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Changing Minds, Policies and Lives

Changing Minds, Policies and Lives
At the beginning of the 21st century more children are entering public care than at the start of the decade, with growing numbers and rates of children being placed in institutions. This is happening despite efforts of reforming the system in many countries. So far initiatives for reform of the family and child welfare system in the transition countries of CEE/CIS states are scattered across the region and not framed within coherent policy. In response to this challenge, the World Bank and UNICEF teamed up in the project “Changing Minds, Policies and Lives” with a purpose to develop knowledge and tools for family and child welfare policy makers and practitioners in the region and to facilitate the reform process.

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:

- Fair and understandable criteria for entitlement to services;

- Transparent decision-making;

- Fairly and consistent allocation of services;

- A planning system to ensure that an appropriate range of services is available to families;

Gatekeeping is a process and requires a system for ongoing monitoring of the plan for each child at regular intervals;

Focus on the whole system. Whilst it operates through controlling decision-making in individual cases, a gatekeeping strategy has to assesses its impact on both the operation of the child protection system and wider connected systems.

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:

- An analysis of the current situation, mapping out the economic roles in the current system, the costs and who pays those costs;

- A proposed institutional structure for new system, specifying new roles, responsibilities, accountabilities and financial flows, and an analysis of the incentives;

- A needs assessment, projecting possible future demand scenarios with a change in practices towards more community and family centered care;

- A costing of the demand scenarios;

- A proposed new financial flow structure;

- A management plan; and

- An activity plan for project implementation.

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;

- A comprehensive strategy to reform the child protection system. Standards are not neutral. They are based on the policy that underpins the child protection system and provide a clear statement of the principles of this policy;

- Starting small. The strategy for reform needs to produce quick benefits whilst at the same time standards remain part of a larger reform process to change the child protection system as a whole. It is suggested that the strategy should start by selecting a pilot area;

- Overcoming the shortcomings of the current system of standards;

- Gaining commitment. The successful development of standards will need many people to change what they do. This is unlikely to be achieved by command alone and it is important to work in a way that gains commitment of the range of people who will be involved in the strategy;

- Develop incentives to grow. Changes should be rewarded and the range of incentives should be brought into play.



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