Children and youths’ involvement in child welfare services: a systematic mapping review

Background and objective

According to the Child Welfare Act § 1-6, all children who are able to form their own views have the right to be involved in all matters affecting them. The child shall receive adequate and adapted information, has the right to freely express his or her views and to be listened to. The child's views shall be given due weight in accordance with the child's age and maturity.

The Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) leads the activities of the Office for Children, Youth and Family Affairs (the governmental child welfare services), and is also a professional body for both state and municipal child welfare services. The Directorate is working to prepare recommendations on children and young people's user involvement in measures within the child welfare services, and therefore wished to receive an overview of the current evidence on user involvement within this context. Bufdir commissioned the Norwegian Institute of Public Health to map out research that has examined 1) how children and young people are involved, 2) children and young people's experiences of and preferences for involvement, 3) dilemmas related to their involvement, and 4) the effect of involvement. In addition, we agreed with Bufdir, that if stated in the included studies, we would also extract data on how children's views are weighted against other considerations.

Method

We performed a systematic mapping review in accordance with international standards. We used the methodological framework described by Arksey and O’Malley (2005). We included evidence syntheses (systematic and non-systematic) and empirical primary studies published in 2000-2020, conducted in one of the Nordic countries, Ireland, the United Kingdom, the Netherlands, or Belgium. We performed a systematic search for studies in selected, relevant databases and sources. References that two researchers independently considered to meet the inclusion criteria, were obtained in full-text. Each full-text publication was evaluated by one researcher. Any uncertainties related to inclusion were resolved through discussion with another researcher. Due to the high number of included studies, we decided to separate out some of the studies. These less relevant studies were placed in an appendix. We extracted data from all other relevant studies. Data extraction and assessment of studies’ methodological quality was performed by one researcher, and checked by another. We categorized and summarized information from the studies.

Results

We identified 100 relevant publications. We extracted data from 77 studies (83 publications). 17 publications were separated out and listed in an appendix. 38% of the 77 included studies were from the United Kingdom, 21% from Norway and 14% from Sweden. We also included studies from Belgium, Denmark, Finland, Ireland, Iceland and the Netherlands. Most of the studies were qualitative studies (77%). We also included one systematic review and three non-systematic reviews, one case-control study, five cross-sectional studies, and eight mixed-methods studies (included both qualitative and quantitative data). 41% of the studies were assessed to have high methodological quality, 46% medium quality, and 13% low quality. Many of the included studies answered two or more of our four research questions.

In total, approximately 4700 participants were included in the identified primary studies (in addition, there were many participants in the four literature reviews). The study participants were mainly children and young people (approximately 3240 children/ young people), but there were also 24 studies, with approximately 1460 adults, in which professionals participated (including employees in the child welfare services, children’s rights workers, advocates, inspectors).

How are children and young people involved in child welfare services (question 1)

For question 1, we included 52 studies (56 publications). In 33 of the 52 included studies, specific measures or interventions to promote children's participation were described. These were: review meetings, advocacy services/use of advocates, panelists, family group conferences, specific models/frameworks (e.g. toolbox, user councils, the Klemetsrud model), complaints schemes, and practice development projects. 19 studies described different situations/settings within the child welfare services or the child care cases where children were involved, and how they were involved. These included foster homes, child welfare institutions, court hearings/court proceedings, care placements, aftercare, and contact/visiting arrangements. One study examined the documentation of children's participation in child welfare reports.

Children and young people's experiences of involvement (question 2)

For question 2, we included 55 studies (58 publications). Five of the studies examined children and young people's experiences of using advocates in meetings between children and child welfare services. The study authors reported on participants' varying experiences, views and knowledge of advocates. Six studies looked at children and young people's experiences of participating in meetings with child welfare services. The authors discussed the structure of the meetings, the roles of the participants in the meetings, the relationship between children and young people and child welfare staff, and their experiences of participating in meetings. 39 studies looked at children and young people's experiences of user involvement in different stages of child welfare cases and/or different child welfare services. The authors presented findings related to their experiences with participating and being heard, how the meetings were experienced and the relationship between children and young people and the adults. Four studies examined children and young people's experiences of family group conferences, one study experiences of user councils, and another study experiences of the model «Barns behov i sentrum (BBIC)» (Children’s needs in focus). Some of the studies examined children and young people's experiences of several measures.

Dilemmas related to children and young people’s involvement (question 3)

For question 3, we included 22 studies (25 publications). 18 of these addressed barriers to children's involvement. Many of these studies discussed various forms of organizational barriers, such as organizational structure, high work pressure, and inadequate training of employees. Other studies discussed how children's prerequisites and needs (e.g. child's age, maturity, or the seriousness of the case) and/or employees' assessments of these aspects can stand in the way of children's involvement. Nine studies presented data that we categorized as dilemmas with children's involvement. Several of these studies show that employees are worried about participation leading to negative consequences for children, and that the need to protect children can make involvement difficult. Two studies that dealt with factors that can facilitate children's involvement, thematized the relationship between children and adults in different ways. One study discussed the importance of good and safe relationships between children and employees in the child welfare services. In several cases, there was an overlap in data for these different topics (barriers, dilemmas, facilitators), as well as for ‘weighting against other considerations’.

Effect of involvement (question 4)

For question 4, we included 5 studies (5 publications). However, only one of the studies had the explicit goal of investigating the effect of user involvement. This was a non-systematic review that examined the effect of children and young people's involvement on health outcomes (mental and somatic health). Because the authors did not identify any relevant studies, they chose to focus more indirectly on the relationship between involvement and health. They found that when involvement is successful, it can help increase children's safety, the success of care arrangements, and the sense of well-being of the children involved. Although the other four studies did not directly address the effect of user involvement, they were considered relevant as they dealt with whether children are allowed to participate, and results of children's involvement. The findings suggest that some children are given the opportunity to participate and their involvement has an impact on decisions made. At the same time, many children experience that user involvement is not genuine, as their views do not affect the decisions made.

Discussion and conclusion

In this mapping review, we included a great number of studies from countries that use the BBIC model for mapping and investigation in child welfare cases, and therefore are 'easy' to compare with Norway. There were 16 primary studies from Norway and 11 from Sweden. Thus, we consider it probable that the results from this review are transferable to a Norwegian context.

There is a lot of research concerning children and young people's experiences of user involvement in encounters with the child welfare services, as well as research regarding dilemmas and barriers to user involvement. Future research should investigate the effect of user involvement on children's health and welfare.