Summary in English

As part of the nationwide supervision of municipal health and care services in 2022-2023, all County Governors examined whether children at children’s and respite homes receive adequate respite care that meets their needs.

Children who live temporarily or permanently at children’s or respite homes do so to enable parents with extensive care and follow-up responsibilities to receive respite. Children who live in children’s and respite homes often have major, complex needs and respite is a crucial service for these children. Respite services comprise targeted cooperation processes in different venues between the child, the family and the service providers. The aim is to enable the children to achieve the best possible functional and coping abilities, independence and participation in society.

The County Governors conducted supervision of 67 children’s and respite homes. Of these, 64 were municipal homes and three were privately run. The County Governors used system audits as the method for conducting the supervision. The County Governors had access to a joint supervisor and support documents drawn up by the Norwegian Board of Health Supervision when conducting the supervision activities. Of the 67 supervision activities, breaches of the law were identified in 51 cases. This represents 76% of the supervision cases.

The overall theme of the supervision was to identify whether children living in children’s and respite homes receive respite care that corresponds to their needs. In order to answer this question, the County Governors examined the following:

1. Does the children’s or respite home have access to adequate information about the child’s situation and needs? 
2. Does the children’s or respite home use the information to identify the need for respite and to formulate goals and actions to support the child? 
3. Does the children’s or respite home implement actions to provide respite care? 
4. Does the children’s or respite home evaluate and correct the goals and actions for respite? 

In this report, the Norwegian Board of Health Supervision will summarise the results of the supervision and provide recommendations to the municipalities and private companies regarding improvement work and how they can ensure safe and positive respite processes to support children in children’s and respite homes. We will also provide some recommendations for the central authorities.

Does the children’s or respite home have access to adequate information 

The supervision identified relatively few violations of the requirements to collect information about the child and their situation. For those enterprises for which breaches of the law were identified, there were shortcomings relating to both the mapping of children prior to moving in and the ongoing collection of information about the children. The data was too poor to formulate goals and actions for the children.

Does the children’s or respite home use the information to formulate goals and actions? 

More than half of the homes were unable to use the information they collected to identify children’s respite needs and devise adequate goals and actions to meet such needs. Both the goals for respite and the actions required to meet the goals were consistently too vague. This meant that action plans could not be used as satisfactory tools in employees’ day-to-day work and it was therefore difficult for specialists to evaluate the impact of actions.

Although some parents considered communication to be adequate, there were differences in how much parents and children were able to actually participate. A general finding was that parents and children had limited opportunity to participate in formulating goals and actions.

Does the children’s or respite home provide respite? 

When County Governors identified breaches of the law when it came to formulating goals and actions, they also concluded that respite care was poorly implemented. There were limited procedures or descriptions in place for implementing actions, even when such actions were complex or the child required actions to be performed in the same way by everyone. This meant that measures were not implemented correctly and undesirable variations in implementation occurred. Implementation became too dependent on the assessment of the individual(s) on shift, rather than being based on a common procedure. This made it difficult for the individual with professional responsibility for the service to monitor practices, which in turn could lead to children not receiving the actions they required.

Do children’s and respite homes evaluate their practices? 

The County Governors pointed out that evaluation of children’s goals and measures was rarely carried out. The supervision also found that parents had limited opportunity to contribute to the evaluation of actions. Professional assessments of the need for change and adaptations were rarely carried out.

Are systematic governance and control measures carried out? 

Those municipalities for which breaches of the law were identified in connection with governance and control had a lack of clear procedures, permanent evaluation points and active use of non-conformity systems. They consistently did not have systems in place to collect information about the children, draw up action plans through multi-disciplinary cooperation, provide respite or evaluate and correct practices. Practices were therefore not managed, but were instead based on the expertise, experience and knowledge each individual employee had in relation to individual children. The consequence could be that some children received adequate respite, while others did not.

High levels of absence due to illness, use of substitute workers and unfilled positions, high levels of part-time employees and difficulty attracting staff with the correct expertise posed a challenge in implementing respite services at many of the homes. Several employees stated that they would like access to skills development in order to perform their jobs.  

Summary and recommendations 

The Norwegian Board of Health Supervision summarises its findings through five main conclusions: 

• Lack of knowledge means that children do not receive respite care.  
• Children and parents are not involved and the service is therefore not adapted to the children. 
• Lack of governance and management results in professional failure at children’s and respite homes. 
• Poor cooperation means that children are unable to access holistic support. 
• Some of the children’s and respite homes have good respite processes in place. 

On the basis of these conclusions, we recommend:  

• That municipalities increase their knowledge of children’s right to respite and what it takes to ensure adequate respite processes at children’s and respite homes.  
• That municipalities implement measures so that children at children’s and respite homes and their parents can contribute to formulating goals and actions for respite and the evaluation and correction thereof.  
• That municipalities must implement measures to ensure that interactions with children at children’s and respite homes take place using the communication methods used by the children.  
• That municipalities must ensure systematic management of respite at children’s and respite homes.  
• That municipalities must ensure that children’s and respite homes are included in multi-disciplinary cooperation regarding children with respite needs. Such cooperation should be based on the children’s needs and children’s and respite homes must help in devising joint goals for the children.     

• That the Norwegian Directorate of Health should consider incorporating examples of good practices at children’s and respite homes in guidance materials relating to respite.   
• That KOSTRA figures should include an overview of the number of children’s and respite homes. 
• That the Norwegian Directorate of Health should consider revising guidance relating to respite and contribute to the implementation of good practices for sub-services. 

• That the Norwegian Ministry of Health and Care Services should consider whether it is necessary to govern the services available at children’s and respite homes to a greater extent in order to improve the legal protection of children.