scholarly journals Is the deinstitutionalisation of alternative care a ‘wicked problem’? A qualitative study exploring the perceptions of child welfare practitioners and policy actors in Thailand

2020 ◽  
Vol 63 (5) ◽  
pp. 626-639 ◽  
Author(s):  
Justin M Rogers ◽  
Victor Karunan

This study examined deinstitutionalisation in Thailand. Qualitative interviews were conducted with a total of 27 child welfare practitioners and policy actors to explore their perceptions of Thai alternative care provision. Findings show that participants perceive deinstitutionalisation as a complex policy challenge. Some felt that the institutions were necessary in order to meet demand, while others felt that cultural barriers prevent a shift to family-based approaches, such as foster care. However, data suggest that it would be difficult to characterise deinstitutionalisation as a ‘wicked policy problem’ as participants were hopeful for change, citing increased family- strengthening policies alongside efforts to implement foster care.

Author(s):  
Sumantra Mukherjee ◽  
Subhadeep Adhikary ◽  
Neepa Basu

The required operational framework of a community-based care mechanism as envisaged under the Revised Integrated Child Protection Scheme and the National Plan of Action for Children 2016, fails to both prevent and effectively respond to the vulnerabilities of children in need of care and protection. Resonance of such unplanned community programming shifts the focus towards institutionalisation of children, thus grossly violating ‘institutionalization as a measure of last resort’, one of the fundamental principles governing the Juvenile Justice (Care and Protection of Children) Act 2015. The act critically justifies the need to empower vulnerable families to care for children and re-emphasises the preventive role in ensuring family-based care or keep children in alternative care setting. The alternative care (sponsorship and foster care) guidelines in Jharkhand was launched in 2018. Since then, it has been found that the state is struggling to implement it. Though there has been some progress in the sponsorship scheme implementation, the kinship and foster care remains completely neglected. Child in Need Institute (CINI) is partnering with Hope & Homes for Children (HHC) since 2017 for pushing the agenda for deinstitutionalisation of children through a two-pronged approach of model creation and district-level technical support to the ICPS system. Working closely in the communities in preventing family separation, led to the understanding that there is a huge need to address the structural gaps for implementing the alternative care guidelines in true spirit. The purpose of the article is to do a systematic analysis of the implementation of the alternative care guidelines in the state and map out the implementation bottlenecks/barriers (systemic, structural and operational), hindering its smooth implementation. Besides that, the article will also try to establish a causal linkage between implementation of alternative care guidelines and dependency on institutional care, thus reflecting the potential of such mechanisms in promoting deinstitutionalisation. The research methodology will be a mix of qualitative and quantitative tools. Tools like content analysis of the key informants’ interviews and case studies will be used to understand the implementation barriers. A quantitative analysis of the secondary data on sponsorship scheme implementation will be done to analyse the gaps. Besides that, the experiences of children and their parents who have been linked with alternative care will also be analysed. District stakeholder consultations in 2 districts will be done to enlist the recommendations for the state. Thus, the key research question that would guide this article are: (a) What are the barriers to implementation of the alternative care program in its current form? and (b) What are the changes that should be made in the guidelines and its implementation process? The article will thus be an advocacy tool for influencing the state government for enhanced priority and investments in alternative care program and reduced focus on institutional care.


Author(s):  
Margaret H. Lloyd Sieger

Children in foster care due to parental substance use disorder are at high risk for delayed permanency. Understudied is the effect of foster care factors on these children’s exits from care. This study analyzed 10 years of federal child welfare data to understand the effect of foster care placement, provider, and support factors for this vulnerable group. Results revealed that several foster care variables influenced time to, and likelihood of, permanency for children with substance-related removals. Foster care setting, foster parent age and race, and several types of federal supports affected permanency trajectories. Children in homes receiving more federal supports were less likely to achieve permanency, suggesting the insufficiency of these supports to counteract the effects of socioeconomic risk on permanency.


2016 ◽  
Vol 20 (5) ◽  
pp. 754-769 ◽  
Author(s):  
Jennifer C. Davidson ◽  
Ian Milligan ◽  
Neil Quinn ◽  
Nigel Cantwell ◽  
Susan Elsley

2018 ◽  
Vol 92 ◽  
pp. 56-64 ◽  
Author(s):  
Thomas M. Crea ◽  
Anayeli Lopez ◽  
Robert G. Hasson ◽  
Kerri Evans ◽  
Caroline Palleschi ◽  
...  

Author(s):  
Ruth Emond ◽  
Carol George ◽  
Ian Mcintosh ◽  
Samantha Punch

This article draws on a critical evaluation of a knowledge exchange (KE) project, Food for Thought, devised to promote and develop awareness of the use of food within children's residential and foster care services. From the 22 qualitative interviews conducted, reflections on the differing forms of knowledge incorporated into the design of the project and its outputs are discussed and the limitations of current thinking on knowledge exchange are explored. Finally, links are made to show how this reflective approach to practice operationalised and enlivened local and national food and care policies.


Author(s):  
Carole J Decker ◽  
Emily Chhatriwalla ◽  
Brian Garavalia ◽  
John A Spertus ◽  
Er Chen ◽  
...  

Background: Explaining the risks and benefits of recombinant tissue plasminogen activator (rt-PA) occurs in a hurried conversation in the emergency department and may not be fully grasped by patients and their caregivers. Risk models describing the heterogeneity of benefits from rt-PA in acute ischemic stroke (AIS) have been created, but are not used in routine clinical practice. To develop a tool (RESOLVE) for modeling each patient’s benefits and risks for rt-PA, we conducted qualitative interviews with survivors, their caregivers and emergency physicians to inform the design and improve usability. Methods: A multidisciplinary research team conducted qualitative research through 10 focus groups of survivors and caregivers. We obtained feedback on their preferred role, desired information and their impressions of alternative formats for presenting risk and benefits. Three emergency physicians from 2 sites have been interviewed (with >15 additional physician interviews being currently conducted, the results of which will supplement these preliminary data at the time of presentation). Results: Survivors and caregivers (63 participants: 39 stroke survivors; 43% male) express a need for more information, including specific risks and benefits to treatment. In general, both groups desired an active role in the acute stroke treatment decision. In contrast, the initial physician interviews indicated a hesitancy to provide NINDS data to patients and caregivers, skepticism of the existing data and cultural barriers to the use of rt-PA in AIS, the latter acquired through residency training or the opinions of their clinical colleagues. The interviewed clinicians, however, felt more positive about using rt-PA when a neurologist was readily available to support the decision. Conclusions: Preliminary findings suggest reluctance by emergency physicians to share data about the benefits of rt-PA to stroke patients and their caregivers, despite the desire of the latter for such information. While the additional planned interviews will be needed to confirm these findings, preliminary insights suggest a compelling need to overcome the reticence of emergency physicians to use clinical data to better engage patients in making a shared decision about rt-PA in AIS.


Author(s):  
Catherine E. Rymph

The conclusion briefly summarizes some of the developments in foster care in the 1970s, 1980s, and 1990s, including the rise of the permanency movement, the passage of the 1980 Adoption Assistance and Child Welfare Act, and the 1997 Adoption and Safe Families Act, each of which shaped the development of foster care, particularly in the areas of subsidized adoption and easier paths to Termination of Parental Rights (TPR). The conclusion also argues that society’s reluctance to adequately support low income birth mothers and low paid foster mothers is part of a broader ambivalence about careworkers in general.


Author(s):  
Ratna Verma ◽  
Rinku Verma

This article has been developed based on a systematic review of research studies conducted in the last 10 years on family-based childcare systems and a rapid review of research and assessments conducted in 2020 to explore the implications of the COVID-19 pandemic on adoption and foster care in India. The study explains child vulnerabilities with a focus on challenges to adoption and foster care before and after the COVID-19 pandemic. The findings depict that India is home to a large number of vulnerable children who have been living with hardships, and the COVID-19 pandemic has put them at a higher risk of adversity. There has been a significant focus on family-based childcare systems, such as adoption and foster care, instead of institutionalisation to provide a safe environment to children in need of care and protection. However, the study shows that the adoption rate has been sharply decreasing in the country due to low social acceptance, unawareness and delays in the adoption process. The study also identifies challenges facing foster care, in terms of lack of financial support to foster parents, lack of an appropriate monitoring system and lack of a social integration plan for children who age out of the system. The COVID-19 pandemic and related measures have further interrupted the process of adoption and foster care and placed several roadblocks in providing a safety net to a large number of children in the country. The article provides viable recommendations that may help make adoption and foster care effective in the country amid the COVID-19 crisis.


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