Last week, in a discussion with global experts on alternative care and care reform, I became increasingly alarmed. The discussion was about the need to have clear definitions and standards to ensure that everyone knows what is meant and expected. I have no argument with that. However, the way the discussion went, implied that once definitions and standards would be agreed upon, this would provide not just a useful framework, but something like a formula or a clear step-by-step guide. With the further implication that if this formula or guide is followed this would automatically lead to good outcomes. That is what I have major issues with.
To even suggest that it might be possible to provide a formula or a step-by-step ‘manual’ that is applicable to all situations and all children and will inevitably lead to success is not just misleading, it could be dangerous and cause a lot of harm. Transition of care and determining the best interests of an individual child are extremely complex processes. Effective and supportive decision-making around them is entirely dependent on the local and individual situation. There is no one-size-fits-all approach or instruction that can be followed to ensure good outcomes in all cases. As much as we would all like for that to be possible. And as much as people on the ground who are starting to learn about and implement principles of transition from institutional to family-based care are pleading for and demanding something like that.
There is a lot that can be provided. There are universal principles and psychosocial needs that should be taken into consideration, there are promising practices and pitfalls that have been proven to often be relevant so they should be taken into account, and there are minimum standards that need to be upheld to ensure safety and good enough practice. In addition to this, through training and experience people develop an understanding and skills that enable them to determine what would be the best, safest, and most effective approach in a given situation. This means a lot of knowledge, skills and guidance can be provided. But not a failsafe formula.
How transition of care should be approached depends on the country and local context. The strengths and requirements of laws, policy and culture should be taken into consideration and used to their best advantage, as well as addressing any gaps that are identified. The structures and facilities that are already there should be used to their best advantage. And adjustments need to be made within the cultural and religious context to ensure buy-in, relevance, and sustainability.
When determining the best interests of an individual child, the circumstances – including background, family, community, psychosocial situation, trauma history, support available, stigma etc – of this particular child need to be evaluated and taken into account. Again, identifying strengths to build on and ways to provide support in areas where this is needed. This usually involves finding a balance between different, possibly conflicting needs, rights and risks. The consequence is that what is in the best interest of one child may not be in the best interest of another child. It is a judgement call.
There is a need to be very aware and transparent about the limitations to how much guidance can achieve. As well as about the danger of being swept along by anyone who claims to be able to provide a failsafe formula. The claim to be able to do so indicates that the person does not recognise the full complexity of the subject. We have to be able to acknowledge and resign to the fact that within the framework that can be provided a lot of insight and initiative are needed to ensure that the right decisions are made for the situation at hand.
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