In the middle of December 2015, representatives from the Ministry of Social Affairs of Estonia, and of the Social Insurance Board, visited Icelandic child protection institutions in order to learn from their success-stories as well as their mistakes, and to consider about the possibilities to use some of their experiences in Estonia. Participants: Eve Liblik, Kaisa Orunuk, Marko Truu, Maie Puusepp, Tiina Merkuljeva and Lianne Teder from the Social Insurance Board, and Pille Soome from the Ministry of Social Affairs. In order to give an overview of the visit and discussed topics, the current article has been set in a chronological sequence.
The Child Protection Agency of the State (the first day of the visit).
At first the general system of child protection was introduced in the agency of child protection with emphasis on the role of the local committees and of the agency of the state – how to monitor, to create competences, to organize stepparenting and special services. More information about the child protection system of Iceland can be found (in English) at http://www.bvs.is/media/barnahus/child-protection-in-iceland-and-the-role-of-the-GACP.pdf. In Iceland, the system of child protection was reconstructed in the first half of the 1990ies. In 1991, there were 210 local governments in Iceland but the population is some of them was about 50 people (including 5 children), only. Despite of that a child protection commission functioned in every local community. According to the new law from 1995, one region of child protection was established for, at least, 1500 people. Therefore, there are 77 local governments in Iceland, but only 27 regions of child protection. If there is a problematic situation with a child in a region, one will turn to the local regional child protection commission. After a new system was established (in 1995), they also started to create a database, which helps both to discover and to solve the problems. Now it is also possible to compare the situation of the country with international data. However, the truth is that other countries do not have so much information, yet. Norway, for example, started to collect this kind of data some years ago, and now one can compare results with Iceland. The situation of those two countries is, generally speaking, similar.
The main aim of the child protection is to help parents to support their own children
The main aim of the national child protection agency is to support the local level, and here we can establish nine important roles. Monitoring. The agency checks the local child protection agencies – how they fulfil their duties according to the law. It includes collecting data from the local commissions through the form of a regular annual report (like a questionnaire), to analyse the number of cases and implementation of the legal regulations. A shorter and simpler report about the number and type of cases as well as persons who were involved in writing this document is compiled on monthly basis. Co-ordinating the process. The national agency compiles an action plan for five years and local commissions for four years, which has to be presented to the agency. Plans of local levels are quite similar, and they are based on the analyses of data. Arrangement of special services on the national level. Local commissions can apply governmental services, including step-parenting. Process of complaints in the context of procedural activities of the regional commissions. There is a special questionnaire at the web site and the agency must answer to the person in two months. The answer is based on the investigation of this case. The agency does not dictate to the commission anything, but gives suggestion for acting in stead. There are about 50 complaints every year. Keeping the list of families willing to adopt a child, and preparing those families. Sometimes the agency organizes campaigns to find more step parents. The agency checks the background of persons, offers the PRIDE-course, and gives an info packet on stepparenting. According to the law, no exceptions are made when sending a child to the relatives – emotional bonds of the child are always very important. Creating standards, directions, and suggestions to support the child protection on a local level. The agency created an online manual with detailed information about how to act in specific situations. It includes regulations, law, examples of cases, and a list of activities, which has to be done before the child-protections-officer decides to move the child out of the family. Those standards are mostly for guidance, not compulsory. In order to evaluate the issue of children at risk, a licensed Ester-evaluation model (created in Sweden) has been used (http://www.ester-bedomning.se/). Educating. The agency rises the competencies of members of the local commissions consistently: courses and conferences in different areas are organised regularly and participation is possible also through the web. It is important to make use of the international experience and examples. In order to succeed, a multi-disciplinary environment has to be created – it means an environment with specialists (of different areas) working together: especially who deal with children (teachers, police, etc.). As new people are entering into the field consistently, the base-education is offered for new specialists permanently. In this context, the website is very important, because through this both professionals and clients can get the necessary information. Organizing the national services. In Iceland, there is a special treatment centre where children can be sent in acute cases. Protection of interests in special areas. Some story about the child protection area can be found in the media every week. On the public level, it is possible to talk without names, to offer the generalised information to the media. In local communities, the services of child protection are often integrated with other social services (in the same office). In bigger places such as Reykjavik, the child protection office situates separately. On the local level, rendering of services of child protection must fit into official regulations of local government. Therefore, they are often connected with other areas like education, labour market, etc. There is an obligation for all people, especially for those who work with children (doctors, teachers, etc.) to inform the regional commission about children at risk. If one does not share this important information, the potential stipulated punishment according to the law is up to 2 years in prison. In practice, this has not been the case yet. There have been some sad cases in Iceland, when a child died – after that the detailed investigation followed to find out the weakest link in child protection. Usually, mistakes can be found within the system. The main way of working on child protection is a partnership between a commission, parents, and different institutions. If the case will go to the court, two specialists from ‘children’s area’ (like a social pedagogue, psychologist) are appointed next the judge, additionally. For example, if there is a case of the local child protection commission who wants to separate the child from the family (the reason, for example, might be a parent who interrupted the obligatory treatment of alcoholism). In 2 months, then (after the problem appeared), the further activities will be decided. In Iceland, there are many treatment-centres for people with alcohol problems, and the local level commissions can order this kind of service from the national level. Realizing the right to complaint is the fundamental issue of a democratic system in the context of valuing human rights. Therefore, there are three ways to file a complaint in Iceland: • If the local child protection commission has made a procedural mistake, one can complain to the national agency (about 50 cases in a year). • In the context of parental rights about 10 cases in a year go to the court. • Problems in the context of child protection (about 30 to 50 cases per year) will go to the commission of appellation (which is a sub-system of ministry). In Iceland, there are about 80,000 children, from whom child protection officers meet with (about) 5,000 in a year. Cases of abuse can be shared into four categories: 1. Neglecting (bad behaviour of parents). 2. Abuse (parents, for example, use physical punishment). 3. Risky behaviour of the child. Often parents are looking for help; but mostly police want to solve the problem, because 15 to 18 year old youngsters are eligible in terms of criminal liability, by law. 4. Pregnancy-risks (bad behaviour of a mother-to-be): about 15 such cases every year. If needed, there is a special institution in Iceland for pregnant women, but problems usually don’t go so far very often. Mostly the awareness raising and practical help are effective enough. One of the problems in Iceland is the lack of people: not enough professionals on a local level. The (ideal) solution would be a mobile team, who in special cases goes to solve the problem where needed. For example, there was a case when the father of a big family (of 5 children) committed suicide, the mother made an attempt of suicide (she was psychologically ill). The distance counselling is mostly offered by phone. In addition, regions support each other, in practice, too. Work descriptions of local commission must include (directly and clearly) the main information: what the commission can do, and what the commission can not do. To turn to a local commission is like a cry for help (for dealing with the child), so – this cannot be considered as a police matter, where law and guilt are central concepts. There are meetings with partners (police, school, preschool institutions) in the regions, where specialists share the information about the current situation in child protection area.
The national agency of child protection (the 2nd day)
Halldor Hauksson’s presentation gave an overview about institutional activities of foster care and interventions. Til 2002, there were 9 institutions specialised on intervention in Iceland, but at the moment only 3 are still working. The average duration of this service has dropped from 16 months to 7 months, recently. From the Estonians’ point of view, those institutions are something between special schools and foster care. This is a short time service of custody and treatment, where the child is removed (for up to 2 years) from the original family. In case of successful intervention, the child can return to home. Actually, removing from home is a last option, used only after other possibilities are tested. In 2008, they started with MST-interventions, which helps the child and family to cope with difficulties. This method is meant for the whole family: every member must co-operate to find resources and joint values in the family. The aim is to create positive behavioural changes of the child, and to improve his or her social skills. The main target is to work together, to keep the child still in his/her own family, and to avoid interventions that are more serious in the future. This kind of system is similar to our MDFT-method. About 80% of clients are from Reykjavik and its’ region. Altogether, there are about 350-360 children in foster care in Iceland, from whom 200 in long-term, 130 in short-term service, and 25 children are under supported care. There is an idea to apply the MST and foster care service simultaneously. And/or to apply any sub-versions of MST.
The department of the MST
Our group also managed to participate in the supervision of the MST-team, where through the Skype a supervisor from Norway was on-line. The MST-team gave an overview of interventions, then they discussed management of cases and future steps.
This is kind of short intervention: a child is removed from the original family and place at an institution, where professionals are working intensively with him or her. Interventions are used to avoid criminal behaviour, violence and abuse of drugs. The institution holds places for 6 children, the duration of service is (generally) 8 weeks. If the result (after this time) is not good enough, the further plans will be made. In this institution, there also is a department for acute cases (5 places). For example, if the child is in danger or because of the behaviour of the child other citizens might be in danger. Drugs can cause situations like this, for example. In this acute department, one can stay till 14 days. The MST-intervention has decreased the need for this institution, significantly. Nowadays they also discuss about allocation of children with special needs in Iceland – do they need a special placement (like children with behaviour problems) or not.
The children-centre Barnahus, department of child protection in Reykjavik
Barnahus The 3rd day of our visit started at Barnhaus’ children-centre, where, at first, we met Thorbjörg Sveinsdottir (the interviewer). The main aim of Barnahus is to involve different institutions to discover cases of child-abuse, and to create the best possible environment for interviewing victims of sexual abuse. If there is any probability of sexual attack, the judge, police, and child protection officers will be involved in the interview (to avoid additional interviews and any extra traumatic experience). It is important to stress that during the interview no specialists are in the same room with the child – they observe the situation through the video camera in next room. The activities of Barnahus are: • To collect evidences for the court. • To conduct exploratory interviews. • Medical examination to discover sexual abuse. • Treatment and therapy. • Multi-professional courses and consultations to inform other specialists about abuse. There are about 300 children every year in Barnahus as clients. Many interviews are about sexual plays of children – so, they cannot always be considered as abuse. The duty of specialists is to find out about abusive cases and those that do not classify as abuse. In schools of Iceland, preventive programs are popular – mostly in the form of movies appropriate regarding the age. During the trip, we also visited the Barnahus’ house, which is located in a quiet area of private houses. For people from outside (mostly children), the entrance has made as safe as possible. The building is like any other house (does not look like an official institution). Rooms inside are well planned and equipped child friendly. In Barnahus, there are nine people working including the manager, interviewers, therapists, and a secretary.
The evidence based program of parenting PMTO
In Iceland, the evidence based parenting program is applied under the title of Parent Management Training-Oregon Model (or shortly PMTO). The aim of this program is to educate and to support parents of children with special needs, and parents of aggressive children. This is the kind of community-based method, which has been used in Iceland since 2000. The Icelandic PMTO team has two aims: • Clinical work with clients. • Training of specialists in the context of PMTO. The psychologists, social workers and doctors are educated to work as PMTO-therapists. Additionally, the translation of manuals and adapting them regarding the local cultural context is an important activity, too. Participants of the program are usually parents (of 3-12 year old children). During the program, parents get individual and group therapy: the main method is role-play. With the PMTO team, 7 therapists work as educators and coaches, and 50 therapists all over the country participate in this programme. Also, 380 other specialists with the additional PMTO education all over Iceland – they mostly work as social workers, at schools, etc. Still, the service is not sufficiently available all over the country. During our meeting, we also got a small therapy demo.
The child protection department of the city government of Reykjavik
The capital city of Reykjavik with 120,000 inhabitants is the biggest local government of Iceland. We were introduced to the management of child protection work at local level. The work consists of three steps: • The registration of a case, which is directed to a team that investigates the case in order to find out all the details and background. • The whole material goes to the therapy team, who will work out an intervention program. Then the exact plan will be worked out, where the duties of participants are fixed. • If the plan of therapy does not work well, the case will be redirected to the team of foster care. The main points of the announcement about a child in need are: • Information from specialists cannot be anonymous. • Ordinary people are allowed to share the information anonymously. To solve the cases, notification meetings are organized regularly – both parents and specialists from different areas are involved (sometimes also the child is invited). The duration of one meeting is 1.5 hours, during this the best solutions are looked after. The focus of child protection (on the level of local government) is to support the child in his or her own living environment. This is the reason why therapy of children and parents has been stressed so much.
The child protection service of Arborg city government
Arborg is the biggest local government of Southern Iceland, with 8000 inhabitants (including 2120 children). Three social workers deal with peoples’ problems from the birth until the end of life. In addition, one part-time (60%) worker is involved to help people to cope at home. Every year about 180-200 cases of child protection area must be dealt with. Small communities usually have both good and bad sides. People know each other, which makes the confidentiality extremely important. On the other side, knowing everybody helps to solve problems faster. The staff of city government is pleased with the co-operation with the national agency of child protection, especially in the field of counselling and education. However, there also are some areas to improve: the counselling organisation should not fulfil the supervisory role. In addition, sometimes the rules of procedures make the process slower. Most intervention services are available in Reykjavik, but in smaller places, it is quite difficult and expensive to develop the complete system. However, the ART-intervention program is available everywhere. The presenter of the local police department explained the process of solving the problem of violence in the family. They started with this about 3 years ago. According to this program, in the context of violent cases the co-operation between police, procurator, child protectors, and social worker is intensive. After getting a phone call, the police with social worker go to the place where the incident happened. All details and background of evidence will be found out, and during the 24 hours, the plan for future interventions is ready. For people involved in this conflict, police will prescript the lawyers without charge. In about 50% of cases, one or both sides of the conflict are immigrants, and a translator is needed. If the family (so far) did not have this kind of problems, and the case is not very serious, the police has right to decide not to open the criminal file. Then the aggressor has to undergo an obligatory anger therapy. All families, where home violence has happened, will stay under observation. They get support to avoid further problems. Police officers learn in courses how to behave in the middle of conflicts. They must be able to evaluate the seriousness of every situation, to know exactly how to cope with problems, and they must fulfil all procedural rules correctly. In the near future, the network will be created to meet every month with police, doctors, social workers, and child protectors in order to deepen the co-operation between different specialists. The aim of this kind of activity is to improve co-operation and solve cases as fast as possible.
Lessons. Kaisa Orunuk, social insurance board
In my opinion, the experience of Iceland proves the importance of collecting statistics and using evidence based practice – only then it is possible to succeed quite fast. For example, the message of one of the researches was that the information about sexually abused children is not openly shared with institutions, which is why a small amount of cases reaches to the court. From this fact the establishment of Barnahus’s interview-centre started, which has been an extremely successful institution, so that people from all over the world come to visit it. After the introduction of evidence based programs (parenting program PMTO, programs for youth with serious behaviour problem MST, etc.), there is not much need for placing children to so called ‘after-institutions’, and many institutions are already closed. Which means the successful prevention: families are supported more and better, children are less damaged, and the process is cheaper. As a background of this success-story of Iceland is a clear vision and a visionary: everywhere the name of Brag was mentioned. He created relations and directed activities to develop this area. Many years he has been the creator of success on the child protection field in Iceland.
The differences between Estonia and Iceland
Our developments are on different levels. For example, we are only making first steps in Estonia to start with evidence-based interventions (parenting programs Wonderful Years, multidimensional-family-therapy MDFT, etc.), whereas in Iceland those programs have been successfully implemented for many years already. In Iceland there also is a strong and well established central co-ordination system of child protection, whereas we will start with it only in 2016. Moreover, the work in Barnhaus’ must be mentioned, which is kind of the ideal model for many countries, including Estonia. Luckily, Iceland shares their experiences in the field of establishing national child protection co-ordination system, and of evidence based intervention programs. The study visit took place under the pre-determined project “Support System Development for Children and Youth at Risk”. The project beneﬁts from grant through the EEA Grants Programme “Children and Youth in Risk”. Programme is managed jointly by the Estonian Ministry of Education and Research, the Estonian Ministry of Justice, the Estonian Ministry of Social Affairs and by the Estonian Youth Work Centre as a Programme Operator Implementing Agency.