Emergency placement in residential childcare institutions: a systematic scoping review
Mapping review
|Published
We summarised research from 2010-2019 on measures (strategies, approaches, offers, methods, service components etc.) related to residential emergency care placement of children and youth.
Key message
We summarised research from 2010-2019 on measures (strategies, approaches, offers, methods, service components etc.) related to residential emergency care placement of children and youth.
Our systematic scoping review identified six primary studies including approximately 100 participants. We identified five qualitative studies exploring experiences and one mixed method study (i.e. includes both quantitative and qualitative data). All studies examined experiences with different measures related to emergency care placement. Two studies were from Norway, three studies were from Sweden, and one study was from Portugal.
The studies are small and diverse in scope. However, the studies found that many children and youth felt that residential emergency care placements could give them an important break from a difficult family situation. Some children and youth stated that they wanted greater predictability, autonomy, and user involvement – before, during and after an emergency care placement. Some staff and professionals stated that lack of evidence is a barrier for informed decisions related to residential emergency care placements, and they found that coordination of services could be useful.
We found no studies that examined the effect of or correlations of different measures for children and youth being placed in residential emergency care. There are also few studies examining children and youths’ experiences with emergency care placement. There is a need for more research on a variety of aspects related to residential emergency care placement of children and youth.
Summary
Background
Children and youth can be placed in out-of-home care in cases where efforts to meet their needs, concerning both safety and care, are not being met. Out-of-home placement can be voluntary or forced, planned or an emergency care placement. Most out-of-home placements are planned. However, there are situations where children and youth need immediate care because they are in a vulnerable or precarious situation, due to their home- or parental situation, or because the child has serious behavioral problems. In such situations, a residential emergency care placement can be necessary. To minimize the possibility that the residential emergency care placement inflicts further trauma, it is important to examine measures that can make children feel safer, and better prepared to handle their experience with the emergency out-of-home placement, both during- and after it occurs.
The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) commissioned the Norwegian Institute of Public Health to conduct a systematic scoping review of studies examining different measures (strategies, approaches, offers, methods, service components etc.) related to residential emergency care placement of children and youth.
Objective
The aim of this systematic scoping review was to map existing research of different measures (strategies, approaches, offers, methods, service components etc.) related to residential emergency care placement of children and youth.
Method
We conducted a systematic scoping review. To identify relevant studies, a search specialist searched seven international databases in October 2019, including MEDLINE, EMBASE and PsycINFO. We also searched Google and manually screened reference lists of relevant studies. We searched for empirical studies and literature reviews published between 2010-2019 on children and youth age 13-18 years, having experienced residential emergency care placement. We excluded studies assessing emergency care placement in foster homes or in acute, short-term foster homes (“beredskapshjem”). Two researchers independently screened all titles and abstracts from the literature search, and thereafter the full texts, for eligibility according to the inclusion criteria. One researcher extracted data from the studies and a second researcher checked the correctness and completeness of the extracted data. From the included studies we sorted and combined data in text and created tables when relevant.
Results
We included six studies: five qualitative studies about experience and one mixed-method study (i.e. includes both quantitative and qualitative data). The studies were published between 2011-2018. Five of six studies were conducted in Norway and Sweden, and one study in Portugal. In total, the studies included around 100 participants (children/youth and social care professionals). Children and youth were participants in three studies, youth and social care professionals in two studies and social care professionals alone in one study. All the included studies explored experiences with different measures and practices related to residential emergency care placements.
One study also assessed the prevalence of different characteristics of children in care and the emergency childcare institution. However, all of the included studies had a different focus: procedures before an emergency removal, youth’s user involvement in emergency care placement, youth’s experiences in emergency care placement including their experiences with social care, an emergency placement framework, and the coordination of services in residential emergency care placement.
The studies’ findings suggest that many of the young people interviewed felt that emergency care placements could provide them with a break from a difficult family situation. Most children and youth discussed their wish for greater predictability, autonomy, and user involvement – before, during and after an emergency care placement. They also talked about wanting trusting relationships with staff, case managers/social workers. Many staff and other professionals felt that the lack of evidence was a barrier for informed decisions related to residential emergency care placements, and they found that coordination of services was useful. Some staff highlighted successful collaboration with parents and other services, enough staff and sufficient education of staff, clear guidelines and procedures which they felt made emergency care placements more efficient.
Discussion
There is limited research (published 2010-2019) on residential emergency care placement of children and youth, yet the findings presented in the six studies that we identified offer some preliminary insights on what children/youth and social care professionals may find important. Many youth and social care professionals highlighted a lack of care services and follow-up after placement in residential emergency care as something they felt was problematic. Some participants described that in their experience child protective service and emergency care institutions mainly focus on removing the child from a difficult situation, whereby the institution becomes a temporary shelter where care needs are insufficiently met.
Some of the study findings indicated a degree of distrust, cultural misunderstanding and conflict between child protective services and the child's family. It is possible that suspicions and mistrust may impact how accepting children/youth and their families are to help during the residential placement and how valuable they perceive the emergency residential care placement.
The results indicate that youth and social work professionals describe their experiences of residential emergency care differently. Youth mainly reported on their experiences regarding out-of-home placement, the care they received in the institution and lack of follow up by the child welfare services. Social work professionals, on the other hand, mainly focused on problems with the conditions surrounding emergency care placements. It seems some of the included studies’ results suggest improvements in several aspects of emergency care placements, such as collaboration, individualized care, clear guidelines and user involvement.
Research on residential emergency care placement of children and youth is limited. We found no studies that examined the effect of, or correlations related to different measures for children and youth in residential emergency care placement. There are also few studies examining children and youths’ experiences with emergency care placement. However, most studies on residential emergency care placement are from Scandinavia (Norway and Sweden), and the findings and themes presented in this scoping review are therefore highly relevant to a Norwegian context.
Conclusion
The aim of this systematic scoping review was to gain an overview of the research evidence on different measures (strategies, approaches, offers, methods, service components etc.) related to residential emergency care placement of children and youth. We found that research on this topic is scare. Overall, the findings from the six included studies suggest that residential emergency care placements can give children and youth an important break from a difficult family situation; lack of evidence can be a barrier for informed, evidence-based decisions in emergency placements; social welfare professionals can find service integration useful.
Finally, it seems children and youth want more predictability, autonomy, and user involvement – before, during and after an emergency care placement. However, it is important to keep in mind that there are few included studies, with few participants, and we have not conducted a full systematic review: we have not assessed methodological quality, synthesized the results or assessed the certainty of the evidence. Cautious interpretations of study results are therefore advised.
