Exploring parents’ repertoire of everyday resistance in child welfare services — Towards a power-sensitive understanding of resistance

Introduction: A high number of children and adolescents receiving child welfare services are in need of mental health services. In Norway, child welfare services and mental health services are organized separately, and no formal mechanisms have existed to ensure collaboration and coordination of services across the organisations. Child welfare is organised under social services in the municipality, while mental health services are organised under the state financed specialist healthcare. For children and their families, in need of both services, this has led to fragmented and poorly coordinated services, and collaboration between providers have been based on ad hoc arrangements. Practice changed implemented: To create a more coherent service the municipality of Kristiansand developed a project – Inter-organisational acute services for children and adolescents (short: the Acute Project) – targeted towards children experiencing acute situations (e.g. suicidal attempts, domestic violence) where they potentially are in need of services from both child welfare and mental health services. Sub objectives in the project are to (a) develop common routines for providers in acute situations, (b) increase providers' competence (c) implement measures to strengthen parents' abilities to handle the acute situation in their own home (e.g. avoid institutionalisation), and (d) ensure coordinated follow-up after the acute situation has stabilised. Key stakeholders in the project are the child welfare guard and the acute-ambulatory unit in the hospital. The regular child welfare service, who takes over the responsibility for a case after the acute situation, is also partly involved. Various measures have been introduced to reach the objectives. The most significant is the abolishment of the professional secrecy across the organisations, meaning that child welfare and mental health services currently are allowed to openly exchange information, which was not the case previously. The Acute Project has received financial support from the Norwegian government, and it is the first (large-scale) attempt in Norway to improve integration across these services. The project period is 2013-2016. Key findings: As researchers we have followed the project since 2014, conducting interviews with a range of providers and children/families who have received combined services. We have also taken part in workshops and surveyed the number, content and outcome of acute case. The research will continue to the ending of the project period. Here we present findings with an emphasis on providers' experiences and perspectives. Employees in both child welfare and mental healthcare report of increased knowledge of each other, increased trust and an understanding of being more equal. The changes are related to their attendance in regularly held common seminars, including case discussions and lectures. Routines to support the integration of services have been introduced, and imply that the parts must telephone each other for each acute case. Furthermore, staff from the acute-ambulatory unit sits in with the child welfare guard once a week, thus bringing the collaborating partners closer to each other. The significance of abolishing the professional secrecy are debated among staff, but in sum it is safe to say that it provides a legal structure that makes communication across the sectors easier. At this point in the project period we will argue that the parties have increased their competence, in particular their 'collaboration competence', and the routines that have been introduced function quite well, but they are also subject to constant revision. Whether the objective of providing alternative measures and strengthening parents' capabilities to deal with the acute situation in their own home is reached within the project can be difficult to determine for a single provider, but there seems to be an agreement that the project helps preventing institutionalization. The follow up after the acute situation seems to have been less affected by the Acute Project. Improved integration and coordination of services is predominantly taking place within the acute situation, less after. Routines are currently being developed to ensure a smoother transition between the acute units and the regular child welfare service. Lessons learned: A number of factors (e.g. legal, fiscal and professional) hamper integration and coordination across child welfare and specialist mental health services. The Acute project removes some of these barriers. However, there is concern about how the collaboration will be affected when/if the abolishment of the professional secrecy ceases. Conclusion: The Acute project tests a form of service integration rarely seen in Norway, by trying to integrate services from the social- and the healthcare sector. If we are to address the complex needs of children and adolescents in need of help from both sectors, measures like the Acute project is highly recommendable.

This thesis explores how standardisation in Norwegian child welfare services (CWS) influences CWS professionals and practices. CWS is a complex field, which has been criticised for poor decision-making and for not putting effective measures into place for families in need. CWS practice is also criticised for not being informed by research. As a response to these criticisms, we have witnessed an increased use of standards and standardisation to ensure effective and accountable services of high quality. Consequently, the use of standardised assessment forms and standardised intervention programmes has been on the rise, in Norway and internationally. This has led to considerable debate concerning the tension between standardisation as a tool of control and professional practice involving discretion. Critical voices have argued that standardisation limits professionals’ discretion and restricts their ability to use specialised abstract knowledge, a key feature of professional work. Much research on standardisation has focused on effects of standardised practices with a top-down approach. Hence, there is a need for research on the ‘ongoing work’ that frontline professionals engage in and how frontline practice is influenced by standardisation, which is the aim of this study. This thesis aims to expand the body of knowledge on how standardisation affects professional practice. This is done by investigating how CWS professionals use two standardised tools commonly used in Norway, namely the Kvello Assessment Framework tool (KF) and Circle of Security - parenting (COS-P). The overall research question is: How do CWS professionals become carriers of standardised practice and how does standardised practice influence the professional role? To answer the research question, a case study design was chosen, the case being standardised practice. The data stem from fieldwork, client documents and interviews with CWS professionals in two child welfare offices. In order to explore how the frontline professionals respond to the standardised tools, the analysis draws on institutional theory and the theory of profession. The body of this thesis consists of three articles. The first article examines how the professionals adapt the two standardised tools into the local practice. Findings are based on observation (45 days), client documents (15) and interviews with 49 participants, including frontline professionals and managers. The findings show that new rules for practice and knowledge emerged, but that the professionals modified the tools for ethical and practical reasons. Consequently, the professionals were active agents through the exercise of discretion. The second article explores how the two standardised tools influence the professional role in relation to CWS work. The analysis is based on interviews with 31 frontline professionals (individual and group interviews). The findings show that the standardised tools enhanced professionals’ competence but also challenged their professional knowledge base, reflective practice and accountability through a more rule-following approach. Moreover, the article points to the potential of doing families injustice. The third article examines how use of the KF influences assessment work in CWS. The data stem from fieldwork, client documents and interviews with 32 CWS professionals, including frontline professionals and managers. While the two first articles focus on both standardised tools, the third article pays particular attention to the KF. Findings revealed that the KF tool led to a proceduralist approach in assessment work, placing demands on focus and activities, as well as interpretative demands upon the professionals. Moreover, lack of transparency in decision-making processes was identified, with a heavy reliance on detecting risk factors. A key question raised in the article is whether the proceduralisation of CWS practice leads to better CWS practices. The thesis expands our knowledge about how standardisation influences professional practice in CWS. By focusing on ‘ongoing work’ performed by the frontline professionals, this thesis provides knowledge on how professionals are also active agents. Although a procedural rule- following approach seemed to dominate among the professionals that took part in this study, some also questioned the standards and took action to alter them with regard to their professional ethos. Moreover, the study contributes knowledge on how standardisation influences professionals’ discretionary space, the knowledge base and the professional role in a CWS practice context. As this thesis shows, standardisation can support CWS practice; however, the use of standardised tools alone will not solve the complexity of CWS work.

This study examined the relationship between initiation of outpatient mental health service use and level of child welfare involvement. Three levels of child welfare involvement were examined: in-home care and no child welfare services beyond an initial investigation, in-home care and additional child welfare services, and placement in out-of-home care (foster care). Longitudinal data were collected for a subsample of children (N=3,592) aged two through 14 years who were enrolled in the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time. Hazard functions revealed a large increase in onset of mental health services immediately after the time of the initial contact with child welfare, varying by level of child welfare involvement and leveling off by three months after the initial contact. The multivariate Cox proportional-hazards model indicated that compared with children who were placed in out-of-home care, those in in-home care who did not receive any further child welfare services were about one-third as likely to use mental health services and those in in-home care who received additional child welfare services were one-half as likely to use mental health services. Other covariates in the model predicted mental health service use, including being older, being Caucasian, having a history of maltreatment (specifically, physical abuse, physical neglect, or abandonment), being uninsured, and need for mental health services, as measured by the Child Behavior Checklist. Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when need for such services is controlled for.

This article focuses on support in transition to adulthood for young people who have been in the child welfare system in Norway. By drawing upon interviews with young people and social workers in child welfare services and social services for adults, we explore differences between the support offered by these two services and how this support is experienced by the young people themselves. The interviews are analysed using the theory of institutional logics as an analytical framework. Institutional logics guide the focus of attention to those who are subject to the logics. The findings are systematised in light of the issues that are given most attention in the social workers’ reasoning about aftercare. The foci of attention in child welfare and social services are compared to the experiences of the young people and how they perceived the support from the two services. We point out the following three dimensions, which seem to capture differences in foci in the services and the young people’s experiences: (1) the extent to which care leavers were recognised as a distinct responsibility; (2) the extent to which the care leavers were perceived as young people or as young adults; and (3) which aim was seen as most relevant – independence or a gradual transition. The findings are discussed in light of legislation and the mandate of the services, thus pointing at different institutional logics.

Child welfare services (CWS) endeavor to protect children and provide respectful investigations and helpful services. This study relies on self-reports by mothers (N = 1,181) who have undergone a CWS investigation and are enrolled in NSCAW III, a nationally representative study of child welfare in the USA. The general linear model analysis examined factors associated with 3 outcomes: engagement with CWS, satisfaction with services, and CWS workers’ responsiveness. Results indicated that CWS workers are commonly leaving parents feeling listened to and understood but not well-served. Including parental engagement and satisfaction measures in routine child welfare practice could help improve service quality.

In many countries, migrants and ethnic minorities express fear of child welfare service (CWS). This is reflected in Norwegian research and media, where fear and mistrust surround the debate on migrants’ relationship with the agency. This thesis explores Norwegian Somalis’ fears of the Norwegian CWS in the context of their situation in Norway and their social world. While the relationship between the Norwegian CWS and several migrant groups is strained, we know little about how fears are constructed and perpetuated within migrant communities. Throughout my dissertation, I emphasise that migrants’ relations to CWS –whether fear factors into it or not – must be understood in light ofprocesses and dynamics far beyond CWS. We must pay attention to tight-knit ethnic communities, social networks, marginalised positions and transnational relations. My inquiry is guided by two core questions: How is the fear of CWS constructed among Norwegian-Somali parents, and how does the fear of CWS impact their everyday lives? These questions were explored through nine months of ethnography, seven months in Oslo and two months in Somalia among returnees from Norway. Fieldwork consisted of, inter alia, observations in cafés and shops, participation in seminars and mosques, participant observation in a transnational school in Somalia, informal conversations, formally organised focus groups and in-depth interviews with parents. The three articles comprising the empirical part of the dissertation cover the following topics. The first article explores how CWS fears among Norwegian-Somali parents are embedded in social networks and transmitted via stories of child removals. This paper provides extensive insight into the construction and perpetuation of fear. The analysis suggests a particular social process underlying Somali parents’ fears, which we coin ABCD, pertaining to (a) their socioeconomic adversities; (b)coping through bonding social capital; (c) children as a “lifeline”;and (d) (disproportionate) diffusion of child removal stories. The results demonstrate the importance of child removal stories that are transmitted through tight-knit social networks as well as why and how these stories spread. Paper 2 is about how second-generation Somali parents portray middle-class identity when interacting with school and kindergarten personnel to avoid racial scrutiny and referrals to CWS. The paper examines how CWS scepticism and fear extend far beyond direct interactions between caseworkers and clients. We show how scepticism and fear influence parents’ encounters with institutions like schools and kindergartens, as these are institutions that have the power and obligation to potentially report to CWS. The third paper addresses Norwegian-Somali returnees’ struggle for a sense of belonging in Norway and their worries regarding their children’s future. It highlights the complexity of being a marginalised migrant in Norway and the consequences thereof. I show that parents utilise temporary return as a tool to strengthen their dual belonging to both Somalia and Norway by reconstituting belonging to both countries through parenting in Somalia. The results reveal that parents cultivate and reproduce Norwegian cultural repertoires when in Somalia in order to maintain a belonging to Norway and to prepare for their future return to Norway, while concurrently encouraging their children to be proud of their Somaliness. In sum, the findings from my thesis imply that Somali parents’ fears of CWS are drawn not only from their perceptions of that single institution but also from their experiences as Somali parents in Norwegian society as a whole. I therefore argue that, if we are to understand CWS fears among migrant parents in general and Somali parents in particular, we must adopt a broader approach that understands parents’ everyday lives and whether and how their experiences relate to socioeconomic marginalisation, racism, coping and networking. I also argue that, to understand CWS fears, we need a bottom-up methodological approach. The in-depth ethnographic account of the Norwegian Somalis’ CWS fears, investigated bottom-up, remains this study’s main contribution.

This state‐of‐the‐art literature review, based on a literature search of multiple scientific bibliographic databases, aims to shed light on what is known about barriers and factors facilitating child participation within the child protection and child welfare services from both children's and social workers' perspectives. The personal relationship between the child and the social worker is mentioned as one of the most important facilitators for participation, although multiple barriers in creating this relationship are demonstrated by both children and case managers and social workers. In studies, children say they should always participate while social workers and case managers identify many situations where, according to them, participation is inappropriate. Professionals' objections to participation mainly stem from the socio‐cultural image of children as vulnerable and in need of adult protection, and a lack of understanding of what participation actually entails. Interventions to strengthen participation should be directed at making social workers and case managers aware that children are knowledgeable social actors.

African American Parents’ experience with early childhood mental health and child welfare services: Racism and seeking understanding

The child welfare service (CWS) in Norway represents a growing field. In 2011 about 52,000 children received help. Families mainly received supportive services in their homes while around 8000 children were taken into the custody of the CWS. Although most actions taken by the CWS are deemed to be supportive and have the consent of the parents, many parents find being assessed by the CWS to be distressing, and there is a widespread feeling that there is a stigma attached to receiving help from the CWS. This article discusses the importance of parents' emotions, and how these emotions can influence their cooperation with the CWS by using the concepts of recognition and trust. The data are based on analyses of 385 interviews with parents in which they describe their emotional encounters with the CWS. The results show that certain emotions can create a barrier between the family's need for assistance and the CWS's actions and initiatives. The article concludes by discussing how the emotional encounter challenges child welfare practice.

BackgroundTo prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS.MethodsA national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern.ResultsOf a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047–3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148–2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190–2.285), P = 0.003) had the highest association with the implementation of measures.ConclusionsPDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Norway is one of the leading countries in the world pertaining to family and Child Welfare Services. While there is no umbrella term for family life education programs in place, there are numerous programs and services offered through the publicly funded health-care service system. The Ministry of Children, Equality, and Social Inclusion oversees family services in Norway (Bufetat, Organisasjon. An underlying agency, the Norwegian Directorate for Children, Youth, and Family Affairs (Bufdir, The Norwegian child welfare services, oversees services pertaining to families and children and is responsible for services relating to child welfare, family counseling, adoption, violence in close relationships, equality, and nondiscrimination. This chapter presents a summary of the child welfare and family programs and services provided by the Norwegian government as part of the public health-care scheme.

Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic.

This book provides social work students at both undergraduate and graduate level with compelling child welfare case examples, intervention plans, and tips for building working alliances with clients. The 50 such case examples, categorized by maltreatment type(s) and by underlying problem(s), each present an intertwined network of issues characterizing the members of a family and their interactions—as in actual field situations. Thus, social work students learning therapy or case management will find a wide variety of scenarios from child welfare services and children/family outpatient care and will learn about the range of challenges clients can face. Using the instruction/practice sheets that illustrate sound approaches for joining with clients to tailor their own interventions, students are provided with the tools to work out the application of assessment and intervention strategies with regard to the particular circumstances of each example. Throughout, the emphasis is on growing the working alliance between social worker and client, reflecting the strength perspective emphasized in social work practice.

The Family Unification Program—a U.S. Department of Housing and Urban Development initiative to facilitate interagency collaboration between the child welfare and public housing service systems—aims to stabilize families at risk for parent–child separation by addressing housing needs. Findings from a randomized controlled trial suggest that families referred to the program experienced lower risk for homelessness and out-of-home placement compared with child welfare services as usual. The findings suggest that housing services offer an effective alternative to foster care.

Kinship care placements are significant for meeting the need for alternative care in child welfare systems worldwide. This qualitative evidence synthesis develops a comprehensive understanding of the role of the Child Welfare Service (CWS) in kinship foster care from the perspectives of kinship caregivers. We reviewed 14 qualitative empirical studies that explore caregivers' perspectives on contact with- and support from the CWS. Our synthesis indicates that most kinship caregivers encounter challenges when interacting with CWS. Three overarching themes were identified: 1) CWS’ role when becoming a kinship carer; 2) common concerns and how these are met by CWS, and 3) expected to manage on their own, afraid to seek help. Findings show that kinship carers often feel unprepared to be caregivers. They face financial constraints, challenges related to their children's needs, and struggles with their own health, all of which can make the responsibilities of caregiving overwhelming. Additionally, many new caregivers fear reprisals from CWS if they seek help and support, so they are left to deal with difficulties on their own. The implications of these findings are discussed.