The UN Convention on the Rights of the Child (CRC) reiterates and confirms the knowledge and research findings concerning children and child development that children’s development in a nurturing family environment is the most fundamental need and right (Article 5). As per a study by UNICEF, most children in CCIs have at least one living parent or relative who can care for them^[1].  In many cases, these family members could care for their children if given the right support. Besides, studies^[2] indicate there is a common perception in society regarding children/adults from shelter backgrounds which appears to be that they are wrong-doers and are placed in shelter care for “correctional” interventions, and therefore avoided or not to be trusted. The stigma attached runs all the way from school experiences through to work and adult life, and they are commonly reported to be perceived as a threat or pity by others. A direct and overwhelming impact of institutionalization has thus been the stereotyping/stigmatization across all spheres of their lives

Miracle Foundation is a 23-year-old organization with a vision ‘“To ensure a family for every child in our lifetime’’ We work for children living in vulnerable situations and in Child Care Institutions with a specific focus on 5 well-being domains. We work in alignment with Mission Vatsalya focusing on family strengthening and family-based alternative care. We collaborate with the state governments and build the capacities of the social workforce on alternatives to institutional care, reaching into communities to identify and strengthen vulnerable families long before the child separates.

Since 2019, Miracle Foundation India has been facilitating, with its CCI partners, the implementation of a systematic process of case management referring to JJA tools of ICP, SIR leveraging Thrive Scale™ to ensure safe, permanent, and sustainable reintegration of children as well as to prevent separation. In this process, Miracle Foundation India has facilitated family strengthening through a systematic case management process leading to the reintegration of more than 3000 children in family and Family-Based Alternative Care, with almost negligible disruptions of reintegration and children continuing to stay in a safe and nurturing family environment.

These successful cases of reintegration have been made possible with systematic case management process focusing on family strengthening. To objectively assess the areas of concern and suitability of placement, Thrive Scale™ was developed by Miracle Foundation. The Thrive Scale™ tool which is an innovative, strength-based approach that enables the measurement of progress and risk assessment at each stage of our work. It focuses on five key domains of well-being: Physical and Mental Health, Education, Family and Social Relationships, Household Economy, and Living Conditions. Developed by the Miracle Foundation, the Thrive Scale™ was created based on extensive research of similar tools utilised by organisations worldwide. It is used to evaluate the family’s situation to identify the necessary support required for the prevention of a child’s separation from family or their reunification with family. It can be employed to assess families at risk of separation, evaluate suitability for foster care/adoption, determine readiness for independent living, or explore other family placements.

The Thrive Scale™ tool serves the following purpose –

• Assess the safety of the family and community environment in facilitating the prevention of separation from family, reintegration, and placement into F-BAC options
• Determine the specific needs of the child and family for a secure living environment
• Develop a comprehensive intervention plan to address the identified requirements
• Monitor and evaluate the quality of prevention and placement progress over time.

The tool draws special attention to critical safety concerns in the life situations of a child and family. These critical safety concerns are termed “Red Flags” which must be addressed with utmost priority. For each question/milestone within all five well-being domains, appropriate options (from one of the four mentioned below) are assigned to indicate the level of concern. In-crisis: Requires immediate attention; Vulnerable: Requires attention, but not urgent; Safe: Attention is helpful, but not necessary; Thriving: No attention needed.

Feedback from the caseworkers within Miracle’s partnering CCIs and government officials reflect that families would choose to stay together if they could, and would not place children in institutions if it did not seem absolutely necessary. Here Thrive Scale tool becomes a practical tool for the case worker to assess the need, address safety concerns, and provide necessary intervention which eventually leads to family strengthening.

To measure the effectiveness of Thrive Scale™, an in-depth analysis of Thrive Scale™ Assessment data for a cohort of 147 children was carried out to understand the progress, trends, and movement of children between ‘’In-crisis’’ and ‘’Thriving’, and to understand the relationship between red flags and Thrive Scale Scores. The assessment was done between August 2020 – March 2022. The average age of children was 15 years and constituted 65% of female children. The children were mainly from Miracle’s CCI partners.

Findings reflected that the time interval between assessments remained constant which was around 60 days and overall Thrive Scale score improved with each assessment and the number of red flags was reduced. Figure 1 depicts the Thrive Scale Score from the 1st to 4th assessment and in corresponding assessments number of children with at least one red flag were identified.

 Figure 1

Some children exhibited a single red flag, while a significant number displayed multiple red flags. Figure 2 illustrates a decline in the absolute number of red flags from 145 in the initial assessment to 105 in the third assessment. This reduction indicates the effectiveness of prompt interventions implemented by the social workforce in addressing these concerns.

Figure 2

Although the number of red flags reduced over a period, findings reflect that it’s not always a linear way. The situation of each child and family situation is different.  Many times at a point when a case worker feels that red flags have been addressed, they see them reoccurring after some time and it takes considerable time to stabilise the situation. From the prevention lens, if the child or family is ‘’In-crisis’’ for any parameter, the case worker must pay urgent attention. While most of the time addressing these concerns is in their control, the other times they may have to refer the case to the experts or connect with their supervisor for guidance. And in whatever way when that’s addressed, addressing concerns does not guarantee a transition to the “Thriving” stage. While immediate issues may be resolved, sustained attention is necessary to prevent a potential regression to an “In-crisis” situation.

As Thrive Scale™ parameters and red flags are closely related, it is also observed that overall Thrive Scale score does improve but this improvement may not be observed in every assessment. It was observed that while some children and family scores improved quickly in other cases it took some time, and in some cases, the scores even dropped. Figure 3 reflects the percentage of children with improved Thrive Scale scores between assessments across five well-being domains This can be seen as a positive trend, indicating that the support or interventions children received during this period were effective in maintaining or enhancing their well-being. That being said, the findings highlight the importance of prioritizing cases identified as “In-crisis” situations. Urgent attention and a commitment to addressing these cases in a timely manner are essential.

Figure 3

The Thrive Scale Methodology is a crucial tool in child case management, working alongside the Social Investigation Report and Institutional Care Plan tools. The Thrive Scale™ tool empowers social workers to make informed decisions based on data and evidence. With early identification of red flags, it supports social workers in planning the intervention accordingly to ensure the safety of children and family strengthening. While all the parameters of the well-being domain are important, ‘’In-crisis’’ situations sometimes require referral to experts or consultation with supervisors. While addressing concern does not guarantee the ‘’Thriving’’ stage, overall Thrive Scale scores may improve, reflecting effective support and intervention for children’s well-being.

Author: Pritam Prasun

Disclaimer: This article was originally published in the 14th edition of the IACN Quarterly Newsletter, December 2023. The views expressed in the article are the author’s and do not necessarily reflect those of Miracle Foundation India.

^[1] https://www.unicef.org/protection/children-in-alternative-care

^[2] f4650b8ba51ef3fff80ff6d218fd7503.pdf (bettercarenetwork.org)