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Evaluation of the programme Barnehjernevernet

  • Engelsk sammendrag av Fafo-rapport 2021:13
  • Ellen Katrine Kallander, Jon Helgheim Holte, Gitte Haugnæss, Marit Brochmann og Terje Olsen
  • 25. juni 2021

The programme Barnehjernevernet (BHV) was established as a pilot project in Oslo in 2016–2017 and continued as a programme in all city districts from 2018. The goal of the programme is to prevent, detect and provide help to children who experience neglect, violence and sexual abuse. A shared knowledge base and collaboration with children and adolescents are key elements in the BHV programme. As specified by the programme, services that meet children and families should have a shared knowledge base founded on love for and a positive view of children, intervene at an early stage and provide competent and relevant help. The programme is based on values in the UN Convention on the Rights of the Child and experience from the ‘My Life’ development project, which is a collaboration between eight major cities and Forandringsfabrikken.

In February 2019, Oslo City Council’s department of children, adolescents and education signed an agreement with Fafo and Agenda Kaupang on implementing an evaluation of the BHV programme. The evaluation was to focus on the BHV strategy document, and this has set the direction for our work.

The overall value base for the BHV programme is formulated as follows:

The BHV programme is a complex undertaking that consists of multiple different initiatives, objectives and priorities. The general question in our evaluation is:

  • Children and adolescents have much knowledge about their lives
  • Children and adolescents have the same value as adults
  • Children and adolescents need love and must be believed and taken seriously

Through the period under review, the key performance indicators for the BHV programme have been:

  1. Children and adolescents shall be involved in their own cases and act as genuine collaboration partners in the development of the service options
  2. The Child Welfare Service shall engage in outreach activities and be present in the places where children and adolescents meet (kindergarten, school and leisure activities)
  3. Child welfare drills, modelled on fire drills, shall be undertaken
  4. Service employees shall be present in the families’ environments
  5. The service’s activities shall be undertaken in compliance with the value base and perspective on children on which the BHV programme is based

How are the Oslo city districts working to ensure that the value base of the BHV programme is implemented and that the performance indicators for the programme are achieved?

This question is further specified:

  1. How did the change in the value base and approach manifest itself in the practices applied by the professionals in the city districts?
  2. How have the city districts complied with the city council’s expectations for activities, as described in the letter of allocation and budget for the BHV programme?
  3. How are the employees collaborating and talking with children and adolescents?
  4. In what ways are the experiences from the city districts systematised to provide a wider knowledge base?

Implementation of the programme in the city districts

The BHV programme must be understood as an ongoing development of the services that have contact with children and adolescents. In other words, it is not a completed project, and our evaluation is therefore not an appraisal of a finished product, but rather a picture of a process that has a history prior to our involvement and that will continue to run afterwards.

In the city district administrations and the field units, the BHV programme is included in other municipal and national programmes with partly overlapping objectives. This means that theoretically, initiatives that target the same objective may help reinforce or counteract each other, and this makes it difficult to distinguish between the results produced by different interventions. We have studied the BHV programme during the first phase of its implementation in ordinary operations. During this start-up period, emphasis was primarily placed on a closer collaboration between the child welfare services, kindergartens and mother-and-child clinics. In 2016–2017, the programme focused on the youngest children, in the age group 0–6 years. It was scheduled to include adolescents aged up to 18 years during 2018, but these efforts have not yet started.

The city districts have been given a great deal of flexibility to develop their own variant of the BHV programme and local initiatives. The city districts are differently organised, and various priorities are therefore made in their interpretation. The programme has been rolled out in two stages. Three districts were appointed to serve as so-called ‘engine districts’ that started their pilot projects in 2018 and 2019. The three ‘engine districts’ – Østensjø, Frogner and Nordre Aker – have therefore made most progress in the implementation of the programme. The three districts have interpreted the assignment quite differently, which is illustrative of the different approaches the districts can choose.

A large number of measures: The city districts have reported a comprehensive number of measures associated with the programme, 123 in all. In some cases it has been difficult to determine whether a measure should be subsumed under the BHV programme, since many parallel initiatives are underway in the districts. One key element of the BHV programme is to develop a shared value base, perspective on children and employee attitudes across organisational boundaries between mother-and-child clinics, child welfare services and kindergartens, based on the ‘Mitt Liv’ development project and the UN Declaration on the Rights of the Child.

The number of reported measures that have been developed locally in the city district indicates that much has worked as intended, in the sense that the programme has paved the way for many activities, pilot schemes and local measures at the district level. Some of these are described in more detail in the report. Some potential for improvement should nevertheless be mentioned.

The competence platform was delayed: The competence platform associated with the programme was delayed and not ready until the summer of 2020. The city district administrations express some disappointment over this delay. Some city districts have addressed this by developing their own competence packages and training sessions for employees.

Challenges in private kindergartens: We can see a certain amount of collaboration between the child welfare services and the private kindergartens in some districts. Judging from the reports from the city districts, however, the collaboration between the child welfare services and the private kindergartens is less well developed at this stage of the programme. However, there seems to be considerable potential for further development of the BHV programme.

Resources: City district administrators point out that undertaking the kind of competence and organisational development that the BHV programme represents in practice is challenging when the programme is not accompanied by specific funding. According to the administrators whom we have interviewed, lack of resources is a significant reason why the major initiatives in the programme, such as child welfare drills and involvement of children and adolescents, have not been implemented to the extent they might have wished for. An assessment should therefore be made regarding the level of resources required to meet the ambitions for involving children and adolescents in decision-making processes. The cost directly associated with the co-determination process is one thing, but the costs of following up and making concrete changes based on the knowledge that emerges from these processes is a different matter.

The attitudes, values and competence of employees

To understand the compliance with the BHV programme’s value base, we organised a survey among the service employees. In the survey, which was sent to all employees in kindergartens, child welfare services and health services for children and adolescents, we asked what values they regard as central to their work and whether the programme had enhanced their competence on topics such as neglect, violence and abuse of children and adolescents.

Approximately 75 per cent of the employees report to have received information regarding the values and perspectives on children that should form the basis of their work with children and adolescents. On an open-ended question about the values that the respondent deems to be most central to their work, aspects such as respect, safety and care are most frequently mentioned. The key values in the BHV programme – openness, collaboration, love and humility – are mentioned somewhat less frequently.

Approximately 40 per cent of the employees feel that significant changes have been made to the guidelines, and a similar proportion report to have changed their own practices in terms of how they meet and interact with children and adolescents in their work. Leaders and employees with lower skill levels (primary or secondary education) most frequently report to have experienced changes in the guidelines or in their own practices. As many as 90 per cent of the respondents report to have received information and knowledge about brain development in children and conditions that have a bearing on the development of the brain. A considerable proportion of the respondents – 67 per cent – report to have enhanced their knowledge about trauma, attachment and neglect. Employees in the child welfare services and the health services score highest on these questions.

Answers pertaining to how they meet children and adolescents, or what can be termed ‘attitude questions’, indicate that the employees largely work in compliance with the programme’s intentions (the value base and the perspective on children), meaning that the employees show their emotions, share experience and include children and adolescents in making daily decisions. All in all, the results of the survey leave the impression that the service employees are generally working in accordance with the programme’s value base and perspective on children, and that their competence on topics such as neglect, violence and abuse of children and adolescents has been enhanced in recent years. However, this is not due to the rollout of the competence platform for the programme, since this work had not yet started at the time of the study.

Measures taken in the city districts

The performance indicators have been met to a varying degree. This may indicate that it will be relevant for the city districts to develop a kind of mix of different measures that in combination will cover what is locally considered most appropriate for that particular district. Many of these measures are perceived by the services as costly, which represents a challenge. Several employees and leaders report that it is a formidable challenge for hard-pressed services to find the space and opportunity to prioritise long-term preventive work over acute cases.

Co-determination: Some city district administrations devote considerable effort to identifying forms of co-determination that will work with the resources available, but these efforts vary between the districts. Different models for co‑determination have been developed and tried out locally, such as user forums, feedback via digital platforms and using adolescents who are former child welfare clients as advisors in the district. However, there seems to be a need for the services to identify methods that can apply the knowledge emerging from this collaboration in service development. Experience gained by employees and leaders in the city districts indicates that it is demanding to work with adolescents in the capacity of advisors. This applies to the co-determination process itself, but also to the follow-up of concrete proposals for changes. Co-determination in the form of anonymous digital feedback in individual cases is a less resource-intensive and costly method, but according to the informants, this also requires resources for development and implementation of changes.

The child welfare services’ outreach activities and presence in venues where children and adolescents meet (kindergarten, school and leisure activities) (performance indicator 2): Approximately one-third of all measures reported to us during the evaluation fall under this performance indicator. Child welfare drills targeting children aged 4–5 years have been tried out in two ‘engine districts’, but this measure is more widespread in the schools than in the kindergartens. Seven city districts have reported to undertake child welfare drills in schools, but the drills have not necessarily been held under the auspices of the city district as an initiative under the BHV programme. There is major variation in the implementation of the child welfare drills. We have no basis for concluding whether or not this in itself gives these children better opportunities for setting boundaries or talking about difficult matters, but it may possibly help raise their awareness. Some districts have established direct linkages from the kindergarten to individual child welfare employees, with a view to lowering the threshold for employees to make contact. However, employees and leaders refer to the difficulty of balancing the time they use for different assignments.

Child welfare drills (performance indicator 3): Nine city districts report to have undertaken child welfare drills targeting kindergarten employees. One challenge is that the purpose and content of these drills have not been defined, and it would have been advantageous if the City Council’s department of children, adolescents and education could have made this clear in writing to the city districts. The City Council’s measure in collaboration with the Frogner ‘engine district’ and the child welfare services have used the following as their basis: ‘Competence development and training for kindergarten employees in revealing and reporting cases of neglect, violence or abuse, with a view to enhancing the employees’ appreciation of detection and action, and to improving coordination between kindergarten employees and child welfare services staff.’ Although there is wide variation in the child welfare drills undertaken in the city districts, a common feature seems to be collaboration meetings arranged by child welfare officers for kindergarten employees, based on information from the child welfare service. This includes information on casework procedures, discussions of child welfare cases that provide the employees with examples of what they should look for in children, and when and how they should alert the child welfare service. The city districts differ in terms of how this work is organised.

The child welfare drills that target kindergarten employees meet the performance indicator for expected activities in the city district. Closer collaboration between the services is one result of the drills. In some districts we see that the kindergartens have been given permanent contact persons in the child welfare service. The informants refer to how the number of cases reported increases after drills have been held. Informants in the child welfare service refer to time constraints as a major obstacle to more frequent drills and their uptake by the kindergartens. This applies to municipal as well as private kindergartens. For capacity reasons, the child welfare services have so far tended to concentrate their attention on their collaboration with the municipal kindergartens.

Service presence in the families’ environments (performance indicator 4): As part of the implementation, two ‘engine districts’ have experimented with services meeting with parents. Examples include the ‘Open Door’ project (Nordre Aker district) and Interprofessional Meetings (Østensjø district). Employees in the city district administrations report difficulty in marketing these schemes to parents, and that these ways of working are resource-intensive seen in relation to their uptake so far. After approximately two years, the employees find that the schemes have failed to reach a significant number of parents. While the intention was that the services should meet the families in their own environment, the schemes appear to form a supplementary arena outside the kindergarten and outside other established arenas.

The service’s work in light of the value base and the perspective on children on which the BHV programme is based (performance indicator 5): In the mapping of the city district’s activities, 35 per cent of the measures implemented are explicitly linked to the programme objective that states that children and adolescents should be genuine collaboration partners in the development of the service options.

There is little variation between the different services when it comes to survey responses to the question of whether they include children and adolescents in decisions that concern them (79–86 per cent). Kindergarten employees most frequently answer that they share experience from their own lives to a great or a very great extent (64 per cent versus 29 per cent in the child welfare service and 16 per cent in the mother-and-child clinics). Approximately 80 per cent of the employees report to show emotions to a great extent in their work encounters with children and adolescents, but there are large variations between the services in this regard. Fully 94 per cent of the kindergarten employees and 70 per cent of the employees in health services for children and adolescents report to show emotions, while in the child welfare services there are significantly fewer – 55 per cent – who report the same. In the responses to the question regarding the importance of meeting children with love as opposed to objectivity, the emphasis is not surprisingly placed on love. Even here, however, there are significant differences in the score for objectivity/love across the services. The average score is highest for kindergarten employees (7.7) and lowest for child welfare service employees (6.4), with the health service employees falling in-between (6.7).

Systematisation of the experience from the city districts for development of a knowledge base: Some of the districts have established schemes for user surveys and systems to measure user satisfaction at regular intervals. One city district introduced qualitatively oriented user surveys among parents and children in order to develop its own profile of the BHV programme. We are not aware of any districts that systematise knowledge from these efforts, for example as a basis for establishing knowledge banks or collections of examples for further development of measures introduced in other districts. The knowledge about what functions well or less well seems primarily to exist in each city district administration and professional community locally. The collaboration that has been established in the BHV programme’s development group, where the local resource persons meet occasionally to exchange experience and share knowledge, represents the most concrete work to systematise shared learning.

What can explain the findings? The city districts have devoted considerable efforts to finding a suitable way of working and their own profile for the BHV programme. Explanatory factors that may have had a bearing on achievement of the more long-term objectives defined in the programme strategy appear to include the following: great freedom to develop measures; development of appropriate structures for interaction; and synergy effects arising from the fact that values and perspectives on children come from many different quarters.

Learning points: It was initially reported that the programme was perceived to have been imposed on the city districts in the first phase in a ‘one size fits all’ fashion, but this attitude seems to have gradually abated. The flexibility given to the city districts to organise and adapt the programme locally to their own organisation seems to have been a success factor.