Foster care for adolescents with complex needs in Sweden

CYP Now has teamed up with the Churchill Fellowship to publish a series of articles summarising key findings from studies undertaken worldwide by Churchill Fellows (see below). This is an abridged version of Caring For All: A Comparative Study of Foster Care for Adolescents with “Complex Needs” by Laurelle Brown (2020), principal consultant at KIJIJI. At the time of her trip, Brown was working at Barnet Council.

POLICY AND PRACTICE

It is widely agreed that the UK is experiencing a crisis in relation to foster care provision, with demand for carers exceeding the number available (The Fostering Network, 2019). In the London Borough of Barnet, the rate of increase in the numbers of children in care outpaced that of new foster carers being recruited. This, in addition to more carers being unable or unwilling to care for adolescents, resulted in the authority struggling to find families for young people.

My motivation to undertake this Fellowship grew amid national fostering research which I felt focused too heavily on the collation of data and insight from just England instead of gathering insight from further afield too.

In Barnet, children living with foster carers achieved better outcomes, such as educational attainment, than those living in other accommodation. However, higher rates of placement breakdown were experienced by foster placements with adolescents than any other age group. In Barnet, most children in care were aged 16 to 18.

The need for more resilient carers, willing, motivated and able to care for adolescents and manage behaviour symptomatic of trauma or attachment issues, and ongoing exploitation was paramount. This Fellowship was therefore born out of the need to source and retain more foster carers for adolescents with “complex needs” in Barnet and nationally.

Picture: Laurelle Brown, right, with ‘T’ and Ingalill Kä llstrand while visiting Stockholm

THE TRIP PARAMETERS

I chose to travel to Sweden, France and Germany where their child protection systems are developed to the extent that would enable comparison, their children in care demographic are similar to Barnet’s (where the majority are in foster care), and it is widely held that these countries are better at working with birth parents of young people with complex needs.

I sought to gather insight on foster carer recruitment strategies and processes being used to increase foster carer numbers; understand how carers were being trained and upskilled to support adolescents with “complex needs” and identify good practice the UK can learn from.

This article focuses on the findings from Sweden because these have the clearest link to UK practice, however, there are lessons that can be taken from all the countries visited.

THE ROLE OF BIRTH FAMILIES

In Sweden, birth families play a central role in care planning and contributing to foster placement decision making. Ingälill Ka Illstrand of fostering team Brömma Stad Sweden explained that in Stockholm, when matching a young person with a prospective carer, both the young person and biological parents are interviewed about their preferences. Based on their feedback, matches are shortlisted, and a placement made.

Agneta Ohman, of the central placements team, Stockholm, explained that as much as possible, biological parents are also involved in the matching process, to help the team establish the child’s needs. Ohman highlighted the importance of birth parents being happy with a placement, as the impact of their negative views being projected onto the child can destabilise a placement. It is only after positive feedback from the birth family that a prospective foster carer will go on to meet the child to explore suitability and begin to develop a rapport.

“If the parents say ‘no’, then we can’t make the placement,” she said. It was shocking to hear that parents who cannot care for their child any longer are able to cause their child to potentially miss out on suitable carers and a safe and caring environment.

A clear theme from European practice was the high level of support provided to birth families, especially to aid reunification. Investment in social workers to support families to make necessary changes to enable reunification is prioritised, and the child’s care plan centres around checkpoints for reunification. Professor Marie Sallnäs, from Stockholm University, explained that Sweden operates a parental right and support model; the whole system is mobilised to support parents. This is prioritised irrespective of the wishes of the child. For example, the Swedish system demands that contact is maintained with families, despite research showing that this is not always wanted by children.

RECRUITMENT

In Sweden, foster carer recruitment is managed by a national board. Expressions of interest are passed onto the local placement teams that manage recruitment. This approach reduces the challenges we experience in England such as councils competing for carers and paying different rates to attract them. It also means that there is a bigger geographical area to place across which could lead to economies of scale.

The Swedish National Board is also responsible for advertising, and they recommend payment amounts, which ensures a degree of consistency between municipalities, thus eliminating a further element of competition. Some municipalities implement their own payment structure, however, and one foster carer told me that private companies offer the best remuneration and support packages for carers. This echoes feedback I have received from foster carers in England, who feel better supported by independent fostering agencies (IFAs).

In Gothenburg, there is a new unit that all placement requests go through for matching, whether an IFA or local authority team. However, Ana Forum, fostering manager at Gothenburg Council, explained that the tender process for this framework meant that “a lot of low-priced private companies were awarded priority, but they aren’t very good”. Forum explained that private companies have sourced families that the municipality cannot approve because they do not meet the expected standards.

There is a small specialist recruitment team in Stockholm that host information days/evenings for prospective carers and carry out initial assessments of families. They also decide what type of carer the applicant(s) should be, for example, an emergency carer or long-term carer. The team provides this for all 14 municipalities in the city.

FOSTER CARER SUPPORT

Foster carers having access to staff, peers, training, supervision, respite and remuneration that reflects their hard work were the six key areas that were highlighted across all interviews, as instrumental in supporting placement stability. Professor Ingrid Heojer from Gothenburg University said most foster carers appreciated the opportunity to meet and talk with each other. She suggested that creating a network of foster carers is a good way of achieving this. “It can make a real difference and keep the foster carers you have,” she said. “You don’t need a lot of money to do this, what you need is trust and goodwill from managers to allow you to do creative things.”

Marie Sallnäs highlighted that foster carers say that the IFAs provide counselling, the staff can be reached around the clock and additional support is provided.

Similarly, Forum reiterated that simply streamlining support so there are not so many meetings for carers, can make all the difference. In addition, providing one-to-one support for carers, such as from a psychologist or educator, is an effective way to meet their needs.

A further example of support was the investment in evidence-based programmes, such as Treatment Foster Care Oregon, for foster carers of children with a high level of need.

PRACTICE IMPLICATIONS

Fostering services should avoid the ease and familiarity of delivering well intentioned, “one size fits all” placement strategies, without genuine consideration of, and being informed by, the needs, identity, interests, capabilities, and potential of the individual young people.

Social care leaders should prioritise birth families’ voices in decision making and provide greater levels of support for foster carers of their children as standard.

Developing market responsive commissioning and frameworks to deliver the most effective business models across local authorities and IFAs will also help to address sufficiency challenges, as well as help ease financial pressures of councils.

After returning from my Fellowship, I refreshed Barnet’s Placement Sufficiency Strategy, and included commitments to offer a more diverse range of placements for adolescents with complex needs, including foster carers. The document was specifically named in a 2019 Ofsted inspection report where we were rated “good”; an improvement from “inadequate” two years before.

Moving forward, I will be supporting foster carers as co-founder and director of KIJIJI, a membership organisation that seeks to empower black safeguarding professionals, including foster carers, through representation, networking, learning and development.

• Caring For All: A Comparative Study of Foster Care for Adolescents with “Complex Needs” by Laurelle Brown from https://tinyurl.com/ygp6pa7r
  

ABOUT THE CHURCHILL FELLOWSHIP

The Churchill Fellowship is a national network of 3,800 inspiring individuals whose mission is to find the world’s best solutions for the UK’s current challenges.

Up to 150 Churchill Fellows are funded each year to visit the world’s leading practitioners and projects on a topic of their choice – from social policy to healthcare to education and more – and bring back new ideas for their communities and sectors across the UK.

Any UK adult citizen can apply, regardless of qualifications, background or age. Fellows are chosen for their potential as change-makers, not their past track record or status.

• Find out about fellows and their ideas at www.wcmt.org.uk.