An International Database and eJournal for Outcome-Evaluation and Research


Entrusting or Caring: care pathways in Italy


Entrusting or caring? The development of interventions for children and adolescents in Italy has been a difficult path against cultural, organizational, professional and economic barriers. The different ideologies and cultures in human services - in conflict with each other - played a relevant role. In the current situation, the issues related to children and adolescents are overshadowed by many other problems: in particular, the care for elderly people, the poverty that is increasingly affecting families, the «welfare recession». Over the past decade the issues related to federalist reforms of public bodies have come first in the public debate, putting behind the needs and problems of individuals and families.

However many efforts have been made for providing more human and comprehensive interventions. The law n. 184 in 1983, thirty years ago, considered foster care as the solution for children in need. «Foster care» means «trusting and entrusting». It is somehow a «pre-judgment» in its literal meaning. This sparked off many micro-systems of solidarity and trust able to recreate family conditions, that are necessary for many children who are forced to live away from their parents. The positive emphasis on foster care led, however, to favour the point of view of adults. From the point of view of children this is an experience of «separation» that, in the most fortunate cases, can become good foster care.

The issue of «good placements» has shaped for years the debate on the best ways for «taking care of children and adolescents», favouring the means (foster care interventions) instead of the goal (children's needs). How to match the point of view of those (professionals) who consider foster care as a solution and those, the children, who are in foster care, separated from their family? Unlike adoption, foster care is a «temporary transplant» and, for this reason, more difficult to manage. Also for this reason, most of the attention should not focus only on need assessment and placement availability, which are technically a diagnosis, i.e. a premise for activating the helping process, avoiding to reduce the social work support to an administrative task. Mismanaged foster care placements are similar to palliative care: they reduce the suffering, but they also delay the effective care.

These contradictions do not affect only our country and they are at the attention of those professionals and researchers who are looking for new ways for solving problems, while the public bodies are more attracted by the less expensive solutions. These are contradictions to face with courage, in order to share effective choices and not only rationalizations that tend to reduce children's hope. One way to avoid such a manipulation consists of starting from the fruit, i.e. the outcomes, wondering if and how the placements planned after the Law 184/83 were effective. Considering the outcome means focusing on responsibilities, avoiding to adapt to the recommended processes based on administrative guidelines that are sometimes redundant, poor in evidence and also used to safeguard the professional responsibilities, in front of the growing conflict between parents and services.

In order to avoid this risk, it is necessary to make the most of the capabilities which are already available: they are professional and non-professional, so as to work in terms of formal and informal services. Foster care is the result of parental and professional contribution, for this reason foster parents must avoid the risk of becoming a «modified organism». This phenomenon is observed in those countries where foster care is more developed because it is used also as an income opportunity for foster families. Different and new forms of foster care need to be explored: in particular those more flexible and temporary, appropriate to the needs of the separated child, without creating illusions on the placement length, that may cause much unnecessary and avoidable suffering. A research that is free from political and cultural bias can help us to «move forward», towards a future of more effective interventions. For this reason, it is important to ask ourselves what we know about «outcomes», in dialogue with different countries, integrating the retrospective evaluation with the current evaluation, not only about the outcomes of placements but also the outcomes of reunification processes.

The choices of the last 50 years. The welfare provisions for children and adolescents during the period 1960-1970 are closely linked to institutionalization due to maladjustment, delinquency, poverty, other different problems, neglect, maltreatment, loss of parents... Interventions and services were run by national bodies and religious institutions, specialized in providing support for several problems. The main laws for promoting the rights of children are enacted, in particular the universal access to middle school (1962) and the law on adoption (1967). The first boost towards the «de-institutionalization» emerged (Canali, Vecchiato 2011). In 1970 the Regions are established (Law 81/1970): they would progressively assume legislative competence and in the organization of services for children and families, while the Provinces are in charge of illegitimate children, blind and deaf children, and children with psychological problems.

In the following decade (1971-80) the overcoming of the national bodies, the transfer of responsibilities from the state to local authorities, the overcoming of special schools, the transition from institutions to the community level get under way. The Family Law (Law 151/1975) is modified and the concept of parental responsibility for both parents overcomes the concept of «paternal authority». People with non severe physical and mental disabilities are allowed to attend the regular schools (Law 118/1971). The decrees for implementing the Regions are approved (1972), and also the law on moral objection and civil service as an alternative to military service (772/1972). Thanks to these laws, many young people could be involved in services that represented an alternative to institutions. The law 405/1975 establishes the «Consultorio familiare» (Family Counselling Service). The law 517/1977 starts the integration for all disabled children in the primary school. The Presidential Decree 616/1977 confers on local municipalities the functions of social services, which the state was formerly in charge of. The law 833/1978 establishes the National Health Service and the law 180/1978 abolishes the asylums, where many children were accommodated. New interventions, such as foster care, residential communities start developing. The juvenile courts collaborate with local authorities for the development of childhood interventions.

Thanks to these efforts, in the years 1981-90, the focus of attention moves to the local community and to the professions to develop, for integrating their ability to provide services. The attention to the rights of children with disabilities is strengthened (with the law 18/1980 on the extension of school attendance to all disabled people and the law 270/1982 on the teachers for special need children supporting school integration). The law 184/1983 promotes new forms of family care and educational residential facilities. Also the juvenile justice is renewed by the Presidential Decree 448/1988 attributing an educational purpose to the juvenile trials.

In the following decade (1991-2000) the independent bodies for child protection are developed and the law 216/1991 on preventing the involvement of children in organized crime activities, the law 104/192 on the integration of students with disabilities, the law 285/197 for the promotion of local plans for children and the law 476/98 on international adoption are approved. The National Observatory on childhood and adolescence is established by the law 451/1997. Symbolically, the law 328/2000 on social services makes a synthesis of the previous forty years.

In the last 12 years (2001-12) the law 149/2001 introduces the lawyer for the child and the mandatory defence for parents and updates the law 184/83 concerning foster care. The «amministrazione di sostegno» (court-appointed guardian for physically or mentally disabled people) is introduced (Law 6/2004) and the joint custody (Law 54/2006) is not technically «temporary» but «ongoing», as it concerns care continuity with shared parental care but «without a family». In 2006 institutions are closed. The Ombudsman for children (Law 112/2011), also symbolically, represents a responsibility to better manage the promotion of children's rights and make every child a citizen.

The figures of difficult pathways. In 1962 in Italy almost 250 thousand children were placed out of their families (16.2% of 0-18 y.o. children), among whom 112,956 in orphanages; 96,293 in institutions for poor or abandoned children; 21,211 in institutions for physically and mentally disabled people.

250,000 children were placed in 1962, a little more than 91 thousand at the end of the seventies. At the end of the eighties they were about 45 thousand. Between 1998 and 1999 the National Centre for Children and Adolescents identified about 15,000 children placed in institutions (12% foreigners) and 10,200 in family foster care (Maurizio 2011).

Altogether 25,000 children are in out-of-home care (2.5 per thousand of the total child population). In 2008 children placed out of their family were 32,400 (16,800 in foster care and 15,600 in residential facilities). By the end of 2010 there were estimated to be 29,309 children out of their family (2.9 per thousand of the total child population). This is the epidemiology of the problem, but it still represents a rough epidemiology, which does not allow us to classify placements on the basis of the underlying problems and needs.

In Italy the use of out-of-home care can be observed in 1.6 per thousand of the children in the region Abruzzo (Centre-South) and a maximum of 4.7 per thousand in the region Liguria (North), with rather marked differences. The average figures, according to Istat, are 3.1 per thousand (North-West), 2.9 per thousand (North-East), 3.0 per thousand (Centre), 1.6 per thousand (South), 3.5 per thousand (Islands). These differences cannot be explained on the basis of the needs and their social epidemiology. The presence/absence of a professional infrastructure and the availability of local services play an important role.

Over the past decade we have tried to give «names to things», since many professional interventions and services, while having the same name, differ from one region to another, from one territory to another. The first step has been sharing a common nomenclature. The second step, still incomplete, is represented by the common usage of a system of classification of available interventions, related to the needs (Istat 2007; Bezze et al. 2012).

Trajectories and care pathways. For the 40% of children and adolescents in foster care, this is not the first experience. 7% of them are living with relatives, friends or acquaintances. Nearly 53% of children come from other placements: 14% used to live in another foster family, about 11% in residential facilities, 1% in residential health settings and (in a similar percentage) in a juvenile detention centre. 3% were homeless (this figure includes also unaccompanied foreign children). The critical issue is the high rate of placement changes (1/3 of the cases considered). Only 1/3 go back to the birth family. The «unaccompanied foreign children» under a protection decree are placed in residential settings (85% vs. 48% of others) rather than in foster families. Considering only foreign children (with parents) in out-of-home care: 57% is placed in residential community compared with the 47% of Italian children. As their age increases, the placement in residential communities prevails, whereas for younger children foster families are the main option: 73% of children between 0 and 2 years old. For 82% of teenagers aged 14 to 17 placement in residential community prevails.

The 71% of children and adolescents with mental disabilities are placed in residential community, while the 70% of their peers with physical problems are in family foster care. Most of the foster families are at their first foster care experience (78%). Approximately one in four families (23%) has more than one foster child, often siblings. Among foster families, 58% are parental couples with children. 14% are single-parent families. 28% are parental couples without children. The 24% of the foreign foster children are placed into families of the same culture, mostly (64%) within their extended families. Overall, almost half of the foster care placements (44%) occur within the extended families. An important role is played by the juvenile justice system, since almost three quarters of foster care placements (76%) have got a judicial decree. Residential community involves especially adolescents 14-17 years old (56%) and preadolescents 11-13 years old (19%). Only 9% of very young children is placed in residential communities: 3% children 0-2 years old, 6% children 3-5 years old.

New problems. The many changes in the family composition that occurred in Italy in the last 15 years highlight a rapid increase in separations and divorces. In 2010, half of separations (49.4%) and one third of divorces (33.1%) involved families with at least one child under age 18. The number of minors who have been placed with either parent (or both) in 2010 amount to 65,427 in separations and 23,545 in divorces, a total of nearly 90,000 children affected by this experience of separation.

In the separations, the 56.7% of children was younger than 11 years old. In case of divorce, children are generally older: the percentage under 11 decreases to 34% of the total.

Since the introduction of the Law 54/2006, that introduced the joint custody of children, the percentage of children placed with their mother has reduced, to the benefit of joint custody. In 2007, the 72.1% of separations involving children resulted in a joint custody. In 2010, the separations involving children in joint custody were 89,8%.

It is an expanding picture, which presents new problems for the protection of the rights of children, since, as mentioned earlier, this is not a «temporary» but an «on-going» custody, run by both parents who continue to exert parental responsibilities after having chosen to no longer be a family.

Poverty as an worsening factor. Absolute poverty among children under 18 years old is a growing phenomenon: poor children and adolescents were the 4.7% in 2005, while in 2011 they accounted for 7% of the child population. In the couples with a child 7 years old, the incidence of absolute poverty has increased by 2.5 percentage points. The most affected age group is from 4 to 6 years: in this age group poor children amount to 7.8% of the total child population.

In our country, more than in Europe, poverty particularly affects families with children: the average national incidence of families in relative poverty rose from 11.1% to 15.6% when there are children in the family, while absolute poverty rose from 5.2% to 6.1% (Istat 2012). The economic difficulty is higher as the number of children increases: the incidence of poverty, equal to 4% among couples with one child and 10.4% among those who have at least three children, rises to 5.7% and 10.9% if the children are under 18.

In 2011 people at risk of poverty or social exclusion have increased in all geographic areas. In the South it increased from 42.7% to 46.2% over 8 years.

The risk of poverty in couples with children has remained fairly stable at around 22-24%, but in 2011 it rose to 26.7% . The risk has increased especially for couples with 3 children or more (+ 5.4 percentage points) and for single-parent families (+ 5.7).

In Italy the share of social protection expenditure for children and family is lower than the average of other European countries. In 2010 it averaged 8% in the 15 and 27 Eu countries, while in Italy it was 4.6%. As a percentage of Gdp, the expenditure for monetary transfers and services to children and families was 1.3% (0.7% transfers and 0.6% services) in Italy, compared to the average 2.3% (1, 5% transfers and 0.8% services) in Europe.

Differences and inequalities among Italian regions are very large, since municipal spending for poor children and families in economic difficulty ranges from around 3 euros to almost 18 euros per capita (the national average is about 12 euros but with a differential of 15 euros between minimum and maximum). These figures tell us about expenditure and social value provided to children and families. They show us the value attributed to children rights in different territories and how far is the implementation, not only the definition, of the essential levels of care for children and families.

Interregional differences emerge both in the ability to address needs and in the allocation of resources. These differences can not be easily justified from the perspective of the levels of care, nor in terms of distributional equity. 

Considering only the 15 Italian regions with ordinary statute, the per capita municipal social expenditure (for children and families in economic difficulty) turns out to be related to the incidence of all children in out-of-home care. This relation is mainly driven by the incidence of children in family foster care rather than the incidence of children in residential settings.

These figures describe a double inequality: capacity of funding the interventions and ability to implement family foster care. Both face a lack of professional infrastructure at the municipal level with lower spending possibilities. Residential placements sometimes follow court decisions, not always with an adequate professional support, also because of the urgency to intervene. Family foster care without a professional action cannot be activated properly, since it would be «accommodation» rather than «fostering».

Being poor in certain regions therefore seems to entail less possibilities of foster care provision. The paradox is that this happens in those areas where the need would be greater. This is at odds with a care based on equal rights in every area. It is not only a problem of guaranteeing the same kind and level of interventions, but primarily of guaranteeing the same adequate levels of professional capacity and organizational infrastructure, both necessary for appropriately delivering services. 

Perspectives. Foster care is genus or species? It is an important difference for avoiding the simplifications that have characterized foster care pathways for the last 30 years. The genus generally identifies a class of elements that have common characteristics . They can be organised into subordinate units (species) with more specific features. The identification of subordinate and better targeted levels does not overshadow the common features, it shows that the «personalization» (i.e., the specification) can generate significant differences in the transition from genus to species. This approach should be used in order to make the various forms of foster care clearer and focused on the need.

Sciences (not only human ones) have become mature classifying the contents of their worlds, from the general to the particular level, in order to go in depth. The specific characteristics are measures of depth and capacity to connect problems and solutions. Even for foster care it is necessary to make this effort of classification (that is necessary for personalization), to favour the effectiveness in connecting properly needs to foster care.

Then the word «foster care» only means a more general field of professional practices for «entrusting and caring». Specific solutions (moving from genus to species) are necessarily different in terms of context (family, residential community ... ), length (temporary foster care/long-term foster care...), competences (professional/non-professional...), intensity (daily/residential/...), formalization (contractual/judicial...), ..., so as to generate and better identify the traditional and new forms of fostering.

In the concept of genus there is no limit to generativity, because it also means potential for generating further solutions. Its boundary is defined by the need, the problem and the capacity within which life-spaces, care and relationship can be defined. Hence the effort to classify the forms of foster care experienced in our country and in other countries is a necessary step, a condition and a source of potential strength, to better identify the potential to expand. It should not be a self-referring effort, centred on the parameters of services to be accredited in a formal way. It must be based on matching needs and problems, with a more targeted capacity to care and reach effectiveness.

The current debate in Italy on the «essential levels of care» (Lea) is exposed to the risk of rights idealism if it will not be able to take into account the relationship between needs, resources, capabilities and duties. There are resources available, provided that they are deeply revisited and reoriented, turning many transfers into services for children and families. The aim is to enhance the matching between professional competences and family motivation. This is well described in the previous section.

But the current lack of political courage leads to keep things as they are, with national actions bypassing the responsibility of regions and municipalities. Regions and municipalities have a primary responsibility for solutions for children and families. But there are old rules still alive that are no longer justifiable after the recent reform of the Constitution and after the law 42/2009 on federalism. These rules guarantee funding, even in times of crisis, to cities that have - on average - more resources than all other cities for taking care of their young citizens, while their peers across the nation have the same rights but less opportunities. This is the reason why the levels of child care need to rely on solutions that are not only technically but also ethically grounded, transparent, non-discretionary, equally able of guaranteeing the rights of children throughout the country.

Key References

Bezze, M., Galardi, G., Innocenti E., Vecchiato T. (2012). Verso un sistema informativo unitario in Toscana. Studi Zancan, 4, pp. 69-122.

Canali, C., Vecchiato, T. (2011). RISC - Rischio per l'infanzia e soluzioni per contrastarlo, Quaderni della Ricerca Sociale n. 12. Roma: Ministero del lavoro e delle politiche sociali.

Centro nazionale di documentazione e analisi per l'infanzia e l'adolescenza (2013). Bambine e bambini temporaneamente fuori dalla famiglia di origine. Affidamenti familiari e collocamenti in comunità al 31 dicembre 2010, Quaderni n. 19 della ricerca sociale. Firenze: Centro nazionale di documentazione e analisi per l'infanzia e l'adolescenza.

Istat (2007). La famiglia in Italia. Dossier statistico. Roma: Istat.

Maurizio, R. (2011). Stanze di vita. Crescere in comunità di accoglienza. Milano: Guerini e associati.


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