Kazuhiro Kamikado: Challenges in Social Care and Expectations for Foster Care

I previously worked at a child guidance center as a child psychiatrist. When I spoke to a child suspected of being abused about entering a temporary shelter, they once told me, "I'd rather be hit at home than go to a place like that." That child had previously been separated from their family and placed in temporary protection and then a children's home, under the explanation that it was to protect them from abuse. Despite adults and society promising children a place to ensure safety and peace of mind, there were many times when children taught me that this was not the case.

The number of consultations regarding child abuse at child guidance centers continues to reach record highs every year. About one child dies every week due to abuse, and it is particularly common among infants and newborns. To prevent such situations, child guidance centers have been required to perform early detection and intervention, and when necessary, separate children from their parents to ensure their safety.

However, abuse response involves more than just the commonly known early detection and intervention; there are stages before and after. Response prior to early detection and intervention is preventive support that assists parents so that their upbringing does not become abusive, thereby maintaining the family unit. The ever-increasing instances of abuse cannot be reduced by early detection and intervention alone. Response is needed "upstream," before abuse occurs. Furthermore, as a response after early detection and intervention, there is social care (alternative care) that guarantees a child a different place to live, separated from their family or parents to ensure safety. Currently, about 42,000 children are under care. In recent years, the term "social care and upbringing" (shakaiteki yoiku) has been used, which includes not only alternative care but also preventive measures, and targets all children.

Voices from those involved in social care include sentiments such as "I wish they had helped my parents sooner" and "For a child who has lost someone to live with, I want it to be a place where there is someone who will live life with them." These voices indicate what is needed in Japan's social care system.

The voice saying "I wish they had helped my parents" indicates a lack of support for remaining a family. Survey results show that 70% of mothers engage in "away-from-home parenting," raising children in towns where they themselves did not grow up, and 60% of mothers have no one to look after their children. Furthermore, out of over 220,000 abuse consultations at child guidance centers, only 2% become subjects of social care, while the remaining 98% of children return home. One can imagine that there are many children struggling to survive at home and many parents continuing to struggle within "away-from-home parenting." This is the first challenge of social care in Japan.

Regarding the social care where children want "someone to live life with them," it is not widely known what happens to children who are suddenly separated one day from their parents, siblings, school friends, and teachers. Social care is divided into residential care and family-based care. Residential care includes infant homes for babies and toddlers, and children's homes for older children. Family-based care includes foster parents and family homes, where children are raised in the caregiver's home. Foster care is often confused with adoption, but foster parents do not have a legal parent-child relationship with the child; they temporarily care for children who cannot live with their biological parents. It is alternative care where they raise the child on behalf of the parents, and allowances and child-rearing expenses are provided. In adoption, a legal parent-child relationship is established between the adoptive parents and the child, and no allowances are provided.

In Japan, the proportion of residential care is extremely high at nearly 80%, compared to 10-50% in other countries; previously it was 90%. Other countries also primarily used residential care in the past, but since the 1960s and 70s, the transition to family-based care has been promoted as a place for children (especially infants) to grow up. Based on evidence, the United Nations also issued guidelines in 2009 recommending family-based care, particularly for infants. On the other hand, a characteristic of Japan is that the proportion of family-based care remains low, which is the second challenge of social care.

In 2016, there was a major revision of the Child Welfare Act. It was a significant revision, the likes of which had not been seen even after the changes in children and families post-war or the ratification of the Convention on the Rights of the Child in 1994. Articles 1 and 2 addressed children's rights, and Article 3 established the principle of priority for family-based care. This content guarantees Japanese children the global standards that align with UN guidelines. In 2017, the New Vision for Social Care was presented, and since then, movements to tackle the two challenges of social care in Japan have accelerated. In particular, the 2022 revision of the Child Welfare Act established and expanded family support services to respond to the wish "I wish they had helped my parents," and foster parent support centers were created to guarantee "someone to live life with them." In 2023, the Basic Act on Children and the Children and Families Agency began operations, and many young people and individuals with experience in social care began participating as members of the newly established Children and Families Council. The "Children's Policy Manifesto," which specifically indicates the direction of future child policies, contains content aimed at solving the two challenges of future social care.

I am particularly focusing on three concepts: "permanency," "attachment," and "children's rights." All of these are things that many children growing up in families take for granted, and it is difficult to imagine what kind of hardships their lack or absence brings. In reality, there is a possibility of this lack or absence in all children, but without realizing it, and based on the assumption that things are surely fine, the essence of what is appearing in various children's distress, behavior, and physical and mental symptoms is often not understood, resulting in responses that remain superficial.

At the root of the distress of children under social care—the children who are struggling the most—is the lack or absence of "permanency," "attachment," and "children's rights" that should naturally be there. I believe that the movement toward realizing new social care since 2016 began by noticing this and attempting to fundamentally solve the children's problems arising from it.

Permanency has been understood to be realized through parent-child relationships where continuity is guaranteed or through special adoption, but it has also been defined from a child's perspective as follows:

It is the guarantee of an upbringing with a future outlook that the child feels will continue from now on. (...) It is a "connection" with one or more people whom the child feels they belong to, a place they can return to at any time, and someone they can trust and rely on at any time. It is something defined by the child themselves, not the adults around them, and is socially and institutionally recognized. It is something that society should guarantee for all children. *1

Regarding attachment, it is necessary to understand the importance of children gaining a base of safety and security through interactions with caregivers and growing through various forms of play and challenges. Even within social care, the importance of obtaining safety and security is understood, but I think it is often not understood that play and challenges are equally important as a set.

Regarding children's rights, there are likely many children who have given up on adults who assume that the contents of the Basic Act on Children and the Convention on the Rights of the Child are so obvious that they "must naturally be fulfilled," or adults who do not notice. In social care, reviewing from the perspective of children's rights often leads to noticing the lack or absence of ordinary experiences and relationships, making one realize the importance of re-evaluating assumptions from this perspective.

I want to rephrase these three keywords learned from social care as "connections with important adults," "security and challenge," and "a childhood where one can grow as themselves," and convey them to many people as things that must not be overlooked and should be guaranteed to all children. I want to continue efforts to first guarantee this to children under social care, then to all children, and further to guarantee it to all adults by having had such a childhood.

In Japan, guaranteeing the best interests of children in social care has been considered mainly within the framework of residential care. However, in the social care promotion plans of each local government starting from fiscal 2025, the goal is not only the transition from facilities to family-based care but also supporting parents to guarantee a place where children can grow up safely, securely, and as themselves at home. This can be called a movement to solve the two challenges in social care simultaneously. By working on them together, it is a great opportunity to realize social care tailored to the needs of children.

Future foster care is expected to involve raising children together with parents, not just after parent-child separation. Specifically, foster parent short stays are spreading nationwide. This is a system where children are looked after in a foster home for a few days to support the parents. Some local governments plan to enhance such support with the goal of having one household per junior high school district. Furthermore, for foster parents to raise children in the community, in addition to professional support, understanding and cooperation from the schools the children attend and, in the case of dual-income households, their companies are necessary. The foster parent system is hardly known to the general public, and social care has not yet been socialized, but in the future, this must be advanced for foster parents to become entities that "help parents while being with the children" in the community. I believe that by socializing social care, a community and society that is easy to live in will be realized not only for children under social care but for all children and families.

Please try to think, "What if it were my child? What if I were the child?" I continue my research and practice at the Waseda University Institute for Social Care *2 and the NPO Family-based Child Care Support Organization *3, thinking as a child psychiatrist and an expert in child and family welfare.

We need people who will think and act together.