Quality of Life as an Outcome Measure of the Child Care System Reform in Georgia

Abstract

Objectives: Quality of Life (QoL) originated in the Classical Antique Period and has been evolving since then. The postmodernist understanding of this concept is a social construct and is increasingly used in such fields as philosophy, psychology, social welfare, employment, healthcare, and economics. QoL and well-being indicators are also applied as Sustainable Development Goals indicators.   The present study on the quality of life (QoL) of children is the first research conducted in Georgia and other Eastern Europe and Central Asia countries. The study aims to measure the QoL of deinstitutionalized children, evaluate the outcomes of childcare system reform in Georgia, and inform further steps. This assessment echoes developed countries' evidence and confirms that a family environment enables children to achieve a higher QoL. The study contributes to a paradigm shift from evaluating service use outcomes only against universal standards towards accepting children's own judgments of their QoL using their criteria. It contributes to the development of individual needs-based policies and programs.   Methods: The assessment applied a QoL measurement instrument developed for this study and used for the first time. The tool was designed based on the Personal Life Quality Protocol created by Prof. James Conroy (USA Centre for Outcome Analysis, USA) and was adapted for Georgia and the target population. The applied tool comprised open- and closed-ended questions, including 20 items measuring the following domains of the QoL using objective and subjective criteria: emotional well-being, interpersonal relationships, material well-being, personal development, physical well-being, self-determination, social inclusion, and rights.   A single observation comparison group study covered 222 respondents, representing the entire population of children from 11 to 18 years of age from a) two large-scale state residential institutions still existing in Georgia in 2012, b) those reintegrated into their biological families in 2010-2012 through state and donor support, and c) those reintegrated into their biological families in 2010-2012 with only state support. Supporting qualitative research covered a small group of previously studied reintegrated children after 4-7 years of their return home—the study adhered to the principles of voluntary participation and informed consent.   Results: The quantitative data and supporting qualitative research data indicate that living in a family results in higher QoL for children. More specifically, the results of the self-reported scale reveal that reintegrated children were happier and had a higher QoL compared to their own scores in institutions. The scores increased from an average of 82.4 (out of 100) in institutions to 88.3 after returning home, with age, sex, and level of education combined. A higher increase in satisfaction with specific domains of family life was associated with a broader range of support by state and donor resources and closer contacts with social workers. A significant correlation was found between the QoL of children (in institutions and at home) and living with siblings.   The presentation will highlight evidence-based recommendations for strengthening family support services, maintaining family connections, improving social work practices, increasing educational opportunities, and introducing modern approaches to assess service use outcomes. It will also discuss the need for a long-term QoL assessment of children reintegrated into their biological families. The latter reside in or are reintegrated into their families from other forms of alternative care. It will permit accurate monitoring of results and the sustainability of childcare system reforms and better define the outcomes for individual children. The presenter will also touch upon the importance of using QoL and well-being indicators for measuring the effectiveness of the SDG efforts, as well as other projects and initiatives.