Primary and secondary prevention measures do not always succeed on their own and, consequently, some children require alternative care. It is at this point that tertiary prevention comes into play.
Tertiary measures imply on-going work within the care setting and with the family, both during and after the placement, that is primarily focused on returning the child to the family home under appropriate and sustainable conditions. In this way, we are looking to prevent further breakdown of the family once the child has returned, and thereby eliminating, as far as possible, the potential need for any future care placements.
The concept of tertiary - or third-level - prevention is probably the least recognised of the three levels. Essentially, tertiary prevention happens once primary and secondary prevention efforts have not succeeded in avoiding a given problem. In other words, it seeks to prevent the problem recurring and making sure the need to place a child in alternative care does not happen again.
So, taking a tertiary prevention approach means, wherever possible, children can be reintegrated back into their family home under conditions that should allow their return to be sustainable and thereby avoiding any future renewed reliance on alternative care.
Early consideration of tertiary prevention
Tertiary prevention therefore has to be a principal focus of any approach the moment a child is received into an alternative care setting. This implies first choosing a care setting that corresponds best to the child’s circumstances and needs and then drawing up a care plan that sets out a path towards eventual reintegration in the parental home. The UN Guidelines for the Alternative Care of Children clearly state that the ‘Removal of a child from the care of the family should be seen as a measure of last resort and should, whenever possible, be temporary and for the shortest possible duration.’ Care plans must therefore take account of the conditions required for reintegration to take place, and should assign responsibilities for all the actions and stages to bring this about.
While the child is in the alternative care placement, simultaneous work has to be carried out with the parents to assess why any previous support did not prevent family breakdown. With that as a base, the nature and level of the future support needed (material, psycho-social or other) for sustainable reintegration can be decided upon.
A key feature of tertiary prevention is recognition that family reintegration is not a one-off event where the child is only physically reunited with the parents in their home. Rather, it is a process that prepares for that reintegration and continues, as long as needed, after the child’s return.
More information on tertiary prevention can be found on page 62 of the handbook Moving Forward: Implementing the ‘Guidelines for the Alternative Care of Children’.