings are often actually sub-contracted workers who are unsupervised, variably qualified, and accountable to no one.
The privatization creep in child and youths service systems is enormous and accelerating. We often talk about our moral and ethical obligations to care for the most vulnerable groups in our society and to do so as part of our collective social contract. Care, in our rhetoric, is understood as a public good. In our practices, however, care is a private product, one that enriches entrepreneurial types exploiting the complacency we have maintained for decades now in assuming our public responsibilities toward children, their families, and their communities. This system is enabled by the institutions that we think of as public, including Children’s Aid Societies, Child and Youth Mental Health Centres, and all manner of non-governmental organizations we think are public entities. It is critically important to understand that child and youth services in countries like Canada, Australia and the UK, are largely private sector services, driven by profit motives, and dealing in products. The commodification of children and youth is nearly complete. In this context, the death of a child in care is not tragic; there is a nearly infinite supply chain of product.
As is always the case, some groups are and will continue to be impacted even more adversely than others. Racial groups subject to ongoing genocides or oppressive systemic and structural dynamics have and will continue to serve as the bulk of the market and sustain the system that is destroying them. Privatization is a euphemism for a shift from humanization to commodification. And we all know what happens when humans become commodified. Transatlantic slavery is one example. There are many more. The absolute minimum step we must take right now is to seriously pay attention to the privatization creep in child and youth services specifically, and in human services more generally.
