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Shifting the Balance from Out-of-Home Care to Community Care

1/10/2015

In every society, there are children in families who cannot adequately raise them or, even worse, who expose them to serious risk and harm.  For these children at high risk, various forms of out-of-home care are offered, including residential facilities, foster care, and adoption.  Residential and foster care offer shorter-term solutions, and are combined with efforts to rehabilitate the birth family so as to enable the child to return home.  Adoption provides an alternative permanent home.


Through the 1990s, Israel had very high rates of out-of-home care, and residential care in particular.  Since the early 2000s, the Ministry of Social Affairs and Social Services introduced a major policy shift, with three important goals.  The first was to reduce the need for out-of-home care by investing more in rehabilitating families and in providing more community-based services.  The second was to shift the emphasis from residential to foster care as a way of providing out-of-home care within a family environment.  Third, there were efforts to reduce the period of time that children spend in out-of-home care. 


From the beginning, MJB accompanied these efforts, playing a significant role in the planning and evaluation of these national reforms.


The Towards the Community reform of 2004 set in place an official policy of shifting resources from out-of-home settings to community-based services in order to strengthen the latter.  This, along with the development of the National Program for Children and Youth at Risk in 2008, provided new resources to rehabilitate families and keep more children at home.  At the same time, efforts were made to expand foster care. 


By 2012, MJB research demonstrated that the total number of children in out-of-home care had declined in absolute terms, and much more in percentage terms. The decline was due to a reduction in residential care, although foster care did increase and become a larger proportion of out-of-home care. 


Beyond tracking the development of the different types of out-of-home care, MJB conducted an in-depth study of the foster care system that revealed a number of major issues.  In particular, despite official policy limiting out-of-home placements to four years, the placements remained quite lengthy (seven years, on average).  This was attributed in part to significant deficiencies in the ways that foster care was implemented.      


At the same time, more attention began to be focused on efforts to improve the adoption system.  Adoption, of course, is an important option for limiting the need for and duration of foster care, and for providing a permanent home for the child.


An MJB study examined the emergence of new adoption models such as “fost-adoption,” in which foster parents permanently adopt the child they had been caring for on a temporary basis, and "open adoption," in which the adopted child maintains contact with the birth parents.  The research also highlighted the lack of coordination between the foster care and adoption systems and triggered new policies to deepen cooperation between the two. 


Throughout this period, an additional focus was on improving the decision-making process with respect to out-of-home placements, by developing interdisciplinary frameworks with representatives from the health and education systems, providing families with greater opportunities to be involved and be heard. 

 

In 2014, the Ministry launched a new phase in its efforts to strengthen the entire child protection system for the benefit of families of children at risk.  The Silman Committee for Child Protection issued sweeping recommendations aimed at enhancing the capacity to find a “permanent home for every child.”  A detailed implementation plan was developed, with a number of pilot programs now being introduced. 

 
One program seeks to strengthen families with children in residential care or who are being considered for out-of-home placement, with the goal of enabling them to return to or remain with their parents.  A second program focuses on children who are in or are candidates for foster care.  Here too, the emphasis is on strengthening the birth family’s ability to raise the child at home, and if this does not work out, to explore adoption opportunities.  Further steps were also recommended to strengthen the decision-making processes. 


MJB provided intensive professional support for developing the committee's recommendations and its implementation plan.  The Institute is now conducting a comprehensive evaluation of these efforts.

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