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Trends in residential care in Finland

Anne Hujala

The increasing role of family-oriented work is emphasised by Anne Hujala, Senior Planning Officer In Finland's National Agency for Welfare and Health.

During the 1980s, welfare services in Finland underwent considerable development. In this article I will concentrate only on a few essential questions concerning residential care, and in particular I wish to highlight family-based work, which has constituted a remarkable change in the orientation of residential settings. Ten years ago it was largely believed that the only task in residential settings was to look after the children, and that social work with parents was something to be carried out in welfare offices. At the beginning of the eighties, residential care workers became conscious of family-oriented work. As a result, the entire role of residential care started to change and residential care work became more rewarding.

During the same decade, child welfare institutions were largely decentralized. At the end of the 1970s, there were 187 child welfare establishments (including children's homes, homes for young people, and community homes), having more than 4,000 places. By the end of the 1980s, there were 181 child welfare institutions with approximately 2,800 places. Some institutions had been closed down and some new ones were set up, but statistics show that residential settings are now much smaller than they were ten years ago, averaging 15 to 16 places each. Most institutions are run by local authority social service departments.

Child welfare measures are provided for approximately 20,000 children, or for about 0.7 to 0.8% of all children under eighteen in Finland. Among them, about 7,000 children are in substitute care, this number evenly divided between residential and foster care. Residential care is often short-term and it is quite common that children placed in foster care had previously been in residential care.

A new child welfare law was passed in 1983, putting the best interest of the child at the forefront of child welfare. Today, the most common reasons for admissions to care are the personal and social difficulties of the parents, such as the use of intoxicants and psychological problems leading to the neglect of children. The most common factors in the child's behaviour resulting in placement are criminal offences and school-related problems.

Family-oriented work
Permanency planning became an important factor in child welfare work in the 1980s. One of the main points in the present Finnish child welfare legislation is the child's right to permanent adult relationships. That may mean that while in substitute care a child has constant contacts with its parents, or that a child has permanent substitute caretakers (in most of these cases these are foster parents). In this phase, families began to be seen also as a resource having an active role in the care and upbringing of a child placed in a residential setting.

In many children's and community homes a reference framework was that of the systemic approach, with the new idea of “networks" “meaning that children grow up as part of a family system in which all members interact, affecting each other all the time. The family, in turn, is also in constant interaction with its surroundings.

To avoid parental feelings of guilt is a concern of residential care workers. Also, they try to create an atmosphere in which family members themselves, and not residential care workers, are the best experts in solving family problems, and should be left to making their own decisions. The role of residential workers is to help find constructive solutions and to support families in their decisions.

Essential changes in approach include a new view of causality, an understanding of the positive meaning of symptoms, and finding out the hierarchies and power relations inside a family and the mechanisms that sustain problems. As a result of these reconsiderations of residential work, new attitudes and working methods have also developed. For example, one basic starting point in family-oriented work is to define the background problems and to seek help together with the family. It is very important to take into consideration the aims of the family and, when starting to resolve problems, to discuss the family's own resources openly.

Treatment plan
According to Finnish child welfare law, social workers must prepare a care plan for every child who is a client of the child welfare services. When a child is in residential care this plan is complemented by a special treatment plan. A treatment plan is an essential document in residential care, but its importance and potential have not yet been fully realized in every residential care unit.

In family-oriented work, treatment aims concerning the whole family have been started, which means that residential care workers consciously try to influence the interaction between members of a family in care. In most cases, the client family also takes a concrete part in making and reviewing the treatment plan. There are differences of opinion among residential care workers whether the client family can always be involved in its own treatment planning or whether it is preferable to discuss this on their own. A treatment plan helps residential care workers and client families to categorise problems, and to try to find new solutions in a consistent manner. In a treatment plan, problems might be defined differently by the client family, the youngster, and the residential care worker. But this awareness constitutes a good starting point for treatment. All treatment plans are individual and, of course, flexible.

Depending on the situation and problems of the family, a constant attempt is made to broaden the scope and variety of treatment tools. There has also been discussion about the creation of tailor-made services.

Most residential care workers in Finland are quite well-educated and trained. More than half of them have a college education involving three to four years of studies after comprehensive or grammar school, or a university education. While changing care work methods towards family orientation, much additional education is needed in order to increase the professional awareness of child care workers. It has been found that the best way of organizing further education is to educate the entire staff team at the same time, allowing for supervised practice in between courses.

Admission to residential care
In connection with the new working methods, much effort has been made to bolster the image of residential settings, requiring a change in attitude of care workers and especially of clients – in putting forward the idea that residential care is not 'the last resort'. Referrals to residential care are nowadays more and more planned. Of course, referrals to emergency care are exceptions. It is usual in some establishments for the client family to visit the residential setting before placement in order to become familiar with it. The first family meeting takes place during the visit. The family has a few days or even some weeks to think the matter over before placement occurs. In many cases, the client family (frequently the youngster) changes its mind, as placement can be voluntary.

Some residential units have developed family-oriented work between residential and open care. This means, for example, that the welfare office social worker begins co-operating with a residential setting while planning the placement. The family meets residential care workers at family meetings which are sometimes combined with a child coming to the residential setting to do homework or to take part in leisure activities. This type of care work sometimes relieves the problematic situation and the family needs no further help or only slight help. Sometimes family-oriented work is to teach the meaning of parenthood and how to act as parents, especially in the case of babies and young children. This means for example that a parent – usually the mother – comes every day to a residential setting to take care of her child. Residential care workers counsel the mother and teach her to take responsibility for the child's care and upbringing. A starting point is in learning everyday activities. The mother eats with the child, puts it to bed for a sleep, joins in outdoor activities with it, bathes it, and accompanies the residential worker to a baby clinic. This type of work can also be carried out outside the residential setting, for example, at the child's own home.

Almost always, residential settings need considerable repair or reconstruction before they are really suitable for family-oriented work. Parents need to know that in designing settings, thought has also been given to their needs, by providing them with their own space. They are not guests visiting their children anymore – they are the child's mother and father.

Placement of entire families
During the last few years, a method called family rehabilitation has been developed, with the aim of providing intensive treatment to a whole family for a short period in a residential setting. The new 1983 child welfare legislation made this type of placement possible as a form of community care assistance.

Last year a special residential setting for whole families was founded. Children without parents are not accepted – always only an entire family. Traditionally, when a child is taken away from the family, the family is broken up. Now the idea is to keep the family seeking help together and to try to get the family into a rehabilitation programme at quite an early phase, before problems become very severe. A period of stay at this residential setting is between one and six months. It is as yet too early to report on the experiences of this setting.

In this type of placement it is important to set a time limit for the length of stay in the residential setting. That is why accurate aims of the placement are important: is it more important to help the parents in creating a better relationship between themselves and their children, or is a better purpose served by helping parents to solve their own problems or analyse their parental abilities? A more common practice is for a whole family to stay for a short period in the residential setting in which the child is placed for a longer time.

Sometimes this rehabilitation period is a summer or a weekend camp offering leisure activities, family meetings and family group meetings.

It has been proven that the family-oriented approach, with parents closely involved, makes it much easier to cope with the child in the different residential care situations. In family-oriented work, residential care workers appreciate the role of parents and make them responsible for their children. Residential care workers have started to co-operate with parents as equal partners and are changing their attitudes about clients. Indeed, this change is needed before improvements in the effectiveness of services become visible.

This feature: From: FICE-Bulletin, 6. 1992

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