Gatekeeping Services for Vulnerable Children and Families

Central and Eastern Europe and the former Soviet Union (in World Bank terminology, the Europe and Central Asia or ECA region) inherited a child protection system from the socialist period that placed excessive reliance on institutional care as a means of looking after children who were unable to remain with their birth parents in the shorter or longer term. Despite the collapse of the ideology that supported this strategy, the numbers of children living in institutional care is higher in many parts of the region than in 1989. This rise in the institutionalised child population is the most disturbing new trend but it parallels a worrying increase in the numbers in all forms of public care over the last ten years. Although important new services have emerged aimed at reducing the level of use of institutional care, the overall pace of reform has been too slow to provide a sufficiently strong safety net to either prevent entry to care or to stop the flow to institutions. Whilst it is fully acknowledged that the huge changes of the last ten years have provided a very difficult environment for bringing about systemic change, the trends suggest that more proactive strategies are needed than are currently in place to make de-institutionalisation a reality. The aim of this paper is to provide a framework to help countries to adopt proactive strategies based on gatekeeping which will bring about a shift from institutional care to family-based types of care. The gatekeeping project aims firstly to promote strategies to divert children from initial entry into public care through the development of community based support programmes to children and their parents and by improving the decision making about how to help children. A second aim is to ensure that where children enter institutional or other forms of state care they are not left to drift but that their situation is regularly reviewed and action taken to promote rehabilitation to their family and community. This problem of targeting services to ensure the best outcomes applies to all countries providing welfare services. The rise in demand for social care services in many parts of the West over recent years has led to radical scrutiny of patterns of service delivery, their costs and effectiveness. Gatekeeping is a key mechanism which planners have used to try and bring about a better balance between demand and supply and to ensure that services are targeted appropriately. The paper has three sections. After briefly outlining the main problems in child care service delivery in the ECA, section I of the paper begins with a discussion of the nature of gatekeeping and its use in a range of health and welfare systems through an examination of the literature. It then outlines the basic elements needed to implement gatekeeping before looking at good practice in this complex area. Section II discusses the current use of gatekeeping in Eastern and Central Europe and Central Asia (ECA) before considering in Section III some of the issues to be addressed in order to maximise its impact. The paper provides an appendix which considers the problems in implementing gatekeeping and how they might be overcome.