Changing Minds, Policies and Lives
Changing Minds, Policies and Lives
The product, a three-volume publication, containing concept papers and tools addressing essential components of the system reform, focuses on three crucial elements of reform, namely the gatekeeping system, redirecting resources into preventive and family based services and standards of care and developing standards for services. The toolkit has been tested in Bulgaria, Romania and Latvia and adapted to address important challenges in the child welfare reform. Below are some key highlights and findings on the components of gatekeeping, financial models and standards in child welfare.
Gate-keeping is the system of decision making that guides effective and efficient targeting of services aiming to ensure that services are provided only to those who meet tightly specified eligibility criteria. It focuses primarily on the needs of the child. Efficient gate keeping has one agency responsible for co-ordination of the assessment of the child’s situation. A range of services to support children and families need to be made available in the community to prevent institutionalization. At the same time there must be a set of alternatives to institutional forms of substitute care including foster care and adoption. Efficient information systems to monitor and review decisions and their outcomes need to be in place. The following components will ensure that gatekeeping is of high quality:
Redirecting resources to community-based services by changing financing flows towards support to families at risk and family-based care alternatives prevents institutionalisation. The toolkit promotes the purchaser-provider model that is guided by client’s needs and the most efficient ways to meet them. The new financing system should place all the public funds for social care into the hands of the purchaser and acknowledge output-based reimbursement. All private and public providers should be subject to licensing.
This financing framework is one of the key public policy tools to ensure access, cost-effectiveness and quality in the social services. The purchaser-provider framework has proven well suited to a decentralized government structure, if the roles are assigned properly. Making the transition to a new financing system will be demanding for all stakeholders. A number of transition problems will emerge. Countries seeking to change the financing structure to a purchaser-provider model need to develop a sound project plan based on:
Changing the financial rules of the game is not enough to ensure better use of public and private resources toward better outcomes. It should be dealt with in the overall reform strategy.
Standards are understood as accepted or approved criteria to measure and monitor the management, provision and quality of services and their outcomes. The aim of the toolkit is to support the assessment of current standards and to guide development of new criteria for service provision and performance outcomes. Appropriately defined standards of care are realistic, reliable, valid, clear and measurable and will ensure the family-centred outcomes. The process of standards development should be participatory to ensure that standards are owned by the stakeholders, shared and understood by the staff, and developed with the participation of children and their parents.
The improvement of standards should be seen within a framework that includes gatekeeping and the redirection of resources within a systemic framework. The following has proved to be needed to change standards for services in the region:
- Changing minds. The whole chain of activities coming into operation in a care episode need to be improved;