Follow-up care for adolescents with risk behaviour

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УДК 364-7.6.32

Follow-up care for adolescents with risk behaviour

Miluse Hutyrova

У Чеській Республіці немає системи гарантованої державної допомоги молодим людям, які щойно закінчили вищі навчальні заклади, немає системи, що допомогла б їхньому входженню у доросле життя. Структура університетського життя підлітків ґрунтовно організована, вона включає в себе матеріальне забезпечення та акцентує увагу підлітка на обов'язкове отримання освіти та кар'єрне зростання. Університетська допомога закінчується, коли підлітки досягають віку дорослої людини та отримують диплом, і повна відповідальність за організацію власного життя покладається виключно на молодого спеціаліста. Майбутнє підлітків із серйозними труднощами (соціальні, психічні та фізичні вади) надзвичайно складне (загроза безробіття, залежності, кримінальні нахили). Координація після університетського життя молодих людей є головним завданням Національної стратегії щодо захисту прав дітей. Мета цієї стратегії -- зниження злочинності та патологічної поведінки молоді.

Цілі дослідження: планування та опис різних способів післядипломної допомоги (підтримка програм забезпечення житлом, реабілітаційних центрів, пансіонатів і першого житла); окреслення можливостей, доступних для молодих людей, які закінчили навчання (допомога в працевлаштуванні, догляд за членами сім'ї, незалежне житло), і їхній статус на ринку праці; порівняння даних, отриманих від ВНЗ та закладів громадського обслуговування. Уроботі розглянуто результати досліджень, отриманих за допомогою структурованих інтерв'ю зі співробітниками та клієнтами окремих чеських навчальних закладів -- інтерв'ю з психологами, соціальними працівниками і науковцями з різних установ.

Ключові слова: університетська допомога, інтеграція в суспі-льство, післядипломна допомога.

In the Czech Republic, there is no systematic state-guaranteed care for young people leaving educational facilities for the provision of institutional education which would support their integration into standard adult life.

The pattern of life in educational facilities for the provision of institutional education is structured; the child's material needs are provided for and the staff of the facilities exhibit a strong effort to support completing compulsory education and preparation for future career. Institutional care ends its role when clients come of age and complete their education, and then it becomes their sole responsibility to organise their own lives. The future of clients with major difficulties (personal, social and health-related) is extremely complicated (unemployment, substance abuse, criminal behaviour etc.).

Theoretical basis.

Every year a number of young people leaving educational facilities for the provision of institutional education begin their independent life in the Czech Republic. Some of them may find themselves in another state-governed facility within a few years. Often the fault lies with the whole system of state-guaranteed care for vulnerable children.

Follow-up care is for the most part the domain and focus of non-profit organisations that have already prepared and published materials based on terrain analysis and research. These are focused on reasons for the high number of children being placed in educational facilities for the provision of institutional education and on finding ways to avoid prolonged withdrawal of children from their primary family (amendment of Act No. 359/1999 Coll., valid from 1 January 2013). These organisations also have practical experience with organising project to help young people live a good quality independent life after leaving an institutional facility.

Substitute institutional care for children and adolescents is in the Czech Republic guided by Act No. 109/2002 Coll., updated on 1 January 2013.

Under substitute educational care is meant institutional education, protective education and care for children requiring immediate assistance.

The term institutional education is misleading; it definitely is not a synonym of substitute family care, but a synonym of institutional family care (Skoviera, 2007).

The term institution is used (in German die Institution, in French institution, in Spanish instituto, in Italian instituto, in Russian institut). In the Czech context the term institutional education is used as a primary term for the system of substitute education.

The placement of children into educational facilities for the provision of institutional education is done based on:

* a writ of preliminary injunction (Act no. 99/1963 Coll., Civil Procedure Rules);

* a writ of institutional education (Act no. 94/1963 Coll., about family);

* a write of protective care (Act no. 218/2003 Coll., judiciary act on juvenile matters); from 1 January 2014 placement of children into facilities will be guided by Act no. 89/2012 Coll (Civil Code).

Facilities for the provision of institutional substitute education are divided under the Ministry of Education, Youth and Sports into these categories:

* Diagnostic Institute;

* Children's Home;

* Children's Home and School;

* Institutional Treatment Institute.

Current functioning of the system of care for vulnerable children leads to reflections about its efficiency. Internationally, the Czech Republic is criticised for placing a high number of children into institutional care facilities; in 2010 there were about 7000 children in 220 facilities (14 diagnostic institutions, 151 children's homes, 27 children's homes with schools, 28 corrective institutions). This is ap-proximately 80 placed children for 100 000 inhabitants. (Note: The numbers are approximate.)

Majority of children remain here until entering adulthood; pro-longed placement in facilities for the provision of institutional education has several reasons:

* organs for social and judiciary child protection, courts as well as head managements of facilities where the child has been placed try to keep a relatively satisfactory state of the child's current situation which especially concerns children from socially weak and disorderly family environment;

* the head management of facilities try to motivate children to complete their compulsory education or to prepare for their future careers which seems very unlikely to happen in their own families. (Gjuricova, 2008)

The outcome of the current state as described is a lacking system for early intervention that would allow for effective collaboration with the child and the whole family in the early stages of the problem development. Similarly rare is work with families of children placed in the facilities for institutional education the goal of which should be a quick return of the child back to his or her family setting.

Very often the child placement into institutional care only inter-rupts a socially pathologic development which continues to evolve after the child's departure from the facility or, alternatively, such development begins due to inadequate conditions in the setting where the child goes.

Based on the above-described facts there are substantial efforts to find solutions for this problem in the Czech Republic. A National Strategy for the Protection of Children's Rights was approved (go-vernment resolution no. 4 of 4 January 2012) which implies that by 2018 respective departments will create a working system ensuring the protection of all children's rights and fulfilling their needs.

The Action Plan for the fulfilment of the National Strategy for the Protection of Children's Rights (approved by government resolution no. 258 of 11 April 2012) establishes assignments for years 2012--2015 and its main goal is raising the quality of the system for the protection of children's rights and for the care for vulnerable children.

The aims of research and methodology.

In the research we used qualitative research methods and we think that they conform to the standard of openness in data collection and emphasise the subjective meaning and interpretation.

The goal was to collect a complex and wide description of expert experiences about the problems of children with severe behavioural disorders that are kept in educational facilities for provision of insti-tutional education. The method of structured interview was used. It enables capturing facts as well as a deeper understanding of the mo-tives and attitudes of the respondents.

Altogether 12 respondents participated in the research inquiry in the institutional education facilities. Age, education and further edu-cation, profession and length of practice (total specialised practice) were among the monitored items. 4 facilities were randomly chosen from a total number of 28 corrective institutions.

Research inquiry had these aims:

* to determine and characterise availability and utilisation of fol-low-up care -- half-way houses, aftercare centres, support programs (for example boarding houses, starting houses) -- in educational fa-cilities for the provision of institutional education;

* to specify possibilities of adolescents and young adults on leaving the institution (follow-up care, family, relationship network, leisure activities, housing...) and their application on the job market;

* to describe the staff's views on the follow-up care in the context of four factors of the quality of clients' lives (housing, work, relationships and leisure).

Determination of the problem, formulation of research questions.

The problem is that in the Czech Republic there is no systematic state-guaranteed follow-up care for children leaving educational fa-cilities for the provision of institutional education. This follow-up care would help them in the early assistance phase to facilitate their entry into independent life. During this phase young people struggle with housing problems, orientation at the job market, securing a job and obtaining social contacts and emotional bonds. This problem seemed crucial to us and therefore our attention in the research was focused on it.

As was stated previously the understanding of the meaning of the term follow-up care is not unified. In the research inquiry we wanted to examine how prepared young people leaving institutional facilities are for entering into real life, how they apply themselves on the job market, what are their expectations and actual possibilities as regards to the housing, relationships and leisure time, what do they know about possibilities of follow-up care and whether they even need it and know where to find it.

We also wanted to ask the staff of the institutional education facilities that were able to share their experience and expectations about the possibilities of follow-up care for their clients.

We tried to pose questions within the four formulated areas com-prising housing, work, relationships and leisure time to help us un-derstand the given theme. We examined the theme from the perspec-tives of both the staff and the clients.

We posed additional questions to the staff asking for their opinions on the current transformation of the system of care for vulnerable children in the Czech Republic. This field was not included in the conclusions.

After an analysis of specialised literature and available analyses and research in this field the following research questions were set:

* Are the clients interested in follow-up care after leaving the facilities for provision of institutional education?

* Is it possible to specify the demands of the clients on the quality and the conditions of supported housing?

* Is it possible to prepare the client during the preparation for independent life in facilities for provision of institutional education for this change in corresponding manner?

* Do the expectations of the staff and clients of the facilities for provision of institutional education differ in respective fields of followup care (accommodation, work, relationships, leisure)?

Results and their analysis as viewed by the staff members of the facilities for the provision of institutional education.

Housing

In the first series of questions, we focused on the field of housing, mainly supported housing, after leaving the facilities for provision of institutional education. Respondents expressed their views on the importance of supportive housing, it's length, quality, rules and moni-toring its' obeying. And last but not least on the financial participa-tion of the clients from their total monthly income.

* All of the 12 respondents expressed equally, that the supportive follow-up housing is important for clients leaving a facility for the provision of institutional education.

* As to the length their opinions varied, the interval varied from 6 months to 2 years.

* 10 out of 12 respondents chose from the response choices about quality of housing an individual room or apartment.

* 8 answering respondents stated half-way house and 6 respon-dents preferred the possibility of living with parents or other relatives.

* The respondents agreed on observance of rules in such apartment where all (these 12 responders) insisted on having sanction rules for disobedience of the rule about aggression and violence.

* Inhibition of alcohol and drugs has appeared in 11 cases.

* A staff (in 9 cases) or a client (in 2 cases) should supervise the obedience of the rules according to the respondents.

* Respondents varied in answers on question about the rent, 4 respondents answered accordingly to the salary, 3 respondents specified one third of the salary.

Work.

Questions related to the area of work were focused on the views of respondents from the category of staff members about the orientation of young people leaving facilities for the provision of institutional education at the job market, as well as their opinions on the applicability of education at the job market, the potential choices from the job opportunities in the context of education, state of health and the job market situation. We also asked about willingness of the young people to undertake further education, requalification, travelling for work and their expectations of wages.

* From the total amount of 12 respondents from the category of staff members of the facilities for the provision of institutional education 10 think that their clients know where to look for a job.

* They also think that their clients know what to do on leaving the facility.

* 7 respondents of the total 12 think that the clients are unlikely to have an opportunity to choose a job.

* 7 respondents think that the clients are willing and able to change jobs.

* It is interesting that the respondents emphasise less freedom of their clients.

Relationships.

In the third series of questions we focused on relationships, we were interested in the views of the respondents on the relationships of the clients leaving facilities of institutional education with family members, partners, and also on starting a relationship and long-term partner relationship.

In all these questions of this series we used a scale: yes, likely, unlikely, no, don't know.

* Of the total of 12 respondents from the category of staff mem-bers of the facilities for the provision of institutional education 7 think that clients are unlikely to desire developing relationships with their family members.

* 6 respondents think that clients are unlikely to desire using fol-low-up care for establishing a partner relationship.

* 7 respondents are certain that clients do not plan a long-term partner relationship.

Leisure.

Last series of questions was aimed at views of respondents on the expectations of the clients leaving the facilities for the provision of institutional education of spending leisure time, meaning how they will spend their free time, how they would like to spend it, how much of their day should the free time comprise and what are the biggest problems in spending free time effectively.

* The staff members of the facilities for the provision of institu-tional education answered the question whether the client has an ex-pectation about spending free time after leaving the facility: 10 respondents out of 12 is certain that it is likely.

* Out of total of 12 respondents 4 think that clients are interested in sports.

* They also think that clients are only interested in passive spending of leisure time, or alcohol and drugs.

* As to the length of the leisure time all respondents answered 2--24 hours.

* Majority -- 8 respondents -- state that the biggest obstacle for spending time effectively is boredom, laziness, lack of interest, low motivation.

Discussion.

It was difficult for staff members of educational facilities to formulate answers clearly. They emphasised great variety of individual young people who are leaving the facilities for the provision of institutional education. This variety is manifested in their behaviour, family setting, personal characteristics and motivation for change.

In the responses there was a clear influence of life and work ex-perience, subjective motivation of staff members was accentuated, such as relationship towards a concrete young person or event etc. It could not be overlooked that majority of respondents from the category of staff members of educational facilities were not concerned by the clients' relationships and connected emotions. They were quite sceptic about long-term family, partner or friendly relationships of the clients. A question arises here, how is it possible under the conditions of educational facilities for the provision of institutional education to penetrate into the inner world of the clients. There are many discrepancies, the clients are not in the facilities voluntarily, are taken away from their natural social environment that in most cases showed signs of social pathology, parents were not able to ensure basic care, their relationship bonds were impaired but despite all this in many cases they desire to return to these family settings after completing institutional education.

An analysis of the results shows difficulties in generalising experience and therefore formulating recommendations. It is important to state that this research was aimed at testing the instruments, methods and ways of work. Also, relatively small number of respondents participated.

Conclusion.

It is evident from the research that follow-up care is considered as needed and necessary. In clients leaving educational state-guaranteed facilities for the provision of institutional education the follow-up care is provided unsystematically. Despite all efforts of social workers of these institutions the placement of their clients into adequate facility of follow-up care is not successful. Young people return to their family settings and to the pathologic patterns of behaviour.

Educational facilities for the provision of institutional education in Czech Republic are currently undergoing a transformation which was observed in the research mainly in the uncertainty about future and tendencies towards defence in some staff members.

It cannot go without saying that the Action Plan for the fulfilment of the National Strategy for the Protection of the Children's Rights in the Czech Republic has set assignments for years 2012--2015 and its goal is raising quality of the system of protection of children's rights and caring for vulnerable children. Among the visions of this transformation is ensuring interdisciplinary and interdepartmental collaboration in the system of institutional care and especially in the care for young adults leaving institutional care with the goal of lowering relapse of social pathology and so strengthening follow-up care. Emphasis is first of all being placed on limiting the range of institutional care and developing preventive educational non-institutional care.

In the Czech Republic, there is no systematic state guaranteed care for young people leaving institutional care facilities which would support their integration into standard adult life. For adolescents, institutional life is highly structured, with secured material needs and a strong focus on completing compulsory education and on career orientation. Institutional care ends its role when its clients come of age and complete their education, and then it becomes their sole responsibility to organize their own lives. The future of clients with major difficulties (personal, social and health-related) is extremely complicated (unemployment, substance abuse, criminal behaviours, etc.).

Post-institutional life of young adults is an issue strongly accentuated by the National Strategy for Children's Rights Protection, whose objective is to reduce criminality, recidivism and other pathological behaviours.

The aims of the study included mapping and characterising various possibilities of follow-up care (support housing programmes -- halfway houses, boarding houses and starting houses); specification of possibilities available to young adults upon leaving an institutional care facility (follow-up care, family care, independent housing) and their status on the labour market; comparing data provided by respondents from institutional care facilities and from social service facilities. young behavior adolescent

The present study discusses research results obtained through structured interviews with staff and clients of selected Czech institutional care facilities -- interviews with psychologists, social workers and ethopedists from different institutions.

Literature and sources

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