Children and teenagers with behavioural difficulties face complex and endruing problems, therefore, over their lifetime they often communicate with authorities as well as educational, social and healthcare services. Aim of current study was to analyse accessibility of different services for children and teens in different systems and find out if there is enough service provided.
Main findings of the study:
- First signs of behavioural difficulties usually show up in school environment and healthcare. Hence, the first service providers to interfere with are educational support services and psychiatry. Quality of these services has an impact on aggravation of behavioural problems.
- In Estonia there is no adapted assessment scales for estimating risks and needs of children with behavioural problems and protocols to decide if the child needs any services.
- Based on the above, children and teenagers’ access to different services is rather chaotic and does not stand on necessity. Main criteria of choosing the service is it’s accessibility. It means, that a person in need may not reach the right service.
- Systematic choice of wrong services is modelling an environment, where, first, problems may aggravate, and second, government’s resources are spent on services, which are not making any improvement on a child, its family and society in general.
- Mental disorders are very common among children with severe behavioural problems. Sometimes a child can have several diagnoses and due to heavy symptoms they may have a disability. In addition, many of these children have substance use disorders.
- Most of the services provided are not suitable for children with mental disabilities, who may be very aggressive, unpredictable and hard to understand.
- In Estonia, there is no evaluation system made to assess exact quality of the provided services. It may potentially cause situation, where the resources are distributed and used beside the purpose.
Here are some possibilities to improve the situation:
- Creating general protocol of service provision and developing valid tool for evaluating eligibility for services. It should also provide a possibility to estimate and consider mental disability.
- Integrating psychiatric treatment in educational and social services as well as in services provided by legal institutions.
- Providing integrated services in therapeutic communities designed for children, who can’t go to special school or jail due to their mental disability and/or behavioural problems.
- Creating a simple case management system, which will bring clarity to case manager’s work.
- Improving access to family based services
- Modernizing services provided in jail. Services must be based on active lifestyle and include psychiatric treatment, cognitive-behavioural therapy, learning of social skills, ser and getting education.
- Create a quality management system for services. This will help to develop more effective services and plan use of services more efficiently.
- Analyse need for residential services among adults with behavioural problems.